858061

research-article2019
SAXXXX10.1177/1079063219858061Sexual AbuseGil-Llario et al.

Article
Sexual Abuse
2020, Vol. 32(7) 850­–877
Development and © The Author(s) 2019
Article reuse guidelines:
Psychometric Properties sagepub.com/journals-permissions
DOI: 10.1177/1079063219858061
https://doi.org/10.1177/1079063219858061
of the Detection of Sexual journals.sagepub.com/home/sax

Abuse Risk Screening

Scale (DSARss)

María Dolores Gil-Llario1, Rafael Ballester-Arnal2,

Vicente Morell-Mengual1 , Lorena Caballero-Gascón1,
and Jesús Castro-Calvo1

Abstract
People with intellectual disability (ID) are more vulnerable to being victims of sexual
abuse (SA) because, in most cases, they are not able to detect the warning signs
that abuse could occur. However, there is a lack of appropriate assessment tools
to determine their vulnerability. To address this limitation, the current study tests
the psychometric properties of the Detection of Sexual Abuse Risk Screening Scale
(DSARss), a new scale developed to assess the ability of individuals with mild or
moderate ID to detect the risk of SA. In all, 246 individuals with mild or moderate
ID (55.3% males) completed the DSARss, along with other scales assessing related
dimensions (e.g., psychopathological symptoms, quality of live). Exploratory factor
analysis (EFA) yielded a four-factor structure explaining 65.34% of the total variance
in the DSARss. Two independent EFAs in males and females were also performed to
confirm the suitability of this four-factor structure according to gender. The reliability
of the total score and subscales ranged between .70 and .93. Likewise, correlations
with other related scales were positive and significant. Temporal stability 6 months
after the first application was .47. Finally, we explored the criterion-related validity of
the DSARss across different SA indicators. These results, along with the absence of
sound questionnaires to assess the risk of SA in people with ID, justify the use of the
DSARss to assess this construct in both men and women.

1Universitat de València—Estudi General, Spain

2Universitat Jaume I, Castellón, Spain

Corresponding Author:
María Dolores Gil-Llario, Department of Developmental and Educational Psychology, Universitat de
València—Estudi General, Avda Blasco Ibáñez, 21, 46010 Valencia, Spain.
Email: dolores.gil@uv.es
Gil-Llario et al. 851

Keywords
sexual abuse, risk assessment, intellectual disability, psychometric properties

Introduction
Much of the current research on sexuality in people with intellectual disability (ID)
focuses on the development of educational programs aimed to promote healthy and
satisfactory sexuality. One of the main contents of these programs is related to the
prevention of sexual abuse (SA; Ailey, Marks, Crisp, & Hahn, 2003), thus recognizing
the importance of addressing this aspect to guarantee the sexual and emotional well-
being of people with ID. Different aspects (e.g., lack of sexual knowledge and experi-
ence, poor interaction skills, a culture of obeisance and compliance, inability to
distinguish between consenting and nonconsenting partners, or difficulties in estab-
lishing personal and physical boundaries) explain their vulnerability (Aylott, 1999).
These factors are clearly different from those documented in the general population,
highlighting the unique nature of SA in people with ID and the need for more research
focused on this particular population. As a result, the prevalence of different forms of
SA in individuals with ID is significantly higher than what is reported in the general
population or other vulnerable populations. In this context, the assessment of SA risk
in people with ID is crucial to develop prevention programs focused on high-risk indi-
viduals with ID and assess the impact of these programs on reducing the risk of SA.
However, there is an evident lack of reliable and valid measures to explore this issue.
In addition, the unique characteristics of people with ID, in terms of cognitive abilities
and the factors predicting the risk of SA, impede the use of other available assessment
measures designed for other populations (such as scales aimed to measure the risk in
children, people with physical disabilities, the general population). Thus, the develop-
ment of new and appropriate (i.e., reliable and valid) measures to assess the risk of SA
in people with ID is crucial. Given this background, the main aim of the present study
is to develop and test the psychometric properties of a scale to assess the risk of SA in
people with ID: the Detection of Sexual Abuse Risk Screening Scale (DSARss).

SA in People With ID: Risk Factors and Prevalence

The World Health Organization (2002) defines SA as

any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or
acts to traffic or otherwise directed against a person’s sexuality using coercion, by any
person regardless of their relationship to the victim, in any setting, including but not
limited to home and work. (p. 149)

When applied to people with ID, SA refers to any situation involving any kind of
sexual activity (i.e., unwanted sexual touching, being forced to touch someone, expo-
sure to sexual contents, or sexual intercourse) that the individual does not want or
852 Sexual Abuse 32(7)

consent to or is unable to understand due to his or her cognitive (i.e., intellectual) level
(Reiter, Bryen, & Shachar, 2007; Verdugo, Rogriguez, Bermejo, & Aguado, 2002). In
this context, the ability to consent emerges as a crucial issue. One of the main concerns
of professionals who support people with ID is their inability to accept or decline a
sexual encounter because they are not able to distinguish between consensual and
nonconsensual sexual acts (McCarthy, 1999). As a result, qualitative studies with
women with ID found that the majority of those who had engaged in sexual practices
with a partner had not given their consent or had experienced problems declining
sexual propositions (McCarthy, 2001).
In addition to the ability to give their consent or not, there are several other factors
that make people with ID more vulnerable to suffering from SA. Some of these factors
are also linked to the risk of SA among persons without ID (e.g., being female or
assaulted by a relative), whereas others (mainly those related with their low cognitive
abilities) are quantitatively and qualitatively different from factors that usually increase
the risk of SA in the general population. For this reason, it is important to take into
account the unique nature of SA in people with ID when assessing their victimization
risk. Risk factors could be classified in different categories that offer a picture of the
areas that should be assessed to estimate the risk of SA in people with ID: (a) factors
related to individual characteristics, (b) factors related to the perception of the risk of
SA, and (c) factors related to reporting the abuse. In any case, the majority of these risk
factors have been identified through retrospective studies (e.g., Balogh et al., 2001),
correlational and cross-sectional studies (Gil-Llario, Morell-Mengual, Ballester-
Arnal, & Díaz-Rodríguez, 2018; Zirpoli, Snell, & Loyd, 1987), or emerged during
theoretically driven researches (Wissink, Van Vugt, Moonen, Stams, & Hendriks,
2015); so, the extent to which these factors predict the risk of SA at a medium/long
term warrants further research.
Regarding factors related to individual characteristics, the gender and the degree of
ID have usually been highlighted as relevant when assessing the risk of sexual victim-
ization. As in the general population, SA does not occur with the same prevalence in
men and women. Indeed, different studies suggest that between 39% and 60% of
women with ID are at risk of being sexually abused compared with 16% to 30% of
men with ID (Swango-Wilson, 2009). Thus, women with ID are considered more vul-
nerable to SA than men, even when other risk factors are present to a similar degree
(Gil-Llario et al., 2018; Liou, 2014; Wilczynski, Connolly, Dubard, Henderson, &
Mcintosh, 2011). As to the degree of disability, several studies showed higher vulner-
ability to SA in people with moderate or mild ID, compared with individuals with
severe ID (Balogh et al., 2001; Liou, 2014; Morell-Mengual, Gil-Llario, Díaz-
Rodríguez, Castro-Calvo, & Ceccato, 2016; Pan, 2007; Zirpoli et al., 1987). Contrary
to what would be expected, people with greater clinical severity and interference from
the ID (i.e., level of dependency) showed less risk of SA.
In addition, different studies highlight the following individual factors as relevant
in increasing the risk of SA in people with ID: (a) a lack of sexual information (i.e.,
inadequate sexual education); (b) poor social skills; (c) cognitive limitations that hin-
der the expression of their desires and needs related to sexuality; (d) communication
Gil-Llario et al. 853

