Masturbation is a common human behavior that impacts nursing in a variety of ways. All too often, nurses find themselves seeking out masturbatory literature after an uncomfortable client encounter ...
INTERVENTIONS FOR CHILDREN WITH SEXUAL BEHAVIOR PROBLEMS RESEARCH, THEORY, AND TREATMENT By Ryan K. Grant, LCSW and Lesley H. Lundeberg, LCSW 4478 U.S. Route 27 • P.O. Box 585 • Kingston, NJ 08528
addiction treatment therapies instrumental in helping bring healing and help treatment for compulsive masturbation disorder include: Holistic therapy; Family therapy; Cognitive behavioral therapy; Dialectical behavioral therapy; EMDR; Experiential therapy; Music therapy; Yoga therapy; A dual diagnosis is often time an important component of the treatment program.Estimated Reading Time: 3 mins
In the sole study that used an individual cognitive-behavioral intervention (Withers and Gaskell 1998), masturbation behavior decreased from 10–12 times per week prior to intervention to an absence of the behavior by the seventh and final treatment session.Estimated Reading Time: 11 mins
These interventions are provided by a trained mental health professional. Then, Amanda Mitten, also a Licensed Professional Counselor at the University of Oklahoma Health Sciences Center, shares examples of recommendations that a mental health professional may request of a child care program. Intervention for Sexual Behavior Challenges
gaging in high-risk behavior—for ex-ample, multiple partners, unprotect-ed sex, substance use, and sexual ex-change. Sexual behavior on inpatient units is less common than in the outpatient community, ranging from 1.5 to 5 percent of patients on adult units over one to two years (3–6). Nevertheless, it can be a very cumbersome issue when it ...
Masturbation is a developmentally appropriate activity. Often when students begin to publicly masturbate, the gut response is to try to get them to stop entirely. That will typically result in the worsening of the behavior or potentially an increase in other problematic behaviors.Estimated Reading Time: 4 mins
The addict engaging in compulsive masturbation seeks therapeutic intervention for help as a last resort, seeking relief from anxiety, obsession, isolation and the inability to …Estimated Reading Time: 9 mins
However, selecting an intervention for ISB can be particularly challenging due to negative public perceptions of such behaviors, the technical difficulty and ethical issues inherent in implementing direct functional behavior assessments (FBA) for sexual behavior, and the difficulty in developing an effective intervention plan for behaviors that may be primarily maintained through automatic reinforcement …
Masturbation is viewed as a developmentally normal behavior in children. When masturbation is practiced beyond normal sexual behavior and causes injuries or pains, treatment becomes necessary  . This is to say when a child or an adolescent reaches a stage of excessive masturbation, treatment or intervention becomes necessary.
In fact, research demonstrates that individuals with disabilities have a disproportionally high risk for engaging in risky sexual behavior and being sexually victimized Ballan According to the client, masturbation has short-term gratification which is regarded as positive effect but when it becomes excessive it is unhealthy. Primarily, further replication of the treatment procedures used in this review would help to validate these approaches. A comparison of procedures for decreasing public disrobing of an institutionalized profoundly mentally retarded woman. Furthermore, findings in this study revealed that the client established a writing page in the magazine for the purpose of fighting excessive masturbation which is active to date. They might also have decreased instructional time and fewer opportunities to learn adaptive behavior because addressing ISB precludes practitioners from targeting educational goals Carlson et al. Activities therefore may replace watching pornographic video, which is healthy. It is generally reported that people with developmental disabilities demonstrate typical patterns of physical development during puberty. Reprints and Permissions. In spite of this change in thinking, it remains that many individuals with disabilities have difficulty expressing their sexual behavior in an appropriate time, place, and manner. Counseling intervention was built in a vicious circle. Table 1 Strengths and potential limitations of treatments for inappropriate sexual behavior. Premature sexual development, or precocious puberty, is another area that may pose challenges for children with developmental disabilities and their families. These findings are in line with that of  who report that preference on healthy activities such as regular exercises help to control excessive masturbation. Recent research has described statistically significant group differences between typically developing adolescent sexual offenders and adolescent sexual offenders diagnosed with autism on survey measures, which provides further indication of the need for individualized behavior analytic treatment Bliel Walters et al. Journal of Pediatric Health Care, 18, Apply Apply. Sexuality education for adolescents and adults with autism spectrum disorders. However, it is also important to