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READINGS

EARLY CHILDHOOD SEXUAL PROBLEMS

By: Dr. Susan Grey Smith

February 8, 2009

All children engage in sexual exploration as a normal part of early childhood development. Preschoolers may comment on all the different bodies they see, be fascinated by bathroom activities and words, sit on your lap and squeeze your breasts, show their genitals and run with glee, and engage in sex play with each other. They may touch their genitals and feel a pleasurable sensation by accident and then repeat the behavior. They are not yet inhibited about sex and may masturbate openly without any sense of shame or guilt. Limits set by parents will often entice children to make a game out of showing off their sexual natures if they know it bothers you. They are lighthearted and innocent with the behaviors.

Parents or caretakers are often alarmed when they see a young child exploring his or her sexuality because as a society, we have not been well-educated about our sexual natures. Socially we Americans tend to be in the extremes—either we don’t talk about sex at all or we engage in obsessive sexuality. We are bombarded daily by sexual language and images through advertisements, soap operas, cable or satellite TV, video games, movies, and the internet. Young children are exposed to sexual information early because living in this age of easy information it is not possible to shield them. Our old strategy of withholding sexual information until the child asks no longer applies. They have the info but not the cognitive ability to understand the social implications. They access the information but have little access to the guidance.

Can you recall the talk your parents had with you about sex? Most of us didn’t have one, or if we did it went something like, “Don’t have sex before you’re married, but if you do, use protection.” Or if we’re really lucky, we may have been given a book, with images and instructions but no guidance. So it is certainly no mystery why we have difficulty incorporating our children’s normal sexual behavior into a healthy parenting routine. We teach our children values around a lot of things, but sex usually isn’t one of them. We think we can just wait for “the talk” until they go through puberty and start having “real” sexual feelings, but by then it is often too late to prevent problems.

Many of the sexual problems that children encounter involve other children. Because we as adults don’t even recognize that they have sexual feelings and thus are not involved in their sexual lives, they play out with each other what they have learned. This can be though normal exploration with age mates, mutual sexual behavior with age mates who have advanced knowledge, or with older children that turns into an abuse of power. Statistics vary but it has been reported that as much as 75-80% of the sexual abuse of young children is committed by other children and adolescents. Thus as a nation we are facing an epidemic of children following in our footsteps—uninformed about all the ways our sexuality can cause us problems and engaging in problematic behavior early that sets one up for a potential lifetime of problems.

Getting off track with our sexual development as originally categorized in 1993 by Dr. Johnson and Dr. Gil and modified here as part of the author’s research consists of three groups of behaviors.

Sexually Reactive Behaviors
Mutual Developmentally Inappropriate or Compulsive Sexual Interactions
Sexually Abusive Behaviors

Children showing Sexually Reactive Behaviors may be reacting to recent or current sexual victimization or exposure to adult sexuality. They display more sexual behaviors than age mates and their sexual curiosity is out of balance in relation to peers. They may show compulsive, self-stimulating behaviors, imitate adult sexual behavior or talk, try to initiate sexual behavior with both younger and older children, or play out the developmentally inappropriate sexual experience in other ways. The child is acting out his or her confusion produced by exposure to sexual information not understandable to the developing child’s mind. These children may feel shame, guilt and anxiety about their sexuality.

Children who engage in Mutual Sexual Behaviors have acted out with other children but have not been caught and the behavior has progressed to being somewhat compulsive and repetitious. Unlike some Sexually Reactive Behaviors, the main ingredient is that they are involved sexually with other children. The child may spend inordinate amounts of time with siblings, in day care, in extended families, in foster care, or in residential placements. They mimic adult sexual behaviors such as looking at pornography, engaging in oral sex, and having sexual intercourse with age mates who keep the behaviors secret. They have been conditioned to believe that the behaviors are no big deal yet they may be engaging younger, more innocent children in their activity or be involved in compulsive, repetitious, and advanced sexual activity that is startling to the adults who catch them acting out. Mutual Behaviors are more difficult to stop if the child has used the behavior as a coping strategy and it has become habituated.

The third category is Sexually Abusive Behaviors. These children go far beyond developmentally appropriate childhood exploration, sex play, or consensual behavior with age mates. The hallmark behavior is coercion—tricking, bribing, threatening, bullying, manipulating, forcing, or just using their relationship to get a much younger child to go along. These behaviors may continue or increase over time as part of a consistent pattern rather than an isolated incident. There may be an impulsive, compulsive, and aggressive quality to the behavior with feelings of anger, loneliness or fear linked to sexual behaviors. Coercion is always a factor and when they are discovered, they do not and cannot stop without intensive and specialized treatment.

