Research paper
FOI 23/24-1401
OFFICIAL
For Internal Use Only
related to intimacy, relationships and sexual health, there is no indication that the therapy is
intended to address sexualised behaviours of concern or inappropriate sexual conduct (IPSA,
n.d; Frickelton, 2013; Rosenbaum et al, 2014).
5. Other interventions for sexualised behaviours of
concern
It can be difficult to structure experimental studies with adequate sample sizes which examine
the effects of treatments on sexualised behaviours of concern. This can be due to ethical
considerations or lack of available participants (Casey et al, 2018). Much of the research is
structured around single participant case studies. This is true of research focussing on young
people and adults.
In their systematic review, Casey et al (2018) conclude that there is insufficient evidence to
determine which specific technique is most effective at reducing inappropriate sexualised
behaviours for people with acquired brain injury, intellectual or developmental disability.
However, the strongest evidence was for behaviour analytic techniques using either a
punishment component or a differential reinforcement component or both.
A narrative review from Warner et al (2022) suggests that Applied Behaviour Analysis (ABA)
can assist with the management of sexualised behaviours of concern in people with Autism
Spectrum Disorder. However, due to the format of the review, the quality and levels of
evidence of included studies was not considered. Also, recommendations were largely based
on the generalisation of ABA techniques to sexualised behaviours rather than direct evidence
of efficacy. For further information on ABA used to manage behaviours of concern please refer
to TAB research paper RES 246 ABA and positive behaviour support.docx.
Pritchard et al (2016) describe a case of reducing significant and problematic sexual
behaviours of concern in a 17 year old with ASD using an individualised multi-component
behavioural intervention. Intervention included cognitive behavioural therapy, sexuality and
relationship education, active support and a points-and-levels behaviour modification system.
At conclusion of the study the subject had not shown sexualised behaviours of concern for 3
months. The authors followed up with Pritchard et al (2021) in which they describe several
cases of individualised multi-component behavioural intervention showing consistent success
in reducing behaviours.
Falligrant and Pence (2020) describe different procedures of differential reinforcement of
alternate behaviour or differential reinforcement of other behaviour, sometimes combined with
punishment, for people with intellectual and development disability. All the interventions they
canvassed were effective at reducing sexualised behaviours of concern, sometimes to near
zero levels. They also describe some studies indicating people with intellectual and
development disabilities may be able to learn self-management methods to reduce
behaviours. However, all the studies described are either single person case studies or very
low sample studies. The authors do not consider quality or levels of evidence in their review.
Sex work and BOC
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