There is a lack of training for parents, school staff, and residential staff aimed at helping persons with intellectual disabilities acquire menstrual self-care skills. This may be due in part to the sensitive nature of this topic, the aversion to performing menstrual care for individuals with a disability, and the lack of empirically supported training protocols. This chapter critically reviews behavior analytic research on menstrual care that has been published in peer reviewed journals. This is followed by a case illustration using behavior analytic methods to teach menstrual self-care skills for a student with autism spectrum disorder in a public school setting. Evaluated using a multiple baseline across behaviors design, it was shown that the student increased her independent performance of selected menstrual self-case skills.
TopLiterature Review
In my quest to find a solution, I searched the research literature. A survey of school nurses supported the thought that menstrual care instruction should be provided by teachers (Tse & Opie, 1986), though no study was found on teachers’ perception of who should teach the skill. A study by Rodgers (2005) found that younger individuals with intellectual disabilities, aged 15-24, were being taught menstrual care by teachers, which could reflect a pattern of young people being cared for at home in recent years. By remaining at home instead of residential facilities, public schools are increasingly receiving these individuals as students and have the responsibility to provide menstrual care instruction in the school setting. Early studies on menstrual care were conducted in residential facilities (Hamilton, Allen, Stephens, & Davall, 1969; Hamre-Nietupski, & Williams, 1977; Richman, Reiss, Bauman, & Bailey, 1984), with more recent studies conducted in school settings (Altundağ, & Çalbayram, 2016; Epps, Stern, & Horner, 1990; Richman & Ponticas, 1986) or in a home setting taught by school staff (Ersoy, 2009). Rodgers and Lipscombe (2005) found that younger individuals were more likely to have been taught to manage their own menstrual care, and were significantly more likely to have been taught menstrual care by a teacher, than individuals a decade older.
The lack of systematic teaching procedures for parents, school, and residential staff may be due to lack of training and the aversion of performing menstrual care for, or with, the individual with ID. Carlson and Wilson (1996) showed that only 5-24 percent of residential care staff had received any training about menstrual care for individuals with high support needs; the remaining 76-95 percent had not received any training (Rodgers & Lipscombe, 2005). Occupational Therapy (OT) literature provides some input on training in menstrual care for those with intellectual and other disabilities, but OT textbooks do not refer to this issue nor provide training (Carlson, 2002).