Nevada Disabilities Conference, 2015 July 20 and 21, 2015Sparks, NV

The Importance of Sexual Education for Individuals with Disabilities

Introductions Deisy HernandezACLU of Nevada, Outreach Coordinator, Nevada Teen Health and Safety Coalition

Megan KennedyDeaf self-advocate, future law student at Northeastern School of Law in Boston, MA with an interest in disability advocacy, policy and legislation

Nevada Teen Health and Safety Coalition

The mission of the Nevada Teen Health and Safety Coalition is to ensure that Nevada is a place where resilient, smart, well-educated young people have a fair shot at growing up to be independent and healthy. We are a broad group of parents, youth, medical professionals, and advocacy organizations building a movement to change the way sexual health education is taught in Nevada so that youth can be better empowered to stay healthy. We believe that schools have a responsibility to provide medically accurate and age-appropriate sex education in Nevada. 1

1 Nevada Teen Health and Safety Coalition, Mission Statement. Retrieved from http://www.nvhealthyteens.org/

Topics1. The importance of sex education for persons with disabilities2. Why medically accurate sex education is needed in Nevada 3. Defining medically accurate sex education4. Sex Education for Specific Disabilities: Issues to Consider

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, or 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 are aggressive & women are promiscuous

● People with disabilities will not marry or have children so they have no need to learn about sexuality 2

2 Author Unknown (PowerPoint Presentation). Social-Sexual Education for People with Disabilities. Georgia State University. Retrieved from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CB4QFjAAahUKEwjEvIPIouHGAhWWnYgKHXQlARA&url=http%3A%2F%2Fwww2.gsu.edu%2F~wwwche%2FSex%2520Ed%2520powerpoint.ppt&ei=t3yoVYSFBpa7ogT0yoSAAQ&usg=AFQjCNHW5kRms3qhtqtL6xd2ahlDqWeUJg&sig2=i4R3uulu24OPz0lO6-eWtg&cad=rja

Myth 1: People with disabilities are asexual●Children with developmental disabilities may learn at a slower rate than peers yet physical maturation usually occurs at the same rate

o Need sex education that builds skills for appropriate language and behavior in public

●Children and youth with disabilities may have some unique needs related to sex education

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 a 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

o This view denies person’s sexuality and full humanity

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

o Belief in this myth can result in reluctance to provide sex education as any offending behavior is seen as uncontrollable

o Education and training are the key to promoting healthy and mutually respectful behavior, regardless of disability

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 is an important part of everyone’s life● 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

Fact or Fiction about Sexuality and Disability

● Nearly 5.2 million youth (aged 5-20) have some long-term physical, mental, or emotional disabling condition. 3

o Due to decreased opportunities for observational and social learning, children and teens with disabilities must gain this information from another source

● Children with disabilities are four times more likely to be victims of violence, including sexual violence, than typically developing children, while adults with disabilities are 1.5 times more likely. 4

● 68-83% of women with developmental disabilities will be sexually assaulted. 5

3 United States Bureau of the Census. Statistical Abstract of the United States: The National Data Book. 123rd ed. Washington, DC: The Bureau: 2003.4 World Health Organization, “Prevalence and risk of violence against children with disabilities”, 2012.5 American Academy of Pediatrics, “Assessment of Maltreatment of Children With Disabilities”, Committee on Child Abuse and Neglect and Committee on Children with Disabilities. American Academy of Pediatrics, 2001; 108; 508.

Why is sexual education important for people with disabilities?

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

Why is sexual education important for people with disabilities?

Sex education is not limited to the reproductive system and forms of contraception; it includes information about:

o Healthy relationships, o Gender identity, o Sexual orientation, o Sexual responsibility, o Self-care and personal hygiene, ando Body image.

What is medically accurate sex education?

Nevada Teen HealthSTI Statistics in Nevada

In Nevada, over 11,000 Chlamydia cases were reported in 2012. 66.5% of those cases occurred in individuals less than 25 years of age.

