Skip to main content
SpringerLink
Log in

A Pictorial Sexual Knowledge Scale for Male High School Students with Intellectual Disabilities in Taiwan

  • Original Paper
  • Published:
Sexuality and Disability Aims and scope Submit manuscript

Abstract

The aim of this study was to develop a pictorial scale for use in assessing the sexual knowledge of male high school students with intellectual disabilities studying at special education schools in Taiwan. A pictorial scale with 40 multiple-choice items was developed to assess the participants' relevant knowledge. Each item consisted of a written question and corresponding illustrations. A total of 181 male high school students in Taiwan participated in the study. Construct validity using exploratory factor analysis generated 26 items formatted into six subscales: puberty and physiology, body boundaries, proper touching, proper relationships, sexually transmitted diseases, and sex and the law. The variance explained for the six subscales was between 6.93 and 11.34%, and the variance explained for the whole scale was 53.99%. The reliability of Cronbach’s alpha was between .58 and .78, and the whole scale’s alpha value was .87. The participants demonstrated a relatively high level of knowledge on the body boundaries and proper relationships subscales, followed in descending order by proper touching, sex and the law, puberty and physiology, and sexually transmitted diseases.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.Yes, I confirm that the author and affiliation have been correctly identified.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. United Nations: Convention on the Rights of Persons with Disabilities. Available at: https://www.refworld.org/docid/4680cd212.html (13 December 2006) Accessed 10 December 2021

  2. Ministry of Health and Welfare of Taiwan: People with Disabilities Rights Protection Act. Available at: https://law.moj.gov.tw/Eng/LawClass/LawAll.aspx?PCode=D0050046 (11 July 2007) Accessed 10 December 2021

  3. Ministry of Health and Welfare of Taiwan: People with Disabilities Personal Care Service Act. Available at: https://law.moj.gov.tw/LawClass/LawHistory.aspx?pcode=D0050187 (9 July 2012) Accessed 10 December 2021

  4. Kijak, R.J.: A desire for love: considerations on sexuality and sexual education of people with intellectual disability in Poland. Sex. Disabil. 29, 65–74 (2011). https://doi.org/10.1007/s11195-010-9184-2

    Article  PubMed  Google Scholar 

  5. Sullivan, F., Bowden, K., McKenzie, K., Quayle, E.: ‘Touching people in relationships’: a qualitative study of close relationships for people with an intellectual disability. J. Clin. Nurs. 22, 3456–3466 (2013). https://doi.org/10.1111/jocn.12375

    Article  PubMed  Google Scholar 

  6. Rushbrooke, E., Murray, C., Townsend, S.: The experience of intimate relationships by people with intellectual disabilities: a qualitative study. J. Appl. Res. Intellect. Disabil. 27, 531–541 (2014). https://doi.org/10.1111/jar.12091

    Article  PubMed  Google Scholar 

  7. Wilson, N.J., Parmenter, T.R., Stancliffe, R.J., Shuttleworth, R.P.: Conditionally sexual: men and teenage boys with moderate to profound intellectual disability. Sex. Disabil. 29, 275–289 (2011). https://doi.org/10.1007/s11195-011-9203-y

    Article  Google Scholar 

  8. Wilkinson, V.J., Theodore, K., Raczka, R.: ‘As normal as possible’: sexual identity development in people with intellectual disabilities transitioning to adulthood. Sex. Disabil. 33, 93–105 (2015). https://doi.org/10.1007/s11195-014-9356-6

    Article  Google Scholar 

  9. Frawley, P., Wilson, N.J.: Young people with intellectual disability talking about sexuality education and information. Sex. Disabil. 34, 469–484 (2016). https://doi.org/10.1007/s11195-016-9460-x

    Article  Google Scholar 

  10. Lam, A., Yau, M., Franklin, R.C., Leggat, P.A.: The unintended invisible hand: a conceptual framework for the analysis of the sexual lives of people with intellectual disabilities. Sex. Disabil. 37, 203–226 (2019). https://doi.org/10.1007/s11195-018-09554-3

