The multi-component model of harmful sexual behaviour for people with autism and co-morbid intellectual disabilities – a theory and practice guide

Date31 January 2019
Published date31 January 2019
Pages1-13
DOIhttps://doi.org/10.1108/JFP-07-2017-0027
AuthorRachel Worthington
Subject MatterHealth & social care,Criminology & forensic psychology,Forensic practice,Sociology,Sociology of crime & law,Law enforcement/correctional,Public policy & environmental management,Policing,Criminal justice
The multi-component model of harmful
sexual behaviour for people with autism
and co-morbid intellectual disabilities a
theory and practice guide
Rachel Worthington
Abstract
Purpose The purpose of this paper is to explore to what extent neuro-typical theories of sexual offending
apply to clients with Levels 2 and 3 autism with a co-morbid intellectual disability (ID). The paper develops a
model of harmful sexual behaviour (HSB) for this client group and makes suggestions for how these
behaviours can be understood and reduced.
Design/methodology/approach The revised Integrated Theory of Sexual Offending (ITSO) (Ward and
Beech, 2016) is used as a starting framework to understand HSB in this client group. This attends to specific
neuropsychological systems, brain development, motivation and emotional processing.
Findings The revisedITSO has some utility in understandingHSB in this client group. This is improvedwhen
neuro-atypicalspecific state factors are identified. Practical ways of establishingthese state factors are made
which attend to the function of the behaviourin line with Good Livesmodel of rehabilitation.
Research limitations/implications Recommendations for ways in which the function of HSB in this client
group can be identified are made as well as recommendations for how treatment can be tailored dependent
on the function of behaviour in this client group.
Practical implications The paper makes practical recommendations for how interventions for people with ID
and autism in line with Ward, Clack and Haigs (2016) Abductive Theory of Method which noted that interventions
should be adopted to consider wider explanations for offending thus acknowledging that trea tment could extend
beyond cognitive behavioural therapy for clinical phenomena. Future treatments for clients with auti sman d LD are
suggested which attend to sensory needs, teaching alternative communication stra tegies for seeking out deep
pressureor attention in ways that do not involve sexual offending, using picture communication, information
technology or Makaton to communicate needs or using social stories to explain the consequences of behaviour. In
addition, neuro-atypical interventions which attend to the neuropsychological functioning of clients could also be
included in treatment for neuro-typical clients, thus ensuring that interventions attend to every aspect of the ITSO
and not purely clinical phenomena.
Social implications Enhancing treatment interventions for clients with ID and autism could both reduce
risk and enhance quality of life for this client group.
Originality/value Much of the work to date exploring HSB in clients with autism has attended to clients
with Level 1 autism or those without an additional ID. This paper provides practitioners with a theory upon
which to understand HSB in clients with a dual diagnosis of Levels 2/3 autism and an ID as well as practical
recommendations for reducing HSB in this client group.
Keywords Intellectual disability, Adults, Therapy, Treatment, Autism, Harmful sexual behaviour
Paper type Conceptual paper
Introduction
Both autistic spectrum disorders (ASD) and intellectual disabilities are neuro-developmental disorders.
An intellectual disability (ID) is identified by using DSM-5 (American Psychiatric Association, 2013) as:
1. a significantly reduced ability to understand complex information or learn new skills
(impaired intelligence);
Received 25 July 2017
Revised 30 September 2018
Accepted 7 October 2018
Rachel Worthington is Forensic
Psychologist at the University
of Central Lancashire,
Preston, UK.
DOI 10.1108/JFP-07-2017-0027 VOL. 21 NO. 1 2019, pp. 1-13, © Emerald Publishing Limited, ISSN 2050-8794
j
JOURNAL OF FORENSIC PRACTICE
j
PAG E 1

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