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Sexuality education for persons with developmental disabilities: a cooperative approach.

One of the basic needs of life for all people, including those who are disabled, is understanding one's own sexuality. Sexuality education can help individuals with developmental disabilities developmental disabilities (DD), the pathologic conditions that have their origin in the embryology and growth and development of an individual. DDs usually appear clinically before 18 years of age.
 find sexual satisfaction, foster responsibility, maturity, and positive actions toward various rehabilitation rehabilitation: see physical therapy.  goals (McNab, 1978). While the focus of this article is on individuals with mild and moderate mental retardation mental retardation, below average level of intellectual functioning, usually defined by an IQ of below 70 to 75, combined with limitations in the skills necessary for daily living. , topics and techniques described are applicable to students with other developmental disabilities. The term developmental disability developmental disability
A cognitive, emotional, or physical impairment, especially one related to abnormal sensory or motor development, that appears in infancy or childhood and involves a failure or delay in progressing through the normal
, as defined by the amended Developmental Disabilities Assistance and Bill of Rights Act of 1987, means a severe chronic disability of a person attributable to a mental or physical impairment which reflects the person's need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services which are of lifelong or extended duration and are individually planned and coordinated.

Traditionally, teaching of sexuality to individuals with developmental disabilities has met objections resulting from society's negative attitude toward the disabled and parental apprehensions regarding decision-making skills of their children in relation to acceptable and unacceptable sexual behaviors sexual behavior A person's sexual practices–ie, whether he/she engages in heterosexual or homosexual activity. See Sex life, Sexual life. . Indeed, some parents of children with disabilities view their children's sexual interests and/or needs as another crisis of parenting rather than a stage of development.

With increasing emphasis on independent living, individuals with developmental disabilities have greater needs for sexuality education. Health and physical educators along with special educators should be collectively involved in developing and implementing appropriate sexuality education programs which help persons with developmental disabilities achieve a more positive self-concept and greater independent living status. This instruction should take place in health, physical education, and special education classrooms on a concurrent basis.

To accomplish these goals, this article focuses on the following areas:

* Why sexuality education for persons with development disabilities?

* Sexuality issues, content, and behavior considerations;

* Collaboratovie role of health, physical, and special educators; and,

* Available resources.

Why Sexuality Education for

Persons with Developmental


Understanding one's own sexuality is a basic need for positive physical and metal health. Sexuality is ability to feel and give warmth and love, development of a positive self-concept, and being able to make responsible decisions regarding physical, mental, emotional, and social aspects of one's sexual health (McNab, 1981). Sexuality is one of the most wonderful aspects of life that everyone has the right to experience and enjoy. Dickman (1985) stated, "A growing number of mentally and physically disabled people are proving that they are neither sexless sex·less  
1. Lacking sexual characteristics; neuter.

2. Lacking in sexual interest or activity: a sexless marriage.
, nor perverted per·vert·ed
1. Deviating from what is considered normal or correct.

2. Of, relating to, or practicing sexual perversion.
, nor helpless dreamers." Like everyone else, people with developmental disabilities want to experience and enjoy positive aspects of their sexuality.

Two contradictory assumptions are often put forth regarding sexuality and people who are developmentally disabled:

* Persons with developmental disabilities are not interested in sex; and,

* They are too interested in sex in perverse, abnormal ways (Dickman, 1985).

The first assumption identifies persons with developmental disabilities as asexual asexual /asex·u·al/ (a-sek´shoo-al) having no sex; not sexual; not pertaining to sex.

1. Having no evident sex or sex organs; sexless.

 and unable to have sexual feelings sexual feelings A constellation of psychological sentiments that constitute desire for sexual satisfaction or release of sexual tension  and relationships. This unfounded assumption often inhibits support for and interest in developing sexuality education programs for person with developmental disabilities.