deficits; (e) the presence of myths and false beliefs regarding sex; (f) poor ability to
distinguish between appropriate–inappropriate sexual encounters, safe–dangerous
sexual situations, or public–private spaces; (g) lack of positive sexual experiences and/
or models; (h) low self-esteem; (i) the need for help with personal body care; and (j)
inability to defend or speak up for themselves (Euser, Alink, Tharner, Van IJzendoorn,
& Bakermans-Kranenburg, 2016; McGuire & Bayley, 2011; Schaafsma, Kok,
Stoffelen, & Curfs, 2017; Vadysinghe et al., 2017; Verdugo et al., 2002; Wilczynski
et al., 2011; Wissink et al., 2015; Yıldız & Cavkaytar, 2017). It is important to point
out that even when some of these individual risk factors have been also linked to SA
among persons without ID (e.g., an inadequate sex education; Finkelhor, Hotaling,
Lewis, & Smith, 1990), their influence in increasing the probability of being sexually
abused is notably higher among people with ID. Thus, ID seems to increase the likeli-
hood of SA through two different mechanisms: increasing the impact of traditional
risk factors and promoting new (and unique) risk factors.
Factors related to the perception of the risk of SA are also important. People with
ID usually deny the risk of SA associated with relatives or other close people (e.g.,
friends or caregivers), and in most cases, they are only aware of the potential risks of
sexual victimization by strangers in “dangerous places” (e.g., walking alone at night).
However, research demonstrates that in the majority of the cases, relatives and acquain-
tances are the perpetrators of this abuse (Wissink et al., 2015). In addition, the pres-
ence of different caretakers increases the likelihood of being a victim of SA to the
extent that it increases contact with “potential” perpetrators (Ailey et al., 2003).
Individuals with ID also feel excessively safe from SA when they are in familiar
places; however, the abuse usually occurs in familiar places (e.g., their own house, the
neighborhood, public places, residential care, or occupational workshop), especially
when it involves repeated episodes (Reiter et al., 2007; Vadysinghe et al., 2017;
Verdugo et al., 2002; Wissink et al., 2015).
The last category of risk factors is related to the reporting of SA. Individuals with
ID do not usually report these situations, even when they are completely aware of the
nonconsensual nature of the sexual encounter (sometimes because the perpetrator is a
relative or a close friend, because of the fear to be punished or judged, etc.; Ailey et al.,
2003). To report the SA, people with ID have to overcome several barriers such as a
sense of guilt, fear of being abandoned or separated from family, or the loss of affec-
tion and rewards/gifts from the perpetrator (a typical strategy perpetrators use to keep
the victim from disclosing the abuse; Akbaş et al., 2009). In some cases, they cannot
report the abuse because they do not know how (when, how, and to whom), whereas
in other cases, people do not believe them. In this regard, studies have shown that a
high percentage of individuals with ID usually trust their families to report the abuse
(67%), but not their caregivers or people outside their families (33%; Beadle-Brown,
Mansell, Cambridge, Milne, & Whelton, 2010; Reiter et al., 2007; Wissink et al.,
2015). Thus, when the abuse occurs within the family circle, individuals with ID often
lack alternative resources to disclose the SA.
There are many factors that hinder the establishment of an accurate prevalence of SA
among individuals with ID. The inability to distinguish between consensual and
854 Sexual Abuse 32(7)

nonconsensual sexual encounters is one of the main problems: It is extremely difficult

to determine whether abuse has occurred if the individual with ID is not able to clearly
report whether he or she consented to the sexual encounter. In this regard, Parker and
Abramson (1995) found that the ability attributed to individuals with ID to consent
affects law enforcement and health professionals’ determination of SA. Another impor-
tant barrier to estimate the prevalence of SA is that individuals with ID do not usually
report these situations, even when they are completely aware of the nonconsensual
nature of the sexual encounter (Ailey et al., 2003). Finally, cultural differences, SA defi-
nitions, or the way SA is explored can also have an impact on the estimation of SA
prevalence rates (Swango-Wilson, 2009). In any case, it has been estimated that indi-
viduals with ID are 4 to 10 times more likely to be victims of SA than people without
ID (Reiter et al., 2007). In children with ID, the meta-analysis conducted by Jones et al.
(2012) found an average prevalence of sexual violence of 14.5% (range between 7.1%
and 24%). In adults with ID, different studies have shown SA prevalence rates ranging
between 40% and 50%, compared with 15% to 17% in the general population (Euser
et al., 2016; Martinet & Legry, 2014; Reiter et al., 2007). Perhaps due to cultural differ-
ences in the phenomenology and reporting of SA, its prevalence in Spanish studies
tends to be lower (around 12%; Diaz-Rodríguez, Gil-Llario, Morell-Mengual,
Salmerón-Sánchez, & Ruiz-Palomino, 2016; Gil-Llario et al., 2018; Gil-Llario, Morell-
Mengual, Ballester-Arnal, & Díaz-Rodríguez, 2019; Verdugo et al., 2002).

Assessment of the Risk of SA in People With ID

Despite the high prevalence of SA in individuals with ID and the devastating effects
on psychological and physical well-being (Gil-Llario et al., 2018, 2019), there is a
lack of instruments to estimate their vulnerability to sexual victimization. Available
measures assessing SA in people with disabilities are focused on people with ID as
perpetrators of the abuse (rather than on the factors that increase the likelihood of
sexual victimization; Boer, Tough, & Haaven, 2004; Embregts et al., 2010; Lindsay,
2002; Lindsay, Elliot, & Astell, 2004). After an in-depth review of academic data-
bases, only one scale emerged that assesses people with ID as potential victims of
SA: the scale developed by Liou (2014). Based on previous studies exploring risk
factors usually included in SA prevention programs for people with ID (Lumley,
Miltenberger, Long, Rapp, & Roberts, 1998) and tests designed to assess sexual
knowledge (McCabe, Cummins, & Deeks, 1999), this scale constitutes a well-inten-
tioned first approach to the empirical assessment of SA risk in people with ID.
However, it presents several theoretical and methodological shortcomings that com-
promise the reliability of the results.
At a theoretical level, the scale by Liou (2014) confuses knowledge about sexuality
with the risk of being sexually abused, devoting a large number of the items to assess
this aspect. However, it is well known that knowledge about sexuality is not the only
or the best predictor of vulnerability. In addition, the large number of items (30 items)
and the use of different response scales (dichotomous and multiple-choice items)
make it difficult for people with ID to fill out the scale. At a methodological level, the
Gil-Llario et al. 855

validation process did not use an accurate psychometric approach: (a) Despite the
dichotomous nature of the majority of its items, the exploratory factor analysis (EFA)
of this scale is based on the Pearson correlation matrix, instead of on the polychoric
correlation matrix; (b) the initial factorial structure is not confirmed by confirmatory
factor analysis (CFA); (c) some of the factors that emerged are only composed of two
items (clearly insufficient and indicative of overfactoring; Raubenheimer, 2004); and
(d) Cronbach’s alphas for some of the subscales are extremely low (between .51 and
.65). The scale was only validated in women between 14 and 18 years old, and so, its
validity in men and adults is unknown. Finally, the illustrations originally developed
(similar to manga pictures), as well as some of the situations and examples of items,
are not suitable for use in adults or in Western contexts.

