Promoting Healthy Sexuality for Children and Adolescents With Disabilities

Abstract

This clinical report updates a 2006 report from the American Academy of Pediatrics titled "Sexuality of Children and Adolescents With Developmental Disabilities." The development of a healthy sexuality best occurs through appropriate education, absence of coercion and violence, and developmental acquisition of skills to navigate feelings, desires, relationships, and social pressures. Pediatric health care providers are important resources for anticipatory guidance and education for all children and youth as they understand their changing bodies, feelings, and behaviors. Yet, youth with disabilities and their families report inadequate education and guidance from pediatricians regarding sexual health development. In the decade since the original clinical report was published, there have been many advancements in the understanding and care of children and youth with disabilities, in part because of an increased prevalence and breadth of autism spectrum disorder as well as an increased longevity of individuals with medically complex and severely disabling conditions. During this same time frame, sexual education in US public schools has diminished, and there is emerging evidence that the attitudes and beliefs of all youth (with and without disability) about sex and sexuality are being formed through media rather than formal education or parent and/or health care provider sources. This report aims to provide the pediatric health care provider with resources and tools for clinical practice to address the sexual development of children and youth with disabilities. The report emphasizes strategies to promote competence in achieving a healthy sexuality regardless of physical, cognitive, or socioemotional limitations.

Knowledge level and access barriers related to sexual and reproductive health information among youth with disabilities in China: a cross-sectional study

“…Barriers to sexuality education for young people with disabilities vary by country, culture and disability types. Unfortunately, most of the studies on barriers to sexuality education for young people with disabilities were conducted in the US and European countries, and the research focus was mainly on intellectual and developmental disabilities and autism spectrum disorders with a gap in the research of other type of disabilities [ 6 , 23 ].…”

Sex and Sexuality in Autism Spectrum Disorders: A Scoping Review on a Neglected but Fundamental Issue

“…Some authors highlighted that although individuals with disabilities, compared to their peers, may have fewer and delayed sexual relationships, they are more likely to engage in risky sexual behaviors [ 34 , 88 , 89 ]. Since sexually active adolescents may be at increased risk for sexually transmitted diseases, it would be helpful to promote the use of protective barriers, such as reversible and appropriate long-acting contraception [ 90 , 91 , 92 ]. Unfortunately, this topic in the literature relating to adolescents with ASD has been poorly considered.…”

Advancing sexual health care in spina bifida multidisciplinary clinics and beyond

“…Pediatricians, pediatric physiatrists, or developmental pediatricians may take a holistic approach to addressing sexual health and education by routinely discussing the topics of pubertal development, developing healthy interpersonal relationships, consent and autonomy, risk of abuse and exploitation, and safe sexual expression 2,4 . Routinely discussing sexual health topics can help normalize and reinforce understanding for patients and their families 2 . When needed, multidisciplinary team members such as physical and occupational therapists can be engaged when adaptations are necessary for successful sexual activity.…”

“…Additionally, team psychologists may work with young people with spina bifida about their self‐esteem, how to process their desires, how to navigate the initiation of relationships, and understanding autonomy and consent. Community pediatricians and family physicians should maintain their role as a source of sexual health education and care in accordance with Bright Futures even if the individual with spina bifida receives care in a multidisciplinary clinic 2 …”

“…Despite being essential components of high‐quality patient‐centered care, sexual health care and education are often inadequately provided to people with disabilities including those with spina bifida 1–3 . The reasons for this are many and include parental and provider discomfort, lack of provider knowledge of disability‐specific sexual health needs of their patients, limited time in clinical encounters, the expectation that someone else will provide sexual health services, the need to focus on urgent clinical problems, and the misperceptions that individuals with disabilities are asexual 2,3 . All of these barriers are amenable to change.…”