Journal of Mental Health Research

in Intellectual Disabilities, 4:107132, 2011

Copyright Taylor & Francis Group, LLC
ISSN: 1931-5864 print/1931-5872 online
DOI: 10.1080/19315864.2011.593696

The Utility and Psychometric Properties of the

Abel-Blasingame Assessment System for
Individuals With Intellectual Disabilities
GERRY D. BLASINGAME
Training, Program Development, & Consultation
Redding, California

GENE G. ABEL
Abel Screening, Inc.
Behavioral Medicine Institute of Atlanta
Atlanta, Georgia

ALAN JORDAN
Abel Screening, Inc.
Atlanta, Georgia

MARKUS WIEGEL
Behavioral Medicine Institute of Atlanta
Atlanta, Georgia

This article describes the development and utility of the AbelBlasingame Assessment System for individuals with intellectual
disabilities (ABID) for assessment of sexual interest and problematic sexual behaviors. The study examined the preliminary
psychometric properties and evaluated the clinical utility of the
ABID based on a sample of 495 male adults with intellectual disabilities and/or developmental delays. The study examined (a) length of assessment time; (b) the ability of test takers
to distinguish between gender and between 4 age groups; (c)
whether the ABID has internal consistency within the cognitive distortions, social desirability scale, and fantasy vignettes
items; (d) the criterion validity of the ABID to detect sustained
sexual interest in children; and (e) whether the use of the
ABID questionnaire as a structured clinical interview increases
Address correspondence to Gerry D. Blasingame, P.O. Box 49-1525, Redding, CA 96049.
E-mail: gerryblasingame@aol.com
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awareness of information about an individuals maladaptive

behaviors important for treatment planning. The findings regarding these areas are discussed as well as the limitations of
the tool in assessing individuals with intellectual disabilities.
KEYWORDS intellectual disabilities, measuring sexual interests,
sexual behavior problems
Human sexuality is a complicated matter. The expression of sexuality by
individuals with intellectual disabilities is further complicated by their level
of cognitive development, sex education, and emotional maturity. Assessing
problematic sexual behaviors among individuals with intellectual disabilities
presents a variety of challenges. These include low intellectual functioning, slower processing speed, working memory deficits, limited vocabulary,
expressive and understanding abilities, and potential acquiescent response
sets (Blasingame, 2005; Finlay & Lyons, 2002). There continue to be controversies regarding the behaviors, motivations, and associated features
that constitute sexual deviance, in general, and these issues become more
complex and less well defined when evaluating problematic or potentially deviant sexual behaviors in individuals with intellectual and other
developmental disabilities (Blasingame, 2005).
The percentage of sexual offenders who have intellectual disabilities
is difficult to ascertain because most research on sex offenders is completed without differentiating individuals with intellectual disabilities or may
exclude them altogether. Studies have reported that individuals with and
without intellectual disabilities tend to commit the same types of sexual
offenses (Day, 1994; Haaven, Little, & Petre-Miller, 1990). Male preferential
pedophilia is reportedly correlated with lower intellectual functioning and
special education placements (Blanchard et al., 1999; Cantor et al., 2006).
Others found that the mean Full Scale Intelligence Quotient (FSIQ) of men
who molest children is lower than that of nonoffenders (Cantor, Blanchard,
Robichaud, & Christensen, 2005). Yet other research indicates that significant
neuroanatomical and neurodevelopmental factors contribute to the propensity for one to develop pedophilia or a related paraphilic disorder (Joyal,
Black, & Dassylva, 2007). Pedophilia, and many other deviant sexual or
paraphilic disorders, are primarily diagnosed among males (Blanchard et al.,
1999).
It has been suggested that the motivation for sexual misconduct by
those who have intellectual disabilities could at times have a genesis other
than sexual deviance, for example, Hingsburger, Griffiths, and Quinseys
(1991) concept of counterfeit deviances wherein the motivation for inappropriate behavior is presumed to be nondeviant even though the behavior
is socially unacceptable. However, some research brings into question the

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notion of counterfeit deviance among those with intellectual disabilities

who sexually abuse (Blanchard et al., 1999; Michie, Lindsay, Martin, &
Grieve, 2006). Phallometric studies (i.e., measurement of penile circumference changes using the plethysmograph) of sexual offenders with and
without intellectual disabilities have found that sex offenders with intellectual disabilities respond more strongly to prepubescent male stimuli and very
young stimuli than nonintellectually disabled sex offenders (Rice, Harris,
Lang, & Chaplin, 2008). It is necessary to rule in or out the presence of sexual deviance, current sexual interest or arousal involving children, or other
forms of sexual preoccupation if one is to assess current risk for reoffense
and develop realistic intervention plans to manage any current risk.
Identifying an individuals sexual preoccupations and preferences are a
significant component of the diagnostic process involving possible paraphilias and assessing risk for sexual reoffense (Association for the Treatment
of Sexual Abusers, 2005). The evaluation of paraphilic sexual behaviors
and sexual deviance in individuals without intellectual disabilities must
frequently cover a number of different areas. Clinicians routinely utilize
questionnaires, scales, and inventories to aid in the assessment of the different topic areas. One important area of assessment focuses on the individuals
sexual arousal or sexual interest patterns. The two most common methods of such assessment include the penile plethysmograph and the use
of attentional measures, such as viewing time (also called visual reaction
time), which are assessed by the Abel Assessment for sexual interest2
(Abel, Huffman, Warberg, & Holland, 1998; Abel, Jordan, Hand, Holland, &
Phipps, 2001; Abel, Rouleau, Lawry, Barrett, & Camp, 1990) and the Affinity
(Glasgow, Osborne, & Croxen, 2003). A number of self-report assessment
instruments assess paraphilic sexual behaviors and sexual deviance over
all, such as the Multiphasic Sex Inventory (Nichols & Molinder, 1996),
Multidimensional Assessment of Sex and Aggression (Knight, Prentky, &
Cerce, 1994), the Abel Assessment for sexual interest2 (Abel et al., 1998),
as well as others. These instruments attempt to cover the full range of paraphilic and/or problematic sexual behaviors and typically include subscales
related to fantasy, sexual attraction, cognitive distortions, and violence.
Other instruments are more specific in their focus, such as measuring
endorsement of myths (e.g., Illinois Rape Myth Acceptance Scale; Payne,
Lonsway, & Fitzgerald, 1999) or assessing fantasy themes (e.g., Sexual
Fantasy Questionnaire; ODonohue, Letourneau, & Dowling, 1997).
However, the degree that such instruments are appropriate for assessing individuals with intellectual disabilities is questioned. For example, some
contain a number of items phrased containing double negatives that may
be confusing for individuals with intellectual disabilities to understand. The
Abel Assessment for sexual interest2 (AASI-2) adult male questionnaire is
written with an average of the eighth-grade reading level, which is too
advanced for individuals with intellectual disabilities. The use of penile