be aware of other potential causes for problematic or severe sexual behaviors. Focus on Autism and Other Developmental Disabilities. Dosen, A. DRO consisted of verbal praise delivered on a variable interval schedule contingent upon nonoccurrence of ISB. For example, Koller suggests that sex education for individuals with ASD should include instruction that is brief, repetitive, and specific; inappropriate behaviors should be promptly responded to and redirected; individuals should be taught an appropriate setting and time during which they can engage in sexual behavior; and private time should be proactively scheduled. After identifying the maintaining consequence to ISB, provide long durations of noncontingent access to that reinforcer prior to situations in which ISB is likely to occur in order to temporarily reduce value of the reinforcer. Given the potential deleterious effects of ISB on individuals with DD who are school age and older, professionals e. Paraphilia as a sexual disability: outcome study in a female with a history of the Kaspar Hauser dwarfism syndrome. Caregivers and educators working with children and youth experiencing sexual behavior challenges should be knowledgeable about the following social, emotional, and behavioral symptoms:. Moreover, punishment only reduces a maladaptive behavior; it does not teach or strengthen adaptive behaviors, which would be critical in a comprehensive treatment plan. Researchers taught the participant to appropriately request for attention utilizing a speech-generating device, which successfully reduced precursor behaviors and targeted ISB. Programs can implement policies and preventive measures to address sexual behavior development and be a supportive factor for children or youth with problematic sexual behavior or sexual behavior challenges. Communicating early and working as a team provides the family with options for support and can prevent a child with risk factors from developing sexual behavior challenges. Behavior Modification. Treatment efficacy of noncontingent reinforcement during brief and extended application. Copy to clipboard. For example, a quotation from  confirms this argument. In order to maintain the social validity of the research in this area, it is important that studies consistently assess the generalization of treatment outcomes across settings and people. Functional analysis and treatment of inappropriate sexual behaviour. Finally, Polvinale and Lutzker conducted behavior probes to determine whether treatment effects were maintained when the trainer was not present. Treatment integrity data was not reported in six of the 12 studies. There were 15 counseling sessions, which were run in nine 9 months of three 3 to four 4 weeks interval. Ensuring safe sexual health encompasses treatment beyond the scope of this review, such as sex education curriculum, contraception education, and social skills education specific to romantic and sexual relationships Tullis and Zangrillo This included the use of antidepressant medications, which can reportedly result in sexual dysfunction Gregorian et al. However, the current literature provides evidence that ISBs are maintained by a range of reinforcers; therefore, identification of the maintaining reinforcer can only serve to better individualize a treatment plan. Two interventions to decrease inappropriate self-touching interventions were then compared. Journal of Child and Adolescent Psychopharmacology, 18 , — I am an Atheist and I would really appreciate if someone would like to help me. It was revealed that excessive masturbation was associated with risk behaviors.
This review provides a systematic analysis of studies that evaluated interventions for inappropriate sexual behavior s of children and adolescents with developmental disabilities. Searches of databases, reference lists, and journals yielded 12 studies that met the predetermined inclusion criteria. Each study was summarized in terms of a participant characteristics, b dependent variables, c research design, d measures and data collection procedures, e independent variables, f treatment integrity, g results, and h level of certainty. All of the 12 studies reported decreases in the target behavior as the result of intervention. The most common intervention involved the use of multi-component behavioral strategies. Clinical implications and suggestions for future research are discussed. As a result, prior to the s, very little research was conducted into the sexuality of those with disabilities Milligan and Neufeldt Childhood sexual development and the sexual behavior of young people with disabilities is an area of research that remains particularly neglected. According to Sandfort and Rademakers , there are two key reasons for this. The first is due to the sensitive nature of this topic. Parents are often reluctant to acknowledge that their children engage in sexual behavior and are even more reluctant to allow their child to participate in research in this area. The second is related to methodology. Sexual behavior is generally viewed to be a private event, and for obvious ethical reasons, it is not appropriate to observe children or adolescents engaging in masturbation or other types of sexual behavior nor are we able to ask particular probing questions if children