Risk Assessment of Adolescents with Intellectual Disabilities Who Exhibit Sexual Behavior Problems or Sexual Offending Behavior

Parents' perceptions of risk and protective factors for problematic sexual behaviour in young Korean individuals with developmental disabilities

BACKGROUND

Limited data exist on problematic sexual behaviour (PSB) in youth with developmental disabilities in South Korea.

METHOD

Sixty-one parents of children with intellectual disabilities or autism spectrum disorder (aged 13-30) reported children's PSB and emotional, behavioural, cognitive, and interpersonal factors. The frequency of PSB in children with developmental disabilities was verified, and various factors' effects on PSB were examined through multiple linear regression analysis.

RESULTS

There were no significant differences in PSB levels between children based on sex and age group. The externalising tendency and a history of family conflict predicted higher PSB. In contrast, protective factors had no significant predictive effects.

CONCLUSIONS

PSB may vary depending on emotional and interpersonal factors, as well as cognitive deficits. Our findings emphasise the importance of interventions for PSB that consider both intrapersonal and interpersonal aspects.

Exposure to sexual content and problematic sexual behaviors in children and adolescents: A systematic review and meta-analysis

BACKGROUND

Exposure to sexual content, such as online pornography or live sexual content, has been posited in the literature as a risk factor for problematic sexual behaviors (PSBs) in children and adolescents, and has been identified as an important avenue for research and intervention, particularly given the ubiquitous access to technology among children.

OBJECTIVE

To examine the association between live/violent and non-violent sexual content exposure and PSB among children and adolescents. Objectives also include informing future research on sexual content exposure as a risk factor for PSB, and providing clinical recommendations related to prevention and intervention.

PARTICIPANTS AND SETTING

Results are based on 16,200 participants (28.65 % female; Mage = 14.26; range = 4.74-17.92) and 27 studies conducted in North America, Europe, Asia, and Africa.

METHODS

A systematic review was conducted of available literature published up to September 2021. Abstract and full-text review were conducted to assess whether studies met inclusion criteria. Random-effects meta-analyses were conducted on included studies.

RESULTS

Significant associations were found between exposure to non-violent sexual content and likelihood of engaging in PSB (OR = 1.82; p < .001; 95 % CI: 1.50-2.21), and between exposure to violent/live sexual content and PSB (OR = 2.52; p < .001; 95 % CI: 1.75-3.61). Sex emerged as a moderator of the association between exposure to non-violent sexual content and PSB, such that the association was stronger in studies with a greater proportion of females.

CONCLUSIONS

Results support the need for future research on risk factors and mechanisms implicated in PSB. Prevention and intervention programs for children with PSB and their families could benefit from incorporating education on sexual content exposure.

Sexual behaviours of individuals with developmental disabilities in South Korea: A qualitative study exploring the views and experiences of professionals

BACKGROUND

Despite the considerable number of young adults with developmental disabilities experiencing sexual desire and exhibiting sexual behaviours as part of their natural biological growth and development, there is a lack of research on effective intervention. This study aimed to explore the views and experiences of professionals on the sexual behaviours of individuals with developmental disabilities.

METHODS

Semi-structured interviews with eight professionals specialising in developmental disabilities and/or inappropriate sexual behaviours were conducted, and their responses were analysed using a qualitative method.

RESULTS

Professionals' experiences were categorised into three based on the groups involved in intervention: people with developmental disabilities (desire, factors leading to lack of desire fulfilment), their family/parents (emotions and cognition/behaviours toward their child's disability and sexuality), and professionals (current intervention method, lack of human/material resources).

CONCLUSION

Based on these findings, we suggest future directions for interventions to address sexual behaviours among individuals with developmental disabilities.

