Developmental Disabilities Bulletin

References

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Breggin, P.R. (1983). Psychiatric drugs: Hazards to the mind. New York: Springer Publishing Company.

Crossmaker, M. (1986). Empowerment: A systems approach to preventing assaults against people with mental retardation and/or developmental disabilities. Columbus, OH: The National Assault Prevention Center.

Crossmaker, M., & Merry, D. (Eds). (1990). Stigma: Stereotypes and scapegoats. Columbus, OH: Ohio Legal Rights Service.

Fagan, J., & Wexler, S. (1988). Explanations of sexual assault among violent delinquents. Journal of Adolescent Research, 3 (3-4), 363-385.

Finkelhor, D. (1984). Child sexual abuse. New York: The Free Press.

Gilgun,J., & Gordon, S. (1985). Sex education and the prevention of child sexual abuse. Journal of Sex Education and Therapy, 1 (1) 46-52.

Ibrahim, F., & Herr, E. (1982). Modification of attitudes toward disability: Differential effect of two educational modes. Rehabilitation Counselling Bulletin, 26 (1), 29-36.

Lang, R.A., & Frenzel, R.R. (1988). How sex offenders lure children. Annals of Sex Research, 1 (2), 303-317.

Langevin, R., Wright, P., & Handy, L. (1989). Characteristics of sex offenders who were sexually victimized as children. Annals of Sex Research, 2(3), 227-253.

Marshall, W.L. (1990). Criminal neglect: Why sex offenders go free. Toronto: Doubleday Canada Limited.

Musick, J.L. (1984). Patterns of institutional sexual assault. Response to Violence in the Family and Sexual Assault, 7(3), 1-2, 10-11.

Packard, E.P. (1875). Modern prosecution or insane asylums unveiled. Hartford, CT: Arno Press.

Pope, K.S., Keith-Spiegel, P., & Tabachnick, B.G. (1986). Sexual attraction to clients: The human therapist and the (sometimes) inhuman training system. American Psychologist, 41, 147-158.

Rindfleisch, N., & Bean, G.J. (1988). Willingness to report abuse and neglect in residential facilities. Child Abuse and Neglect, 12, 509-520.

Rindfleisch, N., & Rabb, J. (1984). How much of a problem is resident mistreatment in child welfare institutions? Child Abuse and Neglect, 8, 33-40.

Ryerson, E. (1981). Sexual abuse of disabled persons and prevention alternatives. In D.G. Bullard & S.E. Knight (Eds.), Sexuality and physical disability: Personal perspectives (pp. 235-242). St. Louis: C.V. Mosby.

School for the disabled loses federal support. (1989).Washington Coalition of Sexual Assault Programs Newsletter (March, 1989), pp. 1-2.

Shaman, E.J. (1986). Prevention for children with disabilities. In M. Nelson & K. Clark (Eds.), The educator's guide to preventing child sexual abuse (pp. 122-125). Santa Cruz, CA: Network Publications.

Shaughnessy, M.F. (1984). Institutional child abuse. Children and Youth Services Review, 6 , 311-318.

Sobsey, D. (1990). Modifying the behavior of behavior modifiers: Arguments for countercontrol against aversive procedures. In A. Repp, & N. Singh (Eds.), Perspectives on the use of non-aversive behavior and aversive interventions for persons with developmental disabilities (pp. 421-433). Sycamore, IL: Sycamore Publishing.

Sobsey, D. (in press). Sexual abuse of individuals with intellectual disability. In A. Craft (Ed.), Practice issues in sexuality and intellectual disability. London: Routledge.

Sobsey, D. (1988). Sexual victimization of people with disabilities: Professional and social responsibilities. Alberta Psychology, 17 (6), 8-9.

Sobsey, D., & Doe, T. (in press). Patterns of sexual abuse and assault. Sexuality and Disability.

Sobsey, D., Gray, S., Wells, D., Pyper, D.,& Reimer-Heck, B. (1991). Disability, sexuality, & abuse: An annotated bibliography. Baltimore: Paul H. Brookes.

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Stuart, C.K., & Stuart, V.W. (1981). Sexual assault: Disabled perspective. Sexuality and Disability, 4(4), 246-253.

Sundram, C.J. (1984). Obstacles to reducing patient abuse in public institutions. Hospital and Community Psychiatry, 35(3), 238-243.

