The Culture of Consent with Individuals with Intellectual and Developmental Disabilities

by Robin Moyher, Ph D, BCBA-D, LBA, George Mason University

Consent is defined as giving assent or approval (Merriam-Webster Dictionary). Often and especially in the current state of #metoo, we think of consent as giving permission or agreement between two (or more) people to engage in sexual activity. Without consent, sexual behavior becomes criminal with a perpetrator and a victim. There are a few particularly vulnerable populations where sexual violence is significantly higher. This includes women, LBGTQ, children, American Indians, prisoners, and individuals with disabilities. If you are a member of more than one of these groups, your chances of becoming a victim increases. This article will focus on individuals with Intellectual and Developmental Disabilities (IDD).

IDD impacts an individual’s communication, social behavior, cognitive, and daily living skills. It also impacts learning whether to comply or not with others’ requests (especially those in positions of authority), self-advocacy abilities, access to sexual education, and potential consequences of sexual violence. Not having a strong expressive language repertoire or poor articulation could make it difficult for an individual to say “no,” even if he or she does wish to refuse the action from an abuser. Deficits in communication also impact the victims ability to report the incident. Poor social skills and judgement are also common deficits in this population. This would include situations where someone is offering a special treat for compliance with an illegal sexual act. The individual with IDD may agree with the act in order to obtain the treat, not realizing the harm it could cause. In another scenario, the individual may be coerced to keep it a secret or a beloved person could get hurt. Due to poor judgment skills, the individual with IDD would be likely to keep the secret. Yet, in a third scenario, they may follow through with an inappropriate sexual request when threatened by the harasser, once again, due to social and poor judgment skills. Closely related to social skills and judgment is the topic of credibility and gullibility. This weakness in determining what is credible and hence falling into the trap of being gullible can have negative effects on individuals with IDD. Cognitive deficits may limit the ability to determine what is and is not appropriate for care provision and interaction. Young adults with IDD often require additional support with self-care tasks such as dressing, bathing, and toileting.

Another area of impact is that at beginning at an early age, individuals with IDD are exposed to forced compliance in the sense that there is a systematic protocol in place for redirection of noncompliance. Simple everyday classroom activities, such as following directions, completing classwork, sitting in a chair and raising one’s hand, learning to take turns, and share with peers, are either met with reinforcement and praise if done correctly, or negative consequences if done incorrectly, to teach the skill. This sets the pattern for children to want to comply with adults’ requests as they have learned good things happen when they do, regardless of whether the request is preferred or not, and continues into young adulthood. The aversive consequences experienced may be more severe for this population than in the general education population (restraints and seclusion) as well. I refer to this as a ‘culture of compliance’ and will refer back to this later in the article.

Although relevant information has always been hard to obtain, researchers have known for more than two decades that people with IDD face serious risk of being sexually assaulted or abused (Sobsey & Varnhagen, 1989). Martin et al. (2006) and Casteel, Martin, Smith, Gurka, and Kupper (2008) concluded that this trend has not changed. The risk of sexual violence lasts throughout the individual with IDD’s lifespan. Also, it is important to note that individuals with IDD are abused by strangers only 8% of the time (Martinello, 2014). Furthermore, 36.7% of the abuse occurred in settings that were encountered because the individual had a disability, such as assistance with a daily living skill or assistance with an employment task (Sobsey & Doe, 1991; Sobsey & Varnhagen, 1989). Therefore, based on these statistics, an individual with IDD who experiences sexual violence is more likely to know the person, and be in a setting and/or situation because of their disability. Frequently individuals with IDD are educated to comply with task requests, may not have had opportunities to not comply (Akbas et al., 2009), and furthermore have a history of reinforced compliance (Wacker, Parish, & Macy, 2008).

Willness, Steel, and Lee (2007) conducted a meta-analysis on the antecedents and consequences of sexual harassment and confirmed that the impact of sexual harassment on the victim is significant in job-related variables (job satisfaction, work productivity, job withdrawal) and more so in personal health variables (mental health, physical health, PTSD, and life satisfaction). In another meta-analysis of antecedent and consequences of workplace violence, Bowling and Beehr (2006) identified consequences of workplace harassment to include strains, anxiety, depression, burnout, lower self-esteem, and lower life satisfaction. Besides job and personal health variables, there is also a financial cost to sexual harassment.

Research has not addressed adequately interventions to teach sexual violence awareness to individuals with IDD. No research has been found to teach these skills in the employment setting only. Training in awareness and prevention strategies is needed for this population in order to increase personal safety at work. For my dissertation in 2016, I investigated the functional relation of a training module for teaching sexual harassment prevention to women with IDD to raise personal safety, awareness, and knowledge in the employment setting. Using multiple baseline probe, all nine female participants were able to respond appropriately to a sexual harassment lure in terms of saying no, leaving, and reporting accurately to a trusted adult. This is great news! I’m currently in the process of turning this intervention into a curriculum. One result of my analysis clearly shows the ‘culture of consent’ this population has been taught. There were two types of harassers in the scenarios presented to the participants—Other (coworker, driver) and Boss. A descriptive analysis was conducted to determine to which harasser participants were most likely to agree to the lure or not agree but also not say “no” during baseline. Of the 97 scenarios presented during baseline where the harasser was Other, participants agreed to the lure in 6% of the instances. Of the 59 scenarios presented during baseline where the harasser was a Boss, participants agreed to the lure in 25% of the instances. Of the 97 scenarios presented during baseline where the harasser was Other, participants did not agree but also did not say “no” to the lure in 69% of the instances. Of the 59 scenarios presented during baseline where the harasser was a Boss, participants did not agree but also did not say “no” to the lure 44% of the instances. In summary, participants were more likely to agree to a lure when it was presented by a Boss, and more likely not agree but also not say “no” when it was presented by Other.  During the intervention, no participants agreed to any of the lures in intervention, regardless of who the harasser was.

This forced culture of consent greatly impacts an individual with IDD ability to refuse unwanted sexual behavior, especially if the person is seen as an authority. The good news is this can be reversed! And it does not need to wait until the individual is an adult either! Teaching consent can and should be taught as early as possible. When toileting and helping with self-care (putting on a jacket, teeth brushing, etc.) the adult should always ask to enter the child’s space and ask permission to do the behavior. When in school, teachers should do the same. Teach that because you gave consent one time does not mean you gave consent for repeated future events. And that you have the right to change your mind. Role play so the student practices saying a firm no. Role play retelling an event accurately so the listener will no the student was in a dangerous place. There is a big difference in ‘he gave me flowers’ and ‘he gave me flowers, but I’ve asked him several times to stop’. Giving students the power to say no in terms of self-advocacy and self-determination is one of the greatest skills we can teach. I find that we, as behavior analysts, are the perfect professionals teach this life saving skill.

 

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