By Clelia Sigaud, M.S.
bSci21 Contributing Writer ([email protected])
I’ve decided to kick off my contribution to bsci21 with a post on a controversial, uncomfortable, and significant topic; namely, sexually inappropriate behaviors in the school setting displayed by people who have developmental disabilities. As fascinating and worthwhile as the treatment of the behavior itself is, I’d like to focus on the contingencies at play that often guide our own behavior, as service providers, when confronted with a clinical challenge such as this.
Most of us are, very understandably, not thrilled with the idea of an individual engaging in sexualized aggression, sexual touching of others, and/or masturbation during the school day. We rightly worry that the individual will hurt someone, and we’re concerned about stigmatization and the privacy and dignity of the person. As the person gets older, we start to wonder how restrictive their adult placement will need to be. There’s no question that one of the most stigmatizing scenarios in this field is that of an individual engaging in inappropriate sexual touching or masturbation while in public. Those of us who have been the staff members in such situations can probably recall that it was quite aversive for us, even if the only punishers were our own thoughts. I once had an adult-sized client disrobe from the waist down in a store and begin to aggress in full view of a dozen community members. Believe me when I say that I did not experience that event as reinforcing in the slightest.
Over the past few years of working with children and adolescents who struggle with both developmental disabilities and inappropriate sexual behavior, I’ve found it helpful to challenge certain thought patterns in myself and others in order to better meet the needs of the individuals receiving services. These thoughts and constructs, in my experience, can act as mental roadblocks – essentially preventing us from addressing the individual’s needs in the moment, and instead focusing on our own discomfort.
The first such challenge is the idea that sexual behavior in people with developmental disabilities is something that should ideally not occur at all. It’s entirely understandable to have concerns about the social repercussions of certain behaviors, and it is indubitable that the reality of intellectual disability raises issues of informed consent, freedom of choice, and individual rights which I, for one, freely admit to being unable to entirely address at this stage of understanding. However, as service providers, we have a duty to uphold the human rights of our clients, including the right to access their own bodies and explore and express sexual motivation (while respecting others’ rights). This, in my opinion, is a pivotal understanding, because it changes the discussion from “why can’t we stop this behavior?” to “how can we support this natural and healthy motivation and teach safety and social skills related to sexuality?”
The second “roadblock,” flowing logically from the first, is the belief that sexuality should not be discussed or taught about in school, and that sexual behaviors should not be allowed during the school day. Sometimes people conceptualize allowing it as “giving in” to bad behavior, teaching inappropriate behavior that shouldn’t be allowed, or “wasting” time that could have been better spent on more academic activities. While I entirely understand that different school settings have various levels of appropriate resources at their disposal, I am hugely in favor of teaching sexual boundaries (and appropriate masturbation behaviors in some cases) to students with developmental disabilities as part of the life skills curriculum. We have a legal and ethical obligation to provide an appropriate education to the students placed in our care, and any individual who is showing inappropriate sexual behavior at school is clearly indicating that s/he could benefit from behavioral interventions aimed at bringing the presentations in line with what will allow the individual to most fully access independence as a child and adult.
As a teacher, I firmly believe that learning to be safe and to seek privacy when necessary are far more functional skills, and are much more supportive of least restrictive placements later in life, than academic skills alone. (It’s important, of course, that the family be closely involved as well, and that their wishes be afforded respect.) Such instruction may not seem very relevant to the “academic” nature of a school, and in a sense, it may not be. However, if school is meant to get students ready for success in life, then it’s difficult to imagine a more worthwhile intervention than a treatment program for a student who has sexually inappropriate behavior.
I recently illustrated a personalized social story for a high school student who engaged in frequent masturbation during the school day. The story was extremely frank and practical, to meet his low level of functioning, and included a number of explicit drawings depicting acceptable settings and ways of engaging in the behavior. The process of writing, illustrating, and implementing the story was awkward at times, but the material was presented in an accessible format and addressed his needs. In that sense, I believe that my colleagues and I were ethically bound to provide the information and instruction to this student, in collaboration with the family.
