Sexual abuse and intellectual disability

Sexual abuse is common among people living with intellectual disabilities. [1] Research published from 2000-2020 illustrates increased prevalence rates of sexual violence against people with intellectual disabilities when compared with the general population.[2]^:61 While people with intellectual disabilities experience sexual violence in many of the same ways as the general population,[3][4]^:73 they often encounter additional issues related to their disability and the environments in which they live. These issues can include increased vulnerability, questions around ability to consent to sexual activities, differential treatment before the law, social attitudes about intellectual disability and sexuality, and restricted access to suitable support and recovery services.

Prevalence and incidence

There are large differences between the prevalence and incidence estimates from independent sources of research as it relates to this topic. Results are often impacted by many factors such as:

• Differences in how sexual abuse is defined, and which experiences are counted as abuse for research purposes.
• Who is asked about the abuse: reported prevalence and incidence are lower if service managers, staff or case notes are consulted, and higher when people with intellectual disabilities are asked directly.
• Whether abuse rates for men and women are combined or calculated separately.
• Differences between the groups of people selected to take part in the research.[5]^:72

Morris (1999) reported that incidence data on sexual abuse of disabled children can be difficult to compile because:

• Parties reporting the incident may not agree on the impairment of the disabled child.
• Information may not be recorded consistently.
• Some children with mild or moderate intellectual disabilities may not be registered with the services that usually record abuse incidents.[6]^:62–63

The highest rate of occurrence of abuse happens within the place of residence of the persons with intellectual disabilities.[7] Other areas of frequency where abuse occurs were at the perpetrator's home and in other public places, such as public toilets.[7]

United States of America

Studies indicate that people with intellectual disabilities are four to ten times more likely to have acts of violence committed against them.[8] Dick Sobsey, Associate Director of the JP Das Developmental Disabilities Centre and Director of the John Dossetor Health Ethics Centre, found that 80% out of 162 people with developmental and substantial disabilities who had been sexually assaulted had been sexually assaulted more than once.[9]

Sobsey estimates that between 15,000 and 19,000 individuals with intellectual disabilities experience rape each year.[9]

It is believed by some that 20% of females and 10% of males are sexually abused in the US every year. The percentage is even higher among people with disabilities. According to research, more than 90% of people with intellectual disabilities will experience some form of sexual abuse at some time in their lives. 49% will experience 10 or more abusive incidents.[10]

Other studies suggest 68% of girls with intellectual disabilities and 30% of boys with intellectual disabilities will be sexually abused before their 18th birthday. According to research 15,000 to 19,000 people with intellectual disabilities are raped each year in the United States.[11]

Sullivan and Knutson found, in 2000, that children with intellectual disabilities were at slightly greater risk of sexual abuse than disabled children in general, who in turn were at 3.14 times greater risk of experiencing sexual abuse than non-disabled children.[12]^:61

Individuals with developmental or intellectual disability are at a higher risk of sexual abuse due to a greater vulnerability factor. In 2007, individuals with intellectual disabilities were victims of approximately 47,000 rapes and sexual assaults [13] Statistic data from 2009 to 2014 drew from the Bureau of Justice Statistics, the rate of serious violent crime as in rape or sexual assault for persons with intellectual disabilities was more than three times the rate for persons without intellectual disabilities including a correlation of 40% of the time the victim was being taken care of by the person who sexually assaulted them [14].

Research has revealed that the largest group of identified perpetrators of sexual abuse is developmental disability service providers or caregivers, based on a study conducted, 87% of a sample case individuals with intellectual disabilities had been sexually abused, and 67% had experienced vaginal or anal penetration [15].

One of the simplest reason as to why sexual abuse occurs in a group home is lack of training for staff providers. A study done with a result from 874 surveys indicated that these service providers lacked basic knowledge about abuse, perpetrator characteristics, and facts about potential victims [16]

In additional to, the second determined cause of sexual abuse against individuals with developmental disability is in some cases are unable to disclose sexual abuse due to the physical or emotional limitations imposed by their disability, leading to the caregivers taking advantage of their intellectual disabilities.[13]

Britain

A study by McCarthy and Thompson in 1997 found a prevalence rate of 25% for men and 61% for women.[17]^:71 A survey by Brown et al. of senior managers in 1992 found an incidence rate of 0.5 per thousand people with intellectual disabilities each year.[18]^:71

