Sex Education for Young People with Disabilities

1. Sex Education for Young People with Disabilities Dr. Julie Williams, Psy.D., ABPP Board Certified Rehabilitation Psychologist Associate Professor / School of Professional Psychology Wright State University

2. Outline • Myths about Sexuality and Disability • How attitudes among parents and providers impact sexual expression of individuals with disabilities • General Considerations for teaching sex education • Strategies for teaching sex education

3. Myths *(Kaufman, Silverburg, & Odette, 2003) • Disabled people are not sexual and/or do not have “real sex” • Disabled people are unnatural therefore, their sexual desires/or urges are treated as bad • People with disabilities have more important things to worry about. • Disabled people are showing poor control if sexual • Disabled people are not sexually desirable therefore they do not experience sexual assaults

4. Resulting Impacts of Myths held by Parents and Providers • Youth with disabilities do not receive any sex education • If they do receive sex education it is “abled-bodied” information and is not in an accessible format for varying disabilities (e.g. Deaf youth, visually impaired and cognitive disabilities) • Sexual expression such as masturbation among youth and young adults is punished, controlled and/or stopped • Unnecessary and/or forced sterilization • Young people with disabilities and adults with disabilities are sexually assaulted frequently and at higher rates then their non-disabled peers. • Rates of sexually transmitted diseases and overall poor sexual health is common among individuals with disabilities.

5. What Parents and Providers Can do to Reverse the Cycle • Parents should act as their children’s primary sex educators • However, Parents need to overcome their fears and get prepared for the conversation.

6. Parent Fears (ADVOCATES FOR Youth Organization) • 1) Talking about sex will encourage sexual experimentation; • 2) Parents believe they don’t know enough to handle questions appropriately; • 3) Parents fear their children already know too much or too little. • 4) Parents of children who are living with disabilities may feel that their children are potential targets for sexual abuse or exploitation. • 5) Parents may fear that their children may be unable to appropriately express their sexual feelings.

7. General Considerations(ADVOCATES FOR Youth Organization) • Before you start a conversation with your child, make sure you know your own values and beliefs. Be honest with yourself. • Acknowledge that everyone, including your child, is sexual—and has sexuality related emotions and desires. • Be ready to assert your personal privacy boundaries. • Start talking with your children about sexuality while they are very young. Do not wait until they reach puberty (or later) for these conversations!

8. General Considerations(ADVOCATES FOR Youth Organization) • Use accurate language for body parts and bodily functions. Research shows that when a child has accurate language for private body parts, she/he is more likely to report abuse, if it occurs, than when the child lacks appropriate language. • Identify times to talk and communication strategies that work best for you and your child. For example, the best time might be Saturday morning on the way to a sports event or after school while you share a snack. • Avoid times and strategies that do not work well for your children and your situation. For example, you may be unable to carry on a coherent conversation while driving .

9. General Considerations(ADVOCATES FOR Youth Organization) • Be clear when discussing and different kinds of relationships. • Use photos, pictures, and other visual materials as often as possible. Showing family photos may help your child to understand different types of families and relationships. • Use ‘teachable moments’ that arise in daily life. For example, talk about a neighbor’s new pregnancy. • Discuss abuse and importance of knowing difference between “good touch” and “bad touch” • Be clear with your child about how to say “no” and how to get help.

10. General Considerations (Advocates for Youth Organization) • Be honest when your child asks questions. If you don’t know the answer, say so. Say you will find the answer and then do so. • Be sure to get back to your child with the answer to her/his question. • Always acknowledge and value your child’s feelings and experience. Offer praise and support. For example, you might say, “That’s a good question, and it is one I have had in the past, too.” Or, “I’m glad you feel happy when we talk. I feel happy, too.” • Be willing to repeat information over time. Don’t be impatient or expect your child to remember everything you said or to have entirely understood it.

11. General Considerations (Advocates for Youth Organization) • Use all the reliable sources of information available to you—other parents whom you trust, the public library, reliable Web sites, local bookstores, educators, and health care providers. • Use information that comes from reputable organizations that deal with disabilities and/or sexuality. • Do not use material that is negative about sexuality as such materials can limit your ability to be your child’s primary sex educator

12. General Considerations for Professionals (Advocates for Youth Organization) • Remember young people with disabilities have feelings, sexual desire, and a need for intimacy and closeness. • Children with disabilities need skills, knowledge, and support. • Understand that youth with disabilities are far more vulnerable to sexual abuse than are their peers. • Youth who live with developmental disabilities are especially vulnerable. • Sex education must, therefore, encompass skills to prevent sex abuse and encouragement to report and seek treatment for unwanted sexual activity. • Remember that youth who confront disabilities feel the same discomfort and suffer the same lack of information that hampers many of their peers regarding sexuality and sexual health.

13. General Considerations for Professionals (Advocates for Youth Organization) • Learn as much as you can about the disabilities of the populations with whom you work. • Be sure that the material addresses boundaries and limits—both setting boundaries and respecting others’ boundaries. • Rely on role plays and interactive exercises. • Use concrete teaching strategies.

14. General Considerations for Professionals (Advocates for Youth Organization) • Be creative. • Modify teaching tools and resources for the youth with whom you work. • Youth who have developmental disabilities, may need visuals like models, dolls and pictures. • Youth with physical disabilities, would benefit from learning of others with similar disabilities who have loving, satisfying intimate relationships.

15. Specific Strategies and Examples Caveat: • It is very important to remember that when it comes to sex education, one size does not fit all!!! • Sex education curriculums need to consider • Range of disabilities and the most accessible delivery of the information • Teachers and parents should be encouraged to consult frequently with experts in disability and sex educators

16. Specific Strategies and Examples Caveats Continued • It is also important to be aware of and prepared to consider and discuss differences in sexual preferences

17. Strategies • Keeping in mind age, disability and knowledge • Assess what the child knows and what the child has been told • Share your teaching strategies with parents to promote comfort and a sense of self efficacy in talking about sex • Consider offering a group session for parents and children to discuss basic sexual health and expression information (this is only to be done as general dialogue and opportunity to open the doors of communication around sexuality. Individuality of sexual education needs need to be considered on a case by case basis. • Give the young adult room to ask questions, to explore and to have assurance his/her privacy will be maintained and respected

18. Specific Strategies and Examples • Disabilities in children and intellectual disabilities in adolescence • Pictures depicting body parts and names of body parts • Role playing • Talk about Masturbation!! • Normalize • Problem-solving with youth safe places and times to masturbate

19. Specific Strategies • Physical disabilities • Mobility • Use information from experts in sexuality and disability to gain knowledge about disability specific sexual function. For example, a youth with a high level spinal cord injury, may experience bowel and bladder control issues and feel ashamed to engage in sexual activity or to date someone. • Sensory • Ensure that materials for those with visual impairments are accessible in terms of size of print and/or audio • Ensure that materials and training for Deaf youth is of the appropriate language/reading levels to be understood.

20. References • Advocates for youth, (Sex education for emotionally, physically and intellectually challenged youth. http://www.advocatesforyouth.org/publications/479?task=view • Ballan M. Parents as sexuality educators for their children with developmental disabilities. SIECUS Report 2001; 29(3):14-19. • Couwenhoven, Terri. Sexuality education: building a foundation for healthy attitudes” Disability Solutions 2001; 4(5). • Neufeld J, Klingeil F, Bryen DN, Silverman B, Thomas A. Adolescent sexuality and disability. Physical Medicine & Rehabilitation Clinics of North America 2002; 13(4): 857-73. • Tepper MS. Becoming sexually able: education to help youth with disabilities. SIECUS Report 2001; 29(3):5-13