Opinions of special education teachers on inappropriate sexual behaviors in adolescents with intellectual disabilities

Inappropriate sexual behaviors may be observed in individuals with intellectual disabilities (ID), especially during adolescence. There are several undesired consequences of exhibiting such behaviors in public spaces, such as schools. The competencies and attitudes of special education teachers, who are responsible for the education of individuals with ID, are of significant influence. This study was conducted to investigate the views of special education teachers working with adolescents with ID on inappropriate sexual behaviors exhibited in educational settings. Accordingly, semi-structured interviews were conducted with 12 special education teachers. The phenomenological research design, one of the qualitative research methods, and thematic analysis were used in this study. Five themes were identified after the analysis of the findings of the study, namely, common behaviors, teacher attitudes, teacher competencies, teacher interventions, and educational content. The findings were discussed on the basis of the relevant studies in the literature and a number of conclusions were reached. Accordingly, the inappropriate sexual behaviors that special education teachers encounter the most frequently are masturbation, undressing, and touching, and when these behaviors are exhibited aggressively, teachers have difficulty in intervening. Participants regard themselves to be incompetent in terms of sexual education and consider relevant educational content inadequate.

Experiences of teachers, educators, and school counselors about the sexual and reproductive health of educable intellectually disabled adolescent girls: a qualitative study

Background

Adolescents with intellectual disabilities are probably twice as many people without intellectual disabilities to be sexually abused by family members, caregivers, close relatives, and others in the community. Sex education and training are essential components of children's and teenagers' education and human rights, as well as a source of worry for parents and society. While the parents are thought to be the most accessible choice as sexual educators, they often do not fulfill this role. Therefore, professional teachers and trainers who have undergone sex education courses for mentally retarded adolescents are more reliable sources to provide the sexual information in terms of their educational role. This study aimed to determine the experiences of teachers, educators, and school counselor parents regarding the sexual and reproductive health of educable intellectually disabled adolescent girls.

Methods

This was a qualitative content analysis study. 35 participants were selected via purposive sampling with maximum variation, and data were collected through in-depth individual interviews, focus group discussions and field notes, and analyzed using the conventional qualitative content analysis method simultaneously.

Results

Three subcategories have emerged: “knowledge and professional experience of teachers, educators, and school counselors with how to educate and care for adolescent sexual health”, “proficiency of teachers, educators, and school counselors in guiding families in solving their child's sexual problems”, “attitude of teachers, educators, and school counselors towards sexual behaviors and sexual education of adolescents” which formed the main category of “teachers, educators, and school counselors’ inefficiency in maintaining ID adolescent girls’ sexual and reproductive health”.

Conclusions

Teachers, educators, and school counselors encounter a variety of issues related to the sexual and reproductive health of intellectually impaired teenage females, as a consequence of the findings. As a result, efforts should be made to enhance knowledge and skill development, as well as the evolution of negative attitudes. Therefore, the teaching of sexual guidelines for teenagers with mental impairments should be included in the agenda of the country's educational policies. Teachers and educators should be taught by health experts via the holding of in-service training courses.

Achieving sexual health is a key task to develop health for all people including adolescents. Adolescents with intellectual disabilities are probably twice as many as people without intellectual disabilities to be sexually abused by family members, caregivers, close relatives, and others in the community. The role of schools and educators to manage children's sexual behaviors and provide appropriate training in this field was accepted by most societies. This research aimed to ascertain instructors', educators', and school counselors' perceptions on teenage females with educable ID's sexual health. Participants in the present study were mothers, teachers, educators, and school counselors who were selected via purposive sampling in Isfahan from July 2017 to April 2018. Data were collected from via semi‑structured interviews, focus group discussions, and field notes, and analyzed using conventional content analysis. The results showed that teachers, educators, and school counselors face different challenges about the sexual and reproductive health of intellectually disabled adolescent girls. Therefore, it should be attempted to promote knowledge and skill and eliminate negative attitudes and make them aware of the sexual rights of intellectually disabled adolescent girls to protect themselves in different situations.

Sex offending among adolescents and young men with history of psychiatric inpatient care in adolescence

BACKGROUND

Some mental disorders have been associated with increased likelihood of sexual offending in adolescents (and adults), but relevant studies tend to be of established sex offenders.

