Presentation on theme: "Human Sexuality Education for Students with Disabilities"— Presentation transcript:
1Human Sexuality Education for Students with Disabilities
2Disabilities among Children and Youth 5.2 million American youth ages 5-20 have some long term physical, mental, or emotional disabling condition1 million youth ages 3-17 are deaf or hard of hearing5,000 infants and toddlers and up to preschoolers are diagnosed with cerebral palsyTwo of every 1000 infants born has cerebral palsy94,000 school age children are blind7,800 Americans suffer spinal cord injuries each year (82% are males avg age 19)
3Disability & 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?
4Fact 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 promiscuousPeople with disabilities will not marry or have children so they have no need to learn about sexualityMyth 3: If people with disabilities are neither asexual nor child-like then they must be oversexed and have uncontrollable urgesThese perspectives remove consequences from an individual’s actions excluding that person from a chance to learn more appropriate sexual behaviorReality is that growth into adulthood combines a physically maturing body and a range of sexual and social needs and feelings
5Fact or Fiction about Sexuality and Disability Myth 1: People with disabilities ar not sexualAll people are sexual beings needing affection, love, and intimacy, acceptance and companionshipChildren and youth with disabilities may have some unique needs related to sex educationChildren with developmental disabilities may learn at a slower rate than peers yet physical maturation usually occurs at the same rateNeed sex education that builds skills for appropriate language and behavior in publicParaplegic youth may need reassurance that they can have satisfying sexual relationships and practical guidance on how to do so
6Fact or Fiction about Sexuality and Disability Myth 2: People with disabilities are childlike and dependentIdea stems from belief that person with a disability is unable to participate equally in an intimate relationshipIf viewed as child-like, or asexual, sexually offensive behavior likely to be denied or minimizedsocietal discomfort with disability and sexuality makes it easier to view anyone with a disability as an eternal childthis view denies person’s sexuality and full humanity
7Fact or Fiction about Sexuality and Disability Myth 3: People with disabilities can not control their sexualityIf 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 uncrontrollableeducation and training are the key to promoting healthy and mutually respectful behavior, regardless of disability
8Fact 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 behaviorSexuality 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 feelingsAdults with developmental delays are different from children in appearance, past life events and available life choicesWe must guard against making inaccurate assumptions by avoiding misinformation and a restrictive attitude towards sexuality of people with disabilities
9The Politics Of Education 1975 P.L Education of All Handicapped Children ActGuaranteed a free, appropriate public education to each child with a disability in every state across the countryIndividuals with Disabilities Education Improvement Act (2004)Students with disabilities have the same educational opportunities to the maximum extent possible as their non-disabled peersIEP 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
10SocializationImportant goals of any human sexuality education program include promoting a positive self-image as well as developing competence and confidence in social abilitiesChildren with disabilities have:Fewer opportunities than their peers to observe, develop and engage in appropriate social and sexual behaviorFewer opportunities to acquire information from peersOften held back by social isolation as well as functional limitationsBy 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.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
11SocializationNational Dissemination Center for Children with Disabilities (NICHCY) recommends:Helping children develop hobbies and pursue interests or recreational activities in the community and after schoolChildren with disabilities should engage in social opportunities and to grow and learn from social errorsExtra-curricular activities present opportunities for friendship based on commonality of interests and provide opportunities to develop competence and self-esteem
12What is Sexuality?According to the Sex Information and Education Council of the U.S. (SIECUS): Human sexuality encompasses theSexual knowledge, beliefs, attitudes, values, and behaviors of individuals.Anatomy, physiology, and biochemistry of the sexual response systemRoles, identity, and personality; with individual thoughts, feelings, behaviors, and relationships.Ethical, spiritual, and moral concerns,Group and cultural variations.