The Republic of Ireland

A study by Dunne and Power in 1990 found an incidence rate of 2.88 per thousand people with intellectual disabilities per year.[19]^:71

Spain

A study by Gil-Llario, Morell-Mengual, Ballester-Arnal and Díaz-Rodríguez in 2017 found a prevalence rate of 2.8% for men and 9.4% for women.[20] Among the women who were abused, only 52.9% trusted someone enough to tell them about what had happened. Of these, 28.6% preferred to tell a close relative, 57.1% told an educator and 14.3% talked to a friend about it. Of the men, 80% decided to talk about their experience of abuse. Half of them (50%) told their father or mother, 25% talked to an educator and 25% discussed the matter with a close relative.

Another Spanish study indicates that the prevalence of sexual abuse is 6.10% when it is self‐reported (9.4% in women and 2.8% in men) and 28.6% when it is reported by professionals (27.8% in women and 29.4% in men).[21]

Risk factors

A number of factors put people with intellectual disabilities at an increased risk of sexual violence. Medical models of disability emphasise risks connected with the person's disability, while social models of disability focus on risks caused by the socially-created environment of the intellectually disabled person.[22]^:16 Not all factors will apply to all people with intellectual disabilities, and some are not exclusive to people with intellectual disabilities.

• Lack of understanding.[23]
• Lack of social awareness and training that would help identify and anticipate abusive situations.[24]^:4
• Ingrained reliance on the caregiver authority figure.[9]
• Long-term dependence on services and personal care.[24]^:4
• Emotional and social insecurities.[9]
• Lack of capacity to consent to sexual activity.[24]^:4
• Lack of knowledge and training in sex education.[9][25]
• Powerless position in society.[9]
• Low self-esteem, contributing to powerlessness.[24]^:4
• Not realizing that sexual abuse can cause harm.[26]
• Not being able to tell anyone about the abuse.[26]
• Learned behaviour not to question caregivers or others in authority.[24]^:4[26]
• Communication difficulties that hinder reporting abuse.[24]^:4
• Fear of not being believed, leading to non-reporting of abuse.[24]^:4
• Feelings of guilt or shame that prevent reporting of abuse.[24]^:4
• Difficulty identifying an appropriate person to report the abuse to.[24]^:4
• Low risk of prosecution for perpetrators.[24]^:5
• Routine prescription of contraceptives to women with intellectual disabilities, leading to reduced risk of detection for perpetrators.[27]^:225

People with moderate to severe intellectual disabilities, and those with additional physical disabilities, form the majority of learning disabled people experiencing sexual violence.[24]^:5

Perpetrator profile

Research suggests that 97% to 99% of abusers are known and trusted by the victim who has the intellectual disability.[26] According to Sobsey and Doe's 1991 analysis of 162 reports of sexual abuse against people with intellectual disabilities, the largest percentage of offenders (28%) were service providers (direct care staff members, personal care attendants, psychiatrists). In addition, 19% of sexual offenders were natural or stepfamily members, 15.2% were acquaintances (neighbors, family friends), 9.8% were informal paid service providers (babysitters), and 3.8% were dates. Further, 81.7% of the victims were women, and 90.8% of the offenders were men.[28]

Law

United States of America

Cases of sexual abuse are considered in many states to qualify as “sexual assault” under the law; sexual assault is often arbitrated through rape or sexual battery statutes. Cases of sexual assault are arbitrated differently according to individual state laws and statutes.

States often have statutes for the intellectually disabled person separate from the general sex offense statutes. Such separate statutes often hold the intellectually disabled person at a “higher standard” than the non-intellectually-disabled person; that is, the legal standards used to prove sexual consent will be stricter for the intellectually disabled individual.[29]

As Deborah W. Denno, Ph.D., J.D., of the Fordham University School of Law explains,

“courts have applied vague, unworkable tests in determining a mentally retarded victim's capacity to consent; it would be unrealistic to suggest that a rigid, precisely defined standard could ever be effective in so amorphous an area as sexual relations.”[29]

Capacity to consent

Six tests are used as such a standard to assess the legal capacity of the intellectually disabled individual to consent to sexual conduct. These are the tests of “nature and consequences”, “morality”, “nature of the conduct”, “totality of the circumstances”, “evidence of mental disability”, and “judgment”. 49 American states use one of these six tests in reviewing cases of sexual abuse, with the exception of Illinois (which uses two tests).[29]

