Problematic sexual behaviors of adolescents with intellectual disability in Saudi Arabia: uncovering the hidden

Abstract

Problematic sexual behaviors signal the need to understand the thoughts and needs of adolescents with intellectual disability. This study investigates the experiences of the family members and teachers who must manage those issues. We employed a hermeneutic phenomenological approach to gain insight into the thoughts and perceptions of two mothers, three brothers, and seven teachers. We conducted in-depth, semistructured interviews and convened focus groups to collect data. The findings refer to the following themes: the forms that problematic sexual behavior takes, the feelings that are associated with it, its management, the detection of aberrant conduct, the identification of its causes, and suggestions for improvements. The findings may refine the academic understanding of the behaviors in question, of their causes, of the experiences of relatives and teachers, and of the means of addressing the attendant problems. This study may also prove useful to family members and teachers of individuals with intellectual disability. Further implications and recommendations that emerge from the findings are also discussed.

Introduction

Individuals with intellectual disability have the same sexual needs as those without disabilities. However, limited awareness and poor sex education can cause behavioral issues. Researchers have previously reported on insufficient knowledge about sexuality and limited access to sex education among adolescents with intellectual disability in recent years (e.g. Björnsdóttir and Stefánsdóttir 2020, Bloor et al. 2022, Chrastina and Večeřová 2020). Adolescents with intellectual disability may become victims of sexual exploitation or inadvertently engage in inappropriate sexual behavior toward others. According to Goli et al. (2022), this group of adolescents is twice as likely to be vulnerable to sexual abuse. Another recent study found that one-third of individuals with intellectual disability have been victims of sexual abuse during adolescence (Tomsa et al. 2021). These issues are even more dangerous, complicated, and difficult to resolve because adolescents with intellectual disability are usually less likely to report sexual abuse and related matters (Chave-Cox 2014, Fogden et al. 2016). Ignorance can also result in sexual and behavioral issues. The relevant behaviors include but are not limited to coercion, aggression, violence, and age-inappropriate actions and words (Department for Education and Child Development 2016). The conduct in question can occur among adolescents with intellectual disability or between them and adolescents without disabilities.

Studies have shown that these issues are not easy for teachers and parents to overcome, face, or even understand (Alzahrani and Abu-Alghayth 2022; Draugedalen 2021, Ey et al. 2017). Accordingly, researchers have recently begun to show more interest in the subject. For instance, Draugedalen (2021) investigated the extent to which teachers are aware of and understand those problems as they occur among primary-school students with intellectual and other disability. The results, which drew on 159 survey responses, indicated deficiencies in understanding and knowledge, as well as difficulties with the management of the problems in question. This gap between students and teachers merits further investigation. Ey et al. (2017) concluded that teachers can identify some but not all problematic behaviors. These results reflect a) the complexity of problematic sexual behaviors among children, b) teachers’ poor understanding of these behaviors and their inability to manage them, and c) the need to address these concerns by studying the experiences of students and teachers.

In this study, we use the term ‘intellectual disability’ to refer to ‘a disability characterized by significant limitations in both intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills. This disability originates before the age of 18’ (Schalock et al. 2010, p. 1). This definition of the American Association on Intellectual and Developmental Disabilities (AAIDD) has been adopted by the Ministry of Education in Saudi Arabia to refer to individuals with intellectual disability (Ministry of Education 2016).