There were over 2,000 Gonorrhea cases reported in Nevada in 2012 and more than 50% were among individuals less than 25 years of age. 6

6 Department of Health & Human Services (2012). Nevada Division of Public and Behavioral Health. STD Prevention and Control Program. Nevada STD Statistics 2012.Image: Martin, J.A., Hamilton, B.E., Osterman, M.J.K., Curtin, S.C., & Matthews, T.J. (2013). Births: Final Data for 2012.National Vital Statistics Reports, 62(9). Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_09.pdf

What is the current state of sex ed in Nevada?

In 1987 Nevada passed NRS 389.065 which states that all school districts have to teach sex education:The board of trustees of a school district shall establish a course or unit of a course of:

●Factual instruction concerning AIDS; and

●Instruction on the human reproductive system, related communicable diseases and sexual responsibility.

Each board of trustees shall appoint a sex education advisory committee (SEAC). 7

7 United States. Nevada Revised Statutes. Chapter 389: Examinations, Standards, Courses and Graduation. Web. https://www.leg.state.nv.us/NRS/NRS-389.html.

Why Nevada needs improved sex education1. Each school district in Nevada has different curriculum2. Sexual responsibility is not defined3. Nevada students are getting vastly different information depending

on where they live4. Some sex ed curriculums focus on abstinence and spend little to

no time on contraception5. Some districts exclude information for LGBTQ students

6. No success in making sex ed more inclusive through legislative changes: 2011, 2013, or 2015

7. Medically accurate and age appropriate sex education has been shown to have positive effects on the lives of teens.

Abstinence-only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy (2008): Among never-married heterosexual adolescents, aged 15-19 years, who participated in the National Survey of Family Growth (CDC) and reported on formal sex education received before their first sexual intercourse, researchers compared the sexual health risks of adolescents who received abstinence-only and comprehensive sex education to those of adolescents who received no formal sex education. 8

Key Findings:●Teens who received comprehensive sex education were 50 percent less likely to experience pregnancy than those who received abstinence-only education.●Teaching about contraception was not associated with increased risk of adolescent sexual activity or STD

Medically Accurate Sex Education: It Works!

8 Kohler et al. “Abstinence-only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy.” Journal of Adolescent Health, 42(4): 344-351. 2008

Abstinence-Only Sex Education Does Not Lead to Teens Refraining from Sex

Emerging Answers 2007: Authored by Dr. Douglas Kirby, discusses what programs work in preventing teen pregnancy and sexually transmitted diseases, including HIV. 9

Key Findings: Abstinence-Only-Until Marriage-Programs●No strong evidence exists that abstinence-only-until-marriage programs delay the initiation of sex, hasten the return to abstinence, or reduce the number of sexual partners.●Strong evidence exists that abstinence-only-until-marriage programs have no effect on sexual behavior.

9 Kirby D, Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases, Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy, 2007, p. 4, http://www.thenationalcampaign.org/EA2007/EA2007_full.pdf.

What needs to be done in Nevada--and nationally?

● Education and communication that includes the child or individual with disabilities in the conversation

● Simply making decisions for them about their sexuality removes their sense of autonomy

● Opportunities to learn from peers and mentors are reduced in children with disabilities; removing one more choice only limits them further

● Lack of knowledge may lead to vulnerability that is exploited by a predator, sexual or otherwise

● Further conversation and legislature to increase comprehensive education for teens with disabilities

Sexuality ● Human sexuality encompasses the sexual knowledge, beliefs, attitudes,

values, and behaviors of individuals. It includes the anatomy, physiology, and biochemistry of the sexual response.

● Sexuality is not limited to biological responses: it involves social roles, identity, and personality with individual thoughts, feelings, behaviors, and relationships. Ethical, spiritual, and moral concerns are raised, as well as group and cultural variations. 10

● It is not merely “the birds and bees”, but a chance to discuss familial and social values that parents may wish to pass on to their children.

● Covers relationships with other people, but also social norms, self-esteem, and how we understand ourselves as different genders.

