Remediating Serious Inappropriate Sexual Behavior in a Male with Severe Acquired Brain Injury

Inappropriate sexual behaviors such as sexual talk, non-genital and genital touching (non-consensual), exhibitionism and coercive sexual behavior are consistently reported sequelae of severe Acquired Brain Injury (ABI). A single-case experimental design was employed to evaluate the relative effectiveness of environmental controls and facilitated access to a sex worker in the management of inappropriate sexual behavior displayed by a male with ABI. Environmental controls comprised behavioral strategies commonly employed to manage disinhibited behavior secondary to ABI such as redirection, cueing appropriate behavior, and verbal feedback. An additional component, facilitated visits to a sex worker, provided a comparison treatment. The introduction of a sex worker contributed to the reduction and eventual extinction of inappropriate behaviors. Improvements were maintained at follow-up probes 1 and 2 years later. The social validity of the intervention is evaluated, and the legal, safety and ethical issues raised by facilitating access to a sex worker are carefully addressed.