Common problematic sexual behaviors

The nature of problematic sexual behavior among individuals with intellectual disability has been the subject of several recent studies (e.g. Björnsdóttir and Stefánsdóttir 2020, Sala et al. 2019, Stein et al. 2018). The behaviors can be classified into two groups: those directed toward individuals with intellectual disability (who are the victims) and those directed toward others. In the former case, the probability of sexual abuse, violence, and exploitation is unusually high (Goli et al. 2022, Rushbrooke et al. 2014, Stein et al. 2018). Adolescents with intellectual disability had the highest victimization rate between 2011 and 2015 (Harrell et al. 2017). Fisher et al. (2016) wrote that individuals with intellectual disability experience rape and sexual assault more often than others, and four of the seven teachers interviewed by the author reported that their female students with intellectual disability had been raped, sexually assaulted, or exploited by close relatives and by neighbors. They had also been misinformed about sexual matters by similarly aged friends without disabilities. These findings highlight the need to study the causes of these developments more extensively. Problematic sexual behaviors can also be directed at peers with or without disabilities or even at the individual with an intellectual disability themselves. Recent studies have identified several such problematic behaviors (e.g. Akrami and Davudi 2014, Goli et al. 2022, McDaniels and Fleming 2016). Akrami and Davudi (2014) found the issue to be more widespread among male adolescents than among female ones. Public masturbation and exhibitionism are common issues, particularly among males. Akdemir (2022) reported that the most common forms of this conduct include sexual touching, masturbation, and undressing. The teachers who participated in that study reported difficulties with understanding and managing such behaviors. The thoughts and needs of adolescents with intellectual disability must be examined carefully if appropriate responses are to be devised.

Sexual behavior internationally and in the Saudi context

In recent years, much noteworthy international research has been published on sexuality among adolescents with intellectual disability (e.g. Björnsdóttir and Stefánsdóttir 2020, Chrastina and Večeřová 2020, Goli et al. 2022, Sala et al. 2019). This research covers various countries, including the US, the UK, Spain, the Republic of Ireland, Norway, Iran, Sweden, Taiwan, South Africa, Sri Lanka, Canada, and the Netherlands, and focuses on sexual behavior and sexual abuse. Adolescents with intellectual disability generally share the same sexual issues as other adolescents, regardless of geographical setting. In Saudi Arabia, talking to students or family members about adolescent sexuality in public or even as part of a research project may clash with traditional values. Saudi parents are generally reluctant to speak to their children about such topics (Alzahrani and Abu-Alghayth 2022), and sex education is unavailable. To the best of our knowledge, only a single study has investigated these topics in the last decade (Alzahrani and Abu-Alghayth 2022). A review of the Arabic literature reveals that the same is true of a number of countries in the region (e.g. Attarawneh 2018, Bakhit 2014, Tabnjat and Shnekat 2018).

In Saudi Arabia, Alzahrani and Abu-Alghayth (2022) conducted a qualitative study to investigate sexual problems among female adolescents with intellectual disability, as well as to unearth their causes. The study focused on the perspectives of teachers. The results were surprising—rape, sexual assault, masturbation, and inappropriate and illegal relationships occur in schools. Interestingly, the teachers attributed these occurrences to external causes, such as teenage girls obtaining unsupervised access to mobile phones or failure to discuss sexuality or sexual behavior within the family unit. Both the problematic sexual behaviors and their potential solutions remain poorly understood. The present study attempts to fill this gap by examining those behaviors in and out of schools; identifying their causes; and, more importantly, analyzing the experiences of families and teachers. The results may contribute in several ways to our knowledge of problematic sexual behaviors among adolescents with intellectual disability, provide a deeper understanding for families and teachers who must manage such behaviors, and help decision-makers at the Ministry of Education who may consider helping teachers manage the behaviors through continuous training programs. The findings may also encourage further research to shed light on other issues related to sexual behaviors among adolescents with intellectual disability.

The following research questions were addressed in this study:

1. How do the participants describe the problematic sexual behaviors that adolescents with mild to moderate intellectual disability exhibit?

2. How do the participants experience the management of the problematic sexual behaviors of adolescents with mild to moderate intellectual disability?

3. How do the participants describe the causes of problematic sexual behaviors?

4. What measures do the participants deem critical for the management of problematic sexual behaviors?

Methods

Drawing on Heidegger’s (1927, 1962) philosophy of the lived experiences of humans, we employed a hermeneutic phenomenological approach (van Manen 1997). Heidegger believed that a lived experience is usually understood through interpretation (Dahlberg et al. 2008). As such, we needed to interpret the lived experiences of the participants (van Manen 1997). The nature of the investigation and the traditions and values of the society in which it unfolded are such that we had to expend much interpretative effort. We expected some participants, especially mothers, to be uncomfortable with discussing the sexual behaviors of their daughters; the implicit consequently predominated in the descriptions that they provided.

