Human Sexuality Education for Students with Disabilities

1. Human Sexuality Education for Students with Disabilities

2. 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)

3. 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?

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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 non-disabled 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

10. 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.

11. 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

12. 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.

13. 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

14. 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

15. 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 • 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

16. 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

17. 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.

18. 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

19. 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

20. 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

21. Sexuality and Disability

22. Human Development and Sexuality • People with disabilities may have: • 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: • 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

23. 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

24. 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

25. 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

26. 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.

27. 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

28. 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

29. 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

30. 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

31. Adapting Sexuality Education and Materials for Students with Developmental Disabilities

32. 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

33. 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”

34. 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 • Self-stimulation

35. 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

36. 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

37. 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.

38. 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.

39. 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 • 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

40. 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

41. Developmental Appropriate Sexuality Education Content • American Academy of Pediatrics & NICHCY suggests the following topics for children ages 5-8: • 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

42. Developmental Appropriate Sexuality Education Content • American Academy of Pediatrics & NICHCY suggests the following topics for children ages 8-11: • 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

43. 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

44. 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. • Small blocks of content presented at a time • Simple and concrete terms • Special materials • More time and repetition

45. 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) • 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 • Repetition, practice, frequent review, feedback & praise

46. 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

47. 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

48. 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

49. Policy Statements on Sexuality Education for Persons with a Disability • Identify policy issues that need to be addressed • 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

50. 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.