Transcript pptx - NYSATSA

ADDRESSING SEXUAL
BEHAVIORS OF ADOLESCENTS
WITH DEVELOPMENTAL
DISABILITIES
Dr. Kristina Osborne-Oliver, Psy.D., NCSP
Dr. Katrina Emmerich, Psy.D.
Dr. Jennifer Brooks, Psy.D.
Tylea S. Gebbie, MS, CAS
St. Anne Institute, Albany, NY
http://www.stanneinstitute.org/
Presentation Prepared for
NYSATSA 2010 Conference
May 4, 2010
AGENDA: TOPICS TO BE COVERED

Introduction and Definitions of Developmental Disabilities




Autism Spectrum Disorders, Intellectual Disabilities, & Learning
Issues
Research on Observable Behaviors, Social Skill Deficits, and
Sexualized Behaviors
Treatment Delivery: General Strategies
Evidenced-Based Specialized Treatments recommended for
this population
Pharmacological
 Educational/Behavioral Approaches
 Recommendations of Targeted Social Skills within Sexual Education
Curriculum



Specific Intervention Ideas for Therapy with Clients with
Developmental Disabilities
Resource List
INTRODUCTION & DEFINITIONS
DSM-IV-TR Diagnostic Criteria:
Pervasive Developmental Disorders

Pervasive Developmental Disorders (PDD)
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Asperger’s Disorder
Autistic Disorder
Rett’s Disorder
Childhood Disintegrative Disorder
Pervasive Developmental Disorder – Not
Otherwise Specified
The term “Autistic Spectrum Disorders” (ASD) is
often used interchangeably with PDD
DSM-IV-TR Diagnostic Criteria:
Asperger’s Disorder

A. Qualitative impairment in social interaction,
as manifested by at least two of the following:
1. Marked impairment in the use of multiple
nonverbal behaviors such as eye-to-eye gaze, facial
expression, body postures, and gestures to regulate
social interaction
 2. Failure to develop peer relationships
appropriate to developmental level
 3. Lack of spontaneous seeking to share enjoyment,
interests, or achievements with other people
 4. Lack of social or emotional reciprocity

DSM-IV-TR Diagnostic Criteria:
Asperger’s Disorder (continued)

B. Restricted repetitive and stereotyped patterns
of behavior, interests, and activities, as
manifested by at least one of the following:
1. Encompassing preoccupation with one or more
stereotyped and restricted patterns of interest that
is abnormal either in intensity or focus
 2. Apparently inflexible adherence to specific,
nonfunctional routines or rituals
 3. Stereotyped and repetitive motor mannerisms
 4. Persistent preoccupation with parts of objects

DSM-IV-TR Diagnostic Criteria:
Asperger’s Disorder (continued)
C. The disturbance causes clinically significant
impairment in social, occupational, or other
important areas of functioning.
 D. There is no clinically significant general delay
in language
 E. There is no clinically significant delay in
cognitive development or in the development of
age-appropriate self-help skills, adaptive
behavior (other than social interaction), and
curiosity about the environment in childhood.
 F. Criteria are not met for another specific
Pervasive Developmental Disorder or
Schizophrenia.

How is Asperger’s Disorder
Different from Autistic Disorder?

The criteria for Autistic Disorder are essentially the same as
Asperger’s Disorder with the exception that there are criteria for
qualitative impairment in communication for Autistic Disorder:

Qualitative impairments in communication as manifested
by at least one of the following:



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
A. Delay in, or total lack of, the development of spoken language
B. Individuals with adequate speech, marked impairment in the
ability to initiate or sustain a conversation with others
C. Stereotyped and repetitive use of language or idiosyncratic
language
D. Lack of varied, spontaneous make-believe play or social
imitative play appropriate to developmental level
There must also be delays in abnormal functioning in at least one
of the following areas, with onset prior to age 3 years: (1) social
interaction, (2) language as used in social communication, or (3)
symbolic or imaginative play.
DSM-IV-TR Diagnostic Criteria: Pervasive
Developmental Disorder-Not Otherwise
Specified (PDD-NOS)

Severe and pervasive impairment in the
development of reciprocal social interaction