Sampling, data collection, and analysis

Recruiting participants was difficult due to the topic, questions, and need to ensure that participants would only be interviewed by individuals of the same gender. However, we employed eligibility criteria to ensure that the participants understood the phenomenon that they would be asked to describe (Creswell 2015). We utilized purposeful snowball sampling (Patton 2015) to ensure conformity with eligibility criteria. Some of the participants were related to adolescents with intellectual disability and were living in the same households as them. Such participants were only recruited if they had experienced problematic sexual behaviors on the part of their relatives with intellectual disability. The teachers who participated needed to have at least seven years of experience teaching adolescents with intellectual disability at a public school or an institute that provides services to individuals with intellectual disability. We also required the teachers to have managed problematic sexual behaviors in the past. Furthermore, we recruited teachers and family members of adolescents with only mild to moderate intellectual disability. In the interviews, we asked participants to confirm the level of intellectual disability that adolescents had been diagnosed with.

After obtaining permission from (anonymous) to conduct interviews and convene focus groups, we sent a WhatsApp message explaining the purpose of the study, criteria, and interview protocol to three teachers who met the criteria. They all agreed to participate. Following each interview, we asked the participant if they would be willing to share the protocol and message with other individuals meeting the eligibility criteria. Eventually, this process led us to two mothers, three brothers, and seven teachers who agreed to be interviewed. For the focus groups, after the first round of analysis, we sent the protocol to all participants before the discussion. Only three teachers agreed to participate in the first focus group, and only three brothers agreed to participate in the second.

The main source of data in this study was a series of in-depth, semistructured interviews conducted virtually using FaceTime or Zoom, depending on the preferences of the participants. They were recorded digitally and verbatim and transcribed by a private service provider. The second author, who is female, interviewed the female participants (mothers and teachers), and the first author, who is male, interviewed the brothers and male teachers. We believed that this measure would make the participants more comfortable and enable them to express themselves freely on a sensitive topic. We obtained the informed consent of all participants prior to the commencement of the interviews. We also organized focus groups. One of our aims was to return to the participants in the focus groups after a first round of analysis to arrive at more profound insights. The two discussions lasted approximately 60 min each. They were conducted through Zoom, digitally recorded, and transcribed verbatim.

Inspired by van Manen (1997), the meaning and essence of participants’ lived experiences were analyzed and interpreted following a hermeneutic phenomenological approach. This process of analysis included frequent and holistic readings of all transcripts; both parts of the dataset and the dataset as a whole were examined to seek in-depth meaning and understanding of participants’ lived experiences and become familiar with the content (Patton 2015, van Manen 1997). To uncover thematic aspects of these experiences, we next highlighted essential and notable statements and phrases related to the phenomenon, which were singled out and isolated (van Manen 1997). Highlighted statements were then coded and given descriptions expressing the initial meaning of participants’ experiences. To better understand emerging themes and uncover ‘knots in the webs’ (van Manen 1997, p. 90) in the lived experiences, all themes and sub-themes were constantly reread, written, and rewritten in an iterative analytical process. This dynamic of analysis and reflective reading and writing enabled the identification and refinement of the final structure of the phenomenon and eventual capturing of the essence.

Ethical considerations

Due to the nature and context of the study, we adopted several measures to ensure compliance with ethical rules. As indicated previously, the participants were interviewed by researchers of the same gender as themselves. Moreover, during the interviews and the focus-group discussions, we did not try to push participants to complete phrases when they hesitated to do so or when we understood what they meant. More importantly, we obtained the informed consent of all participants prior to collecting their data.

Trustworthiness

To ensure objectivity, one researcher reviewed the literature while the other collected data. We set aside our preconceptions about the object of the study and tried to approach it with open minds (Moustakas 1994). Figure 1 displays further details that pertain to trustworthiness.

Figure 1.

Trustworthiness.