Sullivan, P.M., Vernon, M., & Scanlan, J.M. (1987). Sexual abuse of deaf youth. American Annals of the Deaf, 132(4), 256-262.

Sullivan, P.M. Scanlan, J.M., Knutson, J.E., Brookhauser, P.E., & Schulte, L.E. (in press). The effects of psychotherapy on behavior problems of sexually abused deaf children. Journal of Child Abuse and Neglect.

Trudell, W., & Whatley M. (1988). School sexual abuse prevention: Unintended consequences and dilemmas. Child Abuse & Neglect,12, 103-113.

Warnemuende, R. (1986). Misconceptions and attitudes about disability and the need for awareness. Journal of Applied Rehabilitation Counselling, 17 (1), 50-51.

Watson, J.D. (1984). Talking about the best kept secret: Sexual abuse and children with disabilities. Exceptional Parent, 14(6), 15, 16, 18-20.

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Footnotes

[1] Portions of the project that provided the basis for this chapter were funded by National Health Research and Development Program, Health and Welfare Canada under projects 6609-1465 CSA and 6609-1597 FV. Findings and opinions expressed are those of the author and not necessarily those of the funding agency.

The Prevention of Sexual Abuse of People with Developmental Disabilities

Sobsey, D. & Mansell, S.
University of Alberta

Considerable research demonstrates that both children and adults with disabilities experience a much greater risk of sexual abuse and sexual assault (Sobsey, Grey, Wells, Pyper & Reimer-Heck, 1991). However, the available information concerning prevention and treatment of sexual assault and sexual abuse for the disabled is scarce. This paper examines some of the existing prevention programs and proposes alternate sexual abuse prevention strategies for disabled persons.

Some of the strategies discussed in this paper developed out of work completed by the University of Alberta Sexual Abuse and Disability Project [1]. This project began in 1987 and has completed a comprehensive review of the literature (Sobsey, Gray, Wells, Pyper & Reimer-Heck, 1991) and an analysis of more than 150 victims' reports (Sobsey, in press; Sobsey & Doe, in press). The current work of the project is designed to validate prevention components extracted from the two previous phases. Many of these prevention strategies are discussed in this chapter.

Education and Training

Training can be an important component in a risk reduction program. Training potential victims to avoid or resist abuse has been the standard approach to sexual abuse prevention for some time. Nevertheless, it is unrealistic to expect that any program which places sole responsibility for abuse prevention on potential victims will adequately protect or serve the needs of the disabled.

Researchers suggest that prevention training programs also may produce several unwanted effects. Detrimental effects may result from prevention programs which focus responsibility for sexual abuse and/or assault prevention on potential victims but fail to assign ultimate responsibility for sexual victimization to offenders (Trudell & Whatley, 1988; Gilgun & Gordon, 1985). For example, if potential victims fail to prevent sexually abusive or assaultive situations, by implication they may be held responsible for the occurrence. Ironically, prevention training programs that intend to help potential victims protect themselves may ultimately contribute to victim blaming.

Although many children and adults with disabilities possess adequate information and the will to avoid victimization, they still may be powerless to prevent abuse. Despite the problems associated with training programs, there are several types of training which appear to be useful in addressing the needs of the disabled.

Appropriate Sex Education: Everyone, whether disabled or not, needs appropriate education and training in sexuality. The culturally pervasive myths surrounding disability continue to influence both societal perceptions and treatment of the disabled (Warnemuende, 1986). These myths may also contribute to offender's rationalizations for sexually abusing disabled persons. For example, one myth portrays people with disabilities as non-sexual. This erroneous belief not only denies the sexuality of disabled persons, it also may be used to justify denying access to sex education to people with disabilities. Denying the disabled access to sex education may produce several related consequences. It may increase the vulnerability of people with disabilities to possible pregnancy, and venereal diseases, but also to potential abuse by those who will exploit their lack of knowledge about sexuality. For example, in our own research of sexual abuse victims with disabilities, we found cases in which sexual abuse was rationalized by offenders as a form of sex education. This rationale for abuse is not unique to cases involving victims with disabilities; however, Marshall and Barrett report that many incest offenders and child molesters use the same type of rationalization (1990). Those who fail to receive an appropriate and healthy sex education may be condemned to an inappropriate and brutal sex education at the hands of those who will exploit and abuse them. Appropriate sex education for the disabled clearly is an important resource in sexual abuse prevention.