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plethysmography on individuals with intellectual disabilities, especially with

severe or profound intellectual disabilities, may be ethically questionable.
Which instruments may or may not be appropriate for the evaluation of a
client with intellectual disabilities will depend on the scope of the individuals level of cognitive impairment, ability to comprehend test questions,
information processing abilities, degree of emotional maturity, and the specific issues being evaluated. Few scales have been developed specifically
for evaluation of sexual offending in individuals with intellectual disabilities.
The Questionnaire on Attitudes Consistent with Sex Offending (Broxholme
& Lindsay, 2003) is one such tool. However, there is an overall lack of
empirically validated assessment instruments specifically designed for the
evaluation of sexual deviance in individuals with intellectual disabilities.
Being able to access such information regarding persons with intellectual disabilities who are reported to have sexual behavior problems is
important for those who serve as case managers, treatment providers, and
supervising personnel. The evaluation of sexual behavior in individuals with
intellectual disabilities has relied primarily on clinical interviews, behavioral observations, or gathering information from knowledgeable informants
such as parents or staff persons. This can be problematic when assessing
behaviors that have a low base rate or occur in private or secretively.
Unguided self-report information may or may not be accurate and
corroboration is often needed. Additionally, some persons accused of sexual misconduct attempt to present misleading information to prevent the
discovery of their deviance. Persons with intellectual disabilities may also
experience memory deficits, have distorted perceptions, or may not understand questioning that is not tailored to their cognitive level (Blasingame,
2005).
Finlay and Lyons (2001) reviewed some of the common challenges
inherent in assessing individuals with intellectual disabilities. In their review,
the authors discussed difficulties with negatively worded questions, which
are structurally more complex than positively worded questions (e.g., I
dont have trouble falling asleep vs. I can fall asleep). They noted that
questions requiring judgments about time, frequency, or degree may be
problematic for many individuals with intellectual disabilities. As a result,
Likert-type items, common in many psychological questionnaires, assessing
the degree of presence of a symptom (none, a little, quite a bit, etc.) may
be less accurate when used with these individuals. Questions that ask evaluees to determine how they usually or predominately feel, act, or think may
be challenging. Individuals with intellectual disabilities sometimes respond
based on a single salient event rather than on a generalized pattern (Finlay
& Lyons, 2001). Similarly, items requiring a direct comparison between the
individuals current and past emotional states may also present problems due
to having to think about more than one time period at a time. Furthermore,
items relating to abstract concepts are more difficult than those relating to

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specific events. However, using only specific events may make it difficult
for a clinician to aggregate enough specific examples to make a general
determination. In addition to using simple language and sentence structure,
Finlay and Lyons (2001) recommended the use of visual aids, vignettes, and
asking questions via multiple items or methods.
When assessing individuals who have intellectual disabilities or other
cognitive impairments, it is important to recognize the potential for the
individual to have an interest in pleasing the evaluator. This form of
acquiescence or yeah-saying as a response set may not be addressed
when assessment tools use strictly dichotomous (yes-no) response options
(Blasingame, 2005; Finlay & Lyons, 2002). Individuals who are acquiescent
may be trying to please the evaluator, may be confused about the question, or may be unsure what will happen if they give one type of answer as
opposed to another. Finlay and Lyons (2001) suggested using either-or questions rather than using yes-no questions and including an I dont know
option to allow the evaluee to indicate when a question may be confusing.
Using multiple-choice questions, plain language, and periodically asking the
individual to explain the question are ways to guard against this type of
testing error.

DEVELOPMENT OF THE ABEL-BLASINGAME ASSESSMENT SYSTEM

FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES
The Abel-Blasingame Assessment System for individuals with intellectual
disabilities (ABID; Abel & Blasingame, 2005) was developed specifically
to be used with individuals with intellectual, developmental, or learning
disabilities. During its construction and development many of the challenging assessment issues described earlier were considered. The ABID was
designed to aid the clinician in obtaining essential information required
to assess sexual behavior problems. Although not designed to be used as
the sole assessment tool, the ABID does constitute an assessment system
that covers a variety of areas related to problematic and paraphilic sexual
behaviors. The ABID can be conceptualized as including three sources of
information. First, the ABID includes a survey completed by the clinician
regarding the evaluees level of functioning (estimated or actual intelligence score from file information or prior testing), ability to understand
the questions posed, and presenting sexual behavior problems. Second, the
ABID includes a self-report questionnaire completed by the evaluee, albeit
administered verbally as a semistructured interview. Third, the ABID uses
a measure of sexual interest referred to as visual reaction time (VRT) or
viewing time to objectively measure the evaluees sexual interest patterns.
Due to the heterogeneity of individuals with intellectual disabilities,
flexibility in the assessment instrument was determined to be essential. As a

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result, the ABID was developed as a semistructured interview. This format

ensures that the clinician covers all of the essential areas and asks relevant
questions while allowing for the flexibility to adapt the wording of the questionnaire based on the unique characteristics of each case. For example,
individuals with intellectual disabilities often lack a basic understanding of
the terms for sexual anatomy and use idiographic terms or slang. As a result,
the clinician is able to substitute the evaluees own vocabulary in the questions. After reading the question once as written, the clinician may explain
or rephrase the question to aid in a clearer understanding of the question by
the evaluee. Some of the ABID items contain parenthetical notes to the evaluator clarifying the intent of the question to ensure that the original intent is
not changed when questions are explained or rephrased.
The development of the ABID questionnaire attempted to keep the
vocabulary in plain language, limit compound sentences, and use simple
verbiage. The reading comprehension level required for the questionnaire is
estimated at, on average, the second-grade level using the Microsoft Word
software (Kincaid, Fishburne, Rogers, & Chissom, 1975), which estimates
the degree of reading comprehension needed to understand a statement.
Some evaluees may still have comprehension challenges due to working
memory and attentional deficits; evaluators are encouraged to periodically
ask evaluees about the questions to ascertain the persons understanding
during the course of the interview. In addition, visual aids, such as drawn
images and pictures, were included. For example, to increase the validity of
participants self-report, images of children, teens, and adults are presented
in a segment wherein the participant is asked if the subject in the image is of
a boy, girl, man, woman, and the persons general age group such as little
girl, teen girl, or adult woman. This allows the evaluator to establish whether
the evaluee has an accurate sense of the meaning of words such as woman
versus girl or teen. Evaluators are able to discern the participants level of
social awareness of gender and age and assess whether he can distinguish
between different age groups and genders. An evaluees inability to correctly
identify these might raise concern to the evaluator regarding the suitability
of further testing; evaluators are encouraged to interpret findings cautiously
in these situations.
The tendency for individuals with intellectual disabilities to respond in
ways they believe will please the evaluator (i.e., acquiescence) was also
considered. Multiple-choice response options, that is, yes, sometimes,
or no, are used in several domains to reduce the risk of response sets
such as saying yes or no to questions regardless of content and to avoid
responses that the participant might believe are the right answers or what
the evaluator wants to hear (Blasingame, 2005). A further guard against
yeah-saying is that, whenever possible, the ABID asks about a topic in
multiple ways and at different times during the assessment. In addition, the
ABID contains a number of items that measure a persons unwillingness to