10 “Sexuality Information and Education Council of the United States.” SIECUS. Web. Retrieved from http://www.siecus.org/index.cfm?fuseaction=page.viewPage&pageId=494&parentID=472

Risks with No Sex Ed● Over 70% of people with disabilities reported that they had been victims of abuse.

Within that group, it was found that 87% reported emotional abuse, 50% physical abuse, 41% sexual abuse, 37% neglect and 31% financial abuse. 11

o Comprehensive sex education will teach children and teens with disabilities to identify potentially harmful behavior

● People with disabilities are “disproportionately vulnerable to violence”. Stigma, discrimination, and lack of social support and education are cited as risk factors. 12

o Educating people with disabilities about their sexual care and health increases their chances of being able to understand potential dangerous behaviors and put a stop to them

11 Baladerian, Nora J., Ph.D, Thomas F. Coleman, and Jim Stream. Abuse of People with Disabilities: Victims and Their Families Speak Out. A Report on the 2012 National Survey on Abuse of People with Disabilities. Retrieved from http://disability-abuse.com/survey/survey-report.pdf 12 Hughes, Karen, Mark A. Bellis, Lisa Jones, Sara Wood, Geoff Bates, Lindsay Eckley, Ellie Mccoy, Christopher Mikton, Tom Shakespeare, and Alana Officer. “prevalence and Risk of Violence against Adults with Disabilities: A Systematic Review and Meta-analysis of Observational Studies.” The Lancet 379.9826 (2012): 1621-629. Web.

Disability and Sexuality ● People with disabilities may have:

o Difficulty learningo Limited genital/tactile sensationso Difficulty communicatingo Uncertainty about sexual function and fertility

● Development of healthy self-esteem and body image could be hindered by:o Use of braces, crutches, wheelchair, other assistive technologyo Bladder/bowel management routineso Physical differences from other peers (muscle atrophy, loss of limb,

restricted range of motion, etc)o Mistrust of own body. 13

13 Keshav, Dimple and Barbara Huberman. “Sex Education for Physically, Emotionally, and Mentally Challenged Youth.” Advocates for Youth (2006). Web.

Disability and Sexuality ctd.The emotional and social impact of disability on sexuality, self-esteem, and self-concept is hard to understand unless it is your reality.

o Children with disabilities know they are different from peerso Development through puberty and social awareness of your own

sexuality as typically developing is hard enough; teens with disabilities may experience social anxiety, depression, and isolation

o How the teen understands their disability informs their sense of selfo Permanent: many disabilities are lifelong and require some degree of

management o Self-concept and esteem impact interaction with the rest of the world

Sex Education for Specific Disabilities: Issues to Consider

Blind/Visual Impairment ● Tailored information so blind children and teens can have access to

materials● Individual’s knowledge and understanding of their sexuality comes from

sources other than visual:o Reliance on sense of touch and feel for physical body and changeso Concept of self and body image is different without visual cues; also

different understanding of other people’s bodies● Verbal comments on the world: they need information about clothing,

people’s postures, body language, how they are interacting with others, etc. 14

14 Migliozz, Jeff. “Addressing Issues of Sexuality with Students Who Are Visually Impaired.” Perkins eLearning. Perkins School for the Blind. Web. Retrieved from http://www.perkinselearning.org/videos/webcast/addressing-issues-sexuality-students-who-are-visually-impaired

Hard of Hearing/d/Deaf● Dual barriers of communication difficulties and different languages

o Individuals who use American Sign Language (ASL) as primary mode of communication often are not taught sexual signs

o If they do know the proper signs, people around them (teachers or counselors at school, sometimes parents) may not be fluent in ASL and thus cannot understand

● Children or teens who do not use ASL may still face difficulties in the classroomo Media and other materials may not have closed captioning, meaning

students miss valuable information 15

15 Francavillo, Gwendolyn. Sexuality Education, Sexual Communication, Rape Myth Acceptance, and Sexual Assault Experience Among Deaf and Hard of Hearing College Students. University of Maryland, College Park. 2009. Retrieved from: http://drum.lib.umd.edu/bitstream/1903/9937/1/Francavillo_umd_0117E_10898.pdf