Results and discussion

Theme I: forms of problematic sexual behavior

The participants reported on the types of sexual and behavioral problems that they had observed among adolescents with intellectual disability, which the adolescents would direct at themselves or at others. Some adolescents had also been on the receiving end of sexually problematic conduct. The summary of all results is presented in Figure 2.

Figure 2.

Themes and sub-themes resulting from analysis of participants' lived experiences.

Self-oriented behaviors

The analysis of the data showed that sexual behavioral problems can be, among others, verbal, communicated through hints or signals, and explicit. One of the teachers, Faisal, said, ‘In my six years of teaching experience, I have faced more than 20 issues concerning sexual behaviors, including abuse from home, outside, and school’. The participants agreed with the threefold classification of behaviors presented above. The self-oriented behaviors included the adolescent touching their private areas in front of others and masturbating digitally or through the use of tools such as pens. According to one of the teachers, Ali, ‘The most aggressive behavior [is] masturbation and touching sensitive areas. The thing I noticed most in secondary school is that they tend to act out more’. The other teachers also observed that adolescents in secondary school are more likely to exhibit behavioral problems that take the form of actions rather than words.

Ahmed, the brother of an adolescent with an intellectual disability, said that ‘at the beginning, his… behavior was just directed toward himself, touching his private areas and saying some sexual words’. Leen, a teacher, said that ‘there was a female student practicing masturbation in front of other people’. According to participants, there were no general gender differences in the self-oriented behaviors. Recent studies have reported similar findings (e.g. Akdemir 2022;  Alzahrani and Abu-Alghayth 2022). The adolescents in the present research, unlike those in other relevant studies, sometimes performed the aberrant behaviors in front of their peers and teachers. The teachers indicated that adolescents in secondary school were more likely to act in this manner and that the conduct in question occurred between both genders. Conversely, Akrami and Davudi (2014) found problematic sexual behavior to be more common among males than females.

Behavior directed at others

Adolescents with intellectual disability also engage in sexual behaviors that are directed at their peers, teachers, and relatives, among others. The mothers and teachers agreed that such problematic sexual behaviors were observed in both genders but would take the form of sexual acts chiefly among males. Faisal said, ‘I noticed that he [the adolescent] pointed at other students’ and teachers’ sensitive areas’. Reem, also an educator, was surprised by the behavior of one student: ‘She [the adolescent] made some gestures with her finger behind us, the teachers, and we were surprised because it was a nonspontaneous movement’. She added that ‘two of them [the adolescents were] kissing each other secretly and in a strange way’. In addition, the participants indicated that the adolescents also acted in this fashion with their relatives. For instance, Fatimah, the mother of an adolescent with an intellectual disability, said, ‘Our daughters began to say very dirty words to us, and I alerted the teachers’.

Adolescents with intellectual disability as targets of sexually problematic behavior

Problematic sexual behavior directed at adolescents with intellectual disability is highly dangerous and difficult to detect. They are often victims of sexual harassment or abuse by students (with and without disability), relatives, and servants. As noted in the literature, these adolescents are twice as likely to be sexually abused as others (Goli et al. 2022). Nawal, a mother, also said, ‘My poor daughter goes to school, and she does not know anything. The girls are holding her, kissing her, and hugging her, and she does not understand why the teacher is preventing them and her from doing this’. One of the teachers, Amal, said, ‘One of the students was sexually harassed by one of her relatives, and then she acquired the masturbation habit… through the harasser in the family’. The foregoing accords with the results from Tomsa et al.’s (2021) study. They found that one in three adolescents with intellectual disability had been a victim of sexual abuse in some form.

Theme II: managing the problematic sexual behaviors

Behavior management

Family members’ reactions

The teachers thought that the reactions of the families were varied. Some could be harsh. They would use threats and administer corporal punishment. For instance, Reem said, ‘The mother started threatening her daughter in front of us, a very strong threat of beating and harassing… I mean, families are different’. Another participant, Amal, reported that teachers employ the same strategies: ‘Some teachers use the method of threatening and intimidating the student, and you know that even a look can be harmful. It is possible that the girl will continue to make mistakes 10 times behind your back’.

