Welcome to Skills for Educators! ReCAPP's educator skill for October 2001 is:

What Do I Say? How Do I Say It?

Specific suggestions, tips, and ideas for effectively teaching youth with developmental disabilities about sexuality topics

by Lisa Maurer

This article is divided into the following sections:

Introduction

People with developmental disabilities deserve accurate, age-appropriate sexual health information. Providing this information can be difficult when learning channels are blocked, or traditional teaching methods are inadequate.

Also, some commonly used teaching tools (such as diagrams and charts) may not be suitable for youth who have developmental disabilities. These tools often require abstract thought. For instance, diagrams that show internal body parts may not be easily understood by a person who reasons in a more concrete manner.

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Providing quality, comprehensive sexuality education has many benefits for all people. For youth who have developmental disabilities, this information is particularly beneficial. The positive effects go far beyond basic understanding of sexuality topics themselves.

Other benefits include:

1. Self Esteem and Empowerment
   As a youngster once said in a session: "You mean everyone has puberty happen to them? Wow, so I'm finally just like everybody else!" Youth with disabilities may frequently feel isolated and quite different from their peers. Yet the changes and choices of growing up impact all human beings. Learning about the physical changes and processes that affect everyone (without regard to ability or other factors) can be self-affirming.
   
   Physical development and the accompanying feelings provide the sense of being a part of a larger group that shares the same issues (with all the accompanying excitement and anxiety!) The realization of this fact can be very empowering for youth who are constantly viewed as different. In fact, the tangible physical changes and feelings that youth observe and experience may be one of the few instances in which they feel truly equal to non-disabled classmates.
   
   
2. Skill Building
   Sexuality education provides information and opportunity to practice skills that assist youth in recognizing and responding to social and sexual situations appropriately. As youth experience increasing success in navigating the complex world of social relationships, confidence also increases. Set youth up for success by providing ample time for practice.
   
   
3. Improved Communication
   Youth learn to communicate without guilt or embarrassment when sexuality education provides the foundation of anatomically accurate vocabulary. When equipped with the proper terminology, youth can also describe questions, symptoms, and concerns more accurately to caregivers or healthcare providers.
   
   
4. Setting the Stage
   Accurate, age-appropriate sexuality education sets the stage for future topics and discussions. A framework of basic information makes more advanced topics easier to understand. For example, sessions on conception and contraception make much more sense after the groundwork of basic anatomy has already been covered.
   
   
5. Articulating Goals
   Discussions about sexuality and social skills assist youth in envisioning their future. Young people may underestimate their capabilities without these discussions. Making concrete plans toward realistic goals (safeguarding sexual health, finding a sexual partner, parenting, etc.) is easier when youth have had ample opportunities for these discussions.
   
   
6. Preventing Negative Outcomes
   Sexuality education provides youth with information and skills to recognize and prevent sexual abuse. It also provides a framework to understand and avoid behaviors that are socially inappropriate or illegal.
   

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1. Teach Age-Appropriate Information
   Topics should be tailored to the chronological age of the youth. However, the teaching methods/tools that are used may vary from that of non-disabled youth. For example, all young people need to know about puberty — preferably before it happens. However, the manner in which it is taught may be very different and tailored to the needs of the group. Non-disabled youth may easily orient themselves to a chart of the internal human reproductive organs. Youth with disabilities may need more time in order to make sense of this type of visual aid, or they may not find them useful at all.
   
   
2. Be Prepared
   Know as much about your group as possible. Ask what topics are of interest to the group — you may gain insight into their existing knowledge, priorities, and goals that are useful to your lesson. Have thorough command of the subject matter before attempting to teach it. If you have been "drafted" to provide sexuality education in this setting (i.e. you are not a sexuality educator and have been directed to present this unit by your principal), get all the information you can before introducing the topic to students.
   
   
3. Know Your Group
   If you are the regular teacher or leader of your group, you already have information about the group's dynamics and the ways in which the students learn best. If you are a guest instructor, try to learn as much about your group as possible before your sessions. How would the students' teacher/leader characterize their learning styles? What are approaches that work well or not at all? Are there any sexuality issues or questions that are of particular interest to the group? What methods are used by the youth to communicate?
   
