Human Sexuality Education
for Students with Disabilities
1
Disabilities among Children and
Youth
• 5.2 million American youth ages 5-20 have some long term physical,
mental, or emotional disabling condition
• 1 million youth ages 3-17 are deaf or hard of hearing
• 5,000 infants and toddlers and up to 1.500 preschoolers are
diagnosed with cerebral palsy
• Two of every 1000 infants born has cerebral palsy
• 94,000 school age children are blind
• 7,800 Americans suffer spinal cord injuries each year (82% are
males avg age 19)
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Disability & Sexuality: Case Studies
• How much detail must I tell her? Won’t she just get confused?
• Is it really necessary to broach the subject of intercourse since
Johnnie is simply not capable of a close relationship, let alone a
sexual encounter. Besides, he’ll be accompanied all his life by a
support worker, so what chance is there that he will have sex?
• Ronda is non verbal—how can I possibly teach her information
related to relationships, and what is the chance that she would even
understand it?
• Joey has a severe developmental disability and will be child-like for
the rest of his life. He won’t need that type of information.
• Bobbie is still young, there is lots of time to think about teaching him
this type of information in five years or even later. What has "sex" or
"sexuality" got to do with him now?
Fact or Fiction about Sexuality and
Disability
• People with disabilities do not feel the desire to have sex
(if disabled in one way disabled in every way)
• People with developmental and physical disabilities are
asexual, childlike, sexually innocent (do not possess
maturity to learn about sexuality)
• People with disabilities are sexually impulsive
(oversexed and unable to control their sexual urges)
men aggressive & women promiscuous
• People with disabilities will not marry or have children so
they have no need to learn about sexuality
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Fact or Fiction about Sexuality and
Disability
•
Myth 1: People with disabilities ar not sexual
– All people are sexual beings needing affection, love, and intimacy,
acceptance and companionship
– Children and youth with disabilities may have some unique needs
related to sex education
– Children with developmental disabilities may learn at a slower rate than
peers yet physical maturation usually occurs at the same rate
• Need sex education that builds skills for appropriate language and
behavior in public
• Paraplegic youth may need reassurance that they can have
satisfying sexual relationships and practical guidance on how to do
so
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Fact or Fiction about Sexuality and
Disability
• Myth 2: People with disabilities are childlike and dependent
– Idea stems from belief that person with a disability is unable to
participate equally in an intimate relationship
– If viewed as child-like, or asexual, sexually offensive behavior
likely to be denied or minimized
– societal discomfort with disability and sexuality makes it easier to
view anyone with a disability as an eternal child
• this view denies person’s sexuality and full humanity
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Fact or Fiction about Sexuality and
Disability
• Myth 3: People with disabilities can not control their
sexuality
– If people with disabilities are neither asexual nor
child-like then they are oversexed and have
uncontrollable urges.
• Belief in this myth can result in reluctance to
provide sex education as any offending behavior is
seen as uncrontrollable
• education and training are the key to promoting
healthy and mutually respectful behavior,
regardless of disability
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Fact or Fiction about Sexuality and
Disability
• All of these myths remove consequences from an individual’s
actions, excluding them from a chance to learn more appropriate
sexual behavior
• Sexuality important part of everyone’s life from infancy.
• Growth into adulthood combines a physically maturing body and a
range of sexual and social needs and feelings
• Adults with developmental delays are different from children in
appearance, past life events and available life choices
• We must guard against making inaccurate assumptions by avoiding
misinformation and a restrictive attitude towards sexuality of people
with disabilities
The Politics Of Education
• 1975 P.L. 94-142 Education of All Handicapped Children
Act
– Guaranteed a free, appropriate public education to each child
with a disability in every state across the country
• Individuals with Disabilities Education Improvement Act
(2004)
– Students with disabilities have the same educational
opportunities to the maximum extent possible as their nondisabled peers
– IEP include transition plans identifying appropriate employment
and other adult living objectives, referring student to appropriate
community agencies and resources (must begin at age 14)
• Attitudes of people with disabilities has not changes as
fast as the laws enacted to support them – especially in
sexuality and disability
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Socialization
• Important goals of any human sexuality education
program include promoting a positive self-image as well
as developing competence and confidence in social
abilities
• Children with disabilities have:
– Fewer opportunities than their peers to observe, develop and
engage in appropriate social and sexual behavior
– Fewer opportunities to acquire information from peers
• Often held back by social isolation as well as functional
limitations
• By fostering development of social skills, parents and
educators can provide opportunities to learn about the social
contexts of sexuality and the responsibilities of exploring and
experiencing ones own sexuality.
