Tuesday, June 18, 2013

Children with Special Needs: Sexual Development and Adolescent Disability

Sexual development is a multidimensional phenomenon inextricably tied to self-esteem and the capacity to connect with others. The ways in which children and adolescents develop sexually have a strong impact on their ability to successfully navigate this process as an adult. Sexual development is complicated for adolescents with physical disabilities or cognitive, social, or emotional delays, whose identities are oftentimes erroneously equated with asexuality or reproductive inability. Sexual experimentation and behavior is as common among teens with these challenges as in their counterparts, emphasizing the need to discuss sexuality with these youth and ensuring that societal and psychosocial barriers do not hinder their development.

Adolescents may need help talking about these things but have difficulty bringing them up because of feelings of uncertainty, awkwardness, inadequacy, or a lack of language and understanding. Parents may assist by facilitating these conversations without embarrassment and assuring children that their concerns are normal. What follows are a few considerations for parents and caregivers to think about regarding sexual development of teens with special needs:
  • Development of a positive sense of self: Self-image is critical during transformative adolescent years of physical, emotional and social changes. Adolescents with physical, cognitive, social, or emotional challenges are often very conscious of these changes and sometimes see themselves as different from some of their peers, potentially creating anxiety for the teen, especially in the area of sexuality. Inquiries should be made regarding the way an adolescent feels about his/her specific challenge and all that it entails. It is normal for a teenager to experience a sense of loss resulting from their special needs and mourning may be necessary.
  • Independence from parents/caregivers: Many adolescents with a physical, cognitive, social, or emotional challenge understand they require the assistance of caregivers to perform certain functions. However, just like any developing adolescent, they too, wish to achieve a sense of self-reliance and efficacy. Parents may fear that allowing too much independence, though, may somehow be harmful to the adolescent. While a valid concern, parents need to be mindful of their anxieties and worries. Adolescents with these challenges long for the space to grow and try things on their own and develop a sense of responsibility. Not having the ability to do so may hinder their opportunities for normal social and sexual experimentation. 
  • Learning social skills: Friendships are key to adolescents’ sense of self-worth and adolescents with physical, cognitive, social, or emotional challenges feel better about themselves when they are accepted by their peers. Planning for and providing opportunities for these youth to spend time with friends helps them to master appropriate greetings, eye contact, body language, personal space and self-advocacy skills. Typically, inappropriate sexual behavior is the result of developmental immaturity rather than sexual deviance and these opportunities provide a space to learn acceptable behavior. Furthermore, because of the higher risk of sexual abuse among children with special needs, social opportunities and discussions around this area diminish the likelihood that these children will be taken advantage of.

Parents and caregivers help adolescents feel a sense of investment and connection when supporting conversations around issues of identity and sexuality. When disseminating information, facts should be given simply and in such a way that the adolescent can comprehend them. The following topics may be emphasized: body parts and appropriate touch, changes during puberty, social skills, sexual expression and behavior, options around contraception, rights and responsibilities around sexual behavior, privacy awareness, boundaries, and self-protection.

A healthy sense of self, promoted by open communication between teens and their parents, leaves teens  feeling encouraged and supported versus potentially depressed and isolated because they feel different from able-bodied youth. Young people with whom sexuality is addressed are free to voice feelings, in any way they are able, about their bodies and identities and to accept and protect themselves as sexual beings.   

Posted by Asya Brodsky, LSW, CADC


Greyanus, D.E., Demarest, D.S. & Sears, J.M. (1985). Sexuality of the Chronically Ill Adolescent. Medical Aspects of Human Sexuality, 19 (12), 36-49.

Greydanus, D.E., Rimsza, M.E. & Newhouse, P.A. (2002). Adolescent Sexuality and Disability. Adolescent Medicine, 13(2), 223-247.

Sexuality of Children and Adolescents with Developmental Disabilities

Suris, J.C., Resnick, M.D., Sassuto, N. & Blum, R.W. (1996). Sexual Behavior of Adolescents with Chronic Disease and Disability. Journal of Adolescent Health, 19, 124-131.