13What is SexualityHaving a physical sexual relationship (biological/physical)Physical sensations or drives our bodies experienceGenital activity is one small part of human sexualitySocial phenomenon (sociological)FriendshipWarmthApprovalAffectionSocial outletsSpiritualHygienedressWhat we feel about ourselves (psycological)Whether we like ourselvesOur understanding of ourselves as men and women (gender identification)What we feel we have to share with others
14What is Sexuality Education Comprehensive sexuality education takes into considerationThe cognitive domainfacts and dataThe affective domainfeelings, values, and attitudesThe skills domainAbility to communicate effectively and to make responsible decisions
15Parents 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 developmentConcerned aboutOvert signs of sexualityPhysical development during pubertyGenital hygieneFears of unwanted pregnancySTI’sEmbarrassing or hurtful situationsFear that their child will be unable to express sexual impulses appropriatelyTargets of sexual abuse or exploitation
16Parents as Sexuality Educators for their Children with Disabilities Problems most frequently mentioned by parents regarding sexuality education are:Inability to answer questionsUncertain of what children know or should knowConfusion, anxiety and ambivalent attitudes toward sexuality of their childrenEquate learning with intentions to perform sexual activities
17Parents as Sexuality Educators for their Children with Disabilities Parents need to help their child develop life skillsWithout 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.
18General Guidelines for Parents & Professionals Regardless of disability, young people have feelings, sexual desire, and a need for intimacy and closenessTo behave in a sexually responsible manner, each needs skills, knowledge, and supportYouth with disabilities confront the same discomfort and suffer the same lack of information that hampers peers regarding sexuality and sexual healthLearn as much about the disabilities as possibleBefore starting a conversation, make sure you know your own values and beliefs
19General Guidelines for Professionals Be ready to assert your personal privacy boundariesUse accurate language for body parts and bodily functions.Children with accurate language are more likely to report abuse if it occursIdentify times to talk and communication strategies that work best for you and your childAvoid times and strategies that do not work well for your child and your situation
20General 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 questionsAlways acknowledge and value your child’s feelings and experienceBe willing to repeat information over time – don’t expect your child to remember everything you said
22Human Development and Sexuality People with disabilities may have:Difficulty learningLimited genital and other tactile sensationsCommunication problemsUncertainty about their sexual function and fertility statusIssues that may hinder development of healthy body image and self-concept include:Use of braces, crutches, wheelchairBladder and bowl management routinesPhysical differences from peers (atrophy)Diminished gender role expectations from societyMistrust of own body
23Sexuality Education for Persons with a Visual Impairment Visually impaired adolescent has the same interests regarding sexuality as sighted peersProblems related to sex education for the blind include how they learn, how concepts are formed, how to select content, how to train teachers and parentsWhen inability to perceive visual stimuli is impaired, knowledge of sexuality stems from input of other sensesIndividual 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, muscularTeaching Plan includesConcrete teachingUse 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 learnedTalking books, large print books, books in brailleChild’s inability to perceive visual stimuli is impaired, knowledge of sexuality stems from input to other sensesChild can feel reality of their own body, concept of body of opposite sex is not formed, child has no frame of reference to understand descriptions such as fat, tall, pregnant, pretty, muscular
24Sexuality Education for Persons with Hearing Impairment/Deafness Single most prevalent disability in the USDo not have the opportunity to learn about sexuality by overhearing parents, watching tv, or reading materialsCommunication problem as well as a language problemFirst language is American Sign language not EnglishMost reading materials written for 8th grade reading level50% of deaf students age 20 and below read less than fourth grade levelStudents who are deaf can name significantly fewer internal body parts than hearing peersLack knowledge of human anatomy, birth control, STI, emotions and responsibilities in relationships, HIV/AIDS transmission and risk behaviors
25Sexuality Education for Persons with Hearing Impairment/Deafness Videotapes developed for hearing students not accessible to students who are deafStudents don’t have the skills to read captions,Have difficulty watching the action while simultaneously reading closed captionsHave difficulty watching ASL interpreter and video at same timeTeaching strategiesWritten texts or workbooks, videotapes signed in ASL, overheads, diagrams/charts, handouts, written materials
26Sexuality 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 speakingTaken aside and have a discussionShow a picture book with illustrations of his social/sexual circle for inappropriate touchWithin prearranged situations that are role playedSome are able to practice appropriate social interaction by viewing and participating in role playingGeneralization 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.