AIMS

To examine relationships between adolescent mental disorders and subsequent involvement in sex offending and to explore any predictive value of primary diagnoses for subsequent interpersonal offending, whether sexual or violent.

METHODS

We analyse national register-based longitudinal data on males in Finland admitted for their first psychiatric inpatient treatment between the ages of 13-17 in the period 1980-2010 (N = 6749). Cox regression was used for the analysis of multivariate associations.

RESULTS

A subsequent criminal record for sex crime in the 10-year follow up was rare among former child and adolescent psychiatric (CAP) inpatient males (1.5%). Having a subsequent criminal record for non-sex-related violent crime was more common (25%). Time to either sex crimes or non-sex-related violent crimes after a first CAP inpatient treatment was 3-4 years. Whilst the risk of committing non-sex-related violent crimes was elevated in all diagnostic groups compared to those with schizophrenia spectrum disorders, the risk of committing subsequent sex crimes was elevated only in the group with substance use, conduct or personality disorders. Among those with pre-existing criminal history of sex crime, the risk of a subsequent criminal record for sex crime after CAP treatment was increased 11-fold, but the risk for later non-sex-related violent crimes was not increased compared to the rest of the male adolescent CAP population.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

In this first longitudinal study of criminal convictions for sex offending after a period of inpatient psychiatric treatment as an adolescent such convictions were rare, but the difference in post discharge risk of further convictions for sexual offending and non-sexual violent offending raises questions about whether more attention and specific treatment for aberrant sexual behaviours is needed for male adolescents with severe mental disorders.

Social educator students' readiness to address sexual health in their future profession

BACKGROUND

Norwegian social educator students' attitudes towards addressing sexual health are unknown, even if their future clients often have needs related to sexual issues.

PURPOSE

To investigate social educator students' readiness to address sexual health in their future profession.

METHODS

In 2019, 213 social educator students (response rate 34%) responded to the Students' Attitudes towards addressing Sexual Health Extended online questionnaire.

RESULTS

Most of the social educator students felt comfortable and ready to address sexual health in their future profession, but thought they had insufficient competence and education concerning sexual health. There were gender and age differences when discussing sexual health among persons with intellectual disabilities.

CONCLUSION

Despite most Norwegian social educator students feeling ready to address sexual health, they needed additional competences and education. Further research is needed concerning the effectiveness of educational interventions targeting competence in sexual health, to ensure sufficient support for clients in this field.

Persons with Intellectual Disability: Sexual Behaviour, Knowledge and Assertiveness

Background

Persons with ID most often have incomplete, contradictory and imprecise knowledge of sexuality and sexual intercourse itself. They are not provided with sufficient information on their own body and sexuality, and are often discouraged from and sanctioned for trying to sexually express themselves. Sexual abuse due to low sexual assertiveness is also common.

Aim

The principal aim of this study was to establish the presence or absence of sexual activity in adults with ID residing in institutional housing, as well as the level and structure of their knowledge of sexuality, their sexual assertiveness and preparedness to react in a sexually dangerous situation.

Methods

The sample consisted of 100 participants with ID residing in institutional housing. The instruments used included the General Sexual Knowledge Questionnaire, What-if test and Hulbert index of sexual assertiveness. Comparative statistics included coefficient of linear correlation and multiple regression analysis.

Results

The results showed that 82% of the participants are sexually active. Most participants admitted to sometimes having sexual intercourse against their wishes as well as to having difficulty asserting themselves. Their knowledge of pregnancy, contraception and sexually transmitted diseases was very low. Female participants and those that reported having sexual intercourse had more sexual knowledge and were also more sexually assertive.

Conclusion

Knowledge of sexuality and sexual assertiveness of persons with ID residing in institutional housing is very low. Additional information on sexuality is necessary, as well as support in learning to express their own desires and to deal with unwanted sexual activity.

Contemporary Risk Assessment Tools: Should We Use Them for Sexually Abusive Children Ages 4 to 12 Years?