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admit to violations of common social mores, such as impatience, feelings

of anger, and so on (i.e., social desirability). Examples of this might be I
never lie or I am always kind. The evaluee may be asked about exposing
his genitals in public in several different ways, each using slightly different
language or in different contexts. Evaluators can then look for consistency
in the evaluees responses.
A further issue requiring consideration is the variability of individuals with intellectual disabilities to sustain attention over long periods of
time. The ABID has several built-in reminders for the administrator to allow
for brief breaks to prevent fatigue or tiredness. In addition, the computer
software used to administer the ABID allows for the questionnaire to be
administered over multiple sessions if needed by having the option to suspend and resume the questionnaire. In addition to prompting for breaks,
the ABID contains statements read aloud by the clinician to help the evaluee
switch from one topic to the next, which reduces confusion. For example,
the clinician would read the statement, Now I am going to ask you some
questions about your friends, or Now I am going to ask you some truefalse questions. True means I sometimes think this way and false means I
never think this way. There are no right or wrong answers, just whether the
sentence is true or not for you.
The construction of the ABID, with its focus on flexibility of administration, simple language, visual aids, multiple-choice items, and periodic
breaks, provides a framework for allowing the clinician to explore a number of different areas necessary for the evaluation of sexual behavior,
including paraphilic behaviors. These areas include sexual attraction and
sexual interest patterns, history of engaging in sexual behaviors (in general),
involvement in potential paraphilic sexual behaviors, the evaluees own history of sexual abuse, and endorsement of cognitive distortions. In addition,
the questionnaire contains brief items used to assess demographic information, educational attainment, independent living history, drug and alcohol
use, and self reported criminal history. This later information can often
be verified through interviews with knowledgeable informants, clarifying
to what degree the other self-report information can be relied upon.
An essential component of a sexual behavior assessment involves determining the type of persons to whom the evaluee is sexually attracted or
sexually aroused by. The ABID assesses sexual attraction or sexual interest in a number of different ways. First, the ABID questionnaire includes
images depicting individuals of different genders, ages (preschool, grade
school, adolescent, and adult) and races (Caucasian and African American)
and asks the evaluee, Is this kind of person sexy to you? The purpose of
using the visual aid is to avoid the evaluee having to understand the meaning of terms such as child, adolescent, and adult and allows the evaluee to
answer even if he is unable to cognitively distinguish between different age
groups. However, the ABID also contains more direct questions regarding

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sexual attraction and arousal, for example, Have you masturbated while
thinking about a teen girl?
Second, the ABID includes sexual fantasy vignettes that cover consensual sex with a male or female child, coercive sex with a male or female
child, consensual sex with a male or female peer, coercive sex with a male
or female peer, sexual behavior with a sibling, nonsexual violence, theft,
and transvestic fetishism. The evaluee indicates whether each sexual fantasy
vignette is a sex turn-on to him (response options are yes, sometimes, or no).
This information is important as sexual arousal to deviant themes has been
identified as a correlate of sexual reoffending among known sexual offenders (Hanson & Morton-Bourgon, 2004). The fantasy vignette scale includes
items such as Im lying next to my brother. I am getting a hard-on or A
3-year-old girl is crying. I put my hand down her pants anyway. Words that
may solicit strong sexual reactions, that is, names of sexual parts or street
words for them, are used across age and gender in the vignettes to ascertain
whether the evaluee is simply responding to specific sexual words or other
aspects of the vignette.
Third, the ABID includes an objective measure of the evaluees sexual
interest based on VRT (Abel et al., 1998; Abel et al., 1990). During the VRT
assessment, the evaluee is asked to think about doing sex behavior with the
kind of person shown in each of the images while first only viewing the
image and then scoring his subjective sexual interest to the person in the
image. The VRT component utilizes the same images included in the AASI-2
VRT assessment but with simplified instructions wherein the viewing time
for each image is tabulated. VRT is discussed in more detail later in this article. The original AASI-2 VRT asks evaluees to rate each image on a 7-point
Likert-type scale ranging from highly sexually disgusting to highly sexually
arousing. The ABID VRT has simplified the subjective ratings to a 3-point
color-coded scale: sexy to me (green), maybe sexy to me (yellow), and not
sexy to me (red). The ABID contains a number of practice images that allows
the evaluee to practice completing the VRT, including reporting the subjective ratings, while the clinician is in the room and observing the evaluee.
However, once the clinician is satisfied that the evaluee can complete the
VRT portion of the ABID by himself, the clinician leaves the room or sits out
of view of the evaluee to allow the evaluee to view and rate the actual VRT
images in private.
The ABID contains a number of sexual history questions that explore
the evaluees degree of sexual experience. For example, How many times
have you put your mouth on a mans penis? An evaluees word for penis
may be substituted once the evaluator has offered the original question.
Additionally, the ABID uses images depicting individuals of different genders, ages, and races to ask whether the evaluee has ever done sex touching
with the type of person shown in the image. These more basic sexual
history questions are important because many individuals with intellectual