Associated with impairment in either verbal or
nonverbal communication skills or with stereotyped
behaviors, interests, and activities
Criteria are not met for a specific Pervasive
Developmental Disorder, Schizophrenia,
Schizotypal Personality Disorder, or Avoidant
Personality Disorder.
Asperger’s Disorder:
Social-Emotional Domain
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Strengths
Capable of learning social
skills
Motivated to learn social
skills
Encode social situations
visually
Follow the rules
Adult
relationships/friendships may
be established
Innocence and honesty





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

Weaknesses
Poor social cognition
Poor appreciation of social
cues
Minimal eye contact,
affect/facial expression,
showing/sharing, smiling
Inability to see from another’s
perspective
Lack of social reciprocity
Failure to develop peer
relationships
Overly sensitive to criticism
May become rigid/anxious
under stress
May experience rage and/or
depression
Asperger’s Disorder:
Cognitive Domain
Strengths


No clinically significant
delay in cognitive
development
Average, above average,
or gifted

Excellent rote memory

Excellent visual memory

Concrete thinking

Good long-term memory

Good reading mechanics
Weaknesses

Rigid thinking (one track mind)

Difficulty shifting attention

Poor auditory processing skills




Difficulty with abstract
thinking
Problems with
organization/planning
Hyperlexia, comprehension,
writing problems
Failure to generalize/transfer
thinking/skills to other
situations
Why is it important to be familiar with Autism
Spectrum Disorders (ASDs) when providing
services to individuals?

The nature of therapy
Verbal vs. Nonverbal
 Auditory vs. Visual


The nature of the client

Those who have been sexually abused
Reactions to abuse
 Group work


Those who sexually act out
Victim empathy
 Group work

Definition of Intellectual Disability
(ID)

“Intellectual disability (ID) is characterized both by a
significantly below-average score on a test of mental ability
or intelligence and by limitations in the ability to function
in areas of daily life, such as communication, self-care, and
getting along in social situations and school activities.”



Sometimes referred to as a cognitive disability or mental
retardation
Children with ID can and do learn new skills, but they
develop more slowly than children with average
intelligence and adaptive skills.
There are different degrees of ID, ranging from mild to
profound.
(Centers for Disease Control and Prevention, 2005)
DSM-IV-TR Diagnostic Criteria:
Mental Retardation



Significantly subaverage intellectual functioning:
IQ of approximately 70 or below on individually
administered IQ test
Concurrent deficits or impairments in present
adaptive functioning in at least two areas
Onset before 18 years of age
Degrees of Mental Retardation
Mild Mental Retardation
 Moderate Mental Retardation
 Severe Mental Retardation
 Profound Mental Retardation

DSM-IV-TR Diagnostic Criteria:
Learning Disorder
“Learning Disorders (LD) are diagnosed when the
individual’s achievement on individually
administered, standardized tests in reading,
mathematics, or written expression is
substantially below that expected for age,
schooling, and level of intelligence. The learning
problems significantly interfere with academic
achievement or activities of daily living…”
 LDs may persist into adulthood
 Prevalence estimates range from 2-10% of the
general population, and 5% of the school
population

Part 200 Classification Criteria:
Learning Disability


Learning disability (LD) means a disorder in one or more of
the basic psychological processes involved in understanding
or in using language, spoken or written, which manifests
itself in an imperfect ability to listen, think, speak, read,
write, spell, or to do mathematical calculations…The term
includes such conditions as perceptual disabilities, brain
injury, minimal brain dysfunction, dyslexia and
developmental aphasia. The term does not include
learning problems that are primarily the result of visual,
hearing or motor disabilities, of mental retardation, of
emotional disturbance, or of environmental, cultural or
economic disadvantage.”
Response to Intervention (RTI)
Common Cognitive Deficits
Attention – the ability to tune in and
concentrate
 Perception – the ability to make
sense of and understand information
 Memory – the ability to acquire,
hold, and retrieve information
 Comprehension – the ability to
understand what is being said
 Expression – the ability to
communicate
 Coping with change – flexibility

Why is it important to be familiar with
Intellectual and Learning Disabilities when
providing services to individuals?