The Present Study

Given the theoretical and methodological limitations of the scale proposed by Liou
(2014) and the scarcity of other measures to assess the risk of SA in people with ID,
the current study sought to create a new screening scale that could (a) be used in the
assessment of SA risk in adults with mild and moderate ID, (b) be equally applicable
to both men and women, (c) allow us to identify different vulnerability domains as
well as a general index of SA risk, (d) accurately predict the risk of being a victim of
different forms of SA (unwanted sexual touching, SA, and coercion, etc.; criterion-
related validity), and (e) provide initial psychometric properties (factor structure
through EFA, internal consistency, test–retest stability, and convergent validity) for the
new scale. To reach these aims, we designed a new measure to assess the risk of SA in
people with ID: the DSARss. The DSARss is partly based on the previous work by
Liou (2014), but it also includes significant changes derived from current trends in the
study of SA in people with ID. As a result, in this new scale, we address some of the
theoretical, cultural, and methodological concerns that hindered the use of previous
tools (i.e., Liou’s scale) for the assessment of this relevant dimension.

Method
Participants
The study sample included 246 individuals with mild or moderate ID (Table 1). Of them,
55.3% (n = 136) were males, whereas the other 44.7% (n = 110) were females.
Participants ranged in age from 19 to 64 years (M = 37.8 years, SD = 10.43 years),
although the majority were between 19 and 41 years old (64.9%, n = 159). The majority
lived with their parents or guardians (81.3%, n = 200), followed by 8.9% (n = 22) who
lived in nursing homes or hospital settings for people with ID and 6.9% (n = 17) in com-
munity facilities with different degrees of supervision. Less than 3% (n = 7) of the par-
ticipants lived alone or with others without supervision. As for the age of diagnosis of the
ID, in 87.5% of participants (n = 207), this condition was diagnosed before the age of
eight. Around 45% of the participants (n = 111) suffered from other mental and/or
856
Table 1.  Sample Characteristics.

Total Males Females

(n = 246) (n = 136, 55.3%) (n = 110, 44.7%)
% or M (SD) % or M (SD) % or M (SD) Effect size
Age
  Average age 37.58 (10.43) 37.90 (10.18) 37.18 (10.77) D = 0.06
  Age category (between 18 and 29 years old) 30.6% 28.1% 33.6% V = 0.06
  Age category (between 30 and 41 years old) 34.3% 36.3% 31.8%
  Age category (between 42 and 53 years old) 28.2% 28.9% 28.2%
  Age category (between 54 and 65 years old) 6.9% 6.7% 7.3%
Residence type according to Woodman, Mailick, Anderson, and Esbensen (2014) categories
  With relatives (with parents, siblings, guardians . . .) 81.3% 80.1% 82.7% V = 0.07
 Community living (shared apartment with complete or 6.9% 8.1% 5.5%
partial supervision)
 Nursing home/hospital setting (nursing home, congregate 8.9% 9.6% 8.2%
care, hospital setting . . .)
  Independent living (alone or with others with no supervision) 2.8% 2.2% 3.6%
Age of intellectual disability diagnosis
  From birth 21% 21.6% 20% V = 0.02
  Between 1 and 8 years old 66.5% 66% 67.1%
  Between 9 and 18 years old 9.6% 9.3% 10%
  Older than 19 years old 3% 3.1% 2.9
Other mental/physical condition
 No 54.9% 57.1% 52.2% V = 0.05
 Yes 45.1% 42.9% 47.8%
(continued)
 Table 1. (Continued)

Total Males Females

(n = 246) (n = 136, 55.3%) (n = 110, 44.7%)
% or M (SD) % or M (SD) % or M (SD) Effect size
Administration format of the DSARss
 Self-report 93.4% 95.5% 90.7% V = 0.09
 Interview 6.6% 4.5% 9.3%
Sexual behavior and relationship history
  Have you ever had a boyfriend/girlfriend? (Yes) 70.4% 62.7% 79.8% V = 0.18
  Have you ever had sexual intercourse? (Yes) 41.3% 41.3% 41.3% V = 0.10
  Masturbation (yes) 65.4% 81.4% 45.7% V = 0.41
  Mutual masturbation (yes) 28.9% 29.1% 28.8% V = 0.10
  Oral sex (yes) 15.9% 17.2% 14.4% V = 0.12
  Vaginal sex (yes) 28.9% 26.6% 31.7% V = 0.13
  Anal sex (yes) 13.9% 13.4% 14.4% V = 0.12
SA indicators
  Unwanted sexual touching (self-reported) 24.5% 21.8% 27.8% V = 0.06
  SA (self-reported) 20.6% 12.1% 31.1% V = 0.23
  SA (reported by professionals) 11.2% 5% 18.6% V = 0.25

Note. DSARss = Detection of Sexual Abuse Risk Screening Scale; SA = sexual abuse.

857
858 Sexual Abuse 32(7)

physical conditions: The most prevalent one was attention-deficit hyperactivity disorder
(ADHD; 4.5%, n = 5), followed by motor sensory disorders (4.5%, n = 5), hearing loss
or deafness (2.7%, n = 3), epilepsy (2.7%, n = 3), and schizophrenia (2.7%, n = 3).
Almost the majority (93.4%) completed the DSARss as a self-report. Regarding their
sexual behavior and relationship history, 70.4% (n = 171) of the sample reported having
had at least one boyfriend/girlfriend, and 41.3% (n = 102) reported having had sexual
intercourse with a partner. Some of the most prevalent sexual behaviors mentioned were
masturbation (65.4%, n = 153), vaginal intercourse (28.9%, n = 67), mutual masturba-
tion (28.9%, n = 67), and oral sex (15.9%, n = 37). Finally, 24.5% of the participants
self-reported having been victims of unwanted sexual touching, and 20.6% of SA. The
prevalence of SA reported by professionals was 11.2%. Significant differences between
males and females emerged in the lifetime prevalence of masturbation (V = 0.41) and
SA, both self-reported (V = 0.23) and reported by professionals (V = 0.25).

Measures
Demographics.  Demographic data were obtained through two sources. Participants in
the study self-reported their sex, age, sexual behavior, and relationship history,
whereas the professionals responsible for their care at the support services were asked
about their ID severity, age of ID diagnosis, and presence of other physical/mental
disorders (information available in the participants’ clinical records).

Risk of SA.  We followed a two-step process in the development of the DSARss. First,
we performed an in-depth review of previously published scales exploring the risk of
SA in individuals with mild or moderate ID. We identified only one potential scale that
assessed this aspect: Liou’s (2014) illustrated scale. Despite the theoretical and meth-
odological shortcomings of this scale (see the “Introduction” section for a detailed
review), we capitalized on it as a starting point in the development of our own mea-
sure. After examining its content, we decided to (a) remove one section (puberty phys-
iology) designed to explore knowledge about psychical changes during female puberty
(e.g., “Boys and girls have the same reproductive organs”) because we do not consider
enough justified its inclusion in a scale assessing the risk of SA, (b) remove multiple-
choice items to obtain a homogeneous answer scale and simplify its completion, (c)
remove one item that was not relevant in the assessment of adults with ID (e.g.,
“Female students who wear a school uniform would never be sexually abused”), (d)
reword some questions that we considered confusing, and (e) change the illustrations
for all the items (substituting manga pictures with more neutral illustrations). In a
second step, additional items were derived from multiple sources (such as a research
review, clinical experience, or anecdotal reports by professionals working with people
with ID). These new items were developed with a focus on three prominent themes
that emerged during this previous review: (a) the ability to distinguish between appro-
priate and inappropriate sexual contacts, (b) general risk factors and protection skills,
and (c) the acknowledgment of the risk associated with public and private spaces (as
well as adequate behaviors in each of these spaces). To address potential scale
Gil-Llario et al. 859

limitations noted in previous research on individuals with ID (Hartley & MacLean,