Sex education programs for people with disabilities should be individually tailored to the person's age, environment, and communication skills. In sex education programs, although it is necessary to impart explicit information about sexual behavior, choices, and risks, it is also important to reach beyond the biological and address the social and emotional aspects of sexuality.

A critical component in sexuality education is sexual abuse prevention. Several different skills may be involved such as learning to recognize and avoid dangerous situations and becoming aware of personal feelings of discomfort (Watson, 1984; Ryerson, 1981). Learning how to seek advice and help when it is needed are also important skills. For example, students need to learn how to let others know that something doesn't feel good, and that letting others know immediately, before the situation becomes more serious, may prevent escalation to abuse. Sex education, however, is not the only educational intervention that can help prevent sexual abuse of the disabled.

Other Educational Needs: Assertiveness training, choice- making, and personal rights education are essential educational content areas for people with disabilities. Unfortunately, special education programs have often focused on generalized compliance as a goal for students. An unfortunate consequence of this approach is that our best students have been effectively trained to be victims of psychological, sexual, and physical abuse (Sobsey, 1988). Education must not aim at unquestioning compliance and generalization; rather it should aim at teaching students to discriminate between appropriate times for compliance and for asserting personal rights. Education should emphasize an awareness of the range of lifestyles available and help students develop the abilities to choose among these. The development and enhanced access to appropriate social and sexual relationships can reduce vulnerability to more abusive relationships (Shaman, 1986). Therefore, the programs that attempt to isolate or de-sexualize people with disabilities are likely to increase the likelihood of abuse (Musick, 1984).

An important self-protection strategy for many individuals with disabilities is learning enhanced communication skills. Individuals who cannot communicate their feelings are more vulnerable to abuse. Research suggests that offenders seek victims who they consider to be vulnerable and unable to seek help or report the abuse (Lang & Frenzel, 1988). Communication skill deficits may contribute to an offender's perception of victim vulnerability and to the selection of potential victims. Increased vulnerability of deaf children is clearly demonstrated by research that indicates that deaf children experience a greater incidence and risk for sexual abuse than hearing children (Sullivan, Vernon & Scanlan, 1987). Conversely, improved communication skills probably decrease the perception of vulnerability and the risk of sexual abuse.

Staff Training: Disabled children and adults can clearly benefit from some of the previously described educational interventions. However, staff members who are providing educational, vocational, residential, and other related services could also benefit from training (Sundram, 1984). It is important for staff to have an early introduction to a clear policy regarding abuse and sexual behavior. Staff should be trained to recognize and respond appropriately to early signs of abuse, and to their own feelings of aggression or sexual attraction that may arise. Research suggests that many service providers occasionally experience feelings of sexual attraction to one or more clients (Pope, Keith-Spiegel & Tabachnick, 1986). Most service providers, however, maintain appropriate standards of professional conduct. Frequently, the individuals who inappropriately act out their aggressive or sexual feelings have failed to anticipate the possibility of these feelings and have never developed strategies for appropriately dealing with them (Pope et al.,1986). Establishing both clear standards of conduct and boundaries between appropriate and inappropriate behavior, along with access to formal or informal counselling, may help staff cope more appropriately with their feelings.

Staff need to know not only the procedures for reporting abuse but also to be trained to detect the signs of sexual abuse. These prevention components may seem to be "after-the-fact" and perhaps too late to have any preventive effect. However, there are several indicators that these can be powerful prevention strategies. The presence of effective prevention and reporting systems can have powerful deterrent effects on offenders. Potentially abusive staff members who believe that others are not only unlikely to detect but also unlikely to report them, are likely to become active abusers. Alternately, when they believe that they are likely to be detected and reported, their potential abuse is often effectively inhibited. Furthermore, most abusers have many victims. Child molesters, for instance, have on average about 70 victims before they are first apprehended (Barbaree & Marshall, 1988). Consequently, both undetected and unreported cases of sexual abuse allow more people to be victimized. Therefore, while it may be too late to prevent the victimization of past victims, potential future victims may be protected. Also our research suggests that most victims are not sexually abused on only a single occasion (Sobsey & Doe, in press). The abuser typically repeats the offense with the same victim many times over periods of months or years unless the abuse is reported. Therefore, detection and reporting may protect victims from repeated and prolonged abuse.

Administrative Reform

Our research suggests that sexual abuse often takes place in the "disability" service delivery system and abusers are often paid caregivers (Sobsey, in press). The implications of this finding suggest that system reform is an essential part of prevention. There are several administrative reforms that could be implemented in this system to have powerful effects in sexual abuse prevention for the disabled.

