You will be required to find and read oneresearch articleon a topic relating to human sexuality. The research article must be published in peer-reviewed, scholarly journals and must be relatively recent (within the last 10 years). Articles from newspapers, magazines, and websites, or information taken from books or book reviews, are NOT acceptable. In addition to finding and reading the appropriate article, you must include a summary and critique of the article. Your summary should be no less than one page in length.
attached is the article:Denboer, J. W., & Hough, S. (2010). The role of clinical neuropsychology in the study of sexuality and disability.Sexuality and Disability,28(3), 147-155. doi:http://dx.doi.org.ezproxylocal.library.nova.edu/10.1007/s11195-010-9163-7
ORI GIN AL PA PER The Role of Clinical Neuropsychology in the Study of Sexuality and Disability John W. DenBoer • Sigmund Hough Published online: 8 April 2010 � Springer Science+Business Media, LLC 2010 Abstract Human sexuality is the way people experience themselves and each other as sexual beings. Clinical neuropsychology is an area of psychology that specializes in the diagnostic assessment and treatment of patients with brain injury or neurocognitive deficit. Specific neuropsychological correlates of sexuality have been researched in the past, including sex differences in cognitive abilities and sexual orientation. Although some consistent differences between sex and sexual orientation have been found, the majority of these differences appear to be due to an interaction of biological predisposition and sociological factors. Additionally, neuropathological correlates of sexual disorders have been found and future research into the neuropsychological correlates of sexual offenders (i.e., rapists, child molesters) is warranted. Although neuropsychology has been periph- erally involved in research concerning human sexuality, there is a more prominent role for clinical neuropsychologists who are uniquely trained to provide assistance in the diagnosis and treatment of sexual deviance and sexual dysfunction/disability. Keywords Neuropsychology � Sexuality � Assessment � Gender � Sex � Disability Introduction and Purpose Human sexuality, defined as the way people experience themselves and each other as sexual beings [1], is a multifarious and intriguing topic. Clinical neuropsychology is an area of psychology that specializes in the diagnostic assessment and treatment of patients J. W. DenBoer (&) Arizona Neurological Institute, 10474 W. Thunderbird Ave, Sun City, AZ, USA e-mail: [email protected] S. Hough VA Boston Healthcare System, West Roxbury, MA, USA S. Hough Harvard University Medical School, Boston University School of Medicine, Boston, MA, USA 123 Sex Disabil (2010) 28:147–155 DOI 10.1007/s11195-010-9163-7 with brain injury or neurocognitive deficit. Although neuropsychology has been periph- erally involved in research concerning human sexuality, clinical neuropsychologists are uniquely trained to provide insight in the diagnosis and treatment of sex offenders and sexual dysfunction/disability. In addition to reviewing the pertinent research literature, the overarching purpose of this manuscript is to explore the role of clinical neuropsychology in the study of sexuality and disability, as well as to expand on the role of clinical neuropsychologists in the treatment of sexual dysfunction and disability. In doing so, this paper will review the pertinent literature on gender differences in sexuality. The manuscript will conclude with a proposed synthesis between neuropsychology, sexuality, and disability. Background and Key Definitions Encompassing both sexual norms and meanings, sexuality is—at least partially—mediated by society and culture. The behavioral, cultural, and psychological traits associated with one’s sex are typically defined as gender [2] whereas sex refers to one’s anatomy. Indi- vidual sexuality is difficult to define, given that the vibrant and flexible nature of this concept causes it to extend beyond the notions of sexual activity and sexual orientation to include our feelings about our gender, what type of people we are attracted to, and how we feel about our bodies [3]. Similar to other topics in the social sciences, sexuality has been ripe with debate and controversy. According to Foucault’s three-volume History of Sexuality [4–6], since the nineteenth century (when it came to be regarded as a part of human nature) sexuality has developed in a political climate and, as such, has remained inherently subjective. For example, some of the more challenging and evolving questions of psychology concern the mechanisms of sexuality, including (but not limited to) sexual attraction [7]. The complex questions of sexuality also include and affect issues of disability. Sexu- ality has been shown to be an important part of life for individuals with both mental and physical illness. For example, researchers have examined the importance of sexuality in individuals with developmental delay [8], autism [9], and learning disabilities [10]. Additionally, research has examined the relationship between sex and diabetes [11]. Sexuality and disability issues are not just confined to adulthood, but are an inherent and important part of childhood and early adolescence [3]. This includes the study of sexual and reproductive health in individuals with cystic fibrosis [12] as well as an examination of the implications for growing up HIV-positive [13]. The importance of sexuality has also been studied in young adult cancer survivors [14]. Similar to the study of sexuality and disability, clinical neuropsychology has evolved in a relatively short time period to become a diverse and complex area of brain-behavior study. Throughout clinical neuropsychology’s development as a specialty, theorists and practitioners alike have developed wide-ranging theories to account for changes and developments in neuroradiological techniques and cognitive functioning. Today, neuro- psychologists study problems in attention, learning, perception, cognition, personality, and psychopathology [15]. Although clinical neuropsychologists are relied upon to increase diagnostic accuracy, they are also increasingly found performing treatment services in neurorehabilitation environments [16], where they often encounter issues of sexuality, impairment, ability and disability. As the manner and technique for studying the brain has evolved, the definition of clinical neuropsychology has undergone various changes as well. The policy statement 148 Sex Disabil (2010) 28:147–155 123 resulting from the