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Socialization
• National Dissemination Center for Children with
Disabilities (NICHCY) recommends:
– Helping children develop hobbies and pursue
interests or recreational activities in the community
and after school
– Children with disabilities should engage in social
opportunities and to grow and learn from social errors
– Extra-curricular activities present opportunities for
friendship based on commonality of interests and
provide opportunities to develop competence and
self-esteem
What is Sexuality?
• According to the Sex Information and Education Council of the U.S.
(SIECUS): Human sexuality encompasses the
– Sexual knowledge, beliefs, attitudes, values, and behaviors of
individuals.
– Anatomy, physiology, and biochemistry of the sexual response
system
– Roles, identity, and personality; with individual thoughts,
feelings, behaviors, and relationships.
– Ethical, spiritual, and moral concerns,
– Group and cultural variations.
What is Sexuality
•
Having a physical sexual relationship (biological/physical)
– Physical sensations or drives our bodies experience
– Genital activity is one small part of human sexuality
•
Social phenomenon (sociological)
– Friendship
– Warmth
– Approval
– Affection
– Social outlets
– Spiritual
– Hygiene
– dress
•
What we feel about ourselves (psycological)
– Whether we like ourselves
– Our understanding of ourselves as men and women (gender
identification)
– What we feel we have to share with others
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What is Sexuality Education
• Comprehensive sexuality education takes into
consideration
– The cognitive domain
• facts and data
– The affective domain
• feelings, values, and attitudes
– The skills domain
• Ability to communicate effectively and to make
responsible decisions
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Parents as Sexuality Educators for
their Children with Disabilities
• Parents of children with developmental disabilities tend
to be uncertain about the appropriate management of
their child’s sexual development
• Concerned about
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Overt signs of sexuality
Physical development during puberty
Genital hygiene
Fears of unwanted pregnancy
STI’s
Embarrassing or hurtful situations
Fear that their child will be unable to express sexual impulses
appropriately
– Targets of sexual abuse or exploitation
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Parents as Sexuality Educators for
their Children with Disabilities
• Problems most frequently mentioned by parents
regarding sexuality education are:
– Inability to answer questions
– Uncertain of what children know or should know
– Confusion, anxiety and ambivalent attitudes toward
sexuality of their children
– Equate learning with intentions to perform sexual
activities
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Parents as Sexuality Educators for
their Children with Disabilities
• Parents need to help their child develop life skills
• Without appropriate social skills young people
may have difficulty making and keeping friends
and may feel lonely and different.
• Without important sexual health knowledge,
young people may make unwise decisions and
or take sexual health risks.
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General Guidelines for Parents &
Professionals
• Regardless of disability, young people have feelings, sexual desire,
and a need for intimacy and closeness
– To behave in a sexually responsible manner, each needs skills,
knowledge, and support
• Youth with disabilities confront the same discomfort and suffer the
same lack of information that hampers peers regarding sexuality and
sexual health
• Learn as much about the disabilities as possible
• Before starting a conversation, make sure you know your own
values and beliefs
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General Guidelines for
Professionals
• Be ready to assert your personal privacy boundaries
• Use accurate language for body parts and bodily functions.
– Children with accurate language are more likely to report abuse
if it occurs
• Identify times to talk and communication strategies that work best for
you and your child
• Avoid times and strategies that do not work well for your child and
your situation
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General Guidelines for Parents &
Professional
• Be clear when discussing relationships (mother father vs, Paul and
Carol)
• Use teachable moments that arise in daily life (e.g., friends
pregnancy, marriage, adoption)
• Be honest when children ask you questions
• Always acknowledge and value your child’s feelings and experience
• Be willing to repeat information over time – don’t expect your child to
remember everything you said
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Sexuality and Disability
Human Development and Sexuality
• People with disabilities may have:
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Difficulty learning
Limited genital and other tactile sensations
Communication problems
Uncertainty about their sexual function and fertility status
• Issues that may hinder development of healthy body
image and self-concept include:
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Use of braces, crutches, wheelchair
Bladder and bowl management routines
Physical differences from peers (atrophy)
Diminished gender role expectations from society
Mistrust of own body
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Sexuality Education for Persons with a
Visual Impairment
•
Visually impaired adolescent has the same interests regarding sexuality as sighted
peers
•
Problems related to sex education for the blind include how they learn, how concepts
are formed, how to select content, how to train teachers and parents
