Teaching Sex Ed for Youth with Intellectual Disabilities

People with disabilities have the same sexual desires and needs as everyone else. These unique guides from sexualityandu provide resources and information for teachers providing sexual education to youth with intellectual or physical disabilities.

What are intellectual disabilities?

People with intellectual disabilities, also referred to as learning disabilities, experience a range of difficulties, that can be mild to moderate, to severe limitations in functioning. Intellectual disability (ID) can also be described as below average intellectual functioning in the areas most typically of communication, social skills, health and safety, and functional academics.
Developmental disability is a term used to describe severe, life-long disabilities that may be attributed to mental and/or physical impairments, manifested before the age of 18.
The term is most commonly used to refer to disabilities affecting daily functioning in two or more of the following areas:

• capacity for independent living
• economic self-sufficiency
• learning
• mobility
• receptive and expressive language
• self-care
• self-direction

In general, someone is described as learning disabled if there is a large discrepancy between intellectual ability and achievement. The person with a learning disability may have low or high intelligence, but they simply learn below intellectual capability because of a processing disorder.
The developmentally disabled person has a severe and chronic mental impairment that may limit success in several major life areas, and this impairment begins in childhood. Usually people with mental retardation, cerebral palsy, autism spectrum disorder, various genetic and chromosomal disorders such as Down syndrome and Fragile X syndrome, and fetal alcohol syndrome are described as having developmental disabilities. Developmental disabilities are usually classified as severe, profound, moderate or mild, as assessed by the individual’s need for support.
Learning disabilities are developmental disabilities. People with learning disabilities have a chronic mental impairment. However, they are not mentally retarded. Typically they have average to above-average intelligence, but simply cannot learn in certain processing modes, and they must compensate for this disability.
People with intellectual disability have the same sexual needs and desires as those without disabilities. 60-90% of people with mild disabilities report wanting to marry and have children in the future.
Sexuality education for people with ID is particularly important because of the high rates of sexual abuse. Some statistics suggest that as high as 80% of women who have ID and 50% of men with ID will be sexually abused before the age of 18. It is important that we teach skills that make it less likely for people with ID to be victimized, and also more likely to report it if it does occur.

Stereotypes of people with intellectual disabilties

Common stereotypes of intellectually disabled people regarding sex:

1. They will forever remain childlike
2. They are and always will be asexual
3. They are unable to understand their sexual desires
4. They have incontrollable sex drives
5. They are potential sexual deviants, and should be denied sex education in case it ‘gives them ideas’

Challenges for teaching sexual health to students with intellectual disabilities

Approximately 90% of people with ID have difficulty with abstraction. This means that they may have trouble with visualizing and seeing pictures in their heads in the same way as others may be able to. Therefore, when they listen to someone speak, they can often repeat what they have heard but may not fully understand.
It is also very important to model and explain social norms. For example, if we hug a person with ID because they did a chore around the house but we do not explain the connection, they may learn that it is appropriate to hug people without reason.
Sexuality education in the classroom breaks a social norm, because private issues are being talked about in a public space. This can sometimes result in a students leaving a sexuality education class and doing something inappropriate in the corridor. It is important to keep reinforcing the appropriate social norms and the difference between private and public places.
Every person with an ID learns differently. When teaching sexual health, it is optimal to teach the same thing in different ways, rather than using just one approach and teaching more slowly.
Things to consider when teaching sex education to intellectually disabled youth:

• Lack of knowledge about sexual issues. Any info may come from misinformed peers rather than reliable sources like books, parents or teachers. Parents and teachers have been traditionally less likely to speak about sex with youth who have disabilities;
• Mental age may be lower than their physical age;
• They may learn at a slower rate;
• May be at greater risk for sexual abuse because of their willingness to place total trust in others & their tendency to be overly compliant. May also be more dependent on parents and caregivers;
• May be overprotected from parents or caregivers. May have less opportunity for sex with oneself or with others due to a lack of privacy;
• May have difficulty with abstract thinking (ex: what is love?) or understanding the long term consequences of pregnancy or some sexually transmitted infections;
• Youth with intellectual disabilities may have trouble distinguishing between private and public behaviours, or private and public body parts.

Guidelines for teaching sexual health with students with intellectual disabilities

Repeat, repeat and repeat again. It is important to use repetition when teaching youth with intellectual disabilities. You can repeat the same concept from a few different angles to maximize the potential for understanding. Each lesson should begin with a review of the previous lesson(s).
Stay concrete with your examples. Many students with intellectual disabilities do not comprehend well abstract concepts such as love, or that a pregnancy results in having a baby nine months later. The examples used need to be concrete, in the present and almost tangible. Using pictures and videos is a good method.
Don’t overload with information. Going slower with the information is better. If you had wanted to do two sessions of sex education with the group, then schedule four sessions so that you have enough time for the students to process the information, ask questions and have discussions. You can also leave a few days between each lesson so that students have the time to think about the information.
Assume that the students have not had any sex education before (unless you know otherwise). You should start with the basics.
Appreciate that the students ARE sexual and this may be expressed in various ways. For most students, talking about sex will not encourage them to try it. It will just make them more comfortable and informed on the subject for when the moment(s) happens.
Teach the right to refuse. Disabled people can sometimes be trained to be quite compliant.
Remember that context is everything! How does the information fit into their real life? Discuss social situations as examples.
Help youth to practice appropriate affection, with whom and where.
Discuss masturbation. It is important that all students understand the concept and value of masturbation (unless your values are in conflict with this). Students need to know that this is healthy and natural and is entirely appropriate if they are in the right place (private place).

A note about masturbation

It is very important that we prevent sexual behaviour such as masturbation or exposure of genitals in public places, because this behaviour is illegal.
Often people with ID that masturbate in public are told repeatedly to masturbate in their bedrooms. However, often people with ID cannot get excited or orgasm when they masturbate alone in their bedroom. This is because they may require visual stimulation (especially men), but they do not have the ability to visualize images in their heads.
A simple way to solve this problem is to give images (not necessarily pornography but images from magazines) so that they have a source of stimulation in their bedroom.