Association for Behavior Analysis International

There is a long history of individuals with extensive support needs (ESN) being sterilized without their knowledge and consent. Additionally, inappropriate sexualized behavior (ISB) is fairly prevalent among individuals with intellectual or developmental disabilities (IDD); estimates suggest that 18% to 28% of individuals diagnosed with IDD engage in these behaviors. Part of the reason this occurs is a lack of education about sexual development and a lack of interventions to address sexual behaviors and build skills related to self-determination or informed decision-making. This symposium will discuss multiple aspects of addressing and supporting the sexuality of individuals with ESN, including a discussion of a study aimed to increase these skills related to speaking to a doctor about menstrual management, a review of research conducted related to antecedent sex education/interventions and self-determination skills for individuals with ESN, and a review the body of research examining the effects of interventions on ISB before outlining implementation of function-based interventions for educators and practitioners working with students with disabilities who engage in ISB.

Behavior analysts, educators, and other practitioners working directly with individuals with developmental disabilities

There is a long history of individuals with extensive support needs (ESN) being sterilized without their knowledge and consent. Part of the reason this occurs is due to a lack of education about sexual development and a lack of interventions to build skills related to self-determination or informed decision-making. This study aimed to increase these skills related to speaking to a doctor about menstrual management. Three participants were first taught about their menstrual cycles and given preference assessments about reversible birth control options. Participants then created individualized graphic organizers to help guide them through the process of asking about choices and recording the information given from doctors. A single-case multiple probe design was used to examine the effectiveness of using behavioral skills training to increase the skills of asking a doctor about choices and recording the information. All three participants reached mastery level within three to four probes. Two participants stayed at mastery level for their generalization and maintenance probes. One participant did not stay at mastery level for their generalization and maintenance probe but was only 3 points away from mastery level, and 29 points above their baseline level. Suggestions for future research, application, and policy change discussed.

There were five systematic literature reviews conducted related to antecedent sex education/interventions and self-determination skills for individuals with extensive support needs (ESN): (1) comprehensive sex education (CSE), (2) status of use and knowledge of contraceptives, (3) contraceptive interventions and education, (4) self-determination (SD), and (5) SD and contraceptive use. Overall, 4,356 abstracts were reviewed and 94 articles met inclusion criteria. The literature related to contraceptive use and education shows that women with ESN do use contraceptives yet there is inconsistency in their understanding of the contraceptives and most are unaware of other choices. Choices were made by caregivers and physicians without appropriately educating the patients. While there are interventions related to CSE, almost all were not found appropriate to students with ESN and need more modifications and accommodations to truly teach students with ESN. There is not any current literature related specifically to contraceptive use and increasing this knowledge and decision-making. There is promising research for teaching SA/SD skills yet not related to CSE or related issues. There is a clear deficit in research to support individuals with ESN to understand their natural development, how to create and maintain safe relationships, and/or make informed decisions about their bodies.