2006), the items were written in clear language that avoided double-barreled queries
or the use of double negatives and included both positively and negatively worded
statements to filter random responding and/or acquiescence. In addition, each item
included an illustration exemplifying the content of the question. We developed a sep-
arate version for males and females, adapting wording and illustrations to the gender
of those who complete the scale. Therefore, the target of the “action” described in the
item and illustrated in the picture is gender dependent.
An initial pool of 23 items was generated using a dichotomous answer format (true
or false). Each item was fully labeled to facilitate response. In addition, to simplify the
questionnaire for participants with possible visual problems, we included only six
items per page (13-point font size). To increase content validity, items were evaluated
by members of the research team (experts in sexual education) and by professionals
working in support services for people with ID. Feedback was reviewed and incorpo-
rated, reducing the initial pool of items to 19. Psychometric properties for the scale are
displayed in the “Results” section. English male and female versions of the DSARss
are included in the supplemental material (A-Table 1 and A-Table 2). The Spanish ver-
sions are available upon request from the first author.

Domain-specific self-concept. To assess the participant’s self-concept in relevant

domains, the Autoconcepto Forma–5 (AF-5) Scale (García & Musitu, 2014) was
administered. This scale has been successfully employed to assess people with ID
(Suriá-Martínez, 2016). It comprises 30 items distributed in five domains: academic
and work, family, psychic, emotional, and social self-concept. Participants answer
each item on a 5-point Likert-type scale ranging from 0 (never) to 4 (always). Internal
consistency for the total scale in individuals with ID is .74 (Suriá-Martínez, 2016). In
this research, Cronbach’s alpha value for the total scale was .55.

Quality of life.  Quality of life was measured using the INICO-FEAPS (Evaluación inte-
gral de la calidad de vida de personas con discapacidad intelectual o del desarrollo)
scale (Gómez, Verdugo, & Arias, 2015), a tool specially designed and validated for use
with individuals with ID. This 72-item scale measures eight basic dimensions of qual-
ity of life: self-determination, rights, social relationships, social inclusion, personal
growth, physical well-being, emotional well-being, and economic resources.
Responses range from 1 to 4 on a Likert-type scale from never to always. Cronbach’s
alpha in the original study was .89. The INICO-FEAPS demonstrated excellent inter-
nal consistency in this sample (α = .91). In this study, we employed four of the eight
subscales of this self-report measure (self-determination, rights, personal growth, and
social relationships).

SA. Information about sexual victimization was obtained through two sources. First,
participants indicated whether they had ever been the victim of unwanted sexual touch-
ing (“Has anyone ever tried to kiss or touch you when you did not want to?”) or SA
(“Has anyone ever forced you to have sex or to perform a sexual act when you did not
860
Table 2.  Detection of Sexual Abuse Risk Screening Scale Factor Pattern and Factor Structure Coefficients.

Factor pattern and factor structure coefficients (the latter in

parenthesis)

  Factor 1 Factor 2 Factor 3 Factor 4

Factor 1: Acceptance of the abuse due to affection
   4. My father takes care of me, so it is okay to have sexual .949 (.924) .072 (.106) –.103 (.116) –.018 (.151)
relationships with him.
   5. M y teacher takes care of me, so it is okay to have sexual .845 (.902) .095 (.119) .137 (.346) .115 (.295)
relationships with him.
   6. My schoolmates take care of me, so it is okay to have sexual .801 (.767) –.076 (–.020) –.308 (–.087) .219 (.326)
relationships with them.
   7. My uncle takes care of me, so it is okay to have sexual .801 (.864) .302 (.321) .155 (.329) .073 (.266)
relationships with him.
Factor 2: Denial of the risk associated with places
   8. It is impossible to be sexually abused in the street. .245 (.313) .728 (.705) .332 (.324) –.176 (.046)
   9. It is impossible to be sexually abused in my home. .113 (.099) .893 (.886) –.022 (–.074) –.187 (–.115)
  10. It is impossible to be sexually abused in a public place (e.g., –.044 (–.010) .859 (.858) .017 (–.045) .020 (–.045)
school, day care center . . .).
Factor 3: Risk factors and self-protection skills
  11. I am more likely to be sexually abused if someone offers me .185 (.229) –.378 (–.327) .523 (.545) –.365 (.290)
alcohol insistently.
  12. I am less likely to be sexually abused if my parents know where –.046 (.069) –.351 (–.401) .640 (.634) –.135 (–.087)
and with whom I go out.
  13. I am more likely to be sexually abused if I am in a deserted area .302 (.395) –.346 (–.372) .526 (.637) –.099 (–.014)
during the night.
(continued)
 Table 2. (Continued)

Factor pattern and factor structure coefficients (the latter in

parenthesis)

  Factor 1 Factor 2 Factor 3 Factor 4

  14. If someone tries to abuse me, I must cry “Stop! Help!” .039 (.221) .196 (.167) .632 (.646) .142 (.238)
  15. I should be suspicious of a stranger who offers me a gift. .335 (.332) –.218 (–.227) .576 (.634) .024 (.140)
  16. If someone sexually abuses me, I should report it to the police. .056 (.265) .192 (.145) .824 (.831) .045 (.167)
  17. If someone sexually abuses me, I should report it to my teacher. –.247 (–.001) .164 (.127) .773 (.742) .309 (.367)
  18. It is better not to say anything if someone touches my privates .063 (.242) .005 (–.001) .568 (.528) .364 (.333)
without my consent.
Factor 4: Lack of awareness of intimacy rules
   1. It is okay if someone I know touches my butt. .107 (.236) –.081 (–.027) –.054 (.071) .776 (.784)
   2. It is okay if I let that people show my privates. –.011 (.156) –.044 (–.002) .087 (.187) .791 (.797)
   3. If I like someone, I can allow him or her to touch my privates. .224 (.327) .090 (.123) .045 (.151) .606 (.536)
  19. If someone touches me when I do not want, I have to let him or .032 (.166) –.198 (–.167) .114 (.207) .483 (.614)
her anyway.

Note. The DSARss has a different version for men and women. The content of the items is equivalent in both versions but the exact wording for some items
change. The items in this table belong to the women version. Values in bold indicate items comprising each factor.
DSARss = Detection of Sexual Abuse Risk Screening Scale.

861
862 Sexual Abuse 32(7)

want to?”). Subsequently, professionals responsible for their care at the support service
reported whether they were aware that the participant had ever experienced SA (“Do you
suspect or have evidence that [participants name] has ever been forced to have sex?”).

