review by Nicholas Maio, MSPSY, BCBA, LBA, Empowered: A Center for Sexuality
Working in the fields of Behavior Analysis and Human Sexuality seems to raise eyebrows wherever I go; people wonder – how does sexuality get taught through behavioral methodology and why go this route? For this inquiry, I have devised an answer: simply teaching something through didactic instruction is not enough to demonstrate proof of understanding and application of learned knowledge into real-life skills (desired behaviors), so by not pairing sexuality education curriculums – which are based in both physiological and socio-sexual behaviors – with behavioral methodology is doing the learner a disservice.
It was Tarnai (2006) who wrote about comparative looks at sexuality interventions and their efficacy, not only short-term, but also over lengths of time. What was concluded by Tarnai (2006) was that the most powerful interventions were those that incorporated both education and applicable behavioral skills to replace problem behaviors. Neither Behavioral Modification nor Didactic Instruction did as well alone as when paired. Also notable was that the only way to measure long-term efficacy was to probe learners with actresses/actors in the natural environment by providing opportunities to either engage in extinguished problem behavior or maintain their newfound skills.
In learning this, I began my search for curriculums that could be modified for use as Discrete Trial materials, Generalization Exercises, and Role-Plays. I also regularly attend AASECT conferences, and at one, I met Mary Jo, author of Me Too!. Her presentation on her curriculum, developed for use at her own facility, where they do group classes for learners on the Autism Spectrum with proclaimed great success, gave me some excellent ideas for how to proceed an incorporate her work into my own.
I did not have objective data about her curriculum, but I bought it anyway, as it came LOADED with information, worksheets, and almost 90 interactive activities, many being tablet (PC or iPad) compatible. I was already using a few other curriculums’ materials, namely those from Sexuality Education for Adults with Developmental Disabilities by Planned Parenthood of New England, so I combined the materials to develop a set of unique teaching strategies.
My clients now start with an overview lesson (modeling discrete trial responses during Didactic Instruction), then move into their Discrete Trials for any particular topic. These initial trials are usually set up with basic picture materials from Planned Parenthood’s curriculum. Mary Jo’s book does not contain any how-to’s of teaching a topic, which is particularly helpful as a BCBA, because as long as the material is presented and can be demonstrated as learned and independently applied in the natural environment, that should be enough – no need for lengthy, boring lessons.
Once a client has mastered DTT targets in a particular lesson area, such as Boundaries/Consent, Attraction, or Flirting VS Harassment, the client then gets the benefit of roleplays, based in the suggested activities and materials from Me Too! Some of the activities can be done with family members, friends/classmates, and staff, getting everyone involved and ensuring that therapeutic methodology becomes consistent across individuals and environments. Holmes & Himle (2014) note this is both healthy and difficult to do.
For instance, the “Love, Lust, Yuck” game not only helps clients apply the concepts of Attraction VS Love and Flirting VS Harassment, but also sometimes opens up dialogues amongst family members or providers about values, which often come into play in the sexual history of a client, and certainly apply to social validity. I find family members and staff often change THEIR behavior when included in the activities, too!
Also noteworthy is the companion handbook, Inside Out: Abuse Prevention for Adults with Disabilities, is great for learners who can write and/or draw, allowing them an additional diversification to the lesson applications. Some of these, I laminate for clients and have them keep up in their rooms or readily accessible in their binders, particularly ones about self-love and empowerment, affirmations and motivating factors.
Is Me Too! a Behavior Analytic tool? No. It’s just a curriculum, as it stands, but because of the wealth of additional tools therein, Me Too! is perfect for the BCBA looking to ensure understanding is occurring and that skills can be applied in a multitude of ways. It gives me new ideas at times when I am stumped, and the progress my clients make with the games and activities is often mirrored in real life. Such is evident from both reductions in problem behavior and also the overall demeanor of my clients, who display increased social/relational skills and motivation in many areas of life – which is no real surprise, since much of life is tied in some way to our sexuality.
Holmes, L; Himle, M. (2014). Brief report: Parent-child sexuality communication and autism spectrum disorders. Journal of Autism Developmental Disabilities, 44: 2964-2970. DOI: 10.1007/s10803-014-2146-2
Podgurski, Mary Jo. (2012). Me Too!: Real Talk About Sexuality for People of ALL Abilities. Academy Press, Fletcher, NC.
Tarnai, B. (2006).Review of effective interventions for socially inappropriate masturbation in persons with cognitive disabilities. Sex and Disabilities, 24:151-168. DOI 10.1007/s11195-006-9016-6