Houston Conference on Specialty Education and Training in Clinical Neuropsychology defines a clinical neuropsychologist as a professional that ‘‘specializes in the application of assessment and intervention principles based on the scientific study of human behavior across the lifespan as it relates to normal and abnormal functioning of the central nervous system’’ [17]. The 1989 definition provided by The Clinical Neuropsychologist states: ‘‘A Clinical Neuropsychologist is a professional psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system’’ (p. 22). The National Academy of Neuropsychology (NAN) expanded upon and modified this definition in their 2001 statement that ‘‘a clinical neuropsychologist is a professional within the field of psychology with special expertise in the applied science of brain-behavior relationships…’’ (p. 554) [18]. Neuropsychologists who have been very much a part of neurorehabilitation research, cognitive assessment and training, now find themselves encountering patients with con- cerns about sexuality. These include patients with traumatic brain injury and spinal cord injury, as well as those with other types of neurological disability. Fortunately, there has been increasing recognition of the potential secondary effects of sexual dysfunction among neurologically-impaired patients, including (but not limited to) relationship problems [19]. Literature Background Recent literature has begun to explore the connection between clinical neuropsychology and sexuality and disability. This empirical interest has taken the form of articles and books examining gender differences in neurocognitive abilities [20–24]. Additionally, research has also focused on the neurobiological development and neuropsychological correlates of sexual orientation. There has been a burgeoning literature base examining gender differences in neuro- psychological functioning, with much of it taking place in the last three to four decades. This line of research has been highlighted in the seminal text, The Psychology of Sex Differences [25]. The researchers found that girls excelled in verbal memory, while boys showed better quantitative skills and superior spatial abilities. In contrast, Parker and Claxton [26] have found that, since the time of Maccoby and Jacklin’s findings, that female advantages in verbal memory were reduced, with boys edging closer to boys in this domain. Additional findings come in the form of Hyde and Linn [27]. Based on a meta- analysis of 165 studies, the researchers concluded that there were no obvious gender differences in verbal ability. Findings in mathematical achievement also have been shown to be somewhat inconsistent [28, 29]. Neuropsychological Correlates of Sexual Orientation Only recently has research begun to focus on the role of neuropsychology in the study of the development of sexual orientation. Scientists such as Rahman [7] have reviewed evidence and suggested that human sexual orientation may be laid down in neural circuitry during early fetal development. As support for this thesis, Rahman cited a consistent fraternal birth order effect in male sexual orientation. The author concluded that non- heterosexual preferences may reflect generalized neurodevelopment perturbations. In addition to biological research, neurocognitive studies of sexual orientation have also been conducted. Rahman et al. [29] examined the performance of 240 right-handed Sex Disabil (2010) 28:147–155 149 123 participants (60 heterosexual men, 60 homosexual men, 60 heterosexual women, and 60 homosexual women) on the Digit Symbol subtest of the Wechsler Adult Intelligence Scale—Revised (WAIS-R). Results revealed that heterosexual women, homosexual women, and homosexual men outperformed heterosexual men. Neave et al. [30] examined the performance of heterosexual and homosexual males and females on four cognitive tasks, which were shown to reveal evidence of sexual dimorphism. Significant relation- ships were found between salivary free-testosterone levels and cognitive performance on both spatial tasks, but no significant differences were found between the two groups on two verbal tasks. Additionally, gay men and lesbians have been found to be more verbally fluent than heterosexuals [29, 31] although these findings were not replicated in two studies [30, 32]. An additional study found that gay men may receive higher scores than non-gay men on test of object location memory, although no difference was found between lesbians and non-lesbians on these measures [29]. While some studies have found significant differences in sexual orientation, there have been multiple studies that have failed to obtain significant cognitive differences. Addi- tionally, Sanders and Wright [33] failed to obtain a sexual orientation difference in cerebral asymmetry and performance on motor tasks. Additionally, [34] observed no sex-related differences in biological primary mathematical skills, even in non-human primates, a finding that the researchers found to be true for many cultural groups [35]. Research has also examined the biology of bisexuality. Van Hyk and Geist [36] in a meta-analysis of several studies, found that early exposure to masculinizing hormones appeared to predispose human females toward bisexuality, rather than exclusive homo- sexuality. Additionally, van Gorp et al. [37] found that selection site and method of participant recruitment were significant factors related to neuropsychological performance in both symptomatic and asymptomatic HIV-infected gay or bisexual participants. The authors concluded that this ‘‘may serve as a potential source of bias affecting the results of neuropsychological studies of HIV-1 infection’’ (p. 206). Neuroimaging and Sexual Orientation Brain research has revealed structural differences in specific parts of the brain depending on sexuality. Swaab et al. [38] reported a significant difference in the size of the supra- chiasmatic nucleus between homosexual and heterosexual men, although this study was limited by the relatively small sample of brains studied. Additionally, Allen and Gorski [39] when comparing the brains of homosexual and heterosexual men, found a significant difference in the size of the anterior commisure. LaVay [40] also studied four groups of neurons in the hypothalamus (INAH1, INAH2, INAH3, and INAH4), finding that the INAH3 group was twice as large in heterosexual males as compared to homosexual males. Byne (2001) extended this work by finding that the INAH3 weight for the heterosexual male brains was significantly higher than those of the female brains, with the INAH3 weight