In the second assumption, a person who is a developmentally disabled individual is viewed as someone who has abnormal interest in sex that may manifest itself in inappropriate public behavior or other types of sexual misconduct sexual misconduct Professional ethics Any behavior that violates a health professional's ethics through sexual contact of physician and his/her Pt. See Professional boundaries. . Some educators, parents, and other concerned adults may believe sexuality education could stimulate sexual feelings in persons with developmental disabilities and thus possibly lead to inappropriate behavior. Johnson (1973) succinctly suc·cinct  
adj. suc·cinct·er, suc·cinct·est
1. Characterized by clear, precise expression in few words; concise and terse: a succinct reply; a succinct style.

 described the dilemma of persons with mental retardation in stating:

The mentally retarded Noun 1. mentally retarded - people collectively who are mentally retarded; "he started a school for the retarded"
developmentally challenged, retarded
 do indeed tend to be mentally retarded with respect to sex education, and this is one of the characteristics that they share most fully with the brilliant and so-called normal. Nearly all of us are ignorant about sex; and many intelligent people are not even educable educable /ed·u·ca·ble/ (ej´u-kah-b'l) capable of being educated; formerly used to refer to persons with mild mental retardation (I.Q. approximately 50–70).  or trainable in this respect. Unfortunately, some of these sexually-uneducable people are supposed to instruct or otherwise manage the lives of the retarded regarding sex.

A majority of the population with mental retardation in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area.  is mildly retarded; 95% are living in communities and 50% will marry (Dickman, 1985). These individuals, like non-disabled, are exposed to sexual stimuli through media and peers, develop secondary sex characteristics secondary sex characteristic
Any of various characteristics specific to females or males but not directly concerned with reproduction.

secondary sex characteristic 
 including sexual feelings, and experience social interaction associated with physical sexual responses. A developmental disability does not necessarily alter physical and emotional development.

Ignoring sexuality of people who are developmentally disabled may slow down but not eliminate sexual development. In today's society, not only is it their right to learn about and experience positive aspects of sexuality, but it is a necessary life skill. With new responsibilities related to increasing independent living opportunities, individuals with developmental disabilities are experiencing more life situations that require skills related to sexuality issues. Yet many still receive little education and training related to sexual knowledge and behavior.

In addition to specific life skills, sexuality education can help promote positive self-esteem in individuals. Whittaker (1987) stressed that persons who are disabled do not need to like their disability but do need to like themselves. Promoting self-esteem through sexuality education can enable students to recognize and accept positive aspects of human sexuality This article is about human sexual perceptions. For information about sexual activities and practices, see Human sexual behavior.
Generally speaking, human sexuality is how people experience and express themselves as sexual beings.
 in themselves and others.

Sexuality Issues,

Content, and Behavioral


Determining course objectives and content are important first steps in developing sexuality education programs of any population. Daily (1988) identified five components of sexuality which need to be included in sexuality education for persons with development disabilities:

* Sensuality - allow individuals to be aware of and in touch with their bodies, and have a positive attitude toward the image they have of their bodies.

* Intimacy - demonstrate emotional closeness, and ability to share, care, love, and touch to satisfy physical human contact;

* Identity - relate to sex roles and independent living skills;

* Reproduction and birth control - give appropriate information;

* Sexualization This article or section is in need of attention from an expert on the subject.
Please help recruit one or [ improve this article] yourself. See the talk page for details.
 - present positive and negative ways in which sexuality influences others.

Persons with developmental disabilities have basic sexual rights. These rights should be considered when determining course content. Sexual rights include privacy during sexual activities and knowledge of various types and effectiveness of birth control methods, including where to obtain and how to use these methods. Other rights include learning how to avoid exploitative sexual behavior and using available counseling services and resources.