Throughout the twentieth century, there was a public
perception that there was a link between ID and sex
offending
Research has reported higher rates of abuse amongst
people with ID




Furey (1994) examined 461 cases of sexual abuse and
found that 42% of abuse had been perpetrated by
individuals with ID
Less attention has been paid to young people with ID
whose sexual behavior is problematic
Evidence that LD is over-represented in services for sexual
offenders
Individuals with LD are among the most challenging for
services and practitioners
METHODOLOGICAL ISSUES
Inclusion criteria (IQ cut-off)


At what point are individuals with ID expected to
understand societal rules?
Source of the sample


Typically drawn from hospitals, prisons, referrals to
court, police stations, social and health service
referrals


Of 57,000 individuals assesses for the courts in New
York, 2.5% had ID
A study of individuals in hospitals found that 35% were
diagnosed as having ID
Method of determining ID

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
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Variety of IQ tests
Variety of methods for diagnosing ID
Scrutiny of records and history may vary
Treatment Outcomes for Clients
with LD

Research suggests that there is a relationship between outcome
and length of treatment



Day (1993) found a positive relationship between length of stay
over 2 years and a better outcome
Lindsay & Smith (1998) found that individuals in treatment for
less than one year showed significantly poorer progress and were
more likely to reoffend than those treated for at least 2 years
Variables associated with recidivism
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Allowances made by staff
Antisocial attitude
Poor relationship with mother
Denial of crime
Sexual abuse in childhood
Erratic attendance
Poor response to treatment
Low self-esteem
Lack of assertiveness
Offenses involving violence
RESEARCH: WHAT WE
KNOW ABOUT OUR CLIENTS
WITH DEVELOPMENTAL
DISABILITIES
General Observable Behaviors of Clients
with Developmental Disabilities
Standing too close to someone during
conversation
 Staring inappropriately
 Lack of eye contact
 Flat or inappropriate facial expression
 Getting ‘stuck’ on a particular topic during
conversation
 ‘Stimming’ behaviors such as rocking or handflapping

Sexually-Related Behaviors of
Clients with Developmental Disorders

Research has found that individuals with
developmental disabilities may display sexually
inappropriate behavior, including:
 Masturbating in public
 Kissing strangers
 Removing clothing in public
 Touching others inappropriately
 Touching their own private areas in public
 Sexual fetishism
Additional Information Regarding the SexuallyRelated Behaviors of Clients with Developmental
Disorders
Greater tendency to sexually aggress:

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Lack of privacy
More impulsive --Often in Public Settings
Naiveté - Inability to understand normal sexual relationships
More likely to present with less serious or intrusive offenses resulting in
serious bodily harm, violence, or death
More likely to commit sex offenses across categories and be less
discriminating in their victims
More likely to commit sex offenses against younger children and male
children
Sex crimes are seen as part of a pattern of poorly controlled behavior rather
than sexual deviation
“Abuse without abuser” - Initiator of an abusive sexual act does not
understand the concept of consent or the impact of the behavior
on others.
How Impairments Impact the Sexual
Interactions of Clients with Developmental
Disabilities
Difficulties in the following areas:
1. Forming effective
relationships with peers
2. Learning adaptive social
behaviors in an unstructured
fashion
3. Reading social cues (both
subtle and overt)
4. Interpreting the other
person’s feelings
5. Taking another person’s
perspective
6. Being flexible in
conversational topics
Those difficulties may lead to:
1. Lack of appropriate sexual
outlet; considering younger
children “safer” to interact
with;
2. Inappropriate social
interactions; sharing
interests/perseverations
with younger children;
3. Misinterpretation of
another’s body language;
4. Misinterpretation of
another’s friendship or
loving feelings as sexual;
5. Inability to empathize with
victims (“How should I
know how she felt?”);
6. Obsessing/perseverating on
sex and/or pornography
Additional Hypotheses Regarding the Cause of
Sexually Inappropriate Behavior Among Clients with
Developmental Disabilities
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Structural
Modeling
Behavioral
Partner Selection
Inappropriate Courtship
Sexual Knowledge
Perpetual Arousal
Learning History
Moral Vacuum
Medical
Medication Side-Effect
Differentiating Inappropriate from
Deviant Sexual Behaviors

Researchers offer insight into the differentiation of inappropriate
sexual behavior from deviant sexual behavior.
Inappropriate sexual expression may result from default
as the only allowable expression of sexuality.
 Deviant behavior, however, has causes, although not clear
in any population, that are similar to deviant behavior
found in the non-developmentally delayed population.