Procedure
First, the head of the research project (M.D.G.L.) contacted the managers of the main
daytime support service networks for people with ID in the Valencian Community
(Spain): the “Coordinator of Services for People with ID (COPAVA)” and the
“Valencian Institute for Social Action (IVASS).” After the presentation of the study
aims and procedure, both institutions agreed to participate. Of the 54 day-support ser-
vices managed by both institutions, 23 were selected to participate in this research. To
ensure sample representativeness and broad-scale interpretation of the data, in select-
ing the centers, we followed a stratified random sampling procedure according to
population density (Lohr, 2010). We prioritized the selection of centers located in
urban areas with a medium population density (with a higher rate of individuals with
ID), and we completed the assessment in centers located in areas with high and low
population densities. Thus, in the final sample, 22.1% of the participants (n = 54)
were from cities with a population density >500,000, 65.3% (n = 160) from cities
with a population density between 10,000 and 500,000, and 13.1% (n = 32) from cit-
ies with <10,000 inhabitants (considered rural areas; Goerlich & Cantarino, 2015).
Taking into consideration that the treatment of individuals with ID in rural and urban
areas is not equivalent in terms of providing services and community-based care
(Wark, Hussain, & Edwards, 2013, 2014), socialization and integration in the com-
munity (Nicholson & Cooper, 2012), or criminal victimization (Wilson & Brewer,
1992), this recruitment procedure allowed us to obtain a representative sample of indi-
viduals with ID coming from urban and rural areas.
An average of 11 participants completed the assessment in each center. To deter-
mine eligibility for the research, we established the following inclusion criteria: (a)
age above 18 years old, (b) meeting the Diagnostic and Statistical Manual of Mental
Disorders (5th ed., DSM-5; American Psychiatric Association, 2013) criteria for ID
(mild or moderate severity), and (c) having enough communication and reading skills
to carry out the study. Information about ID severity was already included in the par-
ticipant’s clinical records at the daytime support services. Professionals in these cen-
ters determine the IQ level through standardized intelligence tests (i.e., Wechsler Adult
Intelligence Scale [WAIS]) and the level of severity and functional impairment in
conceptual, social, and practical domains. Then, ID severity was determined based on
the criteria proposed by the DSM-5. Participants’ reading skills were assessed before
the study began by consulting their educational supervisors at the support services.
Those who showed low reading skills (or did not know how to read and write) were
excluded from the research only if they did not have high enough comprehension and
communication skills to carry out the assessment procedure with the researcher’s
assistance. Participants were also excluded from the study if their ID was severe or
profound and/or their guardians did not sign the informed consent. Regarding the
Gil-Llario et al. 863

assessment procedure, two members of the research team with extensive experience in
the assessment and treatment of people with ID carried out the data collection. Each
participant was assessed individually. Those who showed good performance on the
previous reading task were given a brief explanation about how to complete the assess-
ment tools, and support was provided while they were filling them in. Those who
showed poor performance on the previous reading task completed the assessment
questionnaires as an interview (administered by the researchers) with greater support
from the pictorial representations of the items (particularly, in the case of the DSARss).
The average time per assessment was 45 min, 10 of which were devoted to establish-
ing rapport with the participant.

Data Analysis
Descriptive analyses were first conducted to characterize participants in terms of
sociodemographic, clinical, and sexual behavior data using the SPSS statistical pack-
age (Version 24.0). To compare participants’ characteristics in males and females, we
performed t tests (continuous variables) and chi-square tests (categorical variables).
The effect size for these contrasts was computed by using G*Power software (Version
3.1); specifically, we estimated Cohen’s d and Cramer’s V (in chi-square tables, 2 × k
is equivalent to Cohen’s W index for effect size; Sheskin, 2007). For Cohen’s d, effect
sizes of about .20 were considered small, close to .50 were moderate, and greater than
.80 were large (Cohen, 1988); for Cramer’s V, these sizes corresponded to values of
.10, .30, and .50, respectively (Ellis, 2010).
To identify the internal structure of the DSARss, EFA was carried out. SPSS
R-Menu (Version 2.4.3), an interface that implements R syntax and procedures in
SPSS, was employed to perform the EFA (Basto & Pereira, 2012; Courtney, 2013).
One of the advantages of this SPSS expansion is the possibility of performing the EFA
based on polychoric correlation matrix; this option is recommended when modeling
dichotomous data and the univariate distribution of ordinal items is asymmetric or has
an excess of kurtosis (such as in the case of DSARss; Ferrando & Lorenzo-Seva,
2017). Following Gaskin and Happell’s (2014) recommendations, the factors were
extracted through principal component analysis (PCA) by applying oblique rotation
(Oblimin). To determine the number of factors to be retained during the EFA, we fol-
lowed the procedure proposed by Ruscio and Roche (2012): that is, comparing the
convergence between more than one retaining procedure. In particular, we estimated
and compared the results from the following six procedures: (a) parallel analysis (PA),
(b) comparison data (CD), (c) very simple structure (VSS), (d) optimal coordinates
(OC), (e) Velicer’s multiple average partial (MAP) procedure, and (f) acceleration fac-
tor (AF). All these indices were calculated on the basis of the polychoric correlation
matrix using SPSS R-Menu (Version 2.4.3). The same procedure was followed to per-
form two independent EFAs according to gender; the results of these EFAs were then
compared to assess structural consistence in both males and females.
Subsequently, the general mean scores of the items, subscales, and the total score on
the DSARss were explored, as well as the percentage of participants whose responses
864 Sexual Abuse 32(7)

on each indicator indicated a high level of risk. Different reliability indexes were calcu-
lated: Specifically, we employed an R package (userfriendlyscience; Peters, 2014) to
estimate ordinal Cronbach’s alpha and omega, item–scale, and item–test correlations.
Temporary stability 6 months after initial application of the DSARss was also obtained
using another R package (psych), based on the polychoric correlation matrix. Convergent
validity was explored by correlating (Pearson’s r for continuous variables and poly-
choric correlation for categorical variables) the DSARss total score and subscales with
related measures. Finally, hierarchical logistic regressions were performed to determine
the most effective predictors of SA indicators (i.e., criterion-related validity). Continuous
and categorical variables (sex) were introduced into a first block following Hardy’s
(1993) coding recommendations. To test the possible moderating effects of sex and age
on the relationship between the independent (DSARss subscales) and dependent vari-
ables in the model, interaction terms were entered into a second block.

Ethics
The study procedures were carried out in accordance with the Declaration of Helsinki.
The Institutional Review Board of the University of Valencia approved the study.
Volunteer participants in the research and their guardians were informed of the study
aim and completed an informed consent.

Results
EFA of the DSARss
To verify the applicability of the EFA to the DSARss, the Kaiser–Meyer–Olkin (KMO)
index (KMO = 0.720), Barlett’s test of sphericity, χ2(171) = 915.6, p < .001, and the
determinant of the polychoric correlation matrix (.0269) were calculated. After the anal-
ysis of the convergence between six different retaining methods, it was estimated that the
appropriate number of factors to be retained was four. In particular, five of these indices
(the PA, CD, OC, MAP, and the VSS) suggested to retain four factors, whereas the AF
proposed only one factor for the DSARss. Given that AF is biased toward underestima-
tion of factors and that accuracy of factor estimation when the PA and the CD converge
is around 92% (Ruscio & Roche, 2012), we decided to ignore the unidimensional pro-
posal. The factorial solution derived from the PCA revealed that the four-factor structure
explained 65.34% of the total variance of the questionnaire. Table 2 includes factor pat-
tern and structure coefficients obtained after oblique rotation.
The first factor (“Acceptance of the abuse due to affection”), which is composed of
four items (Items 4, 5, 6, and 7) and has an eigenvalue of 5.17, explained the highest
percentage of the scale variance (27.24%). These items reflect the normalization of the
abuse when it comes from a person who treats them properly and the inability to iden-
tify it when the perpetrator is a relative, a caregiver, and/or a person for whom they
feel affection (e.g., “My father takes care of me, so it is okay to have sexual relation-
ships with him”). With an eigenvalue of 3.09 and 16.29% of the explained variance,
Gil-Llario et al. 865