Numerous educators have identified specific topics for inclusion in sexuality education programs for persons with mental retardation. Fisher (1974) stated that most individuals who are mentally retarded are capable of learning to confine sexual activity to appropriate and safe times and places. Gordon (1971) believed that the following basic principles regarding acceptable or unacceptable behavior must be taught to persons with mental retardation:

* Masturbation masturbation

Erotic stimulation of one's own genital organs, usually to achieve orgasm. Masturbatory behavior is common in infants and adolescents, and is indulged in by many adults as well. Studies indicate that over 90% of U.S. males and 60–80% of U.S.
 is a normal expression of sex, regardless of how frequently it is done and at what ages. It becomes a compulsive com·pul·sive
Caused or conditioned by compulsion or obsession.

A person with behavior patterns governed by a compulsion.


the state of being subject to compulsion.
, punitive, self-destructive behavior largely as a result of guilt, suppression, and punishment.

* All direct sexual behavior involving genitals gen·i·tals
 should be done in private.

* Any time physically mature people have sexual relations sexual relations
1. Sexual intercourse.

2. Sexual activity between individuals.
 they risk pregnancy.

* Unless they are clear about wanting to have a baby and about responsibilities that go with child rearing, both male and female should use birth control.

* Until an individual is, say, 18, society feels a person should not have intercourse Verb 1. have intercourse - have sexual intercourse with; "This student sleeps with everyone in her dorm"; "Adam knew Eve"; "Were you ever intimate with this man?" . After this, the individual decides, providing birth control is used.

* Adults should not be able to use children sexually.

* In final analysis, sexual behavior between consenting adults--regardless of mental age and whether it is homo-or hetero-sexual--should be no one else's business, providing there is little risk of bringing a child into this world.

Edwards (1975) has identified numerous sexuality education topics including:

* Communication skills

* Public vs. private behavior

* Self-image awareness

* Social Skills

* Dealing with strangers

* Puberty puberty (py`bərtē), period during which the onset of sexual maturity occurs.  

* Wet dreams

* Masturbation

* Menstruation menstruation, periodic flow of blood and cells from the lining of the uterus in humans and most other primates, occurring about every 28 days in women. Menstruation commences at puberty (usually between age 10 and 17).  

* Naming body parts

* Feelings relating to relating to relate prepconcernant

relating to relate prepbezüglich +gen, mit Bezug auf +acc 
 self and other

* Sex roles

* Dating

* Love and relationships

* Intercourse and birth control

* Sexually transmitted diseases Sexually transmitted diseases

Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely

* Marriage and parenting

* Rape and molestation molestation n. the crime of sexual acts with children up to the age of 18, including touching of private parts, exposure of genitalia, taking of pornographic pictures, rape, inducement of sexual acts with the molester or with other children, and variations of these  prevention

* Independent living and decision making skills

Whenever possible, student/client input into content decisions should be considered. Andron (1984) asked 20-37-year-old students with mental retardation who had taken a family life education course what they thought should be taught in sexuality education classes. The following topics were suggested:

* Appropriate social behaviors In biology, psychology and sociology social behavior is behavior directed towards, or taking place between, members of the same species. Behavior such as predation which involves members of different species is not social.  

* Communication skills

* Learning about people's feelings

* How not to get pregnant

* How to obtain and use contraceptives

* How to prevent sexually transmitted diseases

* Less on the physiological aspects of sexuality and more material on how to get along with people

* How to make your own decisions

These students believed they were not exposed to sexuality education because people feared they might not be able to handle the information, and it would encourage their own interest in sexual activity. Students felt it was their right to obtain information about their sexuality.

AIDS is another important topic which should be covered. In February of 1989, a National Forum of HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome  Prevention Education for Children and Young with Special Needs was hosted by the Association for the Advancement of Health Education in collaboration with the Council for Exceptional Children. Representatives from more than 25 national organizations and governmental offices assessed HIV/AIDS education pertaining per·tain  
intr.v. per·tained, per·tain·ing, per·tains
1. To have reference; relate: evidence that pertains to the accident.

 to the needs of special education students. A few of the many conclusions were:

* All children, including special education students, need health education, including HIV/AIDS prevention education.

* Health educators and special educators need to work together in delivery of HIV/AIDS prevention education for children and youth.