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disabilities have not been given sexual education and may not have been
asked about their sexual experiences (perhaps due to the assumption or
wishful thinking that these individuals are asexual). This gives the evaluee
the opportunity to describe normal sexual experiences in addition to the
problem behaviors they may have been involved with.
The ABID includes items regarding the evaluees involvement in
15 problematic sexual behaviors. These items were selected based on
commonly discovered sexual behaviors among individuals who have maladaptive sexual behavior (Abel, Becker, Cunningham-Rathner, Mittelman, &
Rouleau, 1988; American Psychiatric Association, 2000; Blasingame, 2005).
These include exhibitionism, public masturbation, fetishism, transvestic
fetishism, frotteurism, voyeurism, bestiality, making obscene phone calls or
letters, sexual assault and rape, sexual abuse of a minor, masochism, sadism,
urocoprophilia, gender identity dysphoria (transsexualism), engaging in
phone sex (calling paid phone sex lines), and use of pornography (print,
video, and Internet). For each sexual behavior, the clinician asks an overall
question and if the evaluee indicates that he has been involved in this type
of behavior, a series of follow-up questions are asked. For example, Have
you ever secretly looked at people for a sex turn-on (secret means they did
not know you were looking at them)? If the evaluee reports he has engaged
in the behavior, the follow-up questions generally include the estimated age
of onset and last occurrence, the circumstances under which the behavior
occurred, the estimated number of times and number of different victims,
the ages and genders of the victims, relationship to the victims (e.g., family
members, school or group home peers, strangers), amount of fantasy about
the behavior, and degree of self-reported control over the behavior.
In addition, the ABID contains items regarding the evaluees personal
history of sexual abuse. Because the questions can be upsetting to the evaluee, the ABID contains questions exploring the degree of discomfort the
evaluee may experience discussing his own sexual abuse history and allows
the option to bypass further follow-up questions. The follow-up questions
include the estimated frequency and/or duration of abuse, information about
the abuser, and degree of persuasion and coercion used by the abuser. To
aid the clinician in assessing the types of behaviors involved in the sexual
abuse, the ABID contains a drawing of the front and back of a human figure with numbers designating areas of the body. This visual aid allows the
evaluee to simply state the number or point to the figure to designate areas
of the body that were touched either over or beneath the clothing.
Related to engaging in problematic sexual behaviors, and particularly
sexual abuse of children, is the degree to which an individual endorses ideas
permissive toward adult-child sex and deviant sexual behavior. The ABID
contains 20 true-false items to assess cognitive distortions related to sexual
behaviors. True is explained to mean Yes, I think that way, or sometimes
I think that way. False means No, I do not think that way. A response

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such as I dont know is marked as a no response. Examples are It is okay

to sexually touch children if you are nice to them or Sexual touching to
children does not cause them to have any problems. Some of the items
are about unwanted touching or rubbing against another person, a common problem for individuals with intellectual disabilities; voyeurism; and
exhibitionism. The cognitive distortion items are embedded in other types
of statements about positive and negative nonsexual behaviors to avoid
acquiescence.
The ABID also includes a section of items that assess basic demographic
and educational variables, including being enrolled in special education
classes. This section contains items that inquire about the evaluees living
situation and history of living independently. This allows the evaluator to
discern whether the evaluee is an adequate historian as much of this information can be verified in the evaluees records or by discussion with his
care provider. Other sections briefly explore related acting-out behaviors.
In addition to asking whether the evaluee has skipped school, gotten into
fights, and so on, the ABID also inquires whether the individuals friends
have been involved in these behaviors. Another section covers the evaluees
self-reported use of various drugs and alcohol.
This study was designed to determine whether the ABID has psychometrically sound properties and clinical utility in discerning sexual behavior
problems among individuals with intellectual disabilities. The specific characteristics examined via the use of the ABID were (a) the length of
administration time; (b) the ability of ABID test takers to distinguish between
age groups and gender; (c) whether the ABID has internal consistency within
the cognitive distortions, social desirability scale, fantasy vignette items of the
questionnaire, and VRT; (d) whether the ABID detects sustained or persistent sexual interest in children among persons with intellectual disabilities;
and (e) whether the use of the ABID questionnaire as a structured clinical
interview increases information about an individuals maladaptive behaviors
that are important for treatment planning.

METHOD
Four hundred ninety-five (495) adult males with intellectual and/or other
developmental disabilities who were reported to have committed some form
of sexually offensive, abusive, or inappropriate sexual behavior participated
in a variety of evaluative procedures, including the ABID, through 78 sites
across America between 2005 and 2009. Data was drawn from the Abel
Screening, Inc., database in Atlanta. Participants were evaluated while in
state hospital and/or developmental center placements, county jails, board
and care homes, and outpatient offices. Participants were referred for evaluation by themselves voluntarily, a service coordinator, probation officer, case
manager, or court order.

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All participants or their conservators signed informed consent forms

allowing their data to be used anonymously in this research. Participants
and/or their guardians were also advised regarding mandatory child abuse
reporting laws prior to administration of the procedure. The Institutional
Review Board of Georgia State University approved the research protocol
and method of data collection (Protocol H08020).
The evaluators administering the ABID followed the training protocol
in the ABID administration manual (Abel & Blasingame, 2005). Evaluators
read the questionnaire aloud to each participant, making adjustments as
described earlier to accommodate comprehension and attentional deficits.
Responses to the questions were recorded by the evaluator using the computerized form of the questionnaire. The raw data gathered with the ABID
was transmitted electronically to Abel Screening, Inc., where it was scored
by computer. The results were sent back to the evaluators in detailed reports.
The ABID results were then summarized by the evaluators and integrated
into their broader clinical assessment and recommendations.

Participants
The participants ranged from 18 to 69 years of age (mean = 33.3, median =
30.0, and SD = 12.4). Approximately 73% (n = 362) of the participants were
Caucasian, 12% (n = 57) African American, 7% (n = 33) Hispanic/Latino,
3% (n = 13) Native American, and the other participants in smaller numbers
including Asian American and biracial persons.
The FSIQs of the participants were reported by the clinicians who
administered the procedures based on their file information or current testing. Approximately 10% (n = 49) were estimated to be in the 4054 range,
and 90% (n = 446) were in the 5570 range. Of the sample, 48% (n = 236)
indicated they had a guardian or someone with authority over them and 13%
(n = 66) reported living independently.
The reported educational levels of the participants ranged from some
grade school experience and a similarly small number of participants who
had participated in some college classes. Approximately 15% (n = 77) had
not taken classes beyond the eighth-grade level, 27% (n = 136) had taken
high school-level classes but not graduated or obtained a general education
diploma (GED), 51% (n = 251) graduated from high school or obtained a
GED, and 1% (n = 4) had at least some college classes. Of the sample, 87%
(n = 434) reported attending special education classes (at some point), with
the mean length of time in special education classes being 9.2 years (median
= 10 years, SD = 3.9 years, range = 1 to 21 years).