Staff Screening: In a number of cases that have come to our attention, known sex offenders have taken jobs providing personal care to people with disabilities in institutions, group homes, and private residences. Although the number of previously convicted and currently charged applicants is small, the number of victims that each will be likely to have if allowed into the system is large (likely 100 or more). Therefore careful and thorough reference and police checks are essential to the screening process (Musick, 1984). The interview process provides an employer with an important opportunity to determine the suitability of a prospective employee. Using open-ended situational questions may help an employer determine a prospective employee's attitudes towards the disabled and reactions to personal feelings of aggression, stress or arousal in providing personal care to the disabled. Employers in the service delivery system need to be both sensitive to the problems produced by sexual abuse of people with disabilities and conscientious about screening staff in order to prevent it.

In the past, many abusers have been allowed to resign from an agency rather than facing charges for their offenses. Unfortunately, many of these individuals move on to another service delivery setting and continue to abuse the individuals in their care. It is imperative that whenever possible charges be laid and convictions obtained to prevent the possibility of abusers moving from agency to agency. When employees leave an agency because of concerns over the nature of their interaction with service consumers, it is essential that this fact be included in any reference information provided to prospective future employers.

Agency Responsibility: Service providers must accept greater responsibility for the clients they serve. For example, when they fail to provide a reasonably safe environment, they must acknowledge their responsibility for the resulting harm done to the people in their care. Failure to adequately screen staff is one example of agency irresponsibility, but there are several others. Many institutional settings cluster potentially sexually aggressive and vulnerable people together with little attention to the prevention of violence. Institutionalization of dangerous individuals may improve safety in the community, but without adequate safeguards to protect vulnerable people living in institutions, such residents will be at great risk for victimization. Certainly, violence among residents is rarely condoned and typically some attempt is made to maintain order, but institutions have failed to recognize their legal obligation to maintain a level of personal safety similar to that of the general community.

Several recent court decisions suggest that this irresponsibility will no longer be tolerated. In at least three American cases, courts found that mental institutions did not protect residents adequately against sexual assault from other residents (Sobsey, 1988). One American institution for people with developmental disabilities had federal funding withdrawn for the same reason (School for the disabled loses..., 1989). Canadian courts have also recognized this principle. For example, a recent case found a nursing home to be responsible for a physical assault by a resident (Stewart v. Extendacare, 1986). Staff were held responsible because they knew that the developmentally disabled resident was assaultive and failed to take appropriate action to prevent the assault.

Institutions cannot entirely eliminate risk for residents, but they do have a responsibility to provide a level of safety that is not substantially worse than the level currently available in the community. Institutional staff have a responsibility to take reasonable precautions to reduce the risk of abuse for residents.

Responsibility also needs to be established for contract staff. For example, many schools and other programs contract for transportation services to convey students with disabilities to specialized programs. Our research has found many cases of these transportation providers sexually assaulting disabled students (Sobsey & Doe, in press). Once schools and other service providers have knowledge of this risk, they have a responsibility to control it.

Integration and Reduction of Isolation: It is difficult to precisely compare the relative risks for sexual abuse in institutional and community environments. The available research suggests that the risk of being sexually abused within an institutional setting is two to four times as high as for being sexually abused in the community (Rindfleisch & Bean, 1988; Rindfleisch & Rabb, 1984; Shaughnessy, 1984). Therefore, serving more people with disabilities within the community and fewer in institutions may be a powerful prevention strategy.

For individuals who continue to be served in institutional settings, however, reducing the isolation of this service delivery system may have similar preventive effects (Crossmaker, 1986; Musick, 1984). The privacy of individuals living within institutions is both a legitimate and significant concern. Ironically, many of the practices defended in the name of protecting the privacy of the individual have resulted in the isolation of these individuals, thereby increasing their risk for abuse.

Behavioral Control: Two other service reforms need careful consideration. The extensive use of psychotropic drugs for behavior control of people with developmental disabilities may also increase their vulnerability to abuse. In some cases the same people who recommend, prescribe, or administer these mind altering drugs are also the offenders who sexually abuse their drugged victims. The drug may be used deliberately to reduce the resistance of victims or to interfere with the victim's ability to make a complaint. Breggin (1983) has described widespread use of these drugs to control political dissenters, prisoners, and the elderly, in addition to people with intellectual and behavioral disabilities. Animal and human studies reported in these studies document the effects of tranquilizers in suppressing escape and avoidance responses, interfering with the abilities required for self-protection. In some cases, these drugs may be used with good intention but with equally damaging effects. For example, drugs may be prescribed and administered by treatment team members who are unaware of the cause of the behavior to control non-compliant or other "inappropriate" behavior. They may be unaware that the behavior that they are "treating" developed in response to abuse or that they are suppressing the victim's only available means of defense.

