Effectiveness of Behavioural Skills Training (BST) on Knowledge of Sexual Abuse and Resistance Ability Among Children with Intellectual Disabilities: a Randomized Controlled Trial

Sexual abuse of children with intellectual disabilities is a global concern. Rate of sexual abuse among children with intellectual disabilities is 2-4 times the rate in general population. Thirty-nine to 83% of girls and 16%- 32% of boys with Intellectual Disability typically experience sexual abuse by the time they reach the age of 18. There is a need for personal safety programs as one of the multiple approaches to reduce the risk of child sexual abuse. In order to protect themselves against abuse, children with intellectual disability must have the skills to independently recognise potentially abusive situations and respond appropriately. Even though some of the abuse prevention programmes are widely used, the effectiveness of these is not established. The aim of the study was to assess the effectiveness of a Behavioural Skills Training on knowledge of sexual abuse and resistance ability among children with Intellectual Disability.

Sample size calculation for this study was conducted using power analysis, based on the variance from the pilot study. Considering a statistical power of 80% and a significance level set at 5%, 134 children were initially recruited for the study. However, upon concluding the six months, data was available to only 120 subjects. Among these, 60 children received the intervention ( experimental group), while the remaining 60 received Treatment as Usual (the control group).

This study developed a Video based Behavioural Skill Training programme for training children with intellectual disabilities for improving their knowledge regarding sexual abuse and resistance ability against sexual abuse and tested its effectiveness. The study involved children initially watching video presentations depicting appropriate and inappropriate situations and the ideal responses for each scenario. Subsequently, the children engaged in role-playing exercises, where a researcher assumed the roles of a perpetrator, doctor, or nurse. At the same time, parents who participated as co-therapists in the study played their parents' part in the role play. Following each enactment of inappropriate situations, the children were instructed to approach their parents and report the individual's identity and the incident. This role-playing process was reiterated until the children had comprehensively learned the appropriate responses.

The effectiveness of the study was evaluated based on the change in the knowledge scores and resistance ability scores. A randomized controlled design with longitudinal measurement of outcomes was adopted to evaluate the effectiveness of BST on Knowledge of Sexual Abuse and Resistance Ability. Screening for all the children was done in each selected special schools based on the inclusion and exclusion criteria. All subjects who met the criteria were selected for the study.

The children and parents involved in the study were clearly informed about its purpose and objectives. Written informed consent was obtained from the parents, and an attempt was made to obtain assent from the children. Forty-two percent of the children were able to provide signed assent. Participants were assured that the information they provided would remain confidential. It was also ensured that the BST would not interfere with the children's regular school schedules. The investigator closely monitored the children and their parents during the intervention to address any potential adverse effects.