* Misunderstandings and misconceptions Misconceptions is an American sitcom television series for The WB Network for the 2005-2006 season that never aired. It features Jane Leeves, formerly of Frasier, and French Stewart, formerly of 3rd Rock From the Sun.  about HIV/AIDS need to be clarified for professionals, parents of children with special needs, and children with special needs.

* HIV/AIDS prevention curriculum and materials should be developed or modified so that the different types of disabilities-- cognitive, sensory, physical, behavioral--are addressed.

* Objectives on HIV/AIDS prevention education should be written into Individualized in·di·vid·u·al·ize  
tr.v. in·di·vid·u·al·ized, in·di·vid·u·al·iz·ing, in·di·vid·u·al·iz·es
1. To give individuality to.

2. To consider or treat individually; particularize.

 Educational Plans (IEP IEP

In currencies, this is the abbreviation for the Irish Punt.

The currency market, also known as the Foreign Exchange market, is the largest financial market in the world, with a daily average volume of over US $1 trillion.

* HIV/AIDS prevention should focus on behavior.

Topics identified in this article, whether identified by students or professionals, are topics important in sexuality education programs for any population. For students with developmental disabilities, teaching of this content must be modified. Smigielski's (1981) considerations for modification include:

* Using task analysis to simplify manner in which material is presented.

* Using concrete materials students can see and feel.

* Allowing students to practice fundamental social skills.

* Including activities which promote self-sufficiency, overcoming fear, gaining self-confidence, and coping with The Coping With series of books is a series of books aimed at 11-16 year olds, written by Peter Corey and published by Scholastic Hippo. The first book, Coping with Parents, was released in 1989, and the series continued until the last book, Coping with Cash  responsibility.

* Adjusting and modifying objectives.

* Simplifying methods and analogies.

* Using a variety of audiovisual materials.

Using these approaches, the basic educational objective should be to convey to students with developmental disabilities that their sexuality is unique, special, and a positive part of their relatives (McNab 1989).

Roles of Health,

Physical, and Special


Teachers responsible for sexuality education programs for students with developmental disabilities should have the necessary background in both sexuality and special education. Torbett (1985) stated that while teachers, who study special education, "learn a great deal about the methods, techniques, and problems of handicapped chilren, they have had little preparation for dealing with sexual questions, concerns and feelings of their students." Conversely, Dickman (1985) stated, "few trained sexuality education teachers are familiar with special needs of disabled children or the special techniques necessary for teaching them." These statements highlight need for interdisciplinary collaboration among health educators, physical educators, and special educators. Described below are some specific recommendations for collaborative action.

* University preparation programs in school health and physical education should include a course that deals with exceptionality, special education processes such as PETs and IEPs, and teaching techniques and resources for special needs students.

* Undergraduate special education majors should be required to take a course that includes sexuality education principles and teaching techniques.

* In-service programs similar to those in the prior recommendations should be developed for health and physical educators and special educators currently teaching.

* Whenever possible, health and physical education majors participate in student teaching experiences that include special education classes.

* Health and physical educators and special educators in school settings should be collaboratively analyze individual sexuality education needs of special education students and develop appropriate programs. Once developed, such programs could take place in either special education classrooms, health and physical education classrooms, or combinations of the two.

* Importance and potential impact of sexuality education should be promoted among administrators.

* Sexuality education resources should be developed that are appropriate for different disabled populations; this may require health and physical education/special education collaboration.

* Research should be conducted to determine appropriateness and effectiveness of sexuality education programs for students with developmental disabilities.

* Professionals of both disciplines should present and/or publish information pertaining to programs, methods, resources, and research dealing with sexuality education for students with developmental disabilities.


Sexuality education programs can assist individuals with developmental disabilities to live independent lives. To maximize successful planning, development, and implementation of such programs, professional collaboration is needed among health, physical, and special educators. Through such programs, it is hoped that persons with developmental disabilities will reach the goal identified by Perski (1973) to "achieve the highest potential on the continuum of sexual development."