The teachers also explained that some families were understanding of their adolescents’ sexual behaviors; however, they did not always take them seriously. In those cases, no action would be taken. For instance, according to Ali, ‘I sat with a father and talked to him, and I was surprised that he was laughing at the behaviors that I told him about; he never took it seriously’. Fatimah explained that the reaction of her family members depended on the conduct—they did not always feel compelled to react to minor incidents such as the use of profanities. The measures that are adopted to manage sexual behaviors among adolescents with intellectual disability depend on several factors. The teachers who participated would focus on the causes of the behaviors and on their form. Much also depended on the personality of the teacher; they reported relying on counseling, psychologists, and, in some cases, the school administration.

Difficulties

Families and teachers often face difficulties, such as deficits in knowledge about sexual matters and poor collaboration. According to one of the teachers, Fahad, ‘There are teachers who did not even know that such sexual behaviors existed among students, and that is considered a difficulty’. Two recent studies have reported similar findings (Alzahrani and Abu-Alghayth 2022; Draugedalen 2021). A lack of knowledge makes it difficult for educators to address behaviors and collaborate with families. The two mothers whom we interviewed indicated that they sometimes did not know how to react and asserted that schools should fulfill their duties and help families. Conversely, the teachers said that families often fail to collaborate with behavior modification plans. The matter appeared to be complex, and the responses presented here reflect a small set of personal experiences. As such, further research into the matter should be conducted. Yazid, the brother of an adolescent with an intellectual disability, said that he, as a brother, had discussed sexual behaviors with a teacher on several previous occasions. Yazid believed that direct contact was helpful, especially if the siblings were close to each other.

Traditions

The participants believed that, despite the importance of research on problematic sexual behaviors, tradition obscures some elements of the problem. The participants noted that discussions of the topic are infrequent and sensitive. Fatimah said, ‘The subject is as important as it is sensitive’. According to Reem, ‘This subject is a completely hidden aspect, and it is supposed to appear because it is part of the adolescents’ lives and it is a sensitive part’. She claimed that Arabic families ‘usually fear for their daughter’s reputation’. We believe that the poor collaboration between schools and families may lead to an increase in the incidence of such behavior at home and in public. It is thus possible that traditional values help neither the adolescents nor their families.

Shame and silence were also problematic for the participants. Rana, one of the teachers, said, ‘I noticed a lot of shyness in teachers when they started talking about those behaviors’. Ambiguous situations, such as the appearance of signs on the adolescent’s body, were also a cause for concern. Rana continued, ‘Sometimes, signs appear on the student’s body, and as a teacher, I cannot write a medical report or transfer her to a hospital or somewhere else. It is out of my hands’. Sounds that come from behind closed doors can also be concerning. Leen gave the following example: ‘We teachers always talk about suspicions we have that masturbation is occurring in the bathroom, but we are not sure about [it] ’. She added, ‘Because we are not really sure they do it in the bathroom, we think that it is difficult to report it to the families; reporting it would solve nothing’. Those behaviors cannot be addressed by schools alone—families should always participate in behavioral modification plans.

Behavior feelings associated with sexual behavioral problems

Problematic sexual behavior evoked numerous sentiments, including fear and compassion. Both the mothers and teachers reporting feeling such emotions continuously. Reem, the teacher who commented on the girl who had made gestures with her finger and engaged in other problematic sexual behaviors, said, ‘I have not seen her since then. I don’t know what happened to her, I mean, she was a victim. Maybe God knows what the consequences of these behaviors were’. She continued, ‘We, the teachers, can sometimes control… the problematic sexual behaviors, but sometimes it is out of our hands; we cannot protect them, the adolescent’. Fatimah said, ‘As a mother, whether my daughter has a disability or not, this [the problematic sexual behaviors] is scary’. When the participants spoke about the behaviors, they were compassionate and merciful. For example, Reem said, ‘You really feel for them’. She added, ‘The student is basically a victim in the end, whatever the behavior or reasons’.

