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This blog post serves as a companion resource to CalTrin’s Addressing Problematic Sexual Behaviors (PSBs) in Children & Adolescents self-paced course. The course was adapted from two CalTrin-hosted webinars: Addressing Problematic Sexual Behaviors (PSBs) in Children & Adolescents, presented by Michael Gomez, PhD, and Children with Problematic Sexual Behavior, presented by Melissa Bernstein, PhD.

When a child or adolescent displays problematic sexual behavior (PSB), it can trigger fear, confusion, and concern for families, caregivers, educators, and service providers. Yet research and clinical experience show that many common assumptions about these behaviors are inaccurate. The key to helping children and youth is understanding the difference between typical sexual development and concerning behavior, responding without shame or stigma, and connecting families to effective support.

This blog highlights key discussion points and resources shared by Dr. Gomez and Dr. Bernstein in their respective presentations. Both presenters focus on evidence-based treatment approaches and offer concrete examples and tips for working with youth and families impacted by PSB.

Let’s dive in…

Understanding Sexual Development & What Makes a Sexual Behavior Problematic?

Sexual development begins in childhood. Young children are naturally curious about their bodies and the bodies of others. Age-appropriate behaviors may include asking questions about reproduction, exploring body differences, self-touch, or engaging in exploratory play such as “playing doctor.” These behaviors are often part of normal development when they are mutual, spontaneous, age-appropriate, and non-coercive. The challenge for caregivers and professionals is distinguishing between typical exploration and behavior that requires intervention.

A behavior may be considered problematic when it is developmentally inappropriate, harmful, intrusive, or persistent despite guidance and supervision. Professionals often look at several factors:

  • The frequency of the behavior.
  • Whether it interferes with normal social or emotional development.
  • Whether it continues despite clear rules and adult intervention.
  • The presence of force, coercion, intimidation, or manipulation.
  • Whether there is physical or emotional harm to the child or others.

Particularly concerning behaviors include acts involving force, penetration, coercion, or deliberate planning to engage another child in sexual acts. These behaviors warrant further assessment and intervention.

Dispelling Common Myths

One of the most important messages shared by both Dr. Gomez and Dr. Bernstein is that children with PSB should not be labeled as “sex offenders,” “predators,” or “perpetrators.” These labels can stigmatize children, create shame, and obscure opportunities for effective intervention. Instead, the focus should remain on the behavior rather than defining the child by the behavior.

Another common myth is that all children with PSB have been sexually abused. While sexual abuse can be a contributing factor, research discussed in the trainings found that many children with PSB have no known sexual abuse history, and most children who experience sexual abuse do not go on to develop PSB.

Dr. Gomez and Dr. Bernstein also challenge the belief that children who engage in PSB are destined to become adult sexual offenders. Long-term research indicates this is not the case for the majority of youth, particularly when they receive appropriate intervention and support early on.

Why Do Problematic Sexual Behaviors Develop?

There is no single cause of PSBs. Instead, a range of factors may contribute, including:

  • Exposure and Modeling: Children may be exposed to inappropriate sexual behaviors, sexualized media, or environments where healthy boundaries are not modeled. They may also witness coercive or aggressive interactions that influence how they understand relationships and power.
  • Family Stressors: Family challenges such as caregiver stress, substance use, depression, housing instability, or limited supervision can increase vulnerability. A lack of consistent monitoring often creates opportunities for problematic behaviors to occur.
  • Child-Specific Factors: Some children with PSB may also experience: ADHD or other disruptive behavior disorders; Trauma-related symptoms; Social skill deficits; Learning or developmental challenges; or Impulsivity or difficulty following rules.

Understanding these factors helps professionals move from asking “What’s wrong with this child?” to “What experiences and circumstances may be contributing to this behavior?”

The Critical Role of Caregivers

Caregivers often experience intense emotions when they learn about a child’s problematic sexual behavior. Feelings of shock, fear, guilt, shame, anger, confusion, and hopelessness are common. Foster and adoptive parents may worry about safety for other children in the home. Parents may wonder whether they somehow caused the behavior. Professionals can help by:

  • Avoiding judgment.
  • Providing accurate information.
  • Reinforcing that effective treatment is available.
  • Helping families develop safety plans.
  • Supporting consistent supervision and boundary setting.
  • Encouraging healthy communication within the family.

Many caregivers report that reassurance, education, and practical guidance are among the most valuable supports they receive during treatment.