Procedure
Participants were evaluated in a variety of locations by clinicians completing
a larger battery of assessment procedures. Clinicians who use the AASI-2

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and the ABID receive training from the test company in verbal and written
form and are required to pass a brief written test regarding the administration and interpretation procedures. The clinicians administering the ABID
completed the preassessment therapist survey (part of the ABID) to indicate
the types of sexual misconduct that was known from the evaluees official
records prior to administering the ABID questionnaire. Some of the results
discussed later provide the percentage increase of information about sexual
histories post-ABID in comparison to that known prior to administering the
procedures.
The second component of the ABID involves the computer-based,
semistructured interview administered by the clinician. The questionnaire
was read aloud to each participant to facilitate understanding of the questions. This verbal interaction allowed the evaluators to make sure the
individuals understood the nature of the questions and to ascertain the
participants level of comprehension as the testing proceeded. The evaluators read the questionnaire to each evaluee, repeating questions, soliciting
evaluee understanding of the questions, and breaking up the sections for
attention span management based on the evaluators clinical judgment of
the needs of each evaluee.
Following the administration of the semistructured interview, participants completed an objective attentional measure of sexual interest called
VRT as discussed earlier. The image stimuli do not include nudity or sexual activity. For the purposes of this study, data from the preschool-age
and grade school-age stimuli categories are collapsed, by gender and ethnic
groups, into one category.
Each participant rehearsed the VRT procedure utilizing a practice set
of images with the evaluator present to answer any questions or clarify the
procedure. The participant had to successfully demonstrate his understanding of the procedure and rating process prior to proceeding to the actual
VRT assessment, or the preliminary training was repeated. Some participants
were unable to manage the computer aspects of the VRT portion and were
excluded from the final data review. The evaluator was not in the room
(or sat at a distance out of view when organizational rules prohibited the
evaluee being alone) while the actual procedure was taking place to reduce
inhibitory effects.
There were seven images in each stimulus category allowing for intrasubject as well as intersubject comparison for each category of interest in the
VRT segment. The self-report ratings in each subject category were averaged
into one self-report score. In addition to the self-report ratings provided by
the participants, the computer compiled viewing time data as an indicator of
interest, beyond the clients awareness (Abel et al., 1998). The raw data were
converted into z scores; the z scores were then put in a bar graph format.
The bar graph represents the individuals relative interest levels of the image
stimuli by category across the 22 categories. Posttest, the ipsative ranking

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outcome data are presented in the bar graph format for interpretation by the
evaluator.

RESULTS
In addition to describing the development of the ABID, the purpose of this
study was to examine some of the psychometric properties and clinical utility of the ABID based on a large sample of adult males with intellectual
or other developmental disabilities. The analyses included examining basic
information such as the amount of time required to administer the instrument and whether participants could distinguish between gender and ages
using the visual aid images. In addition, the reliability of the cognitive distortion items, social desirability scale, fantasy vignette items, and VRT were
determined. The criterion validity of the ABID to detect sustained or persistent sexual interest in children was evaluated by comparing the responses
on the fantasy vignettes, reported child victims, and VRT responses. This
was accomplished through a series of regression analyses. Next, the clinical
utility of the ABID was examined by comparing the amount of knowledge
clinicians reported on the Therapist Survey of the ABID with the information obtained during the administration of the questionnaire. Finally, the
clinical utility of the ABID was further evaluated by examining the degree
that individuals with intellectual disabilities reported involvement with multiple problematic sexual behaviors, beyond that known at the time of the
original referral.

Length of Test Time

Evaluators were asked to report the amount of time it took to administer the
ABID. Five cases with an administration time less than 15 min were removed
from the analyses. Participants took between 15 min and 6 hr (360 min) to
take the ABID. The mean administration time was 1 hr 23 min (83.8 min, SD
= 37.7 min).

Ability to Distinguish Between Gender and Between Age Groups

Test takers were asked to evaluate 16 images of individuals and determine
the gender and age groups of the individual depicted in the image. The
images were similar to the images included in the VRT and included two
individuals in each of four age groups (preschool, grade school, adolescent, and adult), one Caucasian and one African American. Participants were
asked whether the person in the image was a very little boy (preschool boy),
very little girl (preschool girl), little boy (grade school boy), little girl (grade
school girl), teenage boy, teenage girl, adult man, or adult woman.

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The authors calculated the percentage of images correctly classified for

gender category, age category, and gender and age combined. The sample
revealed a high ability to distinguish between genders. The gender distinction score ranged between 81.3% and 100% correct (mean = 99.4%, median
= 100.0%, SD = 2.0%). Approximately 84% of the participants were able to
identify the genders of all 16 images without error.
Participants had more difficulty identifying the four age groups of the
individuals in the images. The age distinction score ranged between 25.0%
and 100% correct (mean = 75.1%, median = 75.0%, SD = 15.3%). In the
sample, 8% identified half or less of the images correctly, with 44% identifying between 50% and 75% of the ages in images correctly. Although only
5% identified all of the age categories correctly, 92% were able to correctly
identify between 50% and 100% (including 100% correctly). The ability of
participants to correctly identify both age groups and gender correctly was
only slightly less than their ability to correctly identify age groups. The age
and gender distinction score ranged between 25.0% and 100% correct (mean
= 74.7%, median = 75.0%, SD = 15.3%). Similarly, 9% correctly identified
half or less of the gender and age of the person depicted in the image correctly, 45% correctly identified both the gender and age between 50% and
75%, and 91% correctly identified more than 75% of the images.

Reliability
One form of reliability is internal consistency. The most common measure of
internal consistency is the Cronbachs alpha statistic. It ranges between 0 and
1, and 0.7 is generally considered the minimum acceptable value (Nunnally
& Bernstein, 1994). Internal reliability for the ABID cognitive distortion and
social desirability scales were alpha = .84 and alpha = .80, respectively.
The 20 items of the original social desirability scale had an alpha = .73. The
authors analyzed the items and by removing a few from the scoring, the
alpha was increased to .80. While the deleted items remain in the questionnaire, they are no longer tabulated in the reports provided to the evaluators.
The fantasy vignette scales achieved Cronbachs alpha scores ranging from
.82 to .93 (see Table 1). These scores suggest moderate to strong internal
consistency for these scales.
Reliability was also assessed for VRT. The Cronbachs alpha was computed for all 22 categories of images. Because VRT is sensitive to outliers,
the authors decided to remove all reaction times that are more than 60 s
long. Although the mean and standard deviations of VRT differ between
categories, 60 s exceeds 10 standard deviations from the mean in even the
categories with the longest VRT times. Cases were removed listwise for each
category and no more than seven cases were removed for any category.
The VRT scales achieved Cronbachs alpha scores ranging from .76 to .86

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TABLE 1 Cronbachs Alpha for the Fantasy Vignette
Scales
Description of vignette
Female child
Female child force
Female peer
Female peer force
Incest brother
Incest sister
Male child
Male child force
Male peer
Male peer force

Cronbachs alpha
0.89
0.93
0.91
0.82
0.90
0.92
0.92
0.86
0.92
0.83

TABLE 2 Cronbachs Alpha for the Visual Reaction Time Scales

Description of images
Preschool-age Caucasian females
Grade school-age Caucasian females
Adolescent Caucasian females
Adult Caucasian females
Preschool-age Caucasian males
Grade school-age Caucasian males
Adolescent Caucasian males
Adult Caucasian males
Preschool-age African American females
Grade school-age African American females
Adolescent African American females
Adult African American females
Preschool-age African American males
Grade school-age African American males
Adolescent African American males
Adult African American males
Exhibitionism
Voyeurism
Frottage
Sadomasochistic female
Sadomasochistic male
Fetishism