Sexual Victimization of Clients with
Developmental Disabilities

How could it happen?
 Social deficits may increase vulnerability


Language deficits may increase vulnerability

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
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Misinterpreting non-verbal cues
Misunderstanding language
Some developmental disorders are co-morbid with anxiety and/or
depression
 These symptoms may appear or worsen following a traumatic
event
Children with some developmental disabilities tend to be
oversensitive to criticism.
 Self-blame may be particularly problematic
Social and language impairments may impact understanding of
the abuse
DELIVERY OF THERAPY SERVICES:
GENERAL TREATMENT
STRATEGIES
Treatment Guidelines



Treatment should be multidimensional
 Individual therapy
 Group therapy
 Close involvement of caretakers
 Supportive framework to monitor and reinforce key
messages
Focus on the control of elimination of abusive sexual behaviors by:
 Identifying positive goals
 Enhancing social and relationship skills
 Promoting life skills and phased community access
 Create a control plan or relapse prevention plan
Create Risk Management Groups
 Multidisciplinary team approach
 Make decisions regarding mobility, levels of supervision, and
community access
 Constituency may evolve as the young person’s circumstances
change
Structure of Therapy Sessions

People with developmental disabilities do better when
things are predictable and organized

Temporal supports

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Procedural supports


Provide information about the location of objects
Assertion supports


Outline the steps of an activity
Spatial supports


Visual timers, stopwatch, schedules, routines
Help individual initiate and exert control such as in making choices
and maintaining self-control
Provide them with a clear overview of the treatment
process including the contents, frequency, duration, and
place of the sessions and treatment
Interventions with Clients with
Developmental Disabilities

Interventions should:
Be consistently modeled and supported throughout
the external environment
 Be practical and success oriented
 Be at the client’s developmental level
 Be created with and prompted by the client

How will they benefit from the intervention
 Increases motivation to participate in treatment

Involve role-play and rehearsal
 Give the client something tangible to take with them
once that skill is mastered

General Therapy Considerations
Engagement – show interest in the clients
interests and perseverations and allow them to
speak at length about them
 Pay attention to the environment – reduce
distracting noises, florescent lighting
 Praise success – help them to be mindful of their
strengths
 Use multiple modalities – journaling, storywriting, drawing, role-plays
 Deliver information at the client’s pace

Give information in parts
 Plan breaks

General Therapy Considerations
Provide frequent repetition of concepts
 Take time to find the motivation behind the
behavior
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Assist adolescents in generating and taking
ownership of information


Example: Unzipped fly
In the past, fear of “giving the wrong answer” may
have resulted in repeated failure and negative selfevaluation
If the client does not understand something
Do the task with them – help them “connect the dots”
 Give hints – help point the way
 Say directions in a different way

Language and Communication

Clients with developmental disabilities may:
Use the wrong terms or words
 Misuse time concept words
 Confuse sexes or persons in a sentence
 Parrot commonly used treatment terms


Therefore:


Clarify everything
Ask yourself – “Does the client really mean what they
are saying?”
Language and Communication


Your use of verbal and non-verbal communication is very
important
Therefore:
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Use communication that is clear, concrete, and specific
Be concrete, not abstract
Avoid the use of jargon
Check in frequently with the client
Convert therapeutic terms into plain language – define in
simple terms
Draw attention to non-verbal communication and use them
as teaching moments

Example:
 Instead of saying “you seem upset”
 You might say “I notice your arms are crossed and you are
frowning. That tells me that you are upset, am I right?”
Information Processing
Clients with developmental disabilities can be
slow processors of information
 Therefore:

Not responding ≠ Being oppositional
 Give them additional time to process what you have
said
 Do not yell or hurry them
 If taking time to respond do not assume that they are
filtering or editing their response

Generalization
Clients with developmental disabilities have
difficulty generalizing – taking what you have
taught them in therapy and using it in real life
situations
 Therefore:

Use concrete, vivid, and personalized examples
 Do role-plays

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
Create scenarios that involve multiple settings
Take the client out in public

Best way to help a client to generalize
Checking their Comprehension

Clients with developmental disabilities may
present as much higher functioning than they
really are

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For example - May nod their head or answer “yes”
when you ask “do you understand?”
Therefore:
Talk in short, ten (at the most) word sentences
 Ask the client to repeat what you have said in their
own words
 Ask the client to give you an example, what they
have learned, or how they will change their behavior
next time

Working with Clients in Groups

Groups can be beneficial to clients with
developmental disabilities
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Provides a safe environment for learning
Provides practice in social skills and communication
Need to ensure that the group is safe for all
members

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Clients are vulnerable to being teased, bullied, or
ridiculed by peers
Conflict, bullying, or misunderstanding between a
client with a developmental disability and other
group members can greatly damage group cohesion
Working with Clients in Groups

Strategies for increasing involvement

Keep groups active

will retain more and increase interest in coming to group
Make sure the client walks away with something
after every session
 Focus on simple themes
 Incorporate experiential modalities



Drama/play, sand tray, art therapy, music, role play,
storytelling, etc.
Have them do something during group

Write on the board, talking stick
Working with Clients in Groups

Role of the Group Leader

Facilitator may act as a ‘translator’ between these
clients and the other group members

May need to:
 Decode the non-verbals of other group members and explain
them
 Point out what might not be obvious
 Interpret what the client says to other group members if it is
needed to prevent misunderstandings
EVIDENCE-BASED TREATMENT
RECOMMENDATIONS
WHY IS EVIDENCE-BASED SPECIALIZED
TREATMENT LIMITED FOR THIS
POPULATION?
Issues:


There is no controlled study of any
kind, because researchers can’t
ethically provide a no-treatment
condition
There is little research on communitybased programs
PSYCHOPHARMACOLOGICAL
TREATMENTS

Direct hormonal intervention to control
urges by reducing the effect of sex
hormones

Treatment of excessive Masturbation


Lupron (leuprolide), a synthetic nonpeptide analog
of human gonadotropin-releasing hormone.
 Side effects of aggressive behaviors
Indirect intervention directed at comorbid
conditions, such as aggression, impulsivity,
and psychiatric disorders that may affect
sexual disinhibition
PSYCHOPHARMACOLOGICAL
TREATMENTS

Remeron (mirtazapine) is a second-generation
antidepressant that has both noradrenergic and
serotonergic properties.
Rationale for selecting this drug was for its previously
reported antilibidnal effect.
 Also has an anticompulsive effect.
 SSRIs tend not to be chosen, especially with clients
with hyperactivity, irritability, and aggression.


Remeron has found to be effective in the treatment
of
Excessive masturbation
 Sexual fetishism


Further, placebo-controlled, double-blind studies are
needed regarding this topic
COSKUN ET AL (2009) STUDY

5 participants showed very much improvement; 3
participants show much improvement, and 1
showed moderate improvement in excessive
masturbation.


Side effects included appetite increase; weight gain;
and sedation. Other possible side effects could
include increase thirst, urination, and one
participant experienced a hand tremor.
Other improvements were a decrease in
engagement of touching women inappropriately,
disrobing in public, and fetishistic behaviors.
RECOMMENDED EDUCATIONAL
COGNITIVE-BEHAVIORAL
APPROACHES
&
COGNITIVE-BEHAVIORAL TREATMENT
Cognitive-Behavioral Treatment - increasing knowledge base and skill
acquisition

Behavioral Targets

Daily living skills

General interpersonal and educational skills (e.g., social skills,
sex education)

Specialized behavior skills relating to sexuality and offending

Relapse prevention

Cognitive Targets

Embarrassment

Denial

Minimization

Problems with self-esteem

Problems with communication
Anger Management
 Adequate evidence to suggest that anger and violence are highly
significant problems in this population and that treatment incorporating
CBT and anger management will promote self-regulation and reduce
violent incidents
CONSIDERATIONS FOR
SEXUAL EDUCATION IN TREATMENT