   
4. Establish a Baseline
   Has the group covered this information before? Has the group ever had any sexuality education? If so, what was covered? What topics are of interest to the group? Why is the group requesting a workshop at this time?
   
   
5. Respect Youths' Choices and Right to Privacy
   As youth begin to assimilate new information, they may feel more empowered to advocate for themselves. Recognize that when youth begin to assert their own needs and desires, there is tangible evidence of the success of your sessions. Respect the informed choices of youth. Assist with realistic goal setting when necessary.
   
   Realize too that seemingly lofty goals can be (and are) achieved with caring support. Acknowledge and appreciate that (despite usually being lumped into one group) youth come from various backgrounds, have unique learning styles, have differing sexual orientations and most likely have more different issues than they have in common.
   
   
6. Teach Sexuality as Positive and Pleasurable
   Early sexuality education programs designed for people with developmental disabilities sought to prevent sexual exploitation. These early curricula stressed that sexuality was dangerous. Participants in some programs became fearful of the topic — sexual activity seemed something in which people would never willingly choose to participate. Other participants regarded this information with doubt. They had experienced sexuality as pleasurable in their lives. Was there something wrong with them, or were their instructors not telling the truth? Be mindful of this historical context. Use it in crafting sexuality education that affirms sexuality as a source of joy.
   
   
7. Teach the Right to Refuse
   Some youth with developmental disabilities are so accustomed to being ignored that they are overjoyed when anyone pays attention to them. As a result, they may throw themselves into an inappropriate or potentially exploitive friendship or other relationship. Some may view relationships as a way to gain approval, at any cost. Skills such as deciding what qualities one wants in a friend or partner are crucial building blocks to more complex ideas (i.e. when to end a relationship, how to discern others' motivations for involvement).
   
   Most often, a developmentally disabled person is expected to be compliant. In fact, training to improve compliance is a common seminar and in-service topic. Explicitly teaching the right to refuse — to set boundaries with peers, to set sexual limits, to discern the difference between being polite and being used — is often a necessary component of sexuality education.
   
   
8. Remember that Context is Everything
   Sexuality education needs to include not just pieces of information, but how that information fits into real life. Contextual decisions about various social relationships are particularly challenging. The unwritten relationship rules most people follow unconsciously — how to greet people, which people to greet at all, who to kiss, who to hug — are a web of abstract and sometimes changing ideas. People with developmental disabilities may also need assistance in understanding when and why to make exceptions to the rules.
   
   
9. Help Youth to Practice Appropriate Affection
   Teach the ways others of their chronological age (not developmental age) show affection. People are sometimes tempted to treat people with disabilities as if they are young children, regardless of their real age. For example, some youth (and adults) have been encouraged to greet others (even strangers) with a hug. Others have been trained to hold hands with a non-disabled person or another student while crossing the street although they are long past the age at which this is a safety issue.
   
   Treating people with developmental disabilities as children has become so ingrained in much of society that it's created a vicious circle. They are treated like children and then — surprise! — they sometimes behave like children. Breaking this cycle is necessary, and sexuality education that teaches appropriate affection can help to do so.
   
   
10. Recognize the Importance of Feelings
    Remember that feelings are an integral part of human sexuality. Assist youth in identifying and celebrating feelings in themselves and others. Biological concepts are only one part of the sexuality education equation.
    

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1. Use Visual Aids
   Use realistic photos or full body charts. Photos of the youth's family members and friends can form the basis for a discussion on the different types of relationships and how one acts in each of these relationships. Pictures cut from magazines can serve a variety of purposes. Full body charts can be purchased or made by tracing the outline of each youth on a large piece of newsprint roll. Each chart can be personalized according to the students' wishes. Body charts are one concrete way to show where body parts are and what they do. Some groups make these body charts as their first activity and then refer to them throughout the semester or year as each health topic is covered.
   