Cronbachs alpha
0.86
0.86
0.77
0.81
0.82
0.84
0.79
0.85
0.83
0.76
0.76
0.82
0.86
0.77
0.81
0.85
0.83
0.77
0.82
0.81
0.83
0.81

(see Table 2). These scores suggest moderate internal consistency for these
scales.
The criterion validity of the ABID to detect sustained sexual interest in
children was measured in two ways. First the authors demonstrated that the
fantasy vignette scales are correlated to the number of child sexual abuse
victims reported by those in the sample of test takers. Second, we demonstrated that the VRT measures of sexual interest in children were correlated
to the number of child sexual abuse victims reported. Convergent validity for

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fantasy vignettes and VRT was assessed by measuring whether VRT could
predict two fantasy vignette scales (the Male Child and the Female Child).
When the dependent variable is a count, models such as negative binomial regression can be used. Negative binomial regression models the log
of the dependent variable as a linear function of the independent variables.
It also allows for the variance to increase as the predicted value increases
(McCullagh & Nelder, 1989). Measures of model fit such as R-square are
upwardly biased when model fit is assessed on the same data set from
which the model was estimated. Resampling methods such as bootstrapping
can be used to estimate how well the model would fit a similar data set
(Efron & Tibshirani, 1993). Four models were tested.
Model 1 demonstrated criterion validity by showing that the male child
and female child fantasy vignette scores were related to the number of
child sexual abuse victims reported by those in the sample. A negative
binomial model was used where the dependent variable was the number
of self-reported child sexual abuse victims and the two independent variables were male child and female child fantasy vignette scale scores. The
model was statistically significant (chi-square = 67.0, df = 2, p .0001).
The Pearson correlation coefficient between the predicted value and the
dependent variable was .33. The bootstrapped correlation coefficient was
.32. The coefficient for female child was 0.016 (chi-square = 25.7, df = 1,
p .0001) meaning that those who scored higher on the female child fantasy
vignette scale had reported more child sexual abuse victims. The coefficient
for male child was 0.011 (chi-square = 8.6, df = 1, p .0033) meaning
that those who scored higher on the male child fantasy vignette scale had
reported more child sexual abuse victims.
Model 2 demonstrated criterion validity by showing that VRT was
related to the number of child sexual abuse victims reported in the sample.
A negative binomial model was also used where the dependent variable
was the number of child sexual abuse victims (based on self-report) and the
two independent variables were labeled Maxchild and Maxadult. Maxchild
was calculated by taking the mean of eight child categories. Four of the
categories are of boys under the age of 13 and four of the categories are
of girls under the age of 13. The four boy categories are averaged together,
and the four girl categories are averaged together. Maxchild is the higher
of those two means. Maxadult is similarly calculated by taking the higher of
the means of the four adult and adolescent female categories (i.e., taking the
average of the postpubescent female categories) or the adult and adolescent
male categories. The model was statistically significant (chi-square = 22.5, df
= 2, p .0001). The Pearson correlation coefficient between the predicted
value and the dependent variable was .21. The bootstrapped correlation
coefficient was also .20. The coefficient for Maxchild was 1.540 (chi-square
= 19.8, df = 1, p .0001) meaning that as a group those who looked longer
at images of young children relative to postpubescent individuals (adults and

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123

adolescents) reported more child sexual abuse victims. The coefficient for
Maxadult was .9072 (chi-square = 5.8, df = 1, p .0156) meaning that
those who looked longer at images of adults and adolescents relative to
young children reported fewer child sexual abuse victims.
Convergent validity for VRT and the fantasy vignette scales was measured by using VRT to predict two fantasy vignette scales, Male Child and
Female Child. Because both scales were measured on an ordinal scale, ordinal logistic regression was used. The method is described in Agresti (1990)
and Hosmer and Lemeshow (2000). One measure of the rank correlation
used in ordinal logistic regression is the c index. The c index is derived
from the Wilcoxon-Mann-Whitney two-sample rank test and is equivalent to
the area under the receiver operator characteristics curve (AUC) when the
dependent variable is binary. Like the AUC it runs from 0 to 1 with .5 indicating no relationship and 1 indicating perfect relationship (Harrell, 2001).
Model 3 demonstrated convergent validity by showing VRTs ability to
predict the Male Child fantasy vignette scale. The independent variables
were the 16 age, race, and gender categories of VRT grouped into 8 age and
gender categories. The 8 categories were preschool-age male, preschool-age
female, grade school-age male, grade school-age female, adolescent male,
adolescent female, adult male, and adult female (i.e., the Caucasian and
African American images were combined within each age category). The
independent variables were added into a stepwise ordinal logistic regression.
The stepwise estimation of the model was bootstrapped to get an unbiased
estimate of the c index. The model was statistically significant (chi-square =
91.8, df = 2, p .0001). Two independent variables (grade school-age boys
and adult females) were statistically significant. The mean VRT for images
of grade school-age boys had a coefficient of 2.28 (chi-square = 66.1, df =
1, p .0001) meaning that ABID test takers who looked longer at images
of grade school-age boys scored higher on the Male Child fantasy vignette
scale. The other variable was the mean VRT for images of adult females,
which had a coefficient of 1.50 (chi-square = 31.0, df = 1, p .0001)
meaning that ABID test takers who looked longer at images of adult females
scored lower on the Male Child fantasy vignette scale. The unbootstrapped
c index was .79 and the bootstrapped c index was .77.
Model 4 demonstrated convergent validity by showing VRTs ability
to predict the Female Child fantasy vignette scale. The same independent
variables used in Model 3 were again used in a stepwise ordinal logistic
regression model. The model was statistically significant (chi-square = 67.0,
df = 2, p .0001). Again two independent variables were statistically significant (grade school-age girls and adult females). The mean VRT for images
of grade school-age girls had a coefficient of 1.59 (chi-square = 50.7, df =
1, p .0001) meaning that ABID test takers who looked longer at images
of grade school-age girls scored higher on the Female Child fantasy vignette
scale. The other variable was the mean VRT for images of adult females,

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TABLE 3 Therapist Report From File Information Versus Participant Self-Report on ABID
(Number of Cases and % Increase)
Sexual behavior
1 Public exposure
2 Public masturbation
3 Fetishism
4 Frottage
5 Voyeurism
6 Bestiality
7 Obscene calls
8 Masochism
9 Coprophilia
10 Child sexual abuse
11 Rape
12 Sadism
13 Transvestitism
14 Phone sex
15 Pornography
Total

Therapist report
from file

Therapist plus
self-report

% Increase

152
94
64
49
55
36
36
43
12
356
86
42
32
24
132
1,213

175
113
132
79
131
48
56
63
20
369
117
56
46
77
275
1,757

15
20
106
61
138
33
56
47
67
4
36
33
44
221
108
48

which had a coefficient of .98 (chi-square = 18.5, df = 1, p .0001)

meaning that ABID test takers who looked longer at images of adult females
scored lower on the Female Child fantasy vignette scale. The unbootstrapped
c index was .71 and the bootstrapped c index was .70.

