A Review and Treatment Selection Model for Individuals with Developmental Disabilities Who Engage in Inappropriate Sexual Behavior

Abstract

Some individuals with developmental disabilities develop inappropriate sexual behaviors such as public masturbation, disrobing, and touching others in an unwanted sexual manner. Such acts are problematic given the taboo nature of the behaviors and the potential for significant negative consequences, such as restricted community access, injury, and legal ramifications. Therefore, it is necessary to equip caregivers and practitioners with effective treatment options. The purpose of this paper is to review studies that have evaluated behavioral treatments to reduce inappropriate sexual behavior in persons with developmental disabilities. The strengths and weaknesses of each treatment are reviewed, and a model for treatment selection is provided.

Ethics in sexual behavior assessment and support for people with intellectual disability

“…While many clinicians know and can access good information about human sexuality, certified sexuality educators are trained in and adhere to specific ethical guidelines, including restriction on genital touch and may therefore have more information and resources available. Certainly, only those with specific expertise in human sexuality should carry out interventions that address displays of inappropriate sexual behavior [32].…”

“…Some well-trained behavior clinicians could initiate a preliminary investigation, but while the topography suggests the reinforcer would be automatic reinforcement [32] the clinician must be cautious not to assume this and instead investigate other possible functions of the behavior [34,38,39].…”

“…They must consider the appropriateness due to frequency and intensity of the behavior [32], and the legality and ethics of conducting a functional analysis when the behavior has a sexual topography and the subjects is an individual with IDD. When completing a functional analysis [37], environmental stimuli are arranged such that the target behavior is evoked.…”

“…Clinicians must also consider that while sexual behavior has operant properties and is subject to behavioral interventions [32], it is inherently more complex than much of other operant behavior given interactions of hormones, possible medication side effects, social interaction, possible social positive reinforcement, and interaction with media depictions of sexuality combined with vicarious reinforcement, just to name a few. This complexity underscores the importance of consultation with those with education, training, and expertise in sexuality before implementing interventions.…”

“…The key question is of course, who should provide this instruction. However, this is often not clearly established in laws and regulations and therefore there is the danger of accusations of inappropriate behavior, both for staff and for families [32]. Clarity in regulations is essential to avoid such concerns and possibly inefficient service delivery due to fear of overstepping boundaries.…”