This study provides evidence of the role of fear and anxiety in behavior management. Our literature review indicates that previous studies have failed to account for the feelings that the sexual behaviors of adolescents with intellectual disability induce in others. The feelings of the adolescents about the activities in question are more important, but they exceed the scope of this study.

Theme III: causes of behaviors

Exposure to harassment

The participants unanimously agreed that direct exposure to harassment is one of the most significant causes of sexual problems among adolescents. Exposure enables adolescents to learn and imitate behaviors. Am’al said, ‘I figured out that the student who was saying bad words to me and other teachers was told the same words by her older brother’. She added that another student had been harassed by one of her relatives, who had taught her masturbation, which she then began to practice in public. Ali gave the following example: ‘He practiced the behavior of masturbation with someone, and it became entrenched in his mind, and he forgot the source of this behavior. Who taught him? How did it begin?’ Many of the suspected perpetrators of harassment are servants and drivers. Reem explained, ‘A girl with Down syndrome is often left with the maid, and clearly, she is subjected to something inappropriate due to her behaviors and the words she says; her accent is similar to the maid’s’.

Observation of behaviors

Observation of a behavior was also reported to be a cause. Nawal indicated, ‘As for sexual behaviors, when I notice something such as those behaviors, I always see who the last person my daughter was with was, because she imitates imaginatively’. Reem also stated, ‘When a student exhibits a sexual behavior, they are imitating the same behavior [that they witnessed elsewhere] ’. Technology also leads to imitation. Rana said, ‘Some families, whom I know, leave their adolescents watching TV shows unattended, then adolescents imitate behaviors they see on the screen’. Leen reported, ‘[The adolescent] has a phone, and she can open… YouTube and watch any time she wants’. Imitation is common in adolescence, so it is important that families pay attention to their adolescent children and their friends and that they provide them with an optimal environment. Naser, whose brother is an adolescent with an intellectual disability, said, ‘My brother learned the dirty words from both his friend and TV shows’. The teachers reported that age difference plays a significant role. Adolescents of different ages, such as 18 and 13, study in the same classrooms, which makes it easier for the younger ones to learn new problematic behaviors and words from their elder peers; the imitation effect discussed above is thus amplified.

Attention

The participants indicated that problematic sexual behaviors, especially verbal ones, are performed for a clear reason, which is to attract attention. Amal said, ‘An elementary female student utters obscene words at me to get my attention, if she is angry and wants something’. Faisal gave another example: ‘I have a student who exhibits sexual behaviors and speaks bad words. Those behaviors increased, and he took an advantage of it; he did this so other students would pay attention to him’. This tendency can be relevant to the behavior modification plans that teachers introduce to address such issues. Unfortunately, the teachers did not identify any strategies that can sever the link between problematic behaviors and attentional demands.

Impunity due to disability

The teachers believed that the problematic sexual behaviors may have resulted from the impunity that the adolescents enjoyed because of their intellectual disability. Fahad explained, ‘The student goes to complain to the counselor or to the school principal, and they say ‘okay, this student [has] special needs, and he should be not held accountable’. According to Fahad, ‘Taking his disability as an excuse has supported him and made him strong’. A sense of impunity may intensify the sexual behaviors. However, more research is needed to understand the problem from the perspective of the adolescents who engage in such actions.

Boredom and free time

The mothers and teachers believed that adolescents with intellectual disability may exhibit problematic sexual behaviors when they are bored and have excessive free time. Amal said, ‘In high school, I see a lot of [problematic sexual behavior], and I noticed that they always have free time that they do not know how to fill, so they [perform] such behaviors’. Reem gave the following example: ‘When a student is sitting empty handed, then she begins to practice certain behaviors’. The foregoing may explain why some students masturbate at school or in front of others. However, keeping adolescents busy during the school day may not solve the problem because they can practice the same activities at home. Therefore, it is critical that plans to keep adolescents engaged should account for time both at home and at school.