the second factor (“Denial of the risk associated with places”) grouped together three
items (Items 8, 9, and 10). This factor comprises questions about minimizing the risk
of SA in different public and private places (“It is impossible to be sexually abused in
the street” or “It is impossible to be sexually abused in my home”). The eight items
that make up the third subscale (“Risk factors and self-protection skills”; Items 11, 12,
13, 14, 15, 16, 17, and 18) assess the capacity to identify factors that increase the risk
of being sexually abused (“I am more likely to be sexually abused if someone offers
me alcohol insistently”) or protect them from SA and assault (“I should be suspicious
of a stranger who offers me a gift.”), also including important aspects related to the
disclosure of the abuse (“If someone sexually abuses me, I should report it to the
police”). This factor has an eigenvalue of 2.19 and an explained variance of 11.57%.
The fourth factor (“Lack of awareness of intimacy rules”) integrates the other four
items (Items 1, 2, 3, and 19) and has an eigenvalue of 1.94 and an explained variance
of 10.22%. This factor includes items about respect for body intimacy and physical
contact (“It is okay if someone I know touches my butt” or “If someone touch me
when I do not want, I have to let him or her anyway”).
To confirm whether the factor structure for the overall data set was equivalent in
both men and women, two EFAs were performed and then compared according to the
gender. To ensure comparability, EFAs were conducted following the same procedure
that was used for the overall data set (i.e., comparison of multiple indices to decide the
number of factors to retain and derivation of the factorial solution through PCA with
oblique rotation). Detailed results for both EFAs are included in the supplemental
material (A-Table 3 for females and A-Table 4 for males). In both cases, the analysis
of the different retaining procedures (all except the AF) advised the retention of four
factors. Beyond slight differences in explained variance and factorial loadings due to
the reduction in the sample size, the four-factor solution obtained for the overall data
set was consistent according to gender. Distribution of the items across the four
DSARss’ factors as well as the load of each item on the factors they belong to were
similar in men and women and equivalent to those reported for the overall sample.
Variances explained by the factors were also similar (48.84% in males and 50.13% in
females), further confirming the factorial equivalence according to gender.

Descriptive Data, Reliability, and Temporal Stability of the DSARss

A mean value near 0 on the DSARss items indicates a nonexisting or lower risk of
being sexually abused, whereas a value near 1 indicates a medium to high risk. As
Table 3 reveals, the sample’s mean scores on the DSARss’ items range between 0.04
and 0.63, with the majority of the cases lying at the lower end of the score range. Items
3, 9, and 10 had the highest mean values and the highest proportion of risk answers
(48.4%, 62.6%, and 57.7%, respectively). The proportion of participants with a risk
score on the remaining 16 indicators was below 40%. Regarding the factors, the sec-
ond one (“Denial of the risk associated with places”) showed the highest average score
(range = 0-3, M = 1.57), followed by Factor 3 (“Risk factors and self-protection
skills”; range = 0-8, M = 1.52) and Factor 4 (“Lack of awareness of intimacy rules”;
 Table 3.  Descriptive Statistics and Reliability Indexes for Items, Factors, and Total Score of the DSARss.

866
Reliability indexes

  Range M (SD) Risk (%)a Skewness Kurtosis α [CI] Ω [CI] I-F r I-T r
DSARss—total score 0-19 4.54 (2.58) NA 0.98 1.58 .82 [0.79, 0.85] .79 [0.76, 0.83] NA NA
DSARss—Factor 1 0-4 0.36 (0.78) NA 2.96 9.96 .93 [0.91, 0.94] .93 [0.92, 0.94] NA .54b
  Item 4 0-1 0.04 (0.20) 4.5 4.43 17.79 NA NA .73 .37
  Item 5 0-1 0.07 (0.24) 6.5 3.54 10.68 NA NA .74 .47
  Item 6 0-1 0.21 (0.40) 21.1 1.42 0.02 NA NA .76 .36
  Item 7 0-1 0.04 (0.18) 3.7 4.96 22.85 NA NA .74 .45
DSARss—Factor 2 0-3 1.57 (1.15) NA –0.14 –1.42 .73 [0.67, 0.78] .76 [0.71, 0.81] NA .41b
  Item 8 0-1 0.37 (0.48) 37 0.54 –1.72 NA NA .75 .45
  Item 9 0-1 0.63 (0.48) 62.6 –0.52 –1.74 NA NA .82 .25
  Item 10 0-1 0.58 (0.49) 57.7 –0.31 –1.91 NA NA .81 .27
DSARss—Factor 3 0-8 1.52 (1.57) NA 1.06 0.671 .81 [0.77, 0.85] .78 [0.74, 0.82] NA .68b
  Item 11 0-1 0.39 (0.48) 39 0.45 –1.81 NA NA .72 .32
  Item 12 0-1 0.30 (0.46) 30.1 0.87 –1.24 NA NA .66 .29
  Item 13 0-1 0.22 (0.41) 22.4 1.33 –0.21 NA NA .72 .43
  Item 14 0-1 0.06 (0.24) 6.1 3.69 11.726 NA NA .34 .34
  Item 15 0-1 0.20 (0.40) 19.9 1.51 0.29 NA NA .56 .42
  Item 16 0-1 0.05 (0.22) 5.3 4.02 14.29 NA NA .47 .38
  Item 17 0-1 0.09 (0.29) 9.3 2.81 5.94 NA NA .45 .37
  Item 18 0-1 0.20 (0.40) 20.3 1.48 0.20 NA NA .47 .41
DSARss—Factor 4 0-4 1.08 (1.04) NA 0.78 –0.03 .70 [0.63, 0.76] .74 [0.69, 0.79] NA .58b
  Item 1 0-1 0.35 (0.47) 35 0.63 –1.61 NA NA .72 .38
  Item 2 0-1 0.14 (0.35) 14.2 2.06 2.26 NA NA .67 .38
  Item 3 0-1 0.48 (0.50) 48.4 0.06 –2.01 NA NA .66 .41
  Item 19 0-1 0.11 (0.30) 10.6 2.58 4.69 NA NA .44 .29

Note. DSARss = Detection of Sexual Abuse Risk Screening Scale; NA: not applicable; I-F r = corrected item–scale correlation. I-T r = corrected item–test correlation.
aPercentage of users who answer positively to the different risk indicators.
bCorrected scale–test correlation.
 Table 4.  Scores in the DSARss According to Sex, Age, and ID Severity.

Moderate
Males Females Age Mild ID ID
M (SD) M (SD) t d R M (SD) M (SD) t d
DSARss—total score 5.08 (2.71) 3.86 (2.52) 3.77*** 0.46 –.05 4.13 (2.51) 4.53 (2.46) 0.89 0.16
DSARss—Factor 1 0.43 (0.90) 0.27 (0.60) 1.53 0.20 –.01 0.32 (0.71) 0.44 (0.82) 0.85 0.15
DSARss—Factor 2 1.79 (1.11) 1.30 (1.14) 3.41*** 0.43 –.03 1.56 (1.25) 1.58 (1.16) 0.05 0.01
DSARss—Factor 3 1.62 (1.72) 1.40 (1.36) 1.13 0.14 –.03 1.58 (1.57) 1.23 (1.38) 1.29 0.23
DSARss—Factor 4 1.24 (1.02) 0.89 (1.04) 2.59** 0.33 –.03 0.90 (0.94) 1.04 (1.03) 0.78 0.14

Note. DSARss = Detection of Sexual Abuse Risk Screening Scale; ID = intellectual disability.
*p < .05. **p < .01. ***p < .001.