Sexuality Resources for Teachers of Students with

Developmental Disabilities

Birch, D.B. (1987). Developing health skills. Portland, Maine Portland is the largest city in the U.S. state of Maine, with a 2004 population of 63,882. Portland is Maine's cultural, social and economic capital. Tourists are drawn to Portland's historic Old Port district along Portland Harbor, which is at the mouth of the Fore River and part : J. Weston Walch. (Designed to help special educators and health educators conduct health education programs for midly and moderately retarded students and other non-readers.)

Brekkle, B. (1988). Sexuality education for persons with severe development disabilities. Santa Monica Santa Monica (săn`tə mŏn`ĭkə), city (1990 pop. 86,905), Los Angeles co., S Calif., on Santa Monica Bay; inc. 1886. Tourism and retailing are important, and the city has motion-picture, biotechnology, and software industries. : James Stanfield, (A seven-part program with 500 slides emphasizing parts of the body, social behavior, and medical examinations.)

Champagne, M. and Walker-Hirch, L. (1988). Circles I (intimacy and relationships), Circles II (stop abuse), Circles III (safer ways - communicable communicable /com·mu·ni·ca·ble/ (kah-mu´ni-kah-b'l) capable of being transmitted from one person to another.

Transmittable between persons or species; contagious.
 and sexually transmitted diseases). Santa Monica: James Stanfield. (Slide or video format.)

Cowardin, N. and Stanfield J. (1989). Life Facts I FACTS I Federal Agencies' Centralized Trial-Balance System  - sexuality. Santa Monica: James Stanfield. (Thirty-three lesson plans on biological, behavior, sexual and relationship aspects of sexuality.)

Dickman, I.R. (1985). Sex education for disabled persons. (No. 531). New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of
: Public Affairs Those public information, command information, and community relations activities directed toward both the external and internal publics with interest in the Department of Defense. Also called PA. See also command information; community relations; public information.  Pamphlets.

Human Science Press. Sexuality and disability. New York, NY (A quarterly journal.)

Johnson, W.R. and Kempton, W. (1981). Sex education and counseling for special groups: the mentally and physically disabled, ill, and elderly. Springfield, IL: Charles C. Thomas.

Kempton, W., Bass, M.S., and Gordon, S. (1985). Love, sex, and birth control for mentally handicapped people - a guide for parents. Philadelphia: Planned Parenthood Planned Parenthood

A service mark used for an organization that provides family planning services.
 of Southeastern Pennsylvania.

Kempton, W. (1988). Sex education for persons with disabilities that hinder learning. Santa Monica: James Stanfield. (Excellent overall resource for teachers.)

Kempton, W. (1988). Life horizons I and II: sexuality and the mentality handicapped. Santa Monica: James Stanfield. (Twelve programs on slides dealing with anatomy, birth control, sexually transmitted diseases, self-esteem, dating, marriage, and parenting.)

Lexington Center The Lexington Center is located on a 11-acre site in Lexington, Kentucky.[1] It features a convention center, a shopping mall, the Hyatt Regency Hotel, and Rupp Arena.  Child Abuse and Disabled Children Program, (1989). No-go-tell. Santa Monica: James Stanfield. (Child protection curriculum for special needs children ages 3-7.)

Lippen, D. and Randell, D. (1986). Family life education - a manual for special education. Fair Lawn Fair Lawn, borough (1990 pop. 30,548), Bergen co., NE N.J., across the Passaic River from Paterson; inc. 1924. It is residential with light industries. , NJ: Lippin and Randall. (Personal growth and development activities.)

O'Day, B. (1983). Preventing sexual abuse of persons with disabilities - a curriculum for hearing impaired, physically disabled, blind and mentally retarded students. Santa Cruz Santa Cruz, city, United States
Santa Cruz (săn`tə krz), city (1990 pop. 49,040), seat of Santa Cruz co., W Calif., on the north shore of Monterey Bay; inc. 1866.
: Network Publications.