    Article  Google Scholar 

  11. Björnsdóttir, K., Stefánsdóttir, G.V.: Double sexual standards: sexuality and people with intellectual disabilities who require intensive support. Sex. Disabil. 38, 421–438 (2020). https://doi.org/10.1007/s11195-020-09643-2

    Article  Google Scholar 

  12. Schaafsma, D., Kok, G., Stoffelen, J.M.T., Curfs, L.M.G.: People with intellectual disabilities talk about sexuality: implications for the development of sex education. Sex. Disabil. 35, 21–38 (2017). https://doi.org/10.1007/s11195-016-9466-4

    Article  PubMed  Google Scholar 

  13. Yacoub, E., Hall, I.: The sexual lives of men with mild learning disability: a qualitative study. Br. J. Learn. Disabil. 37, 5–11 (2008). https://doi.org/10.1111/j.1468-3156.2008.00491.x

    Article  Google Scholar 

  14. World Health Organization.: Defining sexual health: Report of a technical consultation on sexual health, 28–31 January 2002. World Health Organization. https://www.who.int/reproductivehealth/publications/sexual_health/defining_sexual_health.pdf (2006). Accessed 04 Oct 2020

  15. Thompson, V.R., Stancliffe, R.L., Broom, A., Wilson, N.J.: Clinicians’ use of sexual knowledge assessment tools for people with intellectual disability. J. Intellect. Dev. Disabil. 41, 243–254 (2016). https://doi.org/10.3109/13668250.2016.1164303

    Article  Google Scholar 

  16. Craig, L.A., Stringer, I., Moss, T.: Treating sexual offenders with learning disabilities in the community: a critical review. Int. J. Offender Ther. Comp. Criminol. 50, 369–390 (2006)

    Article  Google Scholar 

  17. Garrett, H.: Development of a community-based sex offender treatment programme for adult male clients with a learning disability. J. Sex. Aggress. 12, 63–70 (2006). https://doi.org/10.1080/13552600600673695

    Article  Google Scholar 

  18. Keeling, J.A., Rose, J.L., Beech, A.R.: An investigation into the effectiveness of a custody-based cognitive-behavioural treatment for special needs sexual offenders. J. Forensic Psychiatry Psychol. 17, 372–392 (2006). https://doi.org/10.1080/14789940600658293

    Article  Google Scholar 

  19. Sakdalan, J.A., Collier, V.: Piloting an evidence-based group treatment programme for high risk sex offenders with intellectual disability in the New Zealand setting. N. Z. J. Psychol. 41, 6–12 (2012)

    Google Scholar 

  20. Wiggins, J., Hepburn, S., Rossiter, R.: Reducing harmful sexual behaviour in adolescents. Learn. Disabil. Pract. 16(8), 16–23 (2013). https://doi.org/10.7748/ldp2013.10.16.8.16.e1447

    Article  Google Scholar 

  21. Murphy, G., Powell, S., Guzman, A., Hays, S.: Cognitive-behaviour treatment for men with intellectual disabilities and sexually abusive behaviour: a pilot study. J. Intellect. Disabil. Res. 51, 902–912 (2007). https://doi.org/10.1111/j.1365-2788.2007.00990.x

    Article  PubMed  Google Scholar 

  22. Sex Offender Treatment Services Collaborative – Intellectual Disabilities (SOTEC-ID): Effectiveness of group cognitive-behaviour treatment for men with intellectual disabilities at risk of sexual offending. J. Appl. Res. Intellect. Disabil. 23, 537–551 (2010). https://doi.org/10.1111/j.1468-3148.2010.00560.x

    Article  Google Scholar 

  23. Glaser, R.: Instructional technology and the measurement of learing outcomes: some questions. Am Psychol 18, 519–521 (1963). https://doi.org/10.1037/h0049294

    Article  Google Scholar 

  24. Galea, J., Bulter, J., Iacono, T., Leighton, D.: The assessment of sexual knowledge in people with intellectual disability. J. Intellect. Dev. Disabil. 29, 350–365 (2004). https://doi.org/10.1080/13668250400014517