   
2. Repeat Key Information
   Repeat key information frequently. To check for understanding, ask the group for feedback. Reinforce important concepts throughout several lessons. Small amounts of information spaced out over time work best. Use opportunities to repeat key ideas in other curriculum areas where appropriate.
   
   
3. Provide Practice Opportunities
   Provide opportunities for youth to practice skills. Role play is an excellent technique. Have youth rehearse how to greet a new acquaintance, how to ask someone out on a date, etc. These practice sessions can even be videotaped and viewed again by the group for constructive comment. They can also serve as excellent review aids. To reinforce appropriate behavior, be sure to use scenes in which the role players were successful. When practical, practice social interactions in real-life community settings as well.
   
   
4. Use Many Approaches
   People learn in many different ways. Recognize that no one approach is best. Use a variety of methods to teach concepts. Ideally, use activities that involve verbal discussion, movement, signs, colors and icons (such as a green light for "okay" and red light for "stop"). Draw upon as many of the senses as possible. Also remember to evaluate your efforts. What methods worked well? Which ones bombed? Why? Experiment, be creative, and learn from successes and mistakes.
   
   
5. Use Humor
   Strive to make sexuality education as ordinary and matter-of-fact as other subjects. Just as in other learning situations, light or funny moments occur. Life is sometimes comical. A sense of humor is key.
   
   
6. Keep Up-to-Date on New Resources
   Research sources of further information regularly. Check the Internet, visit the library, keep current on the latest strategies and materials. There are books and videos on this topic, with new resources available at ever increasing rates.
   
   
7. Network
   Talk with other professionals. Find out if there is a group or listserv for sexuality educators or for people in the field of developmental disabilities that you can join. Talk with others who work with the particular group you teach, and share insights and skills.
   
   
8. Encourage Questions
   Set aside time in lessons to address questions. Don't be afraid to say, "I don't know the answer to that question; let's find out together." Modeling the behavior of seeking out answers to one's questions can demonstrate this skill to the group. It can also empower youth to search for answers on their own without embarrassment. Invite youth to ask questions and discuss sexuality with people they trust. Be sure to cover which people are appropriate people to discuss sexuality issues with. Assist youth in identifying these people ahead of time.
   
   
9. Keep it Simple
   Present ideas in logical ways. The exacting specifics of biology are usually not as vital as their practical applications. For example, it is usually more useful for youth to understand that menstruation is normal and to learn ways to deal with it than it is to memorize the hormonal basis underlying the process.
   
   
10. Be as Concrete as Possible
    The ability to reason abstractly is frequently difficult for youth who have developmental disabilities. Yet some sexuality concepts are quite abstract — love, communication, risk, for example. Practice ways of explaining or demonstrating ideas in a more concrete fashion.
    
    
11. Use Task Analysis
    For more complicated tasks, break down the activity into several distinct steps. This technique can be used for a variety of tasks — everything from doing the laundry to making a peanut butter and jelly sandwich. If you are unsure if your steps are concrete and understandable, write them down and try following them exactly yourself before presenting to the group. The task of using a pad or tampon during menstruation may seem straightforward but requires several separate steps. Likewise, putting on a condom requires the user to successfully complete a number of steps in the appropriate order. Repeat often, and offer feedback and praise.
    
    
12. Involve Others
    Communicate with parents, teachers, coaches, caseworkers, and therapists about the topics being covered. Share ways they can reinforce these lessons in their family or work.

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All people deserve sexuality education and information that is useful, accessible, and appropriate to their stage of physical development and their needs. Sexuality education leads to sexual health, which is defined by the World Health Organization (http://www.who.int/home-page/) as "the integration of the physical, emotional, intellectual, and social aspects of sexual being in ways that are positively enriching, and that enhance personality, communication, and love…every person has a right to receive sexual information and to consider sexual relationships for pleasure as well as for procreation."

Youth who have developmental disabilities are no exception. Often times we simply need to discover creative new ways to teach!

For information about resources related to this topic, see this month's edition of Topic in Brief.

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