Absence of sex-education

According to the participants, the absence of sex education in school curricula is a source of difficulty. Knowledge of avoidance strategies, boundaries in interpersonal interaction, and sensitive domains are lacking, as is awareness of one’s reactions to harassment. Fahad said,

The sexual problems that the student falls into and does [are] a result of not teaching him about the sensitive areas. As a teacher, you give him drawings that explain to him, for example, when a student comes behind you or you stand closely right behind a student, for example, pay attention to your clothes, so no one takes [them] off. Things like this, when the student learns, prevent some of those behaviors.

Amal indicated, ‘Neither in the primary curricula is there… sex education, nor in the high school curricula. There were some awareness initiatives, but they were very few’. Reem added, ‘The curricula never contain any points for [improving] a student’s sexual education, for example, the prohibited places [on] her body, and so on’.

Awareness of behaviors

The analysis of the data also shed light on whether the adolescents have awareness regarding their problematic sexual behaviors and how this may lead to those behaviors. Participants spoke about two factors related to awareness that may lead to such behaviors, namely age and the severity of the intellectual disability. The participants believed that some teenagers may be unaware of the aberration of their actions. Faisal said, ‘The student with intellectual disability exhibit[s] some of… the problematic sexual behaviors while I am looking at him, which means that he does not take my presence into account’. Verbal behaviors were enacted repeatedly in the presence of teachers, and the adolescents usually did not understand the meanings of the words that they used. Amal said, ‘Most girls say words they learned at home, and they don’t even know what [they mean] ’. Those with moderate intellectual disability were typically unaware of the problematic sexual behaviors because they were merely imitating actions that they had seen elsewhere. In similar cases, adolescents with intellectual disability may exhibit more behaviors or more words as a result of the absence of awareness. Amal also reported, ‘Mostly unaware people touch the sensitive area openly and normally, especially those with moderate disability’. Generally, the results indicate that the occurrence of the behaviors is also related to puberty. According to Ahmed, ‘It varies according to the stage of puberty or pre-puberty. After puberty, they are usually aware of the behaviors and begin to have changes that they feel and realize’. Several researchers have also found that a lack of awareness and knowledge regarding sexual behaviors exists among adolescents with intellectual disability (Björnsdóttir and Stefánsdóttir 2020, Bloor et al. 2022, Chrastina and Večeřová 2020).

Conversely, adolescents with mild intellectual disability were usually aware of their behaviors. Amal, speaking on such students, said, ‘They certainly realize those behaviors… sometimes when we confront them, they deny and cry—she is aware that her behavior is wrong’. Faisal said, ‘There was a smart boy who understood all street language. He does not miss anything from street language, and this is what makes it difficult to deal with’.

Theme IV: suggestions

The participants provided a number of suggestions for limiting the incidence of problematic sexual behaviors and for assisting families and teachers who confront such issues.

Caring and emotional fulfillment

The participants spoke about the importance of contentment. They also suggested promoting positive behaviors and satisfying the emotional needs of adolescents, such as the need to feel loved, safe, and cared for by one’s family members and teachers. Reem said, ‘The point of attention and emotional satisfaction is [very important] in rescuing children and adolescents with intellectual disability from sexual behavioral deviations’.

Antiharassment law

The participants emphasized the need to enforce antiharassment laws and raise awareness of their existence, especially among adolescents with intellectual disability. Fatimah said, ‘If my daughter faced being sexually harassed, whether it was physically or verbally, she knows that this is wrong and that this person must be punished, and she understands this’. Rana added, ‘Currently, the Kingdom has put in place laws that I find good to protect them from harassers’.

Sex-education curricula

The results highlight the importance of including sex education in school curricula. The participants believed that it is critical to educate adolescents and their families about sexual behavior, sexual harassment, normal and abnormal relationships, and the means of preventing issues and confronting perpetrators. Fatimah said, ‘Sex education is excellent. I have registered my daughters in courses like this outside school, and I wish there were curricula in school’. According to Fahad, ‘I ask that this be added to the curricula from the elementary level, from the beginning, so that children with intellectual disability are not exploited’. Yazid believes that ‘teaching [such adolescents], especially teenagers, about sexual behaviors would be beneficial for them and for us as families’.