Test name	Description	States using this test
Nature of the conduct	The individual must understand the sexual nature of any sexual conduct and the voluntary aspect of such activity, but does not have to understand the nature and consequences of such sexual activity, or the morality of the conduct.[29]	California, Delaware, Florida, Kentucky, Louisiana, Maine, Montana, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Rhode Island, South Carolina, Texas, Utah: 38% of the USA.
Nature and consequences	Similar to the medical informed consent doctrine in which the patient must understand both the nature and consequences of a procedure; the individual must also understand the risks of behavior, including possible negative outcomes.[29]	Alaska, Arizona, Arkansas, Indiana, Iowa, Kansas, New Mexico, Oklahoma, Pennsylvania, Tennessee, Vermont, Virginia, Wyoming: 26% of the USA.
Morality	The individual must have a moral understanding of the sexual activity and also understand the nature and consequences of sexual conduct.[29]	Alabama, Colorado, Hawaii, Idaho, Illinois (with Totality of circumstances test), New York, Washington: 14% of the USA.
Totality of circumstances	All the facts surrounding the case are weighed up, to determine the cause of the incident.	Illinois (with Morality test).
Evidence of mental disability	A method, rather than a statute, that allows for the court to consider evidence of disability.[29]	Connecticut, Maryland, Massachusetts, Michigan, Mississippi, Missouri, South Dakota, West Virginia, Wisconsin: 18% of the USA.
Judgment	Ascertains whether the individual can exercise judgment regarding consent to sexual activity.[29]	Georgia, Minnesota

Special protection

Intellectually disabled people do get special protection under Australian law. In the penal code, a person is defined as mentally defective if they suffer from "a mental disease or defect which renders him or her incapable of appraising the nature of his or her conduct." The special protection granted to those with intellectual disabilities in these cases is akin to the statutory protection given to children. In cases of sexual abuse, actual consent is irrelevant, because the person is incapable of giving legal consent.[30]

England and Wales

The Sexual Offences Act 2003 defines sexual offences in general, including those perpetrated against or by adults or children. The Act includes specific crimes against adults with intellectual disabilities or mental health conditions:

sexual abuse of vulnerable persons with a mental disorder. These include situations where:

• they are unable to refuse because of a lack of understanding,
• they are offered inducements, threatened or deceived, and
• there is a breach of a relationship of care, by a care worker;[31]

Reported crimes

Daniel D. Sorensen, Chair of the Victims of Crime Committee, Criminal Justice Task Force for People with Developmental Disabilities estimates that less than 4.5% of crimes against people with intellectual disabilities in California are reported compared to the 44% of the general public who experience crimes.[8] The Seattle Rape Relief Project program for victims of sexual assault with intellectual disabilities conclude that there is underreporting of sexual assaults of victims with intellectual disabilities that exceed underreporting with other populations.[8] Several studies suggest 80-85% of criminal abuse of residents of institutions never reach the proper authorities. The studies have found that 40% of those criminally abused and 40% of non-abusing staff of care facilities studied are reluctant to come forward with criminal abuse issues for fear of reprisals or retribution from administrators.[32]

Effects of sexual violence

People with intellectual disabilities can be harmed by sexual violence. The harm is often worse when the violence takes place over a long period and the perpetrator is known to the survivor.[24]^:6 The following effects have been reported, but may not be experienced by all learning disabled survivors of sexual violence:

• Psychological and emotional damage, such as depression, guilt, self-blame and low self-esteem.[24]^:5
• Physical injury.[24]^:5
• Pregnancy.[24]^:25
• Sexually transmitted disease.[24]^:25
• Damage (possibly permanent) to relationships of trust with caregivers, friends and family.[24]^:5
• Disturbed or otherwise changed behaviour, particularly for those who cannot communicate.[24]^:5

Individuals with intellectual disabilities can find it difficult to communicate when sexual abuse is occurring due to communication barriers. It is important for family members and caregivers to recognize some of the behavioral changes that could indicate when sexual abuse is occurring. Some of the following are behavioral changes that have been seen in some but not all victims of sexual abuse:

• Sleep disturbances including nightmares [33]
• Decreased school performance [33]
• Poor concentration [33]
• Enuresis and encopresis[33]
• Aggression[33]
• Social withdraw[33]
• Suicidal ideation[33]
• Eating disturbances[33]

See also

• Facilitated communication
• Disability abuse
• Sexuality and disability
• Sexual abuse
• Sexual assault

References

1. Lin, Lan-Ping; Yen, Chia-Feng; Kuo, Fang-Yu; Wu, Jia-Ling; Lin, Jin-Ding (2009). "Sexual assault of people with disabilities: Results of a 2002–2007 national report in Taiwan". Research in Developmental Disabilities. 30 (5): 969–975. doi:10.1016/j.ridd.2009.02.001. ISSN 0891-4222.
2. Sullivan, P. and Knutson, J. (2000) 'Maltreatment and disabilities: a population based epidemiological study.' Child abuse and Neglect 22, 4, 271 - 288, cited in Higgins, M. and Swain, J. (2010), Disability and Child Sexual Abuse, Jessica Kingsley Publishers.
3. Brown, H., Stein, J. and Turk, V. (1995) 'The sexual abuse of adults with learning disabilities: Report of a second two-year incidence survey.' Mental Handicap Research 8, 1, 3-24, cited in Michelle McCarthy, Sexuality and Women with Learning Disabilities, Second Edition, Jessica Kingsley Publishers, 1999.
4. McCarthy, M. and Thompson, D. (1997) 'A prevalence study of sexual abuse of adults with intellectual disabilities referred for sex education.' Journal of Applied Research in Intellectual Disability 10, 2, 105-124, cited in Michelle McCarthy, Sexuality and Women with Learning Disabilities, Second Edition, Jessica Kingsley Publishers, 1999.
5. McCarthy, Michelle (1999). Sexuality and Women with Learning Disabilities (2nd ed.). Jessica Kingsley Publishers. ISBN 9781853027307.
6. Morris, J. (1999) 'Disabled children, child protection systems and the Children Act.' Child Abuse Review 8, 91-108, cited in Michelle McCarthy, Sexuality and Women with Learning Disabilities, Second Edition, Jessica Kingsley Publishers, 1999.
7. McCarthy, Michelle; Thompson, David (June 1997). "A Prevalence Study of Sexual Abuse of Adults with Intellectual Disabilities Referred for Sex Education". Journal of Applied Research in Intellectual Disabilities. 10 (2): 105–124. doi:10.1111/j.1468-3148.1997.tb00012.x. ISSN 1360-2322.
8. Sorensen, David D (9 August 2002). "The Invisible Victims: an update of an article originally published in Prosecutor's Brief: the California District Attorneys Associations Quarterly Journal" (PDF).
9. Sobsey, D. "Relative victimization risk rates: people with intellectual disabilities".
10. Valenti-Heim, D.; Schwartz, L. (1995). "The Sexual Abuse Interview for Those with Developmental Disabilities". Cite journal requires |journal= (help)
11. Sobsey, Dick (1994). Violence and abuse in the lives of people with disabilities : the end of silent acceptance?. Baltimore u.a.: Brookes. ISBN 978-1557661487.
12. Sullivan, P. and Knutson, J. (2000) 'Maltreatment and disabilities: a population based epidemiological study.' Child abuse and Neglect 22, 4, 271 - 288, cited in Higgins, M. and Swain, J. (2010), Disability and Child Sexual Abuse, Jessica Kingsley Publishers.
13. McEachern, Adriana G. (2012). "Sexual Abuse of Individuals with Disabilities: Prevention Strategies for Clinical Practice". Journal of Child Sexual Abuse. 21 (4): 386–398. doi:10.1080/10538712.2012.675425. PMID 22809045.
14. Harrell, E. (2016). Crime against persons with disabilities, 2009-2014 - Statistical Tables. Retrieved from https://www.bjs.gov/content/pub/pdf/capd0914st.pdf
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16. Bowman, Rachel A.; Scotti, Joseph R.; Morris, Tracy L. (2010). "Sexual Abuse Prevention: A Training Program for Developmental Disabilities Service Providers". Journal of Child Sexual Abuse. 19 (2): 119–127. doi:10.1080/10538711003614718. PMID 20390782.
