Intellectual Disability
Potential problems:
- Issues concerning ability to consent
- High levels of sexual abuse. Individuals with intellectual disability are seven times more likely to be sexually assaulted (Shapiro, 2018).
- Understanding when sexual activity is appropriate
Determining Consent:
- According to Lyden (2007), the areas of rationality, knowledge, and voluntariness must be assessed:
- Rationality is the ability of an individual to understand information and make an informed decision
- Individuals with an IQ between 39-70 should undergo a mental status examination to determine if they are able to consent
- Individuals should have awareness of person, time, place, and event
- Individuals should understand the difference between truth and lies
- Individuals should be able to describe the process of sex
- Individuals should be capable of understanding verbal and nonverbal cues to determine another person is feeling
- Individuals should be able to determine if another person has agreed to engage in sexual activities.
- Knowledge refers to understanding information pertaining to sexual activity and includes:
- Understanding of specific sexual behaviors
- Understanding right to agree or not agree to engaging in sexual activity
- Understanding consequences of sexual behavior
- Understanding pregnancy and sexually transmitted diseases
- Understanding when sexual activity is illegal
- Understanding that sexual activity cannot be conducted with a minor
- Understanding legal standards and social norms on when and where sex is appropriate
- Voluntariness refers to the ability of the individual to make choices independently
- Awareness of ability to decline sexual activity
- Ability to communicate choices independently
- Rationality is the ability of an individual to understand information and make an informed decision
An example of a potential consent assessment can be found here (Arc of Erie County, n. d.).
Level of Risk:
Sexual activities should be considered based on the amount of risk that each activity presents to the individual with intellectual disability (Gill, 2010). For low-risk activities, such as independent masturbation, consent is not necessary. High-risk activities, such as exchange of bodily fluids, carry a lot more consequences and considerations. For high-risk activities such as engaging in sexual intercourse with another person, the individual must be able to consent.
Strategies:
- Education on social norms and expectations for when and where sexual activity is acceptable (BetterHealth, 2019).
- Explanation of the concepts of private versus public spaces and what types of activity are appropriate in each setting.
- Education on when and where it is acceptable to be touched by another person, as well as education on safe versus unsafe touch.
- Giving people with intellectual disabilities the opportunity to develop assertiveness and giving them the opportunity to say no.
- Education on birth control options and assistance with medication management if necessary.
- Determining appropriate settings for masturbation and other sexual behaviors (Linkie & Hattjar, 2012)
- Educating caregivers on masturbation in children. Explain that this is common in young children, and if their child is functioning at the developmental level of a toddler, then this behavior is not unexpected or abnormal.
- Social skills training to facilitate platonic and romantic relationships.
- Use of social stories may be helpful in demonstrating concepts of public vs private and appropriate social behaviors
Resources for Sexuality Education:
- Personal Space Curriculum
- Curriculum for preventing sexual assault in females with developmental disabilities (Arc of Maryland, n. d.)
- FLASH for Special Education
- Online curriculum for children and adults with disabilities (King County, 2013). Includes the topics of private and public, relationships, communication, exploitation, understanding the body, reproduction, and sexually transmitted diseases.
- Sexuality Across the Lifespan
- Educational manual for parents or caregivers of children with disabilities (Baxley & Zendell, 2011). Provides a breakdown for how to teach topics of sexuality starting for grades K-12.
References
Arc of Erie County. (n. d.). Residential services sexual consent assessment tool [PDF Document]. Retrieved from https://www.arceriecounty.org/assets/documents/SexualConsentAssessmentToolAttachmentAB.pdf
Arc of Maryland. (n. d.). Personal space: A violence prevention program for women [PDF Document]. Retrieved from http://www.ncdsv.org/images/Arc_PersonalSpace-AViolencePreventionProgramForWomen.pdf
Baxley, D. L., & Zendell, A. L. (2011). Sexuality education for children and adolescents with development disabilities: An instructional manual for family members of individuals with developmental disabilities [PDF Document]. Retrieved from https://www.fddc.org/sites/default/files/file/publications/Sexuality%20Guide-Parents-English.pdf
Better Health Channel. (2019). Cognitive disability and sexuality. Retrieved from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/intellectual-disability-and-sexuality?viewAsPdf=true
Gill, M. (2010). Rethinking sexual abuse, questions of consent, and intellectual disability. Sexuality Research and Social Policy, 7, 201-213. doi: 10.1007/s13178-010-0019-9
King County. (2013, June). Flash for special education [PDF Documents]. Retrieved from https://www.kingcounty.gov/depts/health/locations/family-planning/education/FLASH/special-education.aspx
Linkie, C., & Hattjar, B. (2012). Stroke and spasticity. In B. Hattjar (Ed.), Sexuality and occupational therapy. Bethesda, MA: American Occupational Therapy Association.
Lyden, M. (2007). Assessment of sexual consent capacity. Sex Disability, 25(3), 3-20. doi: 10.1007/s11195-006-9028-2
Shapiro, J. (2018, January 8). The sexual assault epidemic no one talks about. Retrieved from https://www.npr.org/2018/01/08/570224090/the-sexual-assault-epidemic-no-one-talks-about