are used as the source of information in this area. A third potential consideration relates to the important cultural and religious factors that may restrict or prohibit research in this area. Sexual experimentation and exploration fits within the normal spectrum of human sexual behavior in prepubescent years. In particular, masturbation behavior has been observed to occur in utero Meizner and during early childhood Friedrich et al. According to Leung et al. When defining normal or abnormal sexual behavior, the social, cultural, and familial contexts, the setting in which the behavior is occurring, and developmental norms need to be considered. When masturbation behavior is conducted in a private setting and is not excessive in nature, it is considered to be a normal part of child development. It is generally reported that people with developmental disabilities demonstrate typical patterns of physical development during puberty. The onset of puberty, and the emergence of sexual urges, can be problematic for children with developmental disabilities as this can coincide with an increase in challenging behavior at around the same age Eaves and Ho As children with ASD are not always aware of, or do not respond to norms that dictate the social conventions regarding sexual behavior, inappropriate sexual behavior ISB can emerge. Children with ASD in particular are reported to frequently engage in public masturbation Ruble and Dalrymple ; Stokes and Kaur , inappropriate touching of others Clements and Zarowska ; Stokes and Kaur , and fetishistic behavior Ruble and Dalrymple There are several plausible explanations for this behavior. Firstly, sex education is not always provided to individuals with disabilities and is an area that is often ignored due to the potential embarrassment it may cause parents. Secondly, it is suggested that the predisposition of those with ASD, to engage in self-stimulatory behavior, may contribute towards repeated, inappropriate sexual behavior Dalldorf ; Realmuto and Ruble Thirdly, unlike typically developing children, those with intellectual disabilities, particularly ASD, often require adapted and intensive instructional practices in order to acquire an understanding of the social and behavioral skills that might be learnt incidentally by others Barnhill ; Gerhardt ; Hatton and Tector As a result, these children may have difficulty developing prosocial friendships and intimate relationships, may misunderstand relationship boundaries, may have difficulty understanding those behaviors that are appropriate in public versus private settings Gougeon ; Hellemans et al. Ludlow further suggests that the attention provided in response to the ISB of people with disabilities may provide strong social reinforcement for this behavior. Premature sexual development, or precocious puberty, is another area that may pose challenges for children with developmental disabilities and their families. Precocious puberty is defined as the onset of signs of puberty prior to the age of 8 years in girls and 9 years of age in boys Motzin It is thought that precocious puberty can be caused by damage to the central nervous system and may occur as a result of specific genetic disorders, such as Down syndrome and Fragile X. It is also something that occurs more commonly among females than males. It is important to be aware of the increased risk of early onset puberty among those with developmental disability and, in treatment, to consider the possibility that neurobiological factors might be contributing towards the ISB. There is little agreement in the literature regarding what can be considered ISB. When individuals engage in ISB, there are profound implications for their social and familial relationships, as well as their community and home life. To date, there is limited research that has investigated different approaches to the treatment of childhood masturbation and even fewer studies that have examined ISB among children with ASD or other types of developmental disabilities. As a result, there is little consensus among clinicians regarding best practice for treatment of ISB, and the services and supports that are provided in this area are often limited. Mallants and Casteels conducted a review of the literature which investigated assessment and treatment approaches for childhood masturbation among those with typical development. They developed recommended treatment guidelines as a product of this review. In terms of treatment for childhood masturbation CM , the authors highlight the fact that evidence-based treatment of early CM is lacking. When the assessment identifies that there are no additional confounding factors, it is recommended that treatment should focus on parent education and support. Educational processes should aim to alter parent perceptions of CM so that it is not viewed as pathology but, rather, a typical part of child development. It is further recommended that occurrences of CM should either be ignored or redirected and not punished due to the potential reinforcement that can come from responding to this behavior. Finally, the authors concluded that developmentally appropriate sex education should be provided to children in order to help them to understand what socially appropriate sexual behavior is and what it is not.