    Article  Google Scholar 

  25. McCabe, M.P.: Sexual knowledge, experience, and feelings among people disability. Sex. Disabil. 17, 157–170 (1999). https://doi.org/10.1023/A:1021476418440

    Article  Google Scholar 

  26. Lunsky, Y., Frijters, J., Griffiths, D.M., Watson, S.L., Williston, S.: Sexual knowledge and attitudes of men with intellectual disability who sexually offend. J. Intellect. Dev. Disabil. 32, 74–81 (2007). https://doi.org/10.1080/13668250701408004

    Article  PubMed  Google Scholar 

  27. Talbot, T.J., Langdon, P.E.: A revised sexual knowledge assessment tool for people with intellectual disabilities: is sexual knowledge related to sexual offending behaviour? J. Intellect. Disabil. Res. 50, 523–531 (2006). https://doi.org/10.1111/j.1365-2788.2006.00801.x

    Article  PubMed  Google Scholar 

  28. Thompson, V.R., Stancliffe, R.L., Wilson, N.J., Broom, A.: The content, usefulness and usability of sexual knowledge assessment tools for people with intellectual disability. Sex. Disabil. 34, 495–512 (2016). https://doi.org/10.1007/s11195-016-9458-4

    Article  Google Scholar 

  29. Lindsay, W.R.: Research and literature on sex offenders with intellectual disabilities. J. Intellect. Disabil. Res. 46, 74–85 (2002). https://doi.org/10.1046/j.1365-2788.2002.00006.x

    Article  PubMed  Google Scholar 

  30. Keeling, J.A., Rose, J.L., Beech, A.R.: A preliminary evaluation of the adaptation of four assessments for offenders with special needs. J. Intellect. Dev. Disabil. 32, 62–73 (2007). https://doi.org/10.1080/13668250701378538

    Article  PubMed  Google Scholar 

  31. Liou, W.: An illustrated scale measuring the sexual abuse prevention knowledge of female high school students with intellectual disabilities in Taiwan. Sex. Disabil. 32, 135–151 (2014). https://doi.org/10.1007/s11195-013-9312-x

    Article  Google Scholar 

  32. Hair, J.F., Black, W.C., Babin, B.J., Anderson, R.E., Tatham, R.L.: Multivariate data analysis, 6th edn. Prentice-Hall, Upper Saddle River (2006)

    Google Scholar 

  33. Merchant, K.A.: Organizational controls and discretionary program decision making: a field study. Account. Organ. Soc. 10, 67–85 (1985). https://doi.org/10.1016/0361-3682(85)90032-7

    Article  Google Scholar 

  34. Green, S.B., Salkind, N.J., Akey, T.M.: Using SPSS for windows and macintosh: analyzing and understanding data, 4th edn. Prentice Hall, Upper Saddle River (2005)

    Google Scholar 

Download references

Funding

This research project was funded by the Ministry of Science and Technology (MOST) of Taiwan, as project number 104–2410-H-415–027.

Author information

Authors and Affiliations

  1. Department of Education, National Chiayi University, No. 85, Wenlong Village, Minhsiung Township, 62103, Chiayi County, Taiwan, Republic of China

    Wen-Ying Liou

Authors
  1. Wen-Ying Liou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wen-Ying Liou.

Ethics declarations

Conflict of interest

The author has no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

Items of the Six Subscales

Puberty and Physiology

  1. 1.

    (1) Which is the correct way for a male to protect his penis and scrotum? ➀Wearing loose pants. ➁Deliberately allowing the penis and scrotum to be struck when playing games. ➂Wearing tight pants.

    figure a
  2. 2.

    (2) Which of these physical changes occur when a female reaches puberty?➀ Growth of the Adam's apple. ➁Growth of pubic hair. ➂Nocturnal emissions.

    figure b
  3. 3.