•
When inability to perceive visual stimuli is impaired, knowledge of sexuality stems
from input of other senses
– Individual can feel reality of their body, concept of body of opposite sed not
formed, nor does person have a reference for understanding descriptions such
as fat, tall, pretty, muscular
•
Teaching Plan includes
– Concrete teaching
– Use of other senses (distinguish males from females by smell)
– Opportunities for social learning (may not understand abstract concepts or which
there is a visual reference e.g., masturbation)
– Reinforcement from peers & socialization to generalize and validate information
learned
– Talking books, large print books, books in braille
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Sexuality Education for Persons with
Hearing Impairment/Deafness
• Single most prevalent disability in the US
• Do not have the opportunity to learn about sexuality by overhearing
parents, watching tv, or reading materials
• Communication problem as well as a language problem
– First language is American Sign language not English
– Most reading materials written for 8th grade reading level
• 50% of deaf students age 20 and below read less than fourth
grade level
• Students who are deaf can name significantly fewer internal body
parts than hearing peers
• Lack knowledge of human anatomy, birth control, STI, emotions and
responsibilities in relationships, HIV/AIDS transmission and risk
behaviors
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Sexuality Education for Persons with
Hearing Impairment/Deafness
• Videotapes developed for hearing students not
accessible to students who are deaf
– Students don’t have the skills to read captions,
– Have difficulty watching the action while
simultaneously reading closed captions
– Have difficulty watching ASL interpreter and video at
same time
• Teaching strategies
– Written texts or workbooks, videotapes signed in ASL,
overheads, diagrams/charts, handouts, written
materials
Sexuality Education for Persons with
Autism Spectrum Disorder (PDD)
• Current and effective methods by which to offer information to
individuals with autism include:
• Within functional, practical situations (incidental teaching)
– Example, an individual reaches out and touches a female’s
breasts while gesturing or speaking
• Taken aside and have a discussion
• Show a picture book with illustrations of his social/sexual
circle for inappropriate touch
• Within prearranged situations that are role played
– Some are able to practice appropriate social interaction by
viewing and participating in role playing
– Generalization is often a problem – can not assume the concept
has been learned unless person can apply strategy in variety of
settings with familiar and unfamiliar people.
Sexuality Education for Persons with
Autism Spectrum Disorder (PDD)
• Through the process of modeling
– A trusted female models the stages of using sanitary
napkins over the course of a week incorporating red
dyes of varying strength illustrating the appearance of
light and heavy flows during menstruation
• By means of augmentative communication
– Variety of visual, photographs or line drawings,
concrete objects (pads, condoms), films, wall charts,
– Scripted social phrases and or accurate visuals which
match new situations must be assessed and added to
communication system as individual grows
Sexuality Education for Persons with Spinal
Cord Injury including Spina Bifida
• Impact of spinal cord injury on sexual function dependent largely on
age of person
• Childhood
– Usually a parent’s lowest priority
• Mostly interested in child’s ability to walk, play sports,
– As children approach adolescence it is normal to being to
develop interest in sexual concerns, abilities, & relationships
– Parents tend to feel protective and deny child’s sexuality
• Adulthood
– Adult with SCI has a sexual history with expectations, a partner
who will be impacted
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Sexuality Education for Persons with Spinal
Cord Injury including Spina Bifida
• Changes in sexual response based on location and
degree of the SCI
– Many men and women are counseled to focus on
improving their sexual arousal rather than on
achieving orgasm
– Men and women with intact sensation and specific
nerve reflexes can achieve orgasm but it might take
longer or a longer amount of stimulation
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Sexuality Education for Persons with Spinal
Cord Injury including Spina Bifida
• Capable of understanding a wide range of concepts and facts and
would not need information to be presented in alternate formats
• Might need specific information about how the physical disability
affects expression of sexuality and participation in a sexual
relationship
• Some physical disabilities directly affect sexuality by the
disablement of genital function, most do not
• Absence of sensation does not mean absence of feeling – Inability
to move does not mean inability to please
• Presence of deformity does not mean absence of desire – inability to
perform does not mean inability to enjoy
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Adapting Sexuality Education and
Materials for Students with
Developmental Disabilities
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Contextual Errors and Safety Issues
•
Inappropriate sexual behavior by individuals with disabilities can stem from:
– Lack of opportunity for appropriate sexual expression
– Ignorance of what is considered appropriate behavior
– Poor social education
•
Behavior that leads teens with disabilities into trouble as perpetrators may
not necessarily be atypical for adolescents but it also involves either bad
judgment on the part of the person with a disability or a hasty reaction on
part of parents, school, employer.