Sex Education Information and Education Council of the U.S. (1986). Sexuality and disability: a bibliography of resources available for purchase. New York: New York University New York University, mainly in New York City; coeducational; chartered 1831, opened 1832 as the Univ. of the City of New York, renamed 1896. It comprises 13 schools and colleges, maintaining 4 main centers (including the Medical Center) in the city, as well as the .

Stanfield, J. (1990). Being with people-a social skills training program. Santa Monica: James Stanfield. (An eight-part video series teaching social skills.)

Young Adult Institute, (1988). AIDS and the mentally retarded. New York, NY (Explicit video on the prevention and spread of AIDS.)

Selected References

Andron, L. (1984). They don't teach us becuase they don't want us to learn. Family Life Educator, 3 (1), 18-20.

Daily, D.M. (1988). Sexuality and relations. Abilities: Canada's Journal of the Disabled, 1 (1), 20-21.

Dickman, I.R. (1985). Sex education for disabled persons. (Public Affairs Pamphlet No 531) 381 Park Avenue, New York, NY 10016, p. 1.

Edwards, J. (1975, March). Sex education for the handicapped. Paper presented at the meeting of the American Alliance of Health, Physical Education, Recreation, and Dance, Seattle.

Fisher, J.L. and Krajieck, M.J. (1974). Sexual development of the moderately retarded child. Clinical Pediatrics, 13: 78-83.

Gordon, S. (1971) O.K., let's tell it like it is. Journal of Special Education, 5 (4), 351-354.

Johnson, W.R. (1973). Sex education for the mentally retarded. de la Cruz de la Cruz is a common surname in the Spanish language meaning 'of The Cross.'
  • Carlos de la Cruz
  • José de la Cruz
  • Juana de la Cruz
  • Oswaldo de la Cruz
  • Ramón de la Cruz
  • Tommy de la Cruz
  • Ulises de la Cruz
  • Matthew de la Cruz
  • Cross de la Cruz
, F.F., La Veck, G.D. (ed). Human sexuality and the mentally retarded, New York: BrummerMazel.

McNab, W.L. (1978). The sexual needs of the handicapped. Journal of School Health, 48 (5), 301-306.

McNab, W.L. (1981). Advocating elementary sex education. Health Education, 12 (5), 22-25.

McNab, W.L. (1989). From where I sit. Family Life Educator, 7 (3), 14-15.

Perske, R. (1973). About sexual development: An attempt to be human with the mentally retarded. Mental Retardation, 11 (1).

Smigielske, P.A. and Steinmann, M.J. (1981). Teaching sex education to multiply handicapped adolescents. Journal of School Health, 5 (4), 238-241.

Torbett, D. (1985). In Dickman I.R. Sex education for disabled person. (Public Affairs Pamphlet No. 531.) 381 Park Avenue New York, NY 10006, p. 14.

David A. Birch is coordinator of the Penn State University Western Region Health Education Graduate Program. He has an extensive background in teacher training in health education, including programs for special educators.

Warren L. McNab is professor and coordinator of Health Education at the University of Nevada, Las Vegas “UNLV” redirects here. For other uses, see UNLV (disambiguation).
The University of Nevada, Las Vegas (UNLV) is a public, coeducational university located in Las Vegas, Nevada, USA, known for its programs in History, Engineering, Environmental Studies, Hotel
. Dr. McNab received his BS and MS degrees in health education from Mankato State University and a PhD from Southern Illinois University Southern Illinois University, main campus at Carbondale; state supported; coeducational; est. 1869, opened 1874 as a normal school, renamed 1947. It has a center for archaeological investigation and a fisheries research laboratory. There is also a campus at Edwardsville. . He teaches university level courses on human sexuality and has written extensive in his speciality--adolescent sexuality and health.
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Title Annotation:includes directory of organizations, and resource guide
Author:McNab, Warren L.; Birch, David A.
Date:Jun 22, 1991
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