867
868 Sexual Abuse 32(7)

range = 0-4, M = 1.08). Finally, the sum of the scores on the 19 DSARss items yields
a scale ranging from 0 to 19. The average score on this scale was 4.5 (again at the
lower end of the score range). As expected from a scale assessing the risk of being
sexually abused, the DSARss was right skewed (0.98) and leptokurtic (1.58), reflect-
ing the presence of a large proportion of participants at lower values of the score dis-
tribution (i.e., with a low risk of SA) and a proportion that gradually decreases at
higher values of the distribution.
Reliability analysis of the DSARss, calculated using the ordinal Cronbach’s alpha
(recommended when estimating the reliability of dichotomous scales), found high
internal reliability for the total scale (α = .82) and for the five factors (α ranging
between .70 and .93). Similarly, reliability estimated through the ordinal Ω was .79 for
the total scale and ranged between .74 and .93 for the subscales. Internal consistency
was also supported by item–scale (between .34 and .82), item–test (.25-.47), and
scale–test correlations (.41-.58).
As for the temporal stability of the DSARss, test–retest correlation 6 months after
the first administration was .47 for the total score and from .20 to .52 for the subscales
(rfactor 1 = .52, rfactor 2 = .40, rfactor 3 = .32, rfactor 4 = .20). Temporal stability was below
.30 for Factor 4, which denotes either the sensitivity of this scale over time or the con-
siderable impact of slight response changes on a dichotomous scale with a low number
of items (four items). All the correlations were significant at p < .001.

Convergent and Criterion-Related Validity of the DSARss

Multiple sources of information were taken into account during the analysis of
DSARss’ validity. First, the profile of participants with an increased risk of being
sexually abused was analyzed according to their sex, age, and ID severity (Table 4). It
is expected that the profile of those participants with an increased risk of SA matches
with that highlighted by previous literature, thus supporting the use of the DSARss in
their identification. In this regard, male participants showed an increased risk of SA
measured with the DSARss total score (t = 3.77, p < .001) as well as an increased risk
in two particular domains (“Denial of the risk associated with places” and “Lack of
awareness of intimacy rules”). Differences between males’ scores and females’ scores
reached a small to moderate effect size (d between 0.33 and 0.46) in these cases.
However, the risk of being sexually abused was independent from the participant’s age
and ID severity (mild or moderate; Table 5).
To determine the convergent validity of the DSARss, the total and scale scores were
correlated with other measures used to assess related dimensions (Table 6). The per-
sonal self-concept scale negatively correlated with one of the DSARss factors: “Risk
factors and self-protection skills” (r = −.17). Factor 1 also correlated negatively with
“rights,” one of the quality of life dimensions assessed with the INICO-FEAPS scale
(r = −.17). In addition, the DSARss total score and some of its scales positively
(mainly Factor 3) correlated with different inappropriate sexual and partner behaviors
(such as “Have you ever touched your privates in public?”) as well as with general
sexual behaviors (e.g., vaginal or oral sex).
Gil-Llario et al. 869

Table 5.  Correlations Between the DSARss and Related Measures.

DSARss

  Total score Factor 1 Factor 2 Factor 3 Factor 4

AF-5
  AF-5 social .08 –.01 –.05 –.12 .01
  AF-5 emotional –.06 .01 –.11 –.02 –.031
  AF-5 family .11 –.03 –.07 .10 .08
  AF-5 physical .07 .12 –.03 –.17** –.04
INICO-FEAPS
 Self-determination –.06 –.07 .02 –.07 –.06
 Rights –.05 –.17** .08 –.13 –.04
  Personal growth –.03 –.01 .04 .04 –.11
  Social relationships –.04 .04 –.07 .07 –.09
Inappropriate partner and sexual behaviors
 If you like a person, you can .06 .06 .13* .31*** .13*
force him or her to kiss you
 If you like a person, you can .14* .08 .19** .31*** .21***
force him or her to go hand
in hand
 Have you ever touched .49*** .28*** .18** .38*** .47***
your privates in public?
Sexual behavior
 Masturbation .15* .19** .13* –.11 .21***
  Mutual masturbation .09 .10 .11 –.19* .16**
  Oral sex .12 –.03 .08 –.16 .18**
  Vaginal sex .05 .03 –.07 –.02 .12
  Anal sex .08 .17** .06 –.06 .15*

Note. DSARss = Detection of Sexual Abuse Risk Screening Scale; AF-5 = Autoconcepto Forma–5;
INICO-FEAPS = Evaluación integral de la calidad de vida de personas con discapacidad intelectual o del
desarrollo.
*p < .05. **p < .01. ***p < .001.

Finally, hierarchical logistic regressions were performed to estimate the criterion-

related validity of the DSARss subscales (independent variables) on the following SA
indicators (dependent variables): unwanted sexual touching (self-reported) and SA
(self-reported and reported by professionals; Table 6). In addition, two independent
variables (sex and age) were also included as predictors (first block) and as interaction
terms (second block), to test their possible moderating effect on the relationship
between the DSARss and the dependent variables. However, none of these interaction
terms were significant, and so, they were excluded from the regression models. The
results of the logistic regressions revealed significant models accounting for 7.7% of
unwanted sexual touching, 15.5% of self-reported SA, and 11.2% of SA reported by
professionals. The third factor of the DSARss (“Risk factors and self-protection
870 Sexual Abuse 32(7)

Table 6.  Logistic Regression Models for Unwanted Sexual Touching (Self-Reported) and SA
(Self-Reported and Reported by Professionals).

Unwanted sexual
touching (self- SA (reported by
reported) SA (self-reported) professionals)

  β p value R2 β p value R2 β p value R2

Sex 0.378 .23 7.7%* 1.438 <.001 15.5%** 1.642 <.001 11.2%*
Age –0.007 .62 0.002 .89 0.025 .23  
DSARss—Factor 1 0.349 .14 0.139 .50 0.089 .65  
DSARss—Factor 2 0.034 .80 0.040 .10 0.117 .65  
DSARss—Factor 3 0.246 .009 0.257 .01 0.050 .73  
DSARss—Factor 4 0.200 .17 0.241 .13 0.115 .58  

Note. SA = sexual abuse; DSARss = Detection of Sexual Abuse Risk Screening Scale.
*p < .05. **p < .01. ***p < .001.

skills”) was a significant predictor of self-reported unwanted sexual touching (β =

0.246, p = .009) and SA (β = 0.257, p = .01), whereas sex (being female) was a sig-
nificant predictor of self-reported SA (β = 1.487, p < .001) and SA reported by pro-
fessionals (β = 1.654, p < .001).

Discussion
The aim of this study was to elaborate and test the psychometric properties of the
DSARss, a brief screening measure to assess the risk of people with IDs experi-
encing SA.
The EFA grouped the DSARss items into four factors that explained 65.34% of
the total variance. All the dimensions of the instrument include aspects that the sci-
entific literature has found to be essential in the prevention of SA in people with
intellectual functional diversity (Bowman, Scotti, & Morris, 2010; Reiter et al.,
2007). In addition, considering gender differences in the SA phenomenon (Swango-
Wilson, 2009), the results of the independent EFAs conducted in males and females
revealed that the factorial solution was equivalent to that proposed for the overall
data set. Consequently, this instrument has good construct validity and is sensitive
to gender, which means it is appropriate for the detection of SA in men and women.
In addition, it should be pointed out that although a slight decrease in internal con-
sistency is observed when each factor is analyzed separately with respect to the total
score (Field, 2009), all the subscales show good to excellent internal consistency
with values higher than .70. In this regard, Hartley and MacLean (2006) determine
that internal consistency with values ranging between .60 and .79 can be considered
appropriate when a scale is applied to individuals with ID. These findings, along
with the values of the omega coefficient, indicate that DSARss is a reliable measure
for assessing the risk of SA in people with ID.
Gil-Llario et al. 871