We can avoid many of these problems armed with the proper information. As adults we have to be awake to the fact that children do have sexual natures that can be stimulated early. Just like learning about when our child should be expected to talk in sentences or learn to read, we need to inform ourselves about early sexual development in childhood. We can no longer afford to leave sex education to others, wait till the child asks, or give the “talk” on the other side of puberty. If we are not talking with our children about sex now, most likely someone else is and that person just may be another child.

Teaching Children Responsibility Starts with Parents
Setting Reasonable Limits

By: Susan Grey Smith, Ph.D., LMFT

If you have a child you know how difficult it is to get the message
across that it takes hard work to get what you want. As parents we all want our children to learn to be responsible adults. Yet children seem to want everything handed to them on a silver platter! How do we teach our children about how hard work leads to rewards when we feel so guilty about working so much that we have limited time to spend with them? We all want our children to have the good things that we didn't have, but how do we know when we've crossed the line into over-indulgence?

These dilemmas plague modern society more than they once did because today we have more demands on our time and money, more stress, and TV encouraging kids to buy, buy, buy. I talk to parents every day about setting limits. We all know how work and responsibility should fit together in a child's life but sometimes there is too much "noise" in our environment to recall what our parents taught us. So here goes with a summary of what we already know.

1. There are basic material things people need to survive-these include food, clothing, and shelter. Play Stations, Gameboys, and Air Jordans are not on the list. Teach your children the difference between needs and wants.

2. It takes money to be a consumer. Marketing that targets children treats parents like loan officers loaning money to broke customers (it just doesn't happen). Teach your children that they cannot spend money they don't have.

3. If you're a child, earning money means doing chores. Parents shouldn't have to pay for work that benefits the whole family. But there are usually extra chores to do around the house. It is never too early to provide a way for a child to earn money to pay for what they want. Teach your children the value of a dollar.

4. Children's work (i.e. making good grades and staying out of trouble) should not be tied to money or they will come to believe that the world owes them a living. Help your child learn the value of internal rewards by teaching them to take satisfaction in a job well done. Teach your children that there is intrinsic value in doing the right thing.

5. Don't teach your children to feel entitled and have the right to get what they want, even at another's expense. Teach your children that being an adult takes self-discipline--getting up early when we'd rather sleep in, going to jobs when we'd rather be playing, working late when we'd rather be home, and taking the kids to soccer practice when we're bone tired.

We must model for our kids the value of self-discipline because they don't do what we say do, they do what we do. An early start at teaching self-discipline will give our children the wherewithal they need to make it in our increasingly complex society.

Reactive Attachment Disorder

By: Susan Grey Smith, Ph.D., LMFT

When children are brought into a family through foster care, adoption, or living with relatives after coming from an abusive or neglectful biological family, they can have problems getting close emotionally with others. It is hard for them to trust what people tell them when they have been let down time after time, subjected to a chaotic household, experienced disregard for his or her emotional and/or physical needs, and abandoned by people who are supposed to love them. The child may display signs of withdrawal, reject attempts at closeness with caregivers, and present a generally detached manner with everyone. Or they may show a pattern of becoming too friendly too quickly or by giving affection too freely to relative strangers.

If a child is three years old or older and has established no significant emotional bond with any caregiver, they are at risk for developing an Attachment Disorder. By age seven he or she may be showing few signs of developing a conscience. Some of the behavioral signs that a child may be reacting to attachment issues are:

Resisting help from others, usually being insistent that he/she does not need help from anyone
Hoarding or gorging on food
Aggressive behaviors toward peers, siblings, and caregivers
Frequent lying without showing little or any remorse
Stealing small items without any real use for them
Excessive clinginess to primary caregiver or becoming emotionally upset when out of the caregiver's presence

The long term goal for treating children with an attachment disorder is for them to establish and maintain a bond with at least one special person who takes care of their emotional and physical needs. By doing this, the child becomes more capable of forming warm physical and emotional bonds with others and will want close and intimate connections with others. The child may also need to learn how to keep an appropriate emotional distance and how to tolerate absence from a primary caregiver without panicking.

Developing a Balanced Parenting Style

By: Susan Grey Smith, Ph.D., LMFT

Parenting is a tough job that is getting tougher every day. Parents and children face challenges that our parents never had to deal with. Life is fast paced and there never seems to be enough time. Parents end up thinking that somehow they are to blame for the problems their children deal with. We think, "If only I could be more consistent, more patient, calmer, I could raise a problem free child." Well that is just not true! As parents we do the best we can juggling our responsibilities and busy schedules.