17. McCarthy, M. and Thompson, D. (1997) 'A prevalence study of sexual abuse of adults with intellectual disabilities referred for sex education.' Journal of Applied Research in Intellectual Disability 10, 2, 105-124, cited in Michelle McCarthy, Sexuality and Women with Learning Disabilities, Second Edition, Jessica Kingsley Publishers, 1999.
18. Brown, H., Stein, J. and Turk, V. (1995) 'The sexual abuse of adults with learning disabilities: Report of a second two-year incidence survey.' Mental Handicap Research 8, 1, 3-24, cited in Michelle McCarthy, Sexuality and Women with Learning Disabilities, Second Edition, Jessica Kingsley Publishers, 1999.
19. Dunne, T. and Power, A. (1990) 'Sexual abuse and mental handicap: Preliminary findings from a community based study,' Mental Handicap Research 3, 111-125, cited in Michelle McCarthy, Sexuality and Women with Learning Disabilities, Second Edition, Jessica Kingsley Publishers, 1999.
20. Gil-Llario, Mª Dolores; Morell-Mengual, Vicente; Ballester-Arnal, Rafael; Díaz-Rodríguez, Irene (2017). "The experience of sexuality in adults with intellectual disability". Journal of Intellectual Disability Research. doi:10.1111/jir.12455.
21. Gil-Llario, Mª Dolores; Morell-Mengual, Vicente; Díaz-Rodríguez, Irene; Ballester-Arnal, Rafael (2018). "Prevalence and sequelae of self‐reported and other‐reported sexual abuse in adults with intellectual disability". Journal of Intellectual Disability Research. doi:10.1111/jir.12555.
22. Hollomotz, Andrea, 2011, Learning Difficulties and Sexual Vulnerability, Jessica Kingsley Publishers
23. Sobsey, D; Varnhagen, C. (1989). "Sexual abuse and exploitation of people with disabilities: Toward prevention and treatment". In Csapo M., Gougen L (ed.). Special Education Across Canada. Vancouver: Vancouver Centre for Human Developmental and Research. pp. 199–218.
24. Mencap, Respond, UK Voice, 2001, Behind closed doors: preventing sexual abuse of adults with a learning disability, http://lx.iriss.org.uk/sites/default/files/resources/behind_closed_doors.pdf
25. Schaafsma, Dilana; Kok, Gerjo; Stoffelen, Joke M. T.; Curfs, Leopold M. G. (August 2014). "Identifying Effective Methods for Teaching Sex Education to Individuals With Intellectual Disabilities: A Systematic Review". The Journal of Sex Research. 52 (4): 412–432. doi:10.1080/00224499.2014.919373. PMC 4409057. PMID 25085114.
26. Balderian, N (1991). "Sexual abuse of people with developmental disabilities". Sexuality and Disability. 9 (4): 323–335. doi:10.1007/BF01102020.
27. Taylor, M. and Carlson, G. (1993) "The legal trends: Implications for menstruation / fertility management for young women who have an intellectual disability.' International Journal of Disability, Development and Education 40, 2, 133-157, cited in Michelle McCarthy, Sexuality and Women with Learning Disabilities, Second Edition, Jessica Kingsley Publishers, 1999
28. Sobsey, D.; Doe, T (1991). "Patterns of sexual abuse and assault". Sexuality and Disability. 9 (3): 243–259. doi:10.1007/bf01102395.
29. Morano, JP (June 2001). "Sexual Abuse of the Mentally Retarded Patient: Medical and Legal Analysis for the Primary Care Physician". Primary Care Companion to the Journal of Clinical Psychiatry. 3 (3): 126–135. doi:10.4088/pcc.v03n0304. PMC 181173. PMID 15014610.
30. Lombardi, Kate Stone (25 July 1993). "Rape and the Mentally Retarded". The New York Times.
31. http://www.cps.gov.uk/news/fact_sheets/sexual_offences/, The Crown Prosecution Service, "Sexual Offences Factsheet", accessed 12/11/14
32. Helm, R (1990). "Study finds abusers of disabled often their helpers". The Edmonton Journal: C3.
33. Goodyear-Brown, Paris (2012). Handbook of child sexual abuse: Identification, assessment, and treatment. New Jersey: John Wiley & Sons Inc. pp. 8. ISBN 978-1-118-08292-8.

External links

• "People With Mental Retardation & Sexual Abuse" by Leigh Ann Davis