by Matt Gibson, The Chicago School of Professional Psychology
Sexual behaviors tend to be approached as a taboo topic in our everyday communities. This is even more pronounced when we look at the developmentally disabled community. It has been widely acknowledged that the concept of sexuality has been drastically understudied, especially in the field of behavior analysis and with the developmentally disabled community (Travers & Tincani, 2010). Travers and Tincani looked to provide justification for teaching sexuality and sexual behavior to individuals with developmental disabilities. One of the primary reasons they touched on was the benefit of being able to prevent or identify and report sexual abuse. Another issue raised was the ability to avoid more challenging behavior that arises from a lack of education regarding appropriate sexual conduct.
The behaviors that are considered sexual are generally only treated as necessary targets when they are a behavior that is targeted for reduction due to problematic instances of those behaviors (Robinson, Conahan, & Brady, 1992; Thompson & Beail, 2002). In the study, Thompson et al. focused on decreasing autoerotic asphyxiation that had reached dangerous levels for the individual engaging in the behavior. The individual had not previously received instruction in appropriate sexual behavior and showed great benefits from simple education on appropriate sexual behaviors using behavior-analytic principles. Due to this lack of focus on sexuality and sexual behaviors, people with developmental disabilities may not even receive basic sex education that would be offered to typically developing individuals. Due to this lack of instruction, we see a population that cannot adequately describe or discriminate between appropriate and inappropriate sexual behaviors.
When assessing sexual behavior, it is very important to distinguish what is considered appropriate on an individual level. Despite this individual focus, there are situations where a more universal set of rules is applicable. One of these areas would be in situations where a caregiver is required to assist individuals with activities of daily living that could potentially place the individual at a higher risk for sexual abuse. In these situations a certain range of behaviors, which could be considered sexual in nature, are deemed acceptable in order to ensure appropriate hygiene concerns are addressed. However, this situation increases an individual’s vulnerability and the individual requires training in discriminating what is appropriate contact, who it is appropriate to receive contact from, as well as appropriate methods of reporting instances of abuse as abuse. Individuals with developmental disabilities are estimated to be 4-10 times more likely to be victims of sexual abuse (Baladerian, n.d.). Some programs and strategies have been suggested to try and teach advocacy and situational discriminations (Lefebre, 2013). Due to the overall lack of research and methodology available, more procedures are required to attempt to address the specific issue of addressing abuse reporting in vulnerable populations.
What is needed are instructional designs that can be used to teach individuals, who require help with ADL skills, to discriminate between appropriate and inappropriate contact from staff members and report inappropriate conduct to staff. Creation of a program that allows for increases in an individual’s repertoire for reporting abuse would allow a very vulnerable population to gain a very socially valid skill and decrease their likelihood of encountering a potentially traumatic aversive event The skills being taught could also generalize to reporting of other events such as physical abuse from caretakers or more accurate reporting of aggression from peers. Also, the ability to advocate for themselves is a skill that could be generalized to an incredibly large collection of behaviors.
One major confound for this type of training is in the difficulty of ethically training the behaviors, especially in the presence of the inappropriate touching, in the natural environment. It would not be ethical to expose an individual to behaviors considered to be sexual abuse simple to try and teach reporting of the abuse. Because of this we may see some difficulty engaging in the behavior in the natural environment. Another potential confound is an over-generalization that all behaviors performed by the “appropriate” individuals are appropriate. Programs used should attempt to control for this by clearly outlining what behaviors are inappropriate regardless of the individual, but there could potentially be some difficulty with this, especially with the ethical issues posed with training in the natural environment. A final potential confound would be staff turnover and the addition of new staff. Due to the limited learning history with these individuals they could be viewed as strangers and thus appropriate contact could be viewed as inappropriate. This could require direct teaching using the picture cards, or could potentially show no issue based on a derived relation occurring and the new staff member functioning in the appropriate frame due to their relation to other staff members.
Baladerian, N.J. (n.d.). Children with disabilities & sexual abuse fact sheet.
Lefebre, E. (2013). Designing sex education instruction for individuals with developmental disabilities [PowerPoint Slides].
Robinson, C.P., Conahan, P., & Brady, W. (1992). Reducing self-injurious masturbation using a least intrusive model and adaptive equipment. Sexuality and Disability 10(1). 43-55.
Thompson, A.R., & Beail, N. (2002). The treatment of auto-erotic asphyxiation in a man with severe intellectual disabilities: the effectiveness of a behavioural and educational programme. Journal of Applied Research in Intellectual Disabilities, 15, 36-47.
Travers, J., & Tincani, M. (2010). Sexuality education for individuals with Autism spectrum disorders: critical issues and decision making guidelines. Education and Training in Autism and Developmental Disabilities, 45(2). 284-293.
This piece was originally published as a part of the Summer 2013 STEP SIG Newsletter.