Talking About Sex & Sexuality With Children Who Have Developmental & Intellectual Disabilities

As I discussed in my last Doctor’s Note, talking about sex and sexuality with all children is hard, and leaves most parents feeling anxious. For parents of children with developmental or intellectual disabilities, the topic is even harder. What does he need to know, and when? Will she understand this?  Can’t we just skip that topic, since it won’t be relevant to him?

Like all children, children with delays come to understand things over time. A child with cognitive delays may ask questions that are more typical for a younger child, and will need answers on a level that he or she can understand. The same ideas may need to be repeated a number of times for a child to remember and understand the details.

But while a child’s cognitive understanding of puberty and sexuality may be delayed for his or her age, the process of body maturation, hormonal changes, and sexual feelings usually is not — creating a mismatch that can be dangerous if ignored. Children, teens, and adults with cognitive disabilities need to understand enough about sex to not be victimized. They need to know the parts of their bodies that are “private,” how to say “no” if someone is trying to take advantage of them, and how to report such incidents to parents or caregivers.

Teens and young adults also need to understand their own sexual feelings and urges. They need to know that these are normal feelings, but they may need extra help to understand limits and boundaries, and to learn what it means to have consensual relationships. People with cognitive disabilities can have very fulfilling romantic relationships, once the basic concepts of mutuality and consent are understood. On the other hand, teens and young adults trying to fulfill urges that they do not understand can end up with serious social and even legal consequences.

There is no one-size-fits-all way to have these discussions with your child, but a key rule for parents is to meet your child where he or she is. The mismatch between developmental needs and subject matter can be tricky! Use simple language that your child can understand. Repeat the information multiple times, in different ways. Role playing, dolls, and other visual aids can help, especially for children who have trouble with abstract thinking.

There are some great resources out there to help; here are a few we found:

Sexuality & Disability

This website says it will go off-line in September 2014, due to funding cuts – so check it out now, it’s good!

Teaching Children with Down Syndrome about Their Bodies, Boundaries, and Sexuality

An excellent book on talking with children w/ Down Syndrome & otherintellectual disabilities.

Sex Education for Physically, Emotionally, and Mentally Challenged Youth

Sex Education for Children With Intellectual Disabilities – Tips for Parents

Dr. Sarah Springer, a shareholder in the practice, serves as the Medical Director of Adoption Health Services of Western Pennsylvania.