27Sexuality Education for Persons with Autism Spectrum Disorder (PDD) Through the process of modelingA 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 menstruationBy means of augmentative communicationVariety 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
28Sexuality Education for Persons with Spinal Cord Injury including Spina Bifida Impact of spinal cord injury on sexual function dependent largely on age of personChildhoodUsually a parent’s lowest priorityMostly 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, & relationshipsParents tend to feel protective and deny child’s sexualityAdulthoodAdult with SCI has a sexual history with expectations, a partner who will be impacted
29Sexuality Education for Persons with Spinal Cord Injury including Spina Bifida Changes in sexual response based on location and degree of the SCIMany men and women are counseled to focus on improving their sexual arousal rather than on achieving orgasmMen and women with intact sensation and specific nerve reflexes can achieve orgasm but it might take longer or a longer amount of stimulation
30Sexuality 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 formatsMight need specific information about how the physical disability affects expression of sexuality and participation in a sexual relationshipSome physical disabilities directly affect sexuality by the disablement of genital function, most do notAbsence of sensation does not mean absence of feeling – Inability to move does not mean inability to pleasePresence of deformity does not mean absence of desire – inability to perform does not mean inability to enjoy
31Adapting Sexuality Education and Materials for Students with Developmental Disabilities
32Contextual Errors and Safety Issues Inappropriate sexual behavior by individuals with disabilities can stem from:Lack of opportunity for appropriate sexual expressionIgnorance of what is considered appropriate behaviorPoor social educationBehavior 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 needsComprehensive sexuality education often withheld from this populationNot surprising that teens with disabilities display sexuality inappropriatelyWhether sexual behavior is considered appropriate depends on the location in which the behavior takes place – need to look at problematic behavior in its context
33Contextual Errors and Safety Issues Common social mistakes on part of person with a disabilityPublic-private errorsSexual self-stimulationSaying something inappropriate in publicStranger-friend errorsHugging or kissing a strangerBeing overly familiar with an acquaintanceBoth types of mistakes can put people with disabilities at risk for sexual exploitation or breaking the law “perpetrators”Teaching the difference between public and privateEncourage children to disrobe and dress in the child’s bedroom or bathroom with door closed. By emphasizing privacy, children are taught modestyDemonstrate privacy by knocking on their children’s door before enteringPulling down shades before children disrobeTeach children to ask for help parents should ask their child’s permissionTeach children to wash their own genitals and wipe themselves after using the toilet – also teaches independenceTeaching SocializationParents should schedule social outings when children interact with peersGain understanding of societal norms through increased social interaction and opportunities
34Public/Private Places Teaching behaviors appropriate to the public & private place encourages responsible social and sexual behaviorPwd are capable of learning how to behave appropriately in public and private placesMany inappropriate actions and activities reflect confusion, lack of awareness and limited judgmentMany 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 clothingScratching or touching genitalsFixing or adjusting underclothingSelf-stimulation
35Inappropriate Self-Touch Sexual self-stimulation or masturbation is normal, natural and non-harmful behavior throughout the life cycleSelf-stimulation can be a way of learning to be more comfortable with and/or enjoying one’s sexuality by getting to know one’s bodySelf-stimulation is a private behavior and inappropriate in public places
36Developmental Appropriate Sexuality Education Content Allowable Sexual ExpressionStudents should not be hugged, caressed, massaged, kissed or embraced by peers or teachersExceptions include when need for physical calming may be necessaryIn 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 partsDocument incident
37Stranger-Friend Errors Circles Method of Teaching Social BehaviorSocial 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.
38Circle 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.