    (1) Which is the best way to deal with a boy’s nocturnal emission? ➀ Changing into clean underwear and washing the wet underwear. ➁ Continuing to sleep, letting the semen dry by itself. ➂ Drinking plenty of water.

    figure c
  4. 4.

    (2) Which statement is correct? ➀Boys menstruate during puberty. ➁It is normal for boys to have nocturnal emissions. ➂When the foreskin of a boy’s penis is soiled, it does not need to be cleaned.

    figure d

Body Boundaries

  1. 5.

    (3) In which case is it okay for someone to touch my private parts? ➀When my father sleeps with me. ➁When the teacher helps me to get dressed. ➂When being examined by the doctor in the presence of the nurse.

    figure e
  2. 6.

    (3) Where can you masturbate? ➀School. ➁Cafeteria.➂Own room.

    figure f
  3. 7.

    (1) Which of the following is a way of respecting the privacy of others? ➀Closing the door when using the toilet. ➁Touching someone’s breasts. ➂Watching others take a shower.

    figure g
  4. 8.

    (2) Under what circumstances can you masturbate? ➀When together with many people. ➁When you are alone in your own room. ➂During class.

    figure h
  5. 9.

    (2) Which one is proper behavior among friends? ➀Hiding and peeking at a friend when he is peeing. ➁Dressing neatly when meeting a friend. ➂Masturbating in front of friends.

    figure i

Proper Touching

  1. 10.

    (2) What kind of behavior is appropriate with a female acquaintance? ➀Sexual intercourse. ➁Shaking hands. ➂Touching her crotch.

    figure j
  2. 11.

    (2) Which of the following behavior is wrong? ➀John accidentally fell and brushed against Mary’s breasts. ➁Male classmates playfully touching each other’s penises. ➂Dropping my pants to receive an injection from a nurse when another nurse is present.

    figure k
  3. 12.

    (3) Which behavior is proper? ➀I can touch another’s body if I want to. ➁I am the master of my body, so it’s OK to show my private parts to others. ➂I am the master of my body, therefore I should not let other people touch my body without a good reason.

    figure l
  4. 13.

    (3) What should I do if my male classmate touches my buttocks? ➀Both of us are male, so it’s okay. ➁It’s fun, so it’s okay. ➂Tell him that it’s wrong, and to not do it again.

    figure m

Proper Relationships

  1. 14.

    (2) Which of the following behavior can you do when on a date with a girlfriend? ➀Forcibly touch her thigh. ➁Hold hands. ➂Forcibly kiss her.

    figure n
  2. 15.

    (1) When you are in an intimate relationship with a girl, it’s important for you both to respect each other. Which of the following is respectful behavior? ➀Being on time for a date, and informing her beforehand if you can’t keep the date. ➁If I like a girl, I can touch her body. ➂If a girl doesn’t like me, I can force her to like me.

    figure o
  3. 16.

    (1) Which of the following can you do when dating a girlfriend? ➀Arrange her chair when sitting down. ➁Coerce her into having sex. ➂Stare at her breasts.

    figure p
  4. 17.

    (3) Amongst the following people, which is appropriate for dating? ➀My teacher. ➁My mother. ➂A classmate of similar age.

    figure q

Sexually Transmitted Diseases (STD)

  1. 18.

    (1) Regarding condoms, which of the following is correct? ➀When properly used, condoms provide effective protection against STDs. ➁Condoms have no expiration date; when unopened, they can be used forever. ➂It is wasteful to use a condom only once; it’s okay to keep a used condom and use it next time.

    figure r
  2. 19.

    (1) Which is an effective way to prevent the spread of AIDS? ➀Safe sex. ➁Vaccinations. ➂Lots of exercise.

    figure s
  3. 20.

    (1) Which of the following can transmit the AIDS virus? ➀Sexual intercourse. ➁Attending class together. ➂Hugging.

    figure t
  4. 21.

    (1) Regarding STDs, which of the following is correct? ➀People who have an STD should not engage in unsafe sexual activities, so as to avoid infecting others. ➁People who get STDs will get well without seeing a doctor. ➂An STD can’t be transmitted by having sex only once.

    figure u

Sex and the Law

  1. 22.