A third barrier to developing effective treatment, in my anecdotal observation, is a tendency not to go through the full FBA process for behaviors assumed to be sexually motivated. It’s interesting to note that often, we don’t adequately consider the possibility that “sexualized” behavior may be multi-functional, or even unrelated to sexual motivation at all. This can be a roadblock as we develop treatment, since assuming that an individual’s behavior is automatically reinforced discounts the other variables that may be strongly at play – such as escape and/or attention contingent upon the behavior.
I would be very interested to hear from others who may have experience or knowledge which confirms or contradicts anything I’ve shared, and I’d love to hear whether folks have encountered other barriers to implementing client-centered treatment for sexually problematic behavior.
Let us know your thoughts in the comments below, and be sure to subscribe to bSci21 via email to receive the latest articles directly to your inbox!
Clelia Sigaud, M.S. is a teacher to children with developmental disabilities in urban Maine (to the extent that “urban” and “Maine” can be used in the same sentence). She has several years of experience working with special needs individuals, from preschool through age 20, in a variety of settings. Outside of work, she is earning her doctorate in School Psychology from the University of Southern Maine. Her interests include functional communication training, interventions for sexualized aggression/sexually problematic behavior, treatment of self injury, paraprofessional training, and ethical practice within the field of ABA. In her spare time, she enjoys authoring her own social stories.
The issue of where/when sexual behavior, and in particular masturbation, is appropriate — where the individual can engage in it — is problematic in a school setting. Fairly recently, a consultant and expert on this topic cautioned the staff at my school not to suggest that the individual go to the bathroom for this purpose. she noted that using any type of public bathroom (e.g. at the mall) for masturbation could result in very serious trouble for the person. She emphasized that the only appropriate locations are at home — bedroom or bathroom. That means that as we talk to a student, we are essentially saying “Wait 5, 6, 7 hours”. I am interested in thoughts on that.
Thank you for your thoughtful comment. The argument you present is not unfamiliar to me, as I have colleagues who would certainly agree with the individual you mentioned. I am in absolute agreement that the safest and most socially appropriate place for our learners to behave sexually is in their homes. I completely support setting that standard for all individuals who are able to access a corresponding level of self-management instruction. The students I was advocating for in my post are specifically those adolescents and young adults who have significant disabilities and who, essentially, categorically refuse (whether vocally or, more often, simply through their actions) to comply with a request to wait. In such a situation, using physical redirection or blocking is not a long-term solution, nor would it be consistent with best practice. While a teenage boy with autism, for example, should ideally be masturbating only at home, what is certain is that something must be done if he is consistently doing so in the high school cafeteria. In the interests of including our learners with special needs as much as we can, I believe that we should address their functional deficits in a very individual fashion. As I said, restricting sexual behavior to the home environment would be a very appropriate long-term goal of treatment. At the onset, however, it may be necessary to teach skills such as applicable mands (even if that is simply touching a “private time” card) and relevant discrimination skills (such as masturbating in bathrooms that have only one toilet, thereby distinguishing between publicly accessible multi-stall bathrooms and truly private ones). Something which may be helpful to think about as an individual treatment plan is being deigned is the individual’s functioning level and projected level of independence in adulthood. If the individual will never be in the community unaccompanied, a lower level of independent discrimination will be required than if s/he will be tasked with self-managing while in public. I hope this helps elucidate the original intent of the post.
If an FBA demonstrates that inappropriate sexual behavior is automatically reinforced, which it may not be, I have had success using masturbation as an antecedent intervention. If a client regularly masturbates in a certain setting, or the community in general, masturbating before attending an activity may act as an abolishing operation. Waiting several hours would not be as difficult for these individuals if they have engaged in sexual release prior to the activity. It may also be combined with using a “wait” card or some form of stimulus discrimination to increase effectiveness. Just my two cents but hope it helps!
Thank you for sharing! Proactive thinking such as this can be very helpful in my experience as well.