Sex and genes,part 2: A biopsychosocial approach to assess and treat challenging sexual behavior in persons with intellectual disabilities including fragile X syndrome and 22q11.2 deletion syndrome

Individuals with intellectual disabilities (IDs) – and specifically those with genetic disorders – are more prone to medical and psychological challenges that affect their sexual development, experiences, and fertility. In this review paper we first provide an overview of the biopsychosocial (BPS) model and then explain how the model can guide and improve the assessment and treatment of challenging sexual behaviors by persons with IDs. We discuss two genetic conditions – fragile X syndrome and 22q11.2 deletion syndrome – in case studies, showing how the BPS model can be used to assess and treat the sexual problems of individuals with various types of ID. We conclude with BPS-formulated treatment considerations in three key domains: biomedical treatment (e.g., medication side effects; stopping or changing medications), psychological treatment (e.g., providing psychological therapies), and socio-environmental interventions (e.g., providing socio-sexual education and staff training). Together, these treatment interventions can aid clinicians to prevent and/or treat problematic sexual behaviors of people with IDs.     

A comparison of isolated and synthesized contingencies in functional analyses

Recently, researchers have compared the utility of isolated versus synthesized contingencies in functional analysis (FA) methodology (e.g., Fisher et al., 2016; Slaton et al., 2017). A limitation of these studies is that there were other differences across FA methodologies (e.g., design, contingency) that did not allow for isolation of the influence of isolated versus synthesized contingencies. Therefore, the current study compared outcomes of FAs that involved isolated versus synthesized contingencies for problem behavior of 5 children while controlling for these other differences across FAs (Experiment 1). Next, the current study compared the effects of interventions based on the functions identified in the isolated and synthesized contingencies for each participant (Experiment 2). Results indicated isolated contingency FAs produced differentiated responding for 1 or both functions for all 5 participants, and there were little to no differences between treatments informed by isolated and synthesized contingency FAs.     

A comparison of methods for assessing preference for social interactions

Researchers have evaluated a variety of methods for assessing preference for social interactions, and generally have found that such assessments accurately identify differentially reinforcing, preferred interactions. However, few researchers have compared methods for assessing preference for social interactions, and none have done so with participants across different skill levels. The current study compared the stability and validity of hierarchies produced by social interaction preference assessments (SIPA) and picture-based multiple stimulus without replacement preference assessments (MSWO) with 8 individuals diagnosed with autism spectrum disorder (ASD). The MSWO most often produced valid hierarchies for participants who could match, identify, and tact pictures of social interactions and that the SIPA most often produced valid hierarchies for participants who could not identify or tact pictures of social interactions. A vocal paired-stimulus preference assessment (PSPA) was also conducted with a subset of participants who communicated vocally, and it produced valid hierarchies. Considerations and recommendations for selecting a method of assessing preference for social interactions are discussed.