    (3) Which of the following is illegal? ➀Playing dolls with a male classmate. ➁Shaking hands with a female classmate. ➂Pulling down a girl’s skirt and making her scream in fright.

    figure v
  2. 23.

    (1) Which of the following is illegal? ➀My uncle patting my butt without my permission. ➁My aunt touching my forehead to see if I have a fever when I feel sick. ➂My grandpa pinching my face and saying that I am cute.

    figure w
  3. 24.

    (3) Which of the following is not a form of sexual harassment? ➀Lifting up the skirt of a female classmate. ➁Telling dirty jokes.➂ Holding my girlfriend’s hand while taking a walk together.

    figure x
  4. 25

    (2) Which of the following is correct behavior when using the internet? ➀Giving my phone number and address to anybody who asks for it. ➁Being polite when interacting with people online. ➂Agreeing to go on a date alone.

    figure y
  5. 26.

    (2) Which of the following is illegal to post on the internet? ➀A love letter. ➁Nude photos. ➂A photo from a trip with my girlfriend.

    figure z

Deleted Items of the Six Subscales

Puberty and Physiology

  1. 1.

    3) Which picture represents a boy?

    figure aa
  2. 2.

    (1) Which organ is the male’s reproductive organ? ➀Penis. ➁Fallopian tube. ➂Uterus.

    figure ab
  3. 3.

    (1) Which of these physical changes does a male have during puberty? ➀Growing a beard. ➁Breasts getting bigger. ➂Onset of menstruation.

    figure ac
  4. 4.

    (2) What should a girl do when she has menstrual cramps? ➀Do strenuous exercise. ➁Get plenty of rest. ➂Drink plenty of ice-cold water.

    figure ad

Body Boundaries

  1. 5.

    (2) Which one is not a private part of the body? ➀Buttocks. ➁Arms. ➂Genitals.

    figure ae
  2. 6.

    (3) Which behavior is a private act that should not be seen by others? ➀Playing basketball. ➁Going to school. ➂Changing underwear.

    figure af

Proper Touching

  1. 7.

    (1) What is an effective way to avoid pregnancy when having sex? ➀Using a condom. ➁Taking a shower after sex. ➂Exercising more often.

    figure ag
  2. 8.

    (1) In which kind of relationship is hugging and intimate kissing okay? ➀A man and woman with deep feelings for one another. ➁Ordinary classmates. ➂Father and daughter.

    figure ah

Proper Relationships

  1. 9.

    (3) You like a girl, but that girl doesn't like you. What is this called? ➀Sexual assault. ➁Being in love. ➂Unrequited love.

    figure ai
  2. 10.

    (3) Which of the following places is proper for a date? ➀A remote place in the countryside. ➁My bedroom. ➂A park with lots of people.

    figure aj

Sexually Transmitted Diseases (STD)

  1. 11.

    (2) What should I do if my reproductive organs become painful? ➀Apply toothpaste. ➁See a doctor immediately. ➂What a shame it is. Don’t tell anybody.

    figure ak
  2. 12.

    (2) Which is not a symptom of a sexually transmitted disease? ➀Genital pain. ➁Increased height. ➂Urinary pain.

    figure al
  3. 13.

    (1) What should I do if I get an STD? ➀See a doctor for treatment. ➁Drink plenty of water. ➂Get sufficient sleep.

    figure am

Sex and the Law

  1. 14.

    3) Which of the following is respectful behavior? ➀If I like a classmate, I can touch her body if I want. ➁Ridiculing a boy who likes playing with dolls. ➂Arriving on time for a date.

    figure an

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liou, WY. A Pictorial Sexual Knowledge Scale for Male High School Students with Intellectual Disabilities in Taiwan. Sex Disabil 40, 623–649 (2022). https://doi.org/10.1007/s11195-022-09750-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11195-022-09750-2

Keywords

Search

Navigation