Considerations

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
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Religious or cultural values of parents, caregivers, or
educational staff
May warrant a same-sex teacher
Consent needs to be obtained prior
Provide it at the level of the client’s mental age level
and capacity to learn
Do not go beyond the client’s level of sexual interest
Make the activities interesting, exciting, and fun
(condom races)
Use colorful charts/pictures, collages, art projects,
interactive role plays, have fun!
Start with the basics
SOCIAL SKILLS COMPONENTS
TARGETED IN SEXUALITY
EDUCATION CURRICULUM
HEALTH AND HYGIENE
Gender differences, maturation
 Everyday and sexual hygiene
 Health and wellness
 Masturbation
 Body and disease
 STD and HIV prevention
 Birth control

Based on a review of curricula by Wolfe and
Blanchett (2003)
Hellemans et al. (2007)
RELATIONSHIP SKILLS
Friendship and intimacy
 Responsibility to (sexual) partner
 Family types and roles
 Feelings and expression
 Dating and Marriage
 Parenting
 Sexual Orientation

Based on a review of curricula by Wolfe and Blanchett (2003)
Hellemans et al. (2007)
SELF-PROTECTION/SELF-ADVOCACY
SKILLS
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Protection against abuse
Sexual feelings
Sexuality as a positive aspect of self
Sexual behaviors other than intercourse
Appropriate/inappropriate touching
Appropriate/inappropriate public/private behaviors
Decision making
Use of condoms
Reduction of fear and myths
Personal rights
Sexual discrimination
Saying “no” to nonconsensual sex and high-risk
behaviors
Based on a review of curricula by Wolfe and Blanchett (2003)
Hellemans et al. (2007)
OTHER POSSIBLE
TREATMENT TOPICS





Sexual consent issues
Understanding the abusive sexual behavior
Understanding the impact on others
Negotiating safe and respectful sexual
behaviors
Identifying and managing risk
ADDRESSING SEXUAL BEHAVIOR

Do NOT Extinguish a Sexualized Behavior, without having
a Replacement Behavior.

Replacement strategies






Need to be simple, easily implemented, and without negative
repercussions
May involve both sexual and nonsexual behavior
Involve activities and behaviors that can meet the same perceived
needs as the sexual behavior
Need to be fun, playful, safe, and without secrets or shame
Need to feel good and be something that can be enjoyed time and time
again
Teaching needs to involve concrete examples and props that are
as close to reality as ethically possible – condoms, appropriate oils
or other lubricants, synthetic vaginas, synthetic penises,
nonpornographic sex education videos, life-size dolls, and other
reality-based items.
EXAMPLE SCRIPT OF A REPLACEMENT
BEHAVIOR FOR PUBLIC MASTURBATION

Instructors should teach appropriate times and places regarding
masturbation. The following intervention can be given to a person
supervising an individual with autism:
1. Interrupt the behavior.
2. Remind the person of the appropriate place and time for the behavior.
3. Redirect the person to another activity or to an activity that requires
the use of both hands.
4. Redirect the person to an activity that involves intense focus or high
amounts of physical movement.
5. Redirect the person to an appropriate place to have privacy, such as a
bathroom, shower, or private bedroom.
6. Reinforce staying in assigned areas and taking breaks as scheduled, to
decrease the likelihood that excessive breaks or trips to the bathroom will
occur, and
7. Provide visual evidence of scheduled breaks or private leisure time, so
the person can anticipate and plan for personal needs.
Koller (2000)
INTERVENTION IDEAS FOR
SPECIALIZED TREATMENT WITH
ADOLESCENTS WITH
DEVELOPMENTAL DISABILITIES
WHAT ARE SOCIAL STORIES?

A Social Story is a short story with specific
characteristics that describes a social situation,
concept, or social skill using a format that is
meaningful for persons with developmental
disabilities.

Social Stories were originally developed by Carol
Gray to teach children with autism how to play
games with peers, with the aim to increase their
ability to interact socially with others.
SOCIAL STORY GUIDELINES

Gray has outlined some specific formal aspects
and guidelines for constructing Social Stories:
Perspective of the child for whom the story is written
should always be adopted and maintained.
 Stories are typically written in the first person
singular.
 Behavioral responses should be stated in positive
terms (e.g., I am going to use my low voice.)
 Words and/or images can be used to complement the
relative visual processing strengths.

