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.     

BEHAVIORAL MOMENTUM IN THE TREATMENT OF NONCOMPLIANCE

Behavioral momentum refers to the tendency for behavior to persist following a change in environmental conditions. The greater the rate of reinforcement, the greater the behavioral momentum. The intervention for noncompliance consisted of issuing a sequence of commands with which the subject was very likely to comply (i.e., high-probability commands) immediately prior to issuing a low-probability command. In each of five experiments, the high-probability command sequence resulted in a “momentum” of compliant responding that persisted when a low-probability request was issued. Results showed the antecedent high-probability command sequence increased compliance and decreased compliance latency and task duration. “Momentum-like” effects were shown to be distinct from experimenter attention and to depend on the contiguity between the high-probability command sequence and the low-probability command.     

Heart-rate response to water-immersion isolation as a function of spatial orientation

The present study investigates the effect of spatial orientation of the body on heart rate during conditions of water-immersion sensory isolation. Two groups of three men and three women each were exposed to one of two isolation conditions. In one condition the subject was suspended in a buoyant but vertical attitude; in a second condition the subject was suspended in a buoyant but horizontal attitude. Heart-rate data were obtained continuously during each session. There was no significant difference in mean heart rate between the two conditions. The data were interpreted as providing support for the position that studies comparing recumbent subjects in air isolation with underwater subjects in a vertical suspension attitude are valid, at least for some measures, and are not an artifact of spatial bodily orientation. The possible importance of neutral buoyancy in accounting for the nonsignificant effect of body attitude on heart rate is discussed.     

An evaluation of the Garren-Edwards diet and behavior modification program

This study evaluated the efficacy of the Garren-Edwards Behavior Modification Program, which uses the Garren-Edwards Gastric Bubble as an adjunct to treatment. Group therapy sessions were conducted with 23 morbidly obese subjects for 6 months on a biweekly basis. Each therapy session used a five-stage problem-solving sequence designed to facilitate adaptive behavioral alternatives. In evaluating weight change, a multivariate analysis of variance was conducted along with two preplanned orthogonal comparisons. Patients lost significant amounts of weight between initial to 3-month (p<.0001) and 3- to 6-month intervals (p<0001). A similar treatment effect was noted in an additional sample of 24 morbidly obese subjects following 3 months of treatment (p<0005). The findings support the value of longer goal-oriented programs in promoting continued weight loss. Implications for treatment process and therapist interventions prompted by this new format are discussed.     

Coping with victimization: The impact of rape on female survivors,male significant others,and parents

This paper reports on an unusual study of survivors of rape and the effects on the victim, her significant male other person, and her parents. All survivors were victims of the same rapist and were interviewed from 21 months to ten years after the event. The study indicates that the long-term effects of rape may be more significant than previous researchers and practitioners thought was the case. Recommendations are given for more effective help for survivors and those close to them.This study was funded by the Ohio Department of Mental Health, Office of Program Evaluation and Research, Columbus, Ohio, 1985.     

Ambiguity and rationality

Recently, several theories of decision making and probability judgment have been proposed that take into account ambiguity (Einhorn and Hogarth, 1985; Gardenfors and Sahlin, 1982). However, none of these theories explains exactly what the psychological causes of ambiguity are or addresses the issue of whether ambiguity effects are rational. In this paper, we define ambiguity as the subjective experience of missing information relevant to a prediction. We show how this definition can explain why ambiguity affects decisions in the ways it does. We argue that there are a variety of rational reasons ambiguity affects probability judgments and choices in the ways it does. However, we argue that the ambiguity effect does not cast doubt on the claim that utility theory is a standard of rational choice. Rather, we suggest that the effect of ambiguity on decisions highlights the fact that utility theory, like any normative model of decision making only prescribes the optimal decision, given what one knows.     

Did Pearson reject the Neyman-Pearson philosophy of statistics?

I document some of the main evidence showing that E. S. Pearson rejected the key features of the behavioral-decision philosophy that became associated with the Neyman-Pearson Theory of statistics (NPT). I argue that NPT principles arose not out of behavioral aims, where the concern is solely with behaving correctly sufficiently often in some long run, but out of the epistemological aim of learning about causes of experimental results (e.g., distinguishing genuine from spurious effects). The view Pearson did hold gives a deeper understanding of NPT tests than their typical formulation as accept-reject routines, against which criticisms of NPT are really directed. The Pearsonian view that emerges suggests how NPT tests may avoid these criticisms while still retaining what is central to these methods: the control of error probabilities.A portion of this research was carried out during tenure of a National Endowment for the Humanities Summer Stipend Fellowship; I gratefully acknowledge that support. A version of this paper was presented at the 1987 meeting of the Society for Exact Philosophy. This paper benefited from discussions and communications with George Barnard and Isaac Levi. I thank Harlan Miller for helpful comments on earlier drafts.     

Effects of communication apprehension,familiarity of partner,and topic on selected “women's language” features

In keeping with Lakoff's (1975) notion that the use of women's language (WL) conveys uncertainty on the part of the speaker, the influence of communication apprehension, familiarity of partner, and topic on the use of selected WL forms was investigated. In dyadic conversation with a female friend or stranger, 71 female university students, who had completed the Personal Report of Communication Apprehension—Long, discussed a familiar or an unfamiliar topic. Multiple-regression analyses revealed that (1) communication apprehension was positively related to the use of question intonation, (2) familiarity of topic and partner were negatively related to the use of hedges, and (3) familiarity of topic was positively related to the use of intensifiers. There were no intercorrelations of the linguistic forms. These results challenge the notion that WL forms actually cohere to form a kind of language and suggest that the influence of social and psychological variables on the use of WL is much more complex and multifaceted than Lakoff believed.This article is based on portions of an Honour's thesis completed by the second author, and was presented at the Annual Convention of the Canadian Psychological Association held in Ottawa, Ontario, June 1990.