Similarly, intensive and aversive behavior management programs are sometimes used to control non-compliant, aggressive, sexually inappropriate or other problem behavior of people with disabilities. Unfortunately, these programs are often employed with little attention to the discovery of the cause of the inappropriate behavior. In many cases, the cause of such behavior turns out to be abuse of the individual. Suppressing this behavior through behavioral control may take away the victim's last defence against abuse and silence their only way of letting people know that they are being abused. Abusers may even use such programs as a coercive tool to ensure silence from sexual abuse victims. It is essential that attempts be made to identify the real cause of "behavior problems" before caregivers attempt to eliminate them through the intrusive use of drugs or punishment procedures (Sobsey, 1990).

Various forms of restraint that are sometimes used to control people with atypical behavior also leave them vulnerable to abuse and assault. In our review of cases, we have also come across cases in which "therapeutic restraint" left victims vulnerable to abuse and assault. Whether restraint is accomplished physically, chemically, or through behavioral coercion, its use creates the extreme inequality of power that often leads to abuse. Packard (1875), in her classic description of her own experience as a patient in a 19th century insane asylum, suggests that the "most heinous wrong of our present system consists in the fact that inmates of insane asylums are denied the primeval right of self defense" (cited in Crossmaker & Merry, 1990). Little has changed this fundamental fact in the last century. Only the new, more sophisticated methods of chemical and behavioral restraint have been added to supplement physical restraint. The use of any of these procedures is rarely if ever justified. If they are ever to be used, there must be more stringent controls in place to prevent abuse.

Detection, Reporting, Prosecution and Treatment

The processes of detection, reporting, prosecution and treatment of sexual abuse may seem to be activities that occur only after prevention has failed and therefore of little value in preventing sexual abuse. However, these activities are essential components of prevention programs. Poor detection, reporting, and prosecution results in repeated offenses against the same victims and also to the additional victimization of others. The perception that these crimes go unreported and unpunished encourages potential offenders to act out their drives (Sundram, 1984). Treatment for victims and offenders is also important. Offenders who go untreated are likely to commit future offenses. There is also evidence that many adult sex offenders were victims of sexual abuse as children (Fagan & Wexler, 1988; Langevin, Wright & Handy, 1989; Finkelhor, 1984). Thus, by effective treatment of victims of child sexual abuse, we may not only help the victim but also decrease the chance that some victims will later become offenders.

Detection: Detection of sexual abuse of people with disabilities has often been hampered by several different factors. Society's de-sexualized image of people with disabilities often results in our failure to recognize the possibility of sexual abuse of children and adults with disabilities (Shaman, 1986). A greater public understanding of the frequency of this crime is necessary in order for people to recognize and react to its symptoms. Just as people with disabilities are often stereotyped, caregivers are often viewed as patient, dedicated, quasi-religious figures who are beyond reproach. Consequently, we may have difficulty believing that the same man who was honored by his international religious and fraternal organizations for his dedication in adopting handicapped children from the third world countries, is now charged with sexually abusing these children. It would be equally wrong, however, to stereotype all caregivers as merciless exploiters. Like individuals found in all segments in society, caregivers are variable and complex individuals. We cannot afford to dismiss suspicious events or behavior simply because we believe some individuals are beyond reproach.

Special emphasis should be placed on teaching children and adults to recognize and respond to early signs of abuse. Caregiver-abusers often attempt to disguise their abuse as part of treatment and this ploy may be quite convincing especially at early stages. Symptom-masking is another obstacle to successful detection. Many of the symptoms of sexual abuse may be easily attributed to the victim's disability and thus overlooked (Sobsey, in press). For example, if a physician finds that an adolescent girl is not sleeping well, having difficulties in school, seems fearful of people, and resists physical examination, he should begin to wonder about the possibility that she is being abused. If that child, however, has diagnosis of mental or emotional disability, however, he may be likely to attribute the symptoms to her disability and thus be less likely to detect abuse.