39Contextual Errors and Safety Issues American Academy of PediatricsChildren with disabilities are sexually abused at a rate that is between 2-10 times higher than for children without disabilities68-83% of women with developmental disabilities will be sexually assaultedFor people with SCI, abuse disguised as pressure sores, trauma to the skin, broken bonesFactors influencing these statisticsLess able to defend themselvesOften not alert to potentially dangerous situationsDo not know to report abuseSeek approval and affectionMay be exposed to a large number of caregivers for intimate careTaught to be compliant to authority
40Developmental Appropriate Sexuality Education Content Sexuality Education for children with disabilities requires some degree of individualizationIEP used as an instrument for adapting sexuality curriculumIf human sexuality education is written into the IEP, it is more likely to be designed and delivered around the unique needs of the studentGeneral strategyadapt the pace and presentation of information to the child’s particular needsKnowledge of how a particular disability affects development, learning and sexual expression important in adapting curriculum
41Developmental Appropriate Sexuality Education Content American Academy of Pediatrics & NICHCY suggests the following topics for children ages 5-8:Body partsSimilarities and differences between boys and girlsElementals of reproduction and pregnancyQualities of good relationships (friendship, love, communication, respect)Decision making skills & that decisions have consequencesBeginnings of social responsibility, values and moralsMasturbation can be pleasurable but should be done in privateAvoiding and reporting sexual exploitation
42Developmental 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 selfReproduction and pregnancyImportance of values in decision-makingCommunication within family about sexualityPersonal care and hygiene, diet, exercise,Body image /self-esteemContraception strategiesRights and responsibilities of sexual behaviorFashionable clothes & Inappropriate dressAbstinenceAvoiding and reporting sexual abuseSexually transmitted diseases including HIV/AIDS
43Developmental 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-examSexuality as part of the total selfCommunication, dating, love, intimacy (Qualities of good relationships such as friendship, love, communication, respect, decision making, and knowing there are consequencesImportance of values in guiding ones behaviorHow alcohol and drug use influence decision makingSexual intercourse and other ways to express sexualityBirth control and responsibilities of child-bearingReproduction and pregnancyCondoms and disease preventionDiscussing issues of abuse (signs, prevention, what to do if it is suspected)Healthy diet, body weight, good grooming, exercise
44Teaching Strategies and Techniques For children with learning disabilities & mental retardation consider:Pacing of lessonsReading level and abilityIf reading level of materials is out of reach, limits access to quality printed materials and resources.Small blocks of content presented at a timeSimple and concrete termsSpecial materialsMore time and repetition
45Teaching Strategies and Techniques Role play, modeling, play acting and interactive exercises, use concrete teaching strategiesPhone etiquette, initiating conversation, inviting a friend for a mealBe 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 interactionsMultisensory activitiesIllustrations, 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 resourcesShowing family pictures may help children understand different types of families and relationshipsRepetition, practice, frequent review, feedback & praise
46Teaching Strategies and Techniques Bloom’s TaxonomyDivides educational objectives into three domains:AffectivePsychomotorCognitiveWithin each domain are different levels of learning, higher levels more complex and closer to mastery of material
47Bloom’s Taxonomy Example: Cognitive domain Organized in sequence from basic factual recall to higher order thinking with key words that describe each behaviorKnowledge: list, tell, identify, show, label and nameComprehension: distinguish, estimate, explain, generalize, give examples, summarizeApplication: apply, find, perform, demonstrate, dramatizeAnalysis: criticize, debate, distinguish, compare,Synthesis: plan, set up, design, arrangeEvaluation: judge, score, approve, appraise
48Policy Statements on Sexuality Education for Persons with a Disability Policy development project for your school districtEvolved from need for guidelines to formulate consistent responses to behavioral issuesPublic masturbatory behaviorStudent 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 othersCouples engaging in intimate behavior in public placesIn the absence of a policy different staff members would respond to incidents haphazardly and counter productivelyConsistency of response is an essential component to alter maladaptive behavior
49Policy Statements on Sexuality Education for Persons with a Disability Identify policy issues that need to be addressedDefinition of sexualityPhilosophy about normative sexual developmentInappropriate self-touchMenstruationToileting skillsAllowable sexual expressionSexual orientationSexual exploitationSTI’s and HIV/AIDS infectionPublic and private placesInappropriate dress for work
50Apply 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 classBe prepared to present and/or model your lesson for a small group of your peers.