Clinical Utility: Amount of Information Added

The fifth issue examined in the study was whether the use of the ABID questionnaire as a semistructured clinical interview increased the information
about an individuals maladaptive sexual behaviors. Table 3 demonstrates
the degree of individual participants sexual histories that were known to the
therapist prior to the ABID questionnaire administration and the increases of
admitted behaviors upon completion of the questionnaire. These data show
an average increase of disclosure or knowledge of behaviors by 48% across
the 15 sexual behaviors. Use of the questionnaire facilitated participants
self-disclosure of many problematic sexual behaviors, including behaviors
that were previously unreported or unknown to the evaluators.

DISCUSSION
The ABID is an instrument designed to aid the clinician in the evaluation of
sexual behavior problems in individuals with intellectual or other developmental disabilities. Many challenges inherent in evaluating individuals with

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intellectual disabilities were considered during the development and construction of the ABID. These included flexibility in the administration, use
of simple verbiage, multiple methods of assessing areas of interest to evaluators, inclusion of visual aids, and built-in reminders to the clinician to
take breaks during the administration. The ABID covers a variety of areas
important for the assessment of sexual behavior problems, including sexual
attraction and sexual interest patterns, history of engaging in sexual behaviors (in general), involvement in problematic sexual behaviors, the evaluees
own history of sexual abuse, and endorsement of cognitive distortions and
sexual fantasy vignettes. In addition, the ABID contains brief items used to
assess demographic information, educational attainment, independent living
history, drug and alcohol use, and self-reported criminal history.
In addition to describing the development of the ABID, this study examined some of the psychometric properties of the ABID and issues related to
clinical utility. As expected, the administration times for the ABID varied
greatly and ranged from less than 1 hr to 6 hr. This reflects the heterogeneity and complexity of working with individuals with intellectual and other
developmental disabilities. Although the results in this study represent the
first evaluation of the ABID, the instrument shows potential for use with
individuals comprising a wide range of cognitive impairment.
The amount of confidence in the results of the ABID, as with any instrument used with individuals who have intellectual or other developmental
disabilities, must be tempered depending on the level of impairment of
each evaluee. The ABID contains items used to assess the evaluees ability
to distinguish between genders and ages of individuals. Establishing such
a baseline is important prior to interpreting the results of items inquiring
about sexual attraction and sexual behavior. In the present sample, 91%
of the sample had no difficulties distinguishing between genders of individuals depicted in images. However, the variation in distinguishing ages
highlights the importance of not assuming an evaluee can adequately distinguish between different age groups. A participants inability to distinguish
between genders could indicate problems in social awareness, attention to
detail, or ability to interpret cues in the environment. Understanding the
potential effects of levels of intellectual functioning and establishing a cut
score for the ability to correctly distinguish between age groups is more
complex and awaits further study.
An essential element of any measurement is that it is reliable, including internal reliability. The fantasy vignette items, which related to several
different fantasy themes, were found to have a high degree of internal reliability, as determined by the Cronbachs alpha statistic. Thus, individuals
with intellectual disabilities showed a surprisingly high consistency in rating
the fantasy vignettes, irrespective of their level of intellectual functioning.
In addition, the 22 categories of VRT stimuli also showed a high degree of
reliability, as measured by the Cronbachs alpha statistic. This suggests that

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those with intellectual disabilities show consistency in their VRTs within the
stimulus categories.
The reliability of a measure is important, but measures must also show
clinical relevance to a problem being faced by the client and/or the evaluator. To determine if the various child sexual abuse fantasy vignettes had
utility, the correlation between the fantasy vignettes and the reported number of child sexual abuse victims of the participants was calculated. Results
showed a significant correlation between the Male Child and Female Child
fantasy vignettes and the number of participants self-reported child sexual
abuse victims. This indicated that gathering information regarding sexual
fantasies of individuals with intellectual disability has good utility, as it was
associated with the number of abuse victims reported. Questioning evaluees
about their fantasies has utility for the clinician who is assessing risk for
reoffense and treatment planning.
The ABID was designed to help the evaluator examine the presence
of commonly seen inappropriate sexual behaviors among individuals with
intellectual disabilities. The simplicity of verbiage (plain language), the use
of terms frequently used by individuals with intellectual deficits, and allowing for pauses during the questionnaire so as not to tax the evaluee were
important considerations in the construction of the ABID. It is important
to note that the use of a semistructured interview format, which allows
the interviewer to clarify items through rephrasing the questions, appears to
have contributed significantly to the interviewer learning with which specific
inappropriate sexual behaviors the client was involved. Use of the ABID
increased the frequency of self-report in each of the 15 problematic sexual behaviors with an average increase of 48% across all behaviors. Sexual
behaviors that are usually done in solitude or done in secretive ways make
detection difficult. However, these showed the greatest increase in disclosures after the questionnaire (e.g., fetishism, voyeurism, coprophilia, phone
sex, the use of pornography, and transsexual thoughts and behaviors). Of
particular interest was child sexual abuse that showed the smallest (4%)
increase in reporting after the use of the questionnaire. However, because
child sexual abuse is such a serious sexual behavior, even a 4% increase
reporting is important to be aware of. Without a therapist knowing what
else the individual has been involved in, in detail, he or she cannot organize
treatment to incorporate the specific problematic sexual behaviors of the
client. Knowing what the client has done is critical to organizing a treatment
and disposition plan based on the risk and needs of the individual (Bonta
& Andrews, 2003). The increased disclosure by the clients could at times
result from clients exaggerating the behaviors in which they have been
involved in order to please the interviewer or yeah-saying. Nonetheless,
such increased reporting gives the interviewer the opportunity to question
the client in further detail regarding each of these newly reported behaviors.
Our findings do suggest that these increases in self-reported behaviors are