Reporting Abuse: Much of the sexual abuse of people with disabilities currently goes unreported for several reasons. Many service consumers are often intimidated by the abuser or afraid of disruption of essential services. Some service consumers are unable to communicate about their abuse because of their disability or because their isolated living situation prevents them from having free communication with someone they can trust. Many service providers fail to report abuse for fear of direct retaliation by the abuser or administrative retaliation from authorities who are embarrassed by the reports of abuse within the service delivery system for which they have responsibility.

Complainant protection legislation is essential to combat these obstacles and has been adopted in some states and provinces. Provisions of this legislation may vary, but may include some combination of important elements. First, there is usually a legally mandated requirement to report suspected abuse. Second, there is often protection from legal action taken by the alleged abuser if the charges are not supported. This protection against being sued by the alleged abuser is normally absolute except in the case where it can be proven that the report was made without grounds but rather with malice and intent to injure the accused. Service consumers may be protected against service interruption or withdrawal, subsequent to making a report.

Similarly, service providers who report may be legally protected against administrative retribution. It is very important to have provisions that ensure that all reports go to authorities independent of the service delivery system that is involved, and that administrative investigation cannot be used as a substitute for law enforcement investigation appropriate to the reported crime. In some states and provinces, independent advocates have been appointed to facilitate such reports since an employee of an institution or service system under investigation cannot be expected to act impartially.

Investigation and Prosecution: Good investigation and prosecution procedures are essential to prevention, because failure to convict perpetrators of these crimes allows abusers to continue their abuse and encourages others to believe that they can also become abusers without the fear of punishment for these offenses. Currently, many victims with disabilities are so severely disadvantaged in the criminal justice system that their rights to personal security and equal protection of the law under sections 8 and 15 of the Charter of Rights and Freedoms are almost certainly violated. Legislation will be necessary to restore the balance of rights for disabled victims with those accused of abusing them.

Changes in evidentiary rules are required. Currently, many disabled victims are not allowed to testify in court because they are considered to be incompetent. Others are not allowed to utilize their most effective method of communication to testify. Every citizen who becomes a victim of a crime should have a right to present the best evidence they can in a manner that is most suited to their abilities.

Clarification of issues related to consent are also required in many countries. For example, in Canada, if an offender "honestly believes" that a victim is consenting, no crime has been committed. The law, however, is unclear regarding what constitutes reasonably honest belief in consent. The inability of an individual to fight off an attacker or to clearly communicate should be grounds for a finding of consent to sexual assault.

Complainant protection or "whistleblower" legislation is an essential component in a deterring abuse. People with disabilities should not be in jeopardy of service interruption or more restrictive placement as a result of reporting abuse. Service providers should not be in jeopardy of administrative harassment or other consequences that have occurred in response to their reports of abuse.

Treatment Programs

Many community programs that treat victims of sexual abuse or assault remain inaccessible to people with disabilities or offer programs that are inappropriate to their individual needs. Nevertheless, many treatment centres across Canada have acknowledged this gap in their services and are making excellent progress toward attaining appropriate and accessible services for all. Physical accessibility, alternative telephone devices, provision of translating services, and non-print alternatives for reading materials are among the basic accommodations required. More work needs to be done to identify appropriate treatment alternatives for people with cognitive and communicative impairments that make traditional insight therapy difficult (Sullivan, Scanlan, Knutson, Brookhauser & Schulte, in press).

Attitudes About Disability

The myths surrounding sexual assault and sexual abuse combined with the cultural images of people with disabilities may act as powerful influences in the perpetuation of sexual abuse (Shaman, 1986). Most sexual offenders develop myths about their victims that they employ to both justify their own inappropriate behavior and reduce their behavioral inhibitions. For example, rapists often blame their victims describing them as "asking for it". We need to carefully examine the cultural myths surrounding people with disabilities to determine not only how these attitudes may contribute to abuse and also how changing attitudes may function as a sexual abuse prevention strategy. Five such attitudes are discussed here as examples, but there are several others.

The "Dehumanization" Myth: Sadly, people with disabilities are still portrayed and viewed as less than full members of our society. Labels such as "vegetative state" suggest an image of the person with a disability as not quite human. Such images allow offenders to fuel their existing justifications with the belief that their offenses are less problematic because the victim is not really a fellow human being. Since the offender sees himself as more human and therefore more valuable, he sees nothing wrong with exploiting the less valued individual to meet his own needs.