BASIC SENTENCE TYPES USED IN
SOCIAL STORIES

Sentence Types






Descriptive: Describes the social situation in terms of
relevant social cues.
Directive: Describes the appropriate behavioral
response.
Perspective: Describes the feelings, and/or responses
of the student or of others in the situation.
Affirmative: Expresses a commonly shared value or
opinion within a given culture or community.
Control: Written from the perspective of a person
having autism/PDD, cueing how and when to identify
personal strategies to recall and to use
Cooperative: Describes what others will do to assist
the student.
SAMPLE SOCIAL STORIES

“My name is James. Sometimes, I think about
sex and private areas. It’s okay to think about
sex and private areas. I will try to keep my
thoughts to myself. This is very important. I
may ask my mom or dad a question if I’m
confused” (p. 34).
Borrowed from Tarnai & Wolfe (2008)
SAMPLE SOCIAL STORIES

“My name is Amanda. I am 13. My body is growing and
changing. My mom knows about growing up.
Sometimes, girls get breasts when they are 13. Soon, I
will have breasts too. Most women wear bras to hold
and cover their breasts. This is a good thing to do. I will
wear a bra. If I forget to wear a bra, my mom may
remind me before I go to school. Wearing a bra is a part
of growing up” (p. 34).
Borrowed from Tarnai & Wolfe (2008)
EXAMPLE OF A SOCIAL STORY THAT IS
SITUATION SPECIFIC

“It is okay to have an erection or a “hard-on”
while at school. When this happens, I will ask the
teacher to be excused to use the bathroom. I will
not talk to others about my erection. I know that
this is a private thing and it is natural. Erections
happen to all boys at some time.”
BASED ON ANALYSIS BY BARRY & BURLEW
(2004) AND REYNHOUT & CARTER (2006)
Evidence-Based Good
Instructional Practices
Corresponding Components of
Social Stories Interventions
Explicit Teaching and Demonstration
Task analysis; modeling; cueing; comprehension
check; feedback
Explicit Instruction and Drill-practice of Basic
Skills
Task analysis with repetition and review
Extensive Active Practice
Practice with corrective feedback
Opportunities to Learn/Practice
Fading with tangible cues
Guided Practice with Feedback
Maintenance/generalization training
Small steps, and practice of each step
Visual Aids/schedules; systematic practice
Organizing Questions for review
Reviewing questions for check of comprehension
Graphic Organizers
Visual Aids (words, images, and schedule
Independently useable/accessible Strategy
Social story is a permanent product, and it has
embedded pictorial cues/schedules
EXAMPLES OF INTERVENTIONS

Increase Positive Behavior and Decrease
Negative Behavior


Making Healthy Choices and Thinking
About the Consequences


SODA – Stop, Options, Decide, Act
Managing Risk


Old Me/New Me
Danger zones
Thinking Errors and Self-Talk

Thinking errors with pictures
RESOURCES:
ONLINE AND PAPER
See Handout
Final Thoughts



Diagnosis may be the same but clients may present very
differently
Some people have expressed concern that providing sexual
information to certain clients who experience
developmental delays pose risks to the community – risk is
more if we fail to provide appropriate sexual education.
Necessary to provide education concerning the need for
sexual education to guardians or other care providers – if
we don’t teach them they will make efforts to teach
themselves


Patient and appropriately paced sexual education can prevent
problem behaviors from developing.
Use every moment as a teaching moment

The client may not know that a behavior is ineffective or
inappropriate. Model for them and explain clearly and specifically
what behavior is expected and acceptable.
“Don’t label it as ‘They can’t
learn’ –
Think of it as ‘We haven’t
figured out how to teach them
yet.’”
QUESTIONS?
Have other strategies
worked for you?
CONTACT INFORMATION:
Kristina Osborne-Oliver, Psy.D., NCSP
Email: [email protected]
Katrina Emmerich, Psy.D.
Email: [email protected]
Jennifer Brooks, Psy.D.
Email: [email protected]
Tylea Gebbie, MS., CAS
Email: [email protected]