•
Opportunities for privacy are less frequent for people with special needs
•
Comprehensive sexuality education often withheld from this population
•
Not surprising that teens with disabilities display sexuality inappropriately
•
Whether sexual behavior is considered appropriate depends on the location
in which the behavior takes place – need to look at problematic behavior in
its context
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Contextual Errors and Safety Issues
• Common social mistakes on part of person with
a disability
– Public-private errors
• Sexual self-stimulation
• Saying something inappropriate in public
– Stranger-friend errors
• Hugging or kissing a stranger
• Being overly familiar with an acquaintance
• Both types of mistakes can put people with
disabilities at risk for sexual exploitation or
breaking the law “perpetrators”
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Public/Private Places
•
Teaching behaviors appropriate to the public & private place encourages
responsible social and sexual behavior
•
Pwd are capable of learning how to behave appropriately in public and
private places
– Many inappropriate actions and activities reflect confusion, lack of
awareness and limited judgment
•
Many social problems indicate a limited understanding about public and
private places, private parts of the anatomy and public and private
behaviors.
– Discouraged from public engaging in activities such as:
• Exposing private parts of the anatomy by undressing, pulling down
or lifting up clothing
• Scratching or touching genitals
• Fixing or adjusting underclothing
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• Self-stimulation
Inappropriate Self-Touch
• Sexual self-stimulation or masturbation is
normal, natural and non-harmful behavior
throughout the life cycle
• Self-stimulation can be a way of learning to be
more comfortable with and/or enjoying one’s
sexuality by getting to know one’s body
• Self-stimulation is a private behavior and
inappropriate in public places
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Developmental Appropriate Sexuality
Education Content
• Allowable Sexual Expression
– Students should not be hugged, caressed, massaged, kissed or
embraced by peers or teachers
• Exceptions include when need for physical calming may be
necessary
• In event a teacher is inappropriately touched by a student,
firmly let the student know that the touch is inappropriate
making distinction between touching public and private parts
• Document incident
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Stranger-Friend Errors
• Circles Method of Teaching Social Behavior
– Social Circles is a graphic way of showing children the different
levels of familiarity we are to have with people we know and
don't know.
– Start by drawing a small circle on a large piece of blank paper.
Write the child's name in the circle and/or paste his picture there.
Tell him this is his personal space, his body, and that only
certain people can get real close to him.
– Draw a larger circle around the child's circle and write “family” in
this larger circle. You can write and/or paste pictures of
immediate family members (mom, dad, brother, grandmothers,
grandfathers, close uncles and aunts) in this circle. Explain that
these people are family members. They may kiss or hug him and
it’s okay to sit on their lap, etc. Explain the sort of behavior that
you feel is appropriate with these people.
Circle Method for Teaching Social Behavior
– Next draw an even larger circle around the child's and the family circle.
Label this circle “friends & neighbors – people you know”. Write the
names and/or paste pictures of people who fit into this category (e.g.,
next door neighbors, close church members, teachers, Sunday School
teacher, etc.). Explain the sort of closeness and behavior that you feel is
appropriate with this category of people (e.g., they wave at you, say
“hello”, they may hug you if you want them to hug you, etc.).
– Lastly, draw an even larger circle around the outside of all three smaller
circles. Label this largest of the circles “strangers – people you don't
know”. Explain that it is not okay to hug, kiss, get too close, or touch
strangers or to allow them to touch you. Later you can explain the
exceptions to this (e.g., a policeman when you’re lost, doctors when
Mom or Dad are present, etc.). You want to get across the idea that no
one has the right to touch him without permission and that he cannot
touch strangers, period (for now).
– You may use different colors for each circle to aid in its meaning to the
child or young person. Remember that visual cues like this are a great
way to back up verbal communication.