The "Damaged Merchandise" Myth: Closely associated with the dehumanization concept is the view of the disabled person as damaged merchandise. This is perhaps most clearly articulated by those who advocate for euthanasia of severely handicapped children. They argue that the "potential quality of life" for such a person is so poor that the child is better off dead than alive. Indeed, this myth allows society to kill handicapped children and provides the rationalization which asserts that it is ultimately in their "best interest". In fact, we have little reason to believe that the euthanasia advocates' presentation of so-called indicators of quality of life have any relationships to the individual's own perception of the quality of his or her own life.

The damaged merchandise myth asserts that because the life of the disabled person is worthless, they have nothing to lose in death. The sexual abuser may employ similar reasoning which allows him to regard his victim's life as worthless. Therefore, it provides an offender with a rationalization not only for the choice of victim, but also may alleviate any guilt or inhibition about exploiting a disabled person.

The "Feeling No Pain" Myth: People with disabilities, especially emotional disorders and mental handicaps, are often described as immune to pain and suffering. In fact, there is no basis for this belief since these people are subject to experiencing the same range of feelings as any person. This myth allows offenders to believe that because some victims may not fully understand what is happening to them, they suffer less. Therefore, they rationalize their crime by saying that the victim really wasn't hurt by it. Research shows that people with all kinds of disabilities suffer just as much emotional trauma, physical injury, and social consequences of abuse as any other victim (Stuart & Stuart, 1981; Sullivan, Vernon & Scanlan, 1987).

The "Disabled Menace" Myth: People with disabilities have sometimes been portrayed and viewed as deviant menaces to society who are both dangerous and unpredictable. For the offender, this view often contributes to rationalizations which blame the victim for the abuse. For example, caregivers who sexually abuse their clients may believe that the event occurred as a result of the sexual aggression of the victim. The reality is often the opposite. Sexually inappropriate behavior is often seen in victims of sexual abuse or sexual assault, but it often occurs as a result of their abuse, and should never be used as an excuse for the cause.

The "Helplessness" Myth: Even the portrayal of people with disabilities as vulnerable or helpless may contribute to their abuse. The perception of vulnerability is known to affect the selection of victims by sex offenders. This raises ethical concerns about exposing the frequency of sexual victimization of people with disabilities, since this exposure of vulnerability may encourage future victimization. However, attempting to hide the problem may produce worse problems because it protects abusers. The real answer to combatting the myth of helplessness is through the evolving empowerment of people with disabilities and developing positive, more realistic images appropriate to this empowerment. A more encompassing goal for the empowerment of people with disabilities involves promoting positive societal attitudes towards disability.

Changing Attitudes: Clearly, society's attitudes about people with disabilities continues to contribute to their disempowered position and vulnerability to sexual abuse. Changing societal attitudes towards persons with disabilities may be an important, encompassing and long term empowerment and sexual abuse prevention strategy. A more relevant objective for sexual abuse prevention for persons with disabilities, however, is directly addressing the attitudes of professionals who work with persons with disabilities (Sundram, 1984).

There are a few strategies such as educational programs, contact with the disabled and disability simulation which appear to be successful in promoting positive attitudes towards persons with disabilities (Westwood, Vargo & Vargo, 1981). However, the results from studies attempting to alter attitudes toward persons with disabilities tend to be both conflicting, inconclusive and subject to methodological differences and problems (Westwood et al., 1981). Despite these methodological problems, however, there may be important applications for use of these strategies in professional training programs. Ibrahim & Herr (1982) studied educational and role playing attitude change strategies in undergraduate students in helping professions, and discovered that role playing appeared to be more successful in altering attitudes towards the disabled. Professional training programs promoting positive attitudes toward people with disabilities, combined with increased employer awareness of sexual abuse issues and more rigorous employee screening, may act together to help reduce the risk of sexual abuse for persons with disabilities.

Summary

People with disabilities experience increased risk for sexual assault and sexual abuse, however, much of their excessive risk can be eliminated through appropriate abuse prevention strategies. Effective programs must consider the potential victims of abuse, potential offenders, and the settings in which abuse often takes place. The problems of sexual abuse and sexual assault in our society are not unique to people with disabilities. The most effective forms of prevention must consider all members of society regardless of disability status, however, the most relevant issues for people with disabilities have been presented as the focus of this article.

Note

Request for reprints should be addressed to:

dick.sobsey@ualberta.ca