The world is changing at a whirl wind pace and if it is challenging for adults to keep up, imagine what it must be like for our children. Today's parenting information market is full of advise intended to ease the burden of knowing how to best respond to our children's needs. It seems that instead of helping to relieve us of worry it has created a lot of confusion. In an information driven society, we are all falling victim to listening to the voices of others instead of following our own hearts and minds.

Instinctively we know that good parenting requires a balance between nurturing our children and teaching them how to self-discipline. How do you as a parent find a good balance that is a comfortable fit for you? Diana Baumrind (1978) identified three parenting styles that have held up to strong scientific inquiry over time: authoritarian, permissive, and democratic.

• Authoritarian Parenting Style . A high value is placed on discipline to obtain obedience so as parents we rely on strategies that are punitive. Parents punish children to put them in their place and maintain a parenting heirarchy, even when children are developmentally able to start thinking more for themselves. As parents we tend to be detached, controlling, and demanding and our children are more likely to be discontented, withdrawn, and distrustful.

• Permissive Parenting Style . A high value is placed on having our children like us so as parents we rely on strategies that are noncontrolling and nondemanding. As parents we tend to be too relaxed, under-involved, and lenient and our children are less self-reliant, explorative, and self-controlled.

• Democratic Parenting Style . This is the balanced style, using elements of the other two styles in a unique combination of high control and positive encouragement toward autonomy and independence. As parents we value our children's will power and encourage them to make rational choices. Our children are more self-reliant, self-controlled, and explorative.

If you think your parenting style need some coaching, get in touch with a family therapist. Family therapy is not about giving advise on how to parent although family therapists are informed about the latest scientific research findings. It is about helping you find your way though a maze of information to develop a balanced parenting style that fits your lifestyle and your family's needs.

Different Mental Health Disciplines: What's the Difference?

By: Susan Grey Smith, Ph.D., LMFT

With so many different types of mental health professionals around, how does the consumer of mental health services effectively sort through them to determine who is right to deliver what service? Here is a short list of the different disciplines and how they are trained and function.

Psychiatrists are medical doctors trained primarily as physicians who specialize in knowing about and prescribing psychotropic medication. They are not typically trained extensively in talk therapy although some pursue their psychotherapy interests beyond medical school.

Psychologists are typically trained in an individual approach to mental health viewing problems as occurring within individuals, not between them. With over 50 areas of specialization to choose from, you should always inquire if a particular psychologist was academically trained in family therapy inside their graduate program.

Social workers usually receive their academic training with an administrative focus and must pursue psychotherapy as a specialty beyond graduate school.

A Licensed Marriage & Family Therapist (LMFT) is trained to look at how each person's own personality interacts with others in social relationships . They are extensively trained through live supervision within academic programs to provide psychotherapy to individuals, families, and groups.

Marriage & Family Therapy is the only mental health discipline that requires students in academic training programs to receive live supervision by experienced clinical professors trained in systems thinking who observe their work behind a one way mirror. Live supervision means that clinicians are observed conducting therapy sessions instead of supervisors only hearing what the student thinks is occurring in the session. The therapist is critiqued on their actual work with families, not on the meaning that students make of their work. This type of intensive supervision uniquely equips LMFTs to provide quality services.

Let's take an example of a problem and follow it through. Suppose you think your child might have Attention Deficit Hyperactivity Disorder (ADHD). There is a lot of information available on ADHD and many children who have not been accurately diagnosed are placed on medication as a way to control their behavior. My systemic approach is to first thoroughly assess and diagnose your child through collaboration with you, his or her teachers, coaches, grandparents, and others who know your child best. A school social worker or guidance counselor might be the first person to come in contact with your child and make a referral for services.

If there is a positive diagnosis the next step is to inform you about what treatment approaches are available. Then together we will decide on the best course of action for your child and family. Finally, we will implement our plan by obtaining the resources needed to follow through with treatment.

Other mental health professionals might act as important resources in treating your child. If you decide that you want your child on medication, a psychiatrist can help you make the decision about the type of drug right for him or her. If your child is at risk for having other learning disabilities, we might want to obtain a psychological evaluation from a child psychologist.

Family therapists differ from social workers, psychologists, and psychiatrists in their training as systems thinkers. MFTs believe that people do not live in a vacuum and that each person performs unique roles within society.