RELATIONSHIPS AND SEXUALITY NEEDS: ARE THEY BEING ADDRESSED?

Edmond O’Dea and Richard Egan set out a number of the issues that young people with an intellectual disability have in relation to sexuality and sex education. Dr Edmond O’Dea is Head of Psychology, Brothers of Charity Services, Bawnmore, Limerick & Richard Egan is Educational Psychologist, Brothers of Charity Services, Bawnmore, Limerick.

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In recent years, People with intellectual disability have enjoyed increased freedom to live their lives as fully and as normally as possible. Philosophies of care and education have been redesigned to promote ordinary living principles. Agencies providing education, training and comprehensive residential and support services to this group have developed new ideas and practices around supported employment, a range of supported housing options and the emergence of purposeful leisure pursuits.

This commitment to full inclusion into the community has given people with intellectual disability new experiences, different risks and more opportunities to make choices. Currently, however, many individuals with intellectual disability are not receiving education and support to protect them from abuse, exploitation, unwanted pregnancy, and sexually transmitted diseases while safeguarding their dignity and rights. Recognising the sexual rights of people with intellectual disabilities is difficult for many individuals in our society. This article focuses on the issues of sexual rights and knowledge for young people presenting with a mild range of learning disability.

Students with intellectual disability have differing needs and strengths, yet most of these students have difficulty learning as easily and comprehensively as their non-disabled peers. Many do not readily understand concepts presented in the abstract. Often their ability to generalise from experience is absent or greatly reduced. These learning characteristics increase the vulnerability of special education students to sexually transmitted diseases. Furthermore, many students with intellectual disability live more protected lives than do adolescents without disability. This overprotection yields unwanted by products, such as heightened risk of abuse, lack of knowledge, habitual over-compliance, limited assertiveness and indifferential trusting.

Sexuality and Sex Education.

To date the literature available around this issue is limited. This may be related to society’s discomfort with the sexuality of people with intellectual disabilities, whether they live in institutions or in the community. Existing research indicates that many institutionalised individuals experience some sexual activity, though the range of behaviour is likely to be limited. This may be due in part to caregivers’ limits to the individual’s sexual expression. To date, even less research exists concerning the intellectually disabled population living in a community setting.

At present within Irish schools, Relationships and Sexuality Education (RSE) programmes lie within the curricular areas of Social Personal Health Education

(SPHE). The junior cycle SPHE curriculum (2000) provides young people with the opportunity to develop the skills and competence to learn about themselves and to care for themselves and others. The SPHE also helps students to make informed decisions about their health, personal and social development. The inclusion of RSE in this curriculum is to be commended. However, individuals with intellectual disabilities attending special schools or the mainstream setting still have limited choices. Unfortunately no specific Irish RSE programme exists for young people with a learning disability.

The Law and Sexuality Activity for Individuals with an Intellectual Disability

Many individuals with a learning disability have concerns about whether they are ‘allowed to engage in sexual activity’. This is also a major concern for staff and service providers working with these individuals in the context of education, accommodation and health and social care. The law as it stands (The Criminal Law (Sexual Offences ) Act, 1993 Section 5 – Protection of Mentally Impaired Persons states) currently provides the following information:

(1) ‘A person who a) has or attempts to have sexual intercourse, b) commits or attempts to commit an act of buggery with a person who is mentally impaired (other than a person to whom he is married or to whom he believes within reasonable cause he is married) shall be guilty of an offence and shall be liable on conviction on indictment to—
i) in the case of having sexual intercourse or committing an act of buggery, imprisonment for a term not exceeding 10 years, and
ii) in the case of an attempt to have sexual intercourse or an attempt to commit an act of buggery, imprisonment for a term not exceeding 3 years in the case of a first conviction imprisonment for a term not exceeding 5 years.

(2) A male person who commits or attempts to commit an act of gross indecency with another male person who is mentally impaired shall be guilty of an offence and shall be liable on conviction on indictment to imprisonment for a term not exceeding 2 years.

In this section ‘mentally impaired’ means suffering from a disorder of the mind, whether through mental handicap or mental illness, which is of such a nature or degree as to render a person incapable of living an independent life or of guarding against service exploitations.

While it is clear that this law is there to protect individuals with vulnerabilities from harm, it can also be seen to be restrictive to individuals with intellectual disability. It raises the following questions:

  • Can an individual with an intellectual disability engage in sexual activity with a peer outside of marriage?
  • Can an individual with intellectual disability have an intimate relationship with an individual who does not have an intellectual disability?
  • If the law states that sexual intercourse should only occur for individuals with an intellectual disability within the context of marriage, are structures in place to support this?
Attitudes Towards Sexuality

While sexuality is a normal part of development for all humans, society often views sexuality of individuals with intellectual disabilities as a problem. As a result, these individuals’ needs and rights are often ignored or denied. Some studies have shown that levels of discomfort can be so high that even mild displays of affection, tenderness and simple human touch are sometimes discouraged.

Researchers have explored the attitude of both caregivers and parents. The findings on caregivers’ attitudes are inconsistent. Those working within institutions often recognise that sexual activity exists, but they do not necessarily condone it. Community support staff are generally more liberal than institution or nursing-home staff (Brantmeyer 1983). In relation to sex education attitudes, Ryan and McConkey (2000) reported that in general staff are well disposed to their clients ‘having sex education’, are supportive of marriage, appreciate the need for privacy of sexual behaviours and are tolerant of masturbation This seems to support the contention that attitudes among caregivers have become more liberal in recent years. However, it was also noted that this did not extend to homosexual activities and to people having one-night stands. It is often the case that clients may find themselves having to adjust to different staff attitudes even within the same staff team.

It is understandable that parents of children or adolescents with intellectual disabilities are concerned for the children’s well-being. This concern, however, may be influenced by a lack of knowledge about how to provide sex education and a simple denial of the sexuality of the individual.

The Need for Sex Education

In a study by Schulz and Adams (1987) basic nutrition, sex education, teen pregnancy, marriage and parenthood, developmental tasks, and decision making were information needs identified by adolescents with borderline or mild intellectual disability. In this study over half of the adolescents said their needs were currently unmet in these areas. This study also suggested that homosexuality and masturbation, as well as appropriate means of sexual expression and ramifications of inappropriate expression should also be addressed in sex education curriculum for this population. According to this study, it is evident that lack of sex education may place persons with intellectual disability at increased risk of unwanted pregnancy, sexually transmitted infections, and abuse.

Many sex education programmes have focused on development of sexual skills, improvement of sexual knowledge, or in-depth education on one issue. Many of these programmes lack the evaluation or assessment data necessary to determine their adequacy or efficiency for this population. However, some evidence does suggest that sex education programmes for persons with intellectual disability leads to positive changes in behaviour and social skills development. (Foxx, McMorrow, Storey and Rogers, 1984).

Hinsburger, in a study in 1987, identified some important problems to be addressed in programme curriculum including:

  • Developing a strong self concept and increasing personal power.
  • Establishing peer relationship skills.
  • Developing a positive attitude towards sexual behaviour.
  • Resolving feelings around past negative experiences.
  • Accepting sexual behaviour by others in the individual’s environment.
Conclusions

It does not attempt to answer any of the questions raised in any detail. However, it does highlight the difficulties faced by the individuals themselves and by the staff and carers who help them.

Individuals with an intellectual disability have sexual needs and desires. It is evident that they require knowledge and support to express these needs and desires in a context appropriate to their abilities and in line with many of their age related peers. No longer should these basic human needs be overlooked.

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