During the counseling, we developed a model, which guided us during the counseling sessions and intervention sessions. External link. In particular, masturbation behavior has been observed to occur in utero Meizner and during early childhood Friedrich et al. At the Virtual Lab School, we think it is vital to familiarize yourself with the potential professional or job titles of those who may be working with a family that is experiencing sexual behavior challenges. Familiarize yourself with ways you may be asked to incorporate recommendations for children receiving intervention for sexual behavior challenges. During intervention, new problems may arise and thereafter modified. Archives of Sexual Behavior, 22 , — Simeonson and Bailey define suggestive evidence as studies which produce outcomes that could be plausible. These can include:. Punishment Seven studies were identified that examined the effects of several different types of punishment procedures on ISB for individuals with DD, including restitution, time out, facial screening, physical blocking, and restraint. The treatments for ISB included pharmacological and behavioral interventions, and each reported some positive treatment outcomes in the form of a decrease or elimination of ISB. Treatment of self-injury and hand mouthing following inconclusive functional analyses. Masturbation is practiced at an early age and with time they become addicted from which majority are suffering from it. In this paper, as in the Mulloy et al. Clearly, this indicates the need for early, individualized treatment, yet limited empirical evidence regarding behavior analytic interventions is available. Finally, a developmental disability was defined as one that manifests in childhood i. Fyffe, C. Caregivers and educators working with children and youth experiencing sexual behavior challenges should be knowledgeable about the following social, emotional, and behavioral symptoms:. This session was followed by a sharing session about strategies that can be used to control excessive masturbation. Addressing the sexuality and sex education of individuals with autism spectrum disorder. Conflict of Interest The authors declare that they have no competing interests. Finally, the seventh study by Dozier et al. Response interruption and redirection RIRD to incompatible behavior offers another potential efficacy intervention choice see Martinez and Betz for a review. Demonstrate Demonstrate. Philadelphia: W. Journal of Intellectual Disability Research, 49 , 1— This year, Georgina, a preschool teacher, aims to address challenging sexual behavior in her classroom by sharing with her class rules for expected behavior around the subject of private parts and safe touch. Additionally, Guideline 1. Masturbation in infancy and early childhood presenting as a movement disorder: 12 cases and a review of the literature. Today, many practitioners and caregivers now believe that individuals with developmental disabilities have the same basic right to safe and healthy sexual experiences as other individuals Sullivan and Caterino American Journal of Mental Retardation. In the other intervention condition, the participant was not given pre-session access to attention. It is further recommended that occurrences of CM should either be ignored or redirected and not punished due to the potential reinforcement that can come from responding to this behavior. Masturbation and intervention measures have been widely discussed in developed countries; however, evidence of masturbation intervention from developing countries like Tanzania is not clear. This is a finding that has been demonstrated not only with disabled children and adolescents with ISB but also with adults with an intellectual disability Le Blanc et al. Sexual behaviors in autism: problems of definition and management. World Psychology. The efficacy on noncontingent reinforcement as treatment for automatically reinforced stereotypy. Attention was withheld following ISB in both intervention conditions. Follow these best practices when documenting non-normative incidents of sexual behavior. Behavior Therapy, 12 , — A fifth study by Magee and Ellis demonstrated the need for extreme caution and the importance of a functional behavior assessment when utilizing punishment approaches. No single night was skipped without masturbating. Shavega, T. Journal of Experimental Analysis of Behavior. Motzin, B. Sharafi, M.