Empirical findings are reported on an age group of sexually abusive youth (4-12 years) not commonly studied. Findings are from major studies employing the ecologically framed MEGA ♪ risk assessment tool: MEGA ♪ Combined Samples Studies (N = 3901 [1979-2017] (Miccio-Fonseca Journal of Child Sexual Abuse: Special Issue on Risk Assessment of Sexually Abusive Youth, 2018a, Journal of Child and Adolescent Trauma, 2018b) and MEGA ♪ Combined Cross Validation Studies (N = 2717). Samples consisted of male, female, and transgender-female, ages 4-19 with coarse sexual improprieties and/or sexually abusive youth, including youth with low intellectual functioning. Findings provided normative data, with cut-off scores according to age and gender, establishing four (calibrated) risk levels: Low, Moderate, High, and Very-High. The fourth risk level, Very-High Risk, sets MEGA ♪ apart from other risk assessment tools by the ability to assess those few most seriously concerning and/or dangerous youth, whereas other risk tools (with three risk levels) do not make this differentiation.

MEGA♪ Tool: An Analysis of "Risk/Treatment Needs and Progress Protocol" by Kang, Beltrani, Manheim, Spriggs, Nishimura, Sinclair, Stachniuk, Pate, Righthand, Prentky, and Worling (2019)

A new risk/treatment needs protocol for assessing "juveniles with sex offenses" operationalized in the Treatment Needs and Progress Scale (TNPS) was recently introduced, prompting quick embrace before any serious examination. This article critiques the proposed protocol and TNPS. Highlighted are misleading statements, substantial omissions related to review of research, and significant margins of TNPS underpinnings that cause considerable pause. Target population, essential to adopting and implementing TNPS, is not clearly stated. Multiple basic rudimentary steps are missing in the research protocol for two age groups. The "new" protocol appears to be a re-installment of the old one, applying templates from adult tools and empirical findings on adults to adolescents, thus treating youth like adults, an outdated stance in contemporary research and clinical practice related to risk assessment of sexually abusive youth..

MEGA ♪ : Empirical Findings on the Preternatural: Sexually Violent and Predatory Sexually Violent Youth

Applied are empirical findings from two major studies employing the ecologically framed MEGA ♪ risk assessment tool: MEGA ♪ Combined Samples Studies (N = 3901 [1979-2017] (Miccio-Fonseca 2017a, d) and MEGA ♪ Combined Cross Validation Studies (N = 2717). Samples consisted of male, female, and transgender-female sexually abusive youth, ages 4-19, including youth with low intellectual functioning of borderline or low average. Findings further support a previously presented nomenclature identifying two subsets overlooked by most contemporary risk assessment tools: sexually violent and predatory sexually violent youth (Miccio-Fonseca and Rasmussen Journal of Aggression Maltreatment & Trauma, 18, 106-128, 2009, 2014). MEGA ♪ Studies provided normative data, with cut-off scores (calibrated) according to age and gender, establishing four risk levels: Low, Moderate, High, and Very High. The fourth risk level, Very High, sets MEGA ♪ apart from other risk assessment tools for sexually abusive youth, which are limited to three risk levels. Very High risk level definitively identifies the most dangerous youth, thus empirically supporting the nomenclature of sexually violent and predatory sexually violent youth.

Neuropsychological Risk Factors to Consider When Assessing for Sexually Abusive Youth

Present literature exploring neuropsychological characteristics of sexually abusive youth is lacking, especially with regard to females and youth with low intellectual functioning. Moreover, although areas of neuropsychological functioning have been researched in this population, findings are vastly inconsistent and contradictory. Such gaps in the literature create obvious barriers in the ability to adequately assess risk, particularly pertaining to neuropsychological factors that could inform effective treatment, case management, and supervision options. The purpose of this article is to explore neuropsychological and cognitive deficits that may manifest in youth who have and who have not experienced instances of abuse, for those who have and who have not been convicted of a sex offense, and to provide information for treatment providers, case managers, and supervisors regarding when to consider referring for additional testing.