The first factor, “Acceptance of the abuse due to affection,” evaluates one of the
most important aspects of SA prevention, that is, denial of the risk of SA when the
victim is close to the perpetrator (Verdugo et al., 2002). This factor explores the
likelihood of being a victim of SA by people in the closest environment. Many stud-
ies report the existence of a close relationship (kinship, friendship, or proximity)
between the aggressor and the victim (Eastgate, 2008; Mitra, Mouradian, Fox, &
Pratt, 2016; Reiter et al., 2007). The second factor, “Denial of the risk associated
with places,” includes three items related to the perception of the risk of SA in dif-
ferent locations (Liou, 2014). Several studies show the need to seek out informa-
tion, not only about public places but also about private places (such as occupational
centers) where the individual with ID could have a perception of invulnerability to
SA (Cambridge, Beadle-Brown, Milne, Mansell, & Whelton, 2011). The third fac-
tor, “Risk factors and self-protection skills,” evaluates several elements that other
studies have found to increase the likelihood of sexual victimization, such as drug
use (Taggart, McLaughlin, Quinn, & Milligan, 2006), or decrease it, such as super-
vision by parents, relatives, or guardians (Swango-Wilson, 2011), or mastering
coping skills (Bowman et al., 2010; Verdugo et al., 2002). In addition, this factor
assesses the ability to disclose the experience of SA, as well as the people they
would choose to report it to (e.g., guardian, police). Although rates of SA reported
in people with ID are higher than those reported for people without ID (Reiter et al.,
2007), several studies suggest that this prevalence of sexual victimization may be
even greater due to the nondisclosure. Nondisclosure may be caused by the difficul-
ties to recognize the SA (considering as normal sexually abusive behaviors), by the
shame usually experienced after abuse, or by the inability to report an abusive act
performed by a close relative (presumably for fear of being deprived of their affec-
tion or care; Mitra et al., 2016). This reality highlights the need to thoroughly assess
the ability of people with ID to identify and respond to sexual victimization
(Bowman et al., 2010; Doughty & Kane, 2010). The fourth factor, “Lack of aware-
ness of intimacy rules,” assesses the person’s knowledge about what constitutes a
potential threat to personal space. In addition, it is important to assess their ability
to identify interactions that may involve SA (Bowman et al., 2010; Doughty &
Kane, 2010; Liou, 2014; Swango-Wilson, 2009).
Regarding gender and the risk of being sexually abused, our results suggest that
men with ID present a higher risk of sexual victimization in general and in two
domains: (a) the denial of the risk associated with places and (b) the lack of awareness
of intimacy rules. These results go against the main conclusion derived from previous
studies, that is, victimization figures are higher among women (Liou, 2014; Swango-
Wilson, 2009). These contradictory results could be easily understood analyzing the
difference between risk and victimization: Even when the risk of being sexually
abused is greater in males, the primary target of sexual offenders (in their majority,
males with a heterosexual sexual orientation) is women. Moreover, the real prevalence
of SA among men with ID is probably greater than the currently estimated figure, but
these cases can be silenced by shame or guilt (e.g., a man should be able to defend
himself; Mitra et al., 2016).
872 Sexual Abuse 32(7)

Examining the criterion-related validity of the DSARss (i.e., the predictive power
of the DSARss subscales on different indicators of SA), our results were consistent
with previous findings. As previous research suggests, the ability to identify inappro-
priate sexual encounters or abusive situations and respond to alleged SA were signifi-
cant predictors of two outcomes related to sexual victimization (Bowman et al., 2010;
Liou, 2014). The predictive capacity of risk factors and self-protection skills was
stronger in SA self-reports than in unwanted touching self-reports. On this issue, Tang
and Lee (1999) established that the most severe abusive behaviors (penetration or oral
sex) are easier for people with ID to identify than more subtle abusive behaviors (e.g.,
unwanted touching or kissing). By contrast, the other three subscales of the DSARss
were not significant predictors of SA indicators, thus suggesting that they have limited
power to detect either the future risk of being a victim of SA or the fact that SA has
already occurred.
With regard to evidence of convergent validity, our results show a significant asso-
ciation, in the expected direction, between some factors of the DSARss and self-deter-
mination and personal growth (Verdugo et al., 2002), knowledge about one’s rights
and the rights of others (Bowman et al., 2010; McCormack, Kavanagh, Caffrey, &
Power, 2005), social relations and sexual assertiveness, and self-protection skills
(Eastgate, Van Driel, Lennox, & Scheermeyer, 2011; McCormack et al., 2005). In
addition, sexual experience can be a variable that hinders the disclosure of abuse.
Thus, people with ID may think that if they reveal the abuse, they will be blamed for
voluntarily seeking a sexual relationship that subsequently led to abuse.
Despite a number of interesting findings, this study was limited in several ways. First,
this study is cross sectional and, therefore, does not address whether the increased risk of
SA identified through the DSARss’ scores increases the risk of sexual victimization at a
medium/long term. Thus, future research should carefully examine the predictive power
of the DSARss over future victimization (predictive validity), preferably through longitu-
dinal studies. At a psychometric level, some of the items’ factorial loadings are low and
one of the DSARss subscales (Factor 2) is comprised only by three items. Even when
three is considered the minimum number of items for specifying latent factors
(Raubenheimer, 2004), we do not recommend using scores from this subscale for inter-
pretative purposes; however, it adds important information during the assessment of SA
(the risk associated with the different places where the abuse usually occurs). This study
also possesses the limitations commonly reported in studies in which self-report measures
are used (e.g., socially desirable responses). Considering that our study was focused on
SA, another limitation included the extent to which participants fully disclosed these situ-
ations during the completion of the study scales. In any case, great efforts were made to
prevent the problem of socially desirable responses and SA disclosure: (a) providing par-
ticipants with a private and secure space for the survey’s completion, (b) explaining the
anonymity of their responses and the importance to answer honestly, and (c) investing
time in establishing good rapport with the participant before starting to complete the
study. Another concern is related to the administration format of the scale: Because of
reading problems, 16 participants (6.6%) completed the DSARss as an interview instead
of as a self-report. Ideally, factorial equivalence between both methods should be tested
Gil-Llario et al. 873

but the low number of participants in the interview condition prevents this comparison. In
addition, the reliability of one of the scales employed in the study (the AF-5 Scale) is poor
(α = .55), so the conclusions derived from this measure should be carefully considered.

Conclusion
The present study shows the usefulness of the DSARss as an instrument for screening
the risk of SA in people with ID. Its psychometric properties support its reliability and
validity. In addition, its brevity and simplicity (supported by illustrations) facilitate a
rapid evaluation that makes it possible to obtain valuable information to develop pre-
ventive programs. In any case, the modest criterion-related validity of some of the
DSARss scales on different SA indicators impedes its use as a conclusive tool to deter-
mine the future risk of being sexually victimized or as a forensic test in assessing
potential cases of SA.

Acknowledgments
We thank the anonymous reviewers and the Journal Editor and Action Editor for their insightful
feedback on earlier drafts of this article.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship,
and/or publication of this article.

Funding
The author(s) disclosed receipt of the following financial support for the research, authorship,
and/or publication of this article: This research was supported by grant PSI2014-53546-R (proj-
ect “Sexuality and Quality of Live in People: Consequences of Sexual Abuse”) of the Ministry
of Economy, Industry and Competitiveness (Spain).

Supplemental Material
Supplemental material for this article is available online.

ORCID iD
Vicente Morell-Mengual https://orcid.org/0000-0003-1532-8028

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