Raising awareness of family members

Participants believe that family members are at the core of prevention and remedial measures, which can be implemented through the monitoring of adolescents and through cooperation with schools. Therefore, families should always know how to manage the problematic sexual behaviors that their children may exhibit. According to Amal, ‘The family is the first and last axis. We revolve around the family because they are the strongest link when it comes to this issue’. According to Fahad, ‘Some families do not have experience in the sexual development of individuals with intellectual disability. They imagine that students with intellectual disability do not develop sexually’. Nawal said, ‘Sometimes, it is about teachers; when the teacher communicates and tells the family, the family then becomes aware, and then the adolescent becomes aware and educated’. It is evident from the responses that teachers and families must communicate and co-operate. According to Faisal, ‘There should always be continuous communication between teachers and families to raise awareness’.

Team availability

The teachers indicated that multidisciplinary teams must be introduced at schools so that sexual behavior can be confronted. A teacher, if acting alone, cannot develop and implement plans. The teams should include a psychologist, a specialist on social services, a student counselor, an expert on behavior modification, a doctor, a language-and-speech specialist, and other professionals who can contribute adequately, as well as teachers and school principals. Ali said, ‘I see the necessity of the role of a psychology specialist who works in school only [on] resolving behavioral problems’. Rana noted, ‘I wish there would be a female doctor or a nurse in the school, so any student [who] has been harassed or has other issues [could] visit easily and get medical report’.

Implications and limitations

This study has investigated problematic sexual behaviors among adolescents with intellectual disability. The findings may refine the academic understanding of the behaviors in question, of their causes, of the experiences of relatives and teachers, and of the means of addressing the attendant problems. This study may also prove useful to families and the educators who teach individuals with intellectual disability. The nature of the study and its setting were such that its results present several limitations. It was inordinately difficult for us to conduct interviews with the participants. Each of us interviewed participants of the same gender to expand participation and encourage open sharing. Furthermore, our sample is small. Finding mothers who would speak about the sexual issues that affect their daughters was challenging. Only two mothers agreed to participate out of a total of 15 who were contacted. Moreover, the participants tended to avoid certain words or terms. Many often repeated the sentence, ‘You know what I mean?’ We understood them, and we tried to interpret their words as accurately as possible.

Conclusion

Despite the potential for clashes with traditional values when discussing adolescent sexuality in public or even as part of a research project, this study has investigated the experiences of teachers and mothers in managing the problematic sexual behaviors of adolescents with intellectual disability in Saudi Arabia. The main questions emerging from the study concern how adolescents with intellectual disability experience problematic sexual behaviors and the subjective causes of those behaviors. Future studies may assess the long-term effect of problematic sexual behaviors on adolescents with intellectual disability and on those around them. Moreover, considerably more work should be conducted to understand adolescents’ sexual behaviors in conservative societies and how to address them. Although it is unusual for teachers and family members to discuss sexual behaviors in some societies, it is critical that researchers study these behaviors to gain a better understanding of such phenomena. It is also important to pay further attention to sex education curricula and their role in enhancing sexual awareness among adolescents, family members, and teachers. The results of this study suggest that a lack of awareness exists regarding the sexual behaviors of adolescents with intellectual disability, so providing sex education may help raise sexual awareness. It is critical that families and teachers be granted access to training on sexual issues, including aberrant behavior. The results demonstrate that teachers and family members have challenges managing sexual behavior problems; it is thus critical to provide them with appropriate training in this area. Understanding these behaviors is crucial, and the new understanding presented in this research should improve the ability to manage them. The findings suggest that this would be a fruitful area of research for further work in Saudi Arabia, as well as other countries.

Funding Statement

The authors extend their appreciation to the Deanship of Scientific Research at King Khalid University for funding this work through Group Research Project under grant number (RGP1/345/44).

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

We obtained the informed consent of all of the participants in the study. All of the procedures that involved human participants were designed in accordance with the ethical standards of the institutional and/or national research committee, with the 1964 Helsinki Declaration and its amendments, or with comparable ethical standards.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, [Khalid M. Abu-Alghayth]. The data are not publicly available due to the privacy of research participants.