Try out PMC Labs and tell us what you think. Learn More. 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. Jackson noted that the expression of sexuality has been observed to begin in early childhood. Specifically, young children often explore their own bodies and bodily sensations and learn appropriate and inappropriate ways of touching the bodies of same age peers i. This is the period during which children typically restrict their sexual behaviors e. In addition, there appears to be little by way of educational and behavioral interventions to promote the healthy expression of sexuality by individuals with DD Sullivan and Caterino This underutilization of behavioral principles to positively impact developmentally and age-appropriate sexual behaviors is no doubt at least partially due to the discomfort some stakeholders are likely to experience when discussing sexuality. The relative lack of effective interventions combined with an increased need for systematic instruction to acquire new skills contributes to the development of inappropriate sexual behaviors ISBs for some individuals with DD. Without appropriate intervention, such behaviors might persist and worsen over time as the child continues to develop physically to sexual maturity. Some school age children and adults with DD have been reported to engage in ISB such as disrobing, public masturbation, inappropriately touching others, publicly discussing sexual topics, and sexual arousal to atypical objects or individuals with potentially serious consequences e. Broadly, ISB is defined as a response class performed within an environment that deems the behavior as being unacceptable by societal standards e. There is limited information on the prevalence of ISB exhibited by individuals with DD, which might be a result of ethical concerns regarding the measurement of private or taboo behaviors Lund Although many ISBs are often publicly displayed, observers may feel uncomfortable observing and recording such behaviors because of the sexual content and relevant societal norms; for example, recording of public masturbation would require visually observing such behavior which may cause uneasiness for both the observer and client. However, the results of descriptive survey studies and the publication of intervention studies addressing these behaviors suggest that ISBs are evident in a significant number of children and adults with DD. Over the last five decades, published research has described the assessment and behavioral treatment of ISB displayed by individuals with DD. These behaviors have included a exhibitionism or disrobing e. Individuals with DD who engage in ISB may experience negative outcomes including injury, limited community participation, restricted access to educational resources, social rejection Early et al. They might also have decreased instructional time and fewer opportunities to learn adaptive behavior because addressing ISB precludes practitioners from targeting educational goals Carlson et al. Additionally, some topographies of ISB may pose a threat of injury to self, for example masturbatory behavior can result in soft tissue damage Singh and Coffey Many topographies of ISB also adversely affect others. Caregivers and witnesses to ISB could feel victimized or threatened. Furthermore, community members may be the targets of persons with DD who sexually offend Craig et al. Other individuals with DD may also be at a higher risk of victimization due to placement of individuals displaying ISB in treatment facilities Lund ; Lundervold and Bourland Depending on the nature and severity of the behavior, as well as the culpability and age of the individual with DD, some ISB, such as sexual aggression, sexual coercion, and public disrobing, might have legal ramifications. Though the exact prevalence of criminal justice system involvement is unknown, estimates indicate that the number of adult sexual offenders with a DD is as high or higher than rates in the general population Lindsay et al. Furthermore, there is evidence to suggest that adult sexual offenders begin offending as adolescents Lakey Clearly, this indicates the need for early, individualized treatment, yet limited empirical evidence regarding behavior analytic interventions is available. Treatment options have traditionally been relegated to cognitive behavioral group therapy e. Recent research has described statistically significant group differences between typically developing adolescent sexual offenders and adolescent sexual offenders diagnosed with autism on survey measures, which provides further indication of the need for individualized behavior analytic treatment Bliel Walters et al. In light of these many potential negative consequences, there would seem to be some value in interventions to educate individuals with DD about personal boundaries, modesty, the social rules governing touching others, and the socially appropriate expression of sexuality. In addition, it would seem important to identify and implement empirically supported interventions to treat ISB as a way of ensuring individuals with DD who engage in ISB have optimal opportunities for social interaction and community inclusion. Given the potential deleterious effects of ISB on individuals with DD who are school age and older, professionals e. However, selecting an intervention for ISB can be particularly challenging due to negative public perceptions of such behaviors, the technical difficulty and ethical issues inherent in implementing direct functional behavior assessments FBA for sexual behavior, and the difficulty in developing an effective intervention plan for behaviors that may be primarily maintained through automatic reinforcement e. Past reviews of the literature pertaining to the sexuality of individuals with DD have primarily focused on sex education curricula see Blanchett and Wolfe ; Sullivan and Caterino for reviews. In regard to evaluating specific interventions, Tarnai completed a systematic review of interventions addressing socially inappropriate masturbation for persons with DD. The purpose of this paper was therefore to analyze peer-reviewed behavioral intervention studies aimed at reducing ISB among individuals with DD. Seven categories of interventions for ISB were identified. Based on the respective advantages and disadvantages of these interventions, a treatment selection model is provided to assist practitioners in choosing an appropriate intervention based on client, behavior, and environmental characteristics. The search was restricted to English language journals, although the years of publication were not restricted. The abstracts of the resulting articles were reviewed to identify studies for inclusion. An ancestry search of the references in included articles was also completed to identify additional articles. To be included in this review, a study must have evaluated the effects of a behavioral treatment that was intended to address ISB with at least one individual of any age with DD. A target behavior was considered inappropriate if it grossly violated social norms e. A treatment was deemed behavioral if it implemented treatments that utilized operant or respondent conditioning and if the treatment aligned with the seven dimensions of applied behavior analysis ABA as described by Baer et al. Finally, a developmental disability was defined as one that manifests in childhood i.