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127

consistent across question formats. Given the areas of greatest increase in

reporting were areas of behavior that are done secretively, the question of
veracity of self-report information due to socially desirable responding could
be raised. In this study we were unable to gather information that would separately corroborate the self-reported information. Nonetheless, although the
evaluees willingness to make these self-report statements about child victims
or other sexual behaviors may not always be accurate, making the statements did correlate with greater viewing times of children in the same age
and gender groups. Evaluators should nonetheless use caution when using
the results of this or other assessment tools when working with individuals
with intellectual disabilities.
The ability of the ABID to detect sustained sexual interest in children
was evaluated with a series of regression analyses examining the relationship between the objectively measured VRT, the fantasy vignettes, and the
number of self-reported child sexual abuse victims. The study examined the
criterion validity of using the fantasy vignettes and VRT assessment to assess
sexual interest in children. The results of the negative binomial regression
analyses revealed that both the fantasy vignettes and VRT had significant
correlations with the number of children participants self-reported having
sexually abused. The resulting, bootstrapped Pearson correlations for the
child fantasy vignettes were r = 0.32 and r = .20 for the VRT. Additionally,
the VRTs to the grade school male and grade school female stimulus categories showed good predictive ability for endorsement of child fantasy
vignettes. Taken together, these results demonstrate preliminary validity for
using fantasy vignettes and VRT for assessing sexual interest in individuals
with intellectual disabilities.
The development of any questionnaire designed for use in evaluating individuals with intellectual disabilities will need to consider these the
many challenging issues involved with such testing. In addition, instruments
will require validation based on the population being assessed. Caution is
needed when applying norms or factor structures based on the general population. Further validity studies are needed, such as a known groups study,
regarding the relationship between VRT and the fantasy vignettes. Such further validation studies are needed before the VRT component could be used
independent of the ABID questionnaire.
Although formal, direct feedback from the clinicians using the ABID
in this study was not available, the issue of clinical utility was examined
through the amount of information about sexual behavior problems added
through the administration of the ABID. Not surprisingly, behaviors carried out in public or most likely to lead to an outcry by a victim, such as
exhibitionism or child sexual abuse, showed the smallest increases in disclosure over what was previously known. However, for behaviors done in
private, the increases in disclosure were substantial and included increases

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over 100% for fetishism, voyeurism, phone sex, and pornography. In addition, 63% of the sample admitted to engaging in more than one form of
problematic sexual behavior, although there was a wide variety of these
other behaviors reported. These results emphasize the importance of asking
about these problematic sexual behaviors and the value of doing so in an
organized and structured manner.
Limitations of this study include that replication of the findings with different subgroups of individuals with varying levels of intellectual functioning
and working memory are needed to further substantiate the tests generalizability. Therapists must be cautious when using results of such testing
if it could harm or bring additional consequences to the evaluee because
it is the evaluees willingness to report inappropriate sexual behaviors or
fantasies that reveals this new information. Designing test characteristics
that allow assessment of those with intellectual disabilities could extend
to other problematic behaviors where limited information is known about
the individual.
Given that the data for this study were gathered from 78 sites, the characteristics of the test administrators are not formally known. In order to
obtain the Abel Assessment system the test purchaser must be a licensed
mental health professional and training is provided by the test publisher,
Abel Screening, Inc. Particular data on the individual test administrator, such
as level of education, experience with testing with individuals with intellectual disabilities, or gender of administrator, was not gathered for this study.
These characteristics may or may not have an effect on test takers or the
process of completing the ABID. This is an area for further research.
Another area for future research involves gathering data on individuals who may have been referred for testing with the ABID but who were
determined ineligible by the professional completing the evaluation. Some
evaluators have anecdotally reported that an individual was too low functioning or too poor a historian to complete the ABID, but there was no
systematic collection of that information. The number of excluded individuals is unknown. Being able to explore the exclusion criteria selected by
the evaluators at the different sites could aid in further understanding the
generalizability of the findings presently reported.
Another aspect of data collection that deserves further attention is the
level of impairment in adaptive functioning and skills. We do know that 13%
of those taking the test lived independently, which may suggest a somewhat
higher level of functioning. However, many of the individuals who took
the test were placed in developmental centers, hospitals, or group homes
as a legal sanction due to their sexual behavior problems. The individuals
who participated in the testing were previously diagnosed with one form
or another of intellectual or other developmental disability. Although by
definition this would imply that the test takers were rated at two standard
deviations below the norm in at least two adaptive functioning areas, those

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129

specific data were not collected for this study. Future research should seek
to clarify whether any particular area(s) of impaired adaptive functioning
affected the outcomes reported from the ABID testing.
The ABID is the first attempt to collect this broad range of information specifically from persons who have intellectual disabilities who also
reportedly have sexual behavior problems. Measuring the validity and reliability of a new test typically involves comparison of its findings with
other known instruments. As discussed earlier, there are no tools for comparison regarding individuals who have intellectual disabilities and sexual
behavior problems. There are other statistical procedures that can be implemented in future research, such as the Measurement Stability and Interviewer
Concordance. Empirical data from these types of procedures could ascertain if there are different outcomes based on sample or subsample size
or whether different test administrator characteristics such as gender elicit
different results.
Evaluators should use caution both in administering and interpreting the
ABID. For example, some individuals may key in on specific words or experiences. In so doing they may overfocus on a limited aspect of a question
rather than considering the larger context in the question. Evaluators should
make every effort to monitor for this type of response set during administration, perhaps by having the evaluee repeat the question or identify aspects
of the question that get their attention.
Finally, the summary report provided to the evaluators is very detailed
regarding the self-report information gathered in the interview process.
Given that this is the first published support of the instrument described in
this study, evaluators should recognize that the significance of the findings
are in the scale or section totals rather than in the individual items endorsed.
As such evaluators should use caution in identifying single items in their
reports to the referring parties so as to not overstate the contribution of
single items or questions. Evaluators final reports should avoid overemphasizing individual self-report responses that may inadvertently bias a reader.
Underattending to individual items may likewise underestimate treatment
needs or risk levels whereas overattending to individual items may exaggerate needs or risk factors. Evaluators need to be thoughtful of how their
report readers may interpret the information provided. By attending to these
types of issues, the potential for iatrogenic harm can be reduced. Further
research in this area is also warranted.
In conclusion, the ABID was developed in response to the shortage of
instruments for evaluating sexual behavior problems among individuals with
intellectual disabilities. It was specifically designed for and takes in consideration many of the challenges inherent in the assessment of individuals
with intellectual disabilities. This study described the ABIDs construction
and content and evaluated some of the psychometric properties and clinical
utility. Despite achieving statistical significance, some of the psychometric

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properties were not as strong as would be preferred. Nonetheless, the

instrument shows promise for use with this very complex problem and
unique client population. Further research is indicated to establish additional
psychometric properties and further validation.

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