Contextual Errors and Safety Issues
• American Academy of Pediatrics
– Children with disabilities are sexually abused at a rate that is
between 2-10 times higher than for children without disabilities
– 68-83% of women with developmental disabilities will be sexually
assaulted
– For people with SCI, abuse disguised as pressure sores, trauma to the
skin, broken bones
• Factors influencing these statistics
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Less able to defend themselves
Often not alert to potentially dangerous situations
Do not know to report abuse
Seek approval and affection
May be exposed to a large number of caregivers for intimate
care
– Taught to be compliant to authority
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Developmental Appropriate Sexuality
Education Content
• Sexuality Education for children with disabilities
requires some degree of individualization
– IEP used as an instrument for adapting sexuality
curriculum
– If human sexuality education is written into the IEP, it
is more likely to be designed and delivered around
the unique needs of the student
– General strategy
• adapt the pace and presentation of information to the child’s
particular needs
• Knowledge of how a particular disability affects development,
learning and sexual expression important in adapting
curriculum
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Developmental Appropriate Sexuality
Education Content
• American Academy of Pediatrics & NICHCY suggests
the following topics for children ages 5-8:
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Body parts
Similarities and differences between boys and girls
Elementals of reproduction and pregnancy
Qualities of good relationships (friendship, love, communication,
respect)
Decision making skills & that decisions have consequences
Beginnings of social responsibility, values and morals
Masturbation can be pleasurable but should be done in private
Avoiding and reporting sexual exploitation
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Developmental Appropriate Sexuality
Education Content
• American Academy of Pediatrics & NICHCY suggests
the following topics for children ages 8-11:
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Pubertal changes (menses, wet dreams, masturbation)
Sexuality as part of total self
Reproduction and pregnancy
Importance of values in decision-making
Communication within family about sexuality
Personal care and hygiene, diet, exercise,
Body image /self-esteem
Contraception strategies
Rights and responsibilities of sexual behavior
Fashionable clothes & Inappropriate dress
Abstinence
Avoiding and reporting sexual abuse
Sexually transmitted diseases including HIV/AIDS
Developmental Appropriate Sexuality
Education Content
•
American Academy of Pediatrics & NICHCY suggests the following topics
for children ages 12-18:
– Health care, health promoting behaviors such as regular check-ups,
breast and testicular self-exam
– Sexuality as part of the total self
– Communication, dating, love, intimacy (Qualities of good relationships
such as friendship, love, communication, respect, decision making, and
knowing there are consequences
– Importance of values in guiding ones behavior
– How alcohol and drug use influence decision making
– Sexual intercourse and other ways to express sexuality
– Birth control and responsibilities of child-bearing
– Reproduction and pregnancy
– Condoms and disease prevention
– Discussing issues of abuse (signs, prevention, what to do if it is
suspected)
– Healthy diet, body weight, good grooming, exercise
Teaching Strategies and Techniques
• For children with learning disabilities & mental
retardation consider:
– Pacing of lessons
– Reading level and ability
• If reading level of materials is out of reach, limits access to
quality printed materials and resources.
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Small blocks of content presented at a time
Simple and concrete terms
Special materials
More time and repetition
Teaching Strategies and Techniques
•
Role play, modeling, play acting and interactive exercises, use concrete
teaching strategies
– Phone etiquette, initiating conversation, inviting a friend for a meal
•
Be creative, develop specialized teaching tools and resources (models,
dolls, pictures, personal stories)
– Pictures of family and friends can be a springboard for talking about relationships
and social interactions
•
Multisensory activities
– Illustrations, anatomical models, slides, photos, audio-visual, interactive
games (e.g., full body drawing or chart to show where body parts are
and what they do)
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Use photos, pictures or other visual materials as often as possible as well
as the library, other parents, websites, educators and health care providers
as resources
– Showing family pictures may help children understand different types of
families and relationships
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Repetition, practice, frequent review, feedback & praise
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Teaching Strategies and Techniques
• Bloom’s Taxonomy
– Divides educational objectives into three domains:
• Affective
• Psychomotor
• Cognitive
– Within each domain are different levels of learning,
higher levels more complex and closer to mastery of
material
Bloom’s Taxonomy
•
Example: Cognitive domain
– Organized in sequence from basic factual recall to higher order thinking
with key words that describe each behavior
• Knowledge: list, tell, identify, show, label and name
• Comprehension: distinguish, estimate, explain, generalize, give
examples, summarize
• Application: apply, find, perform, demonstrate, dramatize
• Analysis: criticize, debate, distinguish, compare,
• Synthesis: plan, set up, design, arrange
• Evaluation: judge, score, approve, appraise
Policy Statements on Sexuality
Education for Persons with a Disability
• Policy development project for your school district
– Evolved from need for guidelines to formulate consistent
responses to behavioral issues
• Public masturbatory behavior
• Student engaged in self-stimulating behavior such as touch his/her
genitals, rubbing against an object, rubbing him/herself against the
floor in a public part of a building (classroom, lunchroom)
• Unacceptable touching of others
• Couples engaging in intimate behavior in public places
– In the absence of a policy different staff members would respond
to incidents haphazardly and counter productively
– Consistency of response is an essential component to alter
maladaptive behavior
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Policy Statements on Sexuality
Education for Persons with a Disability
• Identify policy issues that need to be addressed
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Definition of sexuality
Philosophy about normative sexual development
Inappropriate self-touch
Menstruation
Toileting skills
Allowable sexual expression
Sexual orientation
Sexual exploitation
STI’s and HIV/AIDS infection
Public and private places
Inappropriate dress for work
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Apply your Understanding
• Develop a series of three lesson plans on
a sexuality education topic discussed in
class.
• Bring these lessons and any props you
develop to class
• Be prepared to present and/or model your
lesson for a small group of your peers.