Physical Disability● Physical functions such as sensation, motor control and arousal may be

affected● There may be a lack of privacy in daily life, so student’s input should be

respected ● Self-esteem and self-concept should be discussed● Due to wide variety of physical disabilities, individual needs should be

addressed. 16

16 The Society of Obstetricians and Gynecologists of Canada (SOGC), Teaching Sex Ed for Youth with Physical Disabilities. Web. Retrieved from http://www.sexualityandu.ca/en/teachers/teaching-sex-ed-for-youth-with-physical-disabilities

Intellectual Disability ● Abstract concepts may be difficult for children/teens with intellectual

disabilities to understand o May be able to repeat what was said but not comprehend

● Social norms may have been taught (sex is private), but sex ed breaks those norms (private issues being talked about in public)

● Same issue may need to be taught in different ways: visual aids (videos), role play (if appropriate), written information, etc.

● Teach the right to refuse. 17

17 The Society of Obstetricians and Gynecologists of Canada (SOGC), Teaching Sex Ed for Youth with Intellectual Disabilities. Web. Retrieved from http://www.sexualityandu.ca/teachers/teaching-sex-ed-for-youth-with-intellectual-disabilities

Resources for Educators● Appropriate sex education may need to be written into a school-age child’s

Individualized Education Program (IEP) o Chances of curriculum being adapted around the needs of the child

are much higher if it is written into their IEPo Ex.: if a child with autism needs materials presented only using picture

boards, child who is blind needs materials in Braille, child with a developmental disability needs curriculum spread across a week instead of two days. 18

18 “Topic: Individualized Education Program (IEP)”. IDEA – Building the Legacy of IDEA 2004. U.S. Department of Education. Retrieved from: http://idea.ed.gov/explore/view/p/%2Croot%2Cdynamic%2CTopicalBrief%2C10%2C

Developmentally Appropriate Sexuality Education Content

Recommended by the American Academy of Pediatrics: ages 5-8●Body parts●Similarities/differences between boys and girls●Elementals of reproduction and pregnancy●Qualities of good relationships●Decision making skills, consequences of decisions●Beginning of social responsibilities, morals, judgment●Avoidance/reporting sexual exploitation. 19

19 Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. Promoting Healthy Sexual Development and Sexuality. American Academy of Pediatrics. Retrieved from https://brightfutures.aap.org/Bright%20Futures%20Documents/9-Sexuality.pdf

Developmentally Appropriate Sexuality Education Content

Recommended by the American Academy of Pediatrics: ages 8-11●Puberty changes (menstruation, wet dreams, define masturbation (good touch/bad touch)●Sexuality as self-image and concept●Reproduction and pregnancy●Values and their roles in decision making●Communication within family unit about sexuality●Personal care, hygiene, diet, exercise●Body image and self esteem●Contraception strategies and options●Responsibilities of sexual behavior●Abstinence●Sexually transmitted diseases, including but not limited to HIV/AIDS. 20

20 Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. Promoting Healthy Sexual Development and Sexuality. American Academy of Pediatrics. Retrieved from https://brightfutures.aap.org/Bright%20Futures%20Documents/9-Sexuality.pdf

Recommended by the American Academy of Pediatrics: ages 12-18●Health care--regular check-ups, breast/testicular self-exams●Sexuality as part of the total self●Communication, dating, love, intimacy, healthy vs. unhealthy romantic and platonic relationships ●Alcohol and drug use and their influence on decision making●Birth control and responsibilities of child bearing●Reproduction and pregnancy●Condoms and disease prevention●Issues of abuse●Healthy diet, body weight, hygiene, exercise. 21

Developmentally Appropriate Sexuality Education Content

21 Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. Promoting Healthy Sexual Development and Sexuality. American Academy of Pediatrics. Retrieved from https://brightfutures.aap.org/Bright%20Futures%20Documents/9-Sexuality.pdf

But...as we know...what is developmentally appropriate for typically developing children may not be appropriate for

children and teens with disabilities!

On a personal note...

SourcesPlease see the complete list of resources for parents and teachers that will be provided to you.