What Effective Treatment Looks Like

The good news is that evidence-based interventions for PSB are highly effective. One of the strongest treatment approaches discussed in the trainings is caregiver-involved Cognitive Behavioral Therapy (CBT). This approach focuses on:

  • Active caregiver participation.
  • Teaching healthy boundaries and sexual behavior rules.
  • Strengthening supervision strategies.
  • Building safety plans.
  • Developing social and emotional skills.
  • Encouraging healthy peer relationships and prosocial activities.

Research highlighted in both trainings found extremely low rates of future problematic sexual behavior among children who completed evidence-based treatment. Most youth do not continue these behaviors into adolescence or adulthood. In fact, studies show that 85-95% of children and adolescents with PSB who receive appropriate interventions will not reoffend, and they are at no greater risk than the general population to grow up and continue to sexually offend as adults (Caldwell, 2016; Lussier, 2017).

Key Takeaways: Connection & A Trauma-Informed and Hopeful Approach

An important takeaway is that isolation is rarely the answer. Most children with PSB can safely remain at home, attend school, participate in sports, and engage in community activities when appropriate supervision and treatment are in place. Removing children from positive peer groups, extracurricular activities, or supportive environments can actually increase risk by limiting opportunities to develop healthy social skills and relationships. Instead, the goal should be safety combined with connection and growth.

Perhaps the most important lesson emphasized by Dr. Gomez and Dr. Bernstein is that problematic sexual behavior is a behavior, not an identity. Children and adolescents who engage in these behaviors are still children and youth who need guidance, support, accountability, and opportunities to learn. A trauma-informed, developmentally appropriate response helps families move beyond fear and stigma. By focusing on evidence rather than myths, professionals can create pathways to healing for the child, the family, and everyone impacted by the behavior.

The resources highlighted below are intended to be used with CalTrin’s self-paced course to help further your knowledge on PSB and emphasize the importance of replacing judgment with understanding and fear with informed intervention to create the best chance for positive outcomes and long-term well-being for children and adolescents alike.

Addressing Problematic Sexual Behaviors (PSBs) in Children & Adolescents Resources

California Training Institute (CalTrin)

Hey, that’s us! Access recordings and materials from prior CalTrin trainings related to this topic, browse our self-paced courses, keep an eye on the calendar for upcoming webinars and workshops, and explore our relevant resource collections:  

Note: You will need to log in to your CalTrin account to access the self-paced courses and select archived training materials. You can create a free account here.

National Center on the Sexual Behavior of Youth (NCSBY)

The National Center on the Sexual Behavior of Youth (NCSBY) promotes better lives through better choices by youth, caregivers, and professionals for healthier responses to and prevention of problematic sexual behavior of youth. Get started with resources geared towards the target audiences:

Download the NCSBY Fact Sheet: Children with Sexual Behavior Problems: Common Misconceptions vs. Current Findings. Discover more on the NCSBY’s Resources & Education page.

National Children’s Alliance

The National Children’s Alliance (NCA) has convened expert practitioners in addressing youth and children with problematic sexual behaviors in the CAC setting to develop an overview of sample best practice documents. PSB Resources for CACs, Partners, & Caregivers, include:

In addition, the National Children’s Alliance Learning Center: Addressing Youth and Children with Problematic Sexual Behaviors module provides a set of resources is intended to educate leaders, staff, partners, and caregivers on this crucial issue and to help improve Child Advocacy Centers’ response to PSBs.  

Oklahoma TF-CBT

Oklahoma TF-CBT provides information and resources for families considering Trauma-Focused Cognitive-Behavioral Therapy, professionals interested in learning about TF-CBT treatment, and TF-CBT therapists implementing the model within Oklahoma.

Resources highlighted in CalTrin’s PSB trainings include:

Safe Kids Thrive

Safe Kids Thrive provides free tools and resources to schools, childcare centers, and other youth-serving organizations to prevent child sexual abuse.

Additional Resources

Child Abuse & Neglect: Trauma-Focused CBT for Youth with Complex Trauma by Cohen, Mannarino, Kliethermes, & Murray (2012)

Cognitive and Behavioral Practice: Implementing Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) With Preteen Children Displaying Problematic Sexual Behavior by Brian Allen (2018)

HealtyChildren.org: Sexual Behaviors in Young Children: What’s Normal, What’s Not?

National Child Traumatic Stress Network: Understanding and Coping with Sexual Behavior Problems in Children

The Massachusetts Legislative Task Force on the Prevention of Child Sexual Abuse: Overview of the Research on Children and Adolescents Engaging in Problematic Sexual Behavior

Taking Action Booklets (PDF Downloads):

Trauma-Focused Cognitive Behavioral Therapy.org: TF-CBT LGBTQ Implementation Manual

Recommended Videos

The following videos were recommended by Dr. Gomez in his presentation:

*Last updated November 3, 2026

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