Who’s Missing? Awareness of Lesbian, Gay, Bisexual and Transgender People with Intellectual Disability

The Experiences of 2SLGBTQ+ Adults Labeled with Intellectual and/or Developmental Disabilities When Navigating Mainstream Queer Social Spaces

Drawing on interviews with 31 2SLGBTQ+ people labeled with developmental and/or intellectual disabilities, this exploratory study focuses on participants' experiences navigating mainstream queer social spaces. The current study is an explorative qualitative view at the intersection of the 2SLGBTQ+ and disability community. There is a call for more inclusive spaces for people with disabilities within queer social areas. Although queer spaces attempt to be free and inclusive, many have inaccessible activities and locations. The findings depict that individuals with lived experiences are not often represented in the 2SLGBTQ+ community due to a lack of inclusion. Participants highlighted feelings of rejection as people with disabilities were not represented in many 2SLGBTQ+ focused groups or organizations. The current paper calls attention to creating more inclusive intersectional spaces to promote inclusivity and ensure people with disabilities have the opportunity to contribute through an active role in the 2SLGBTQ+ community.

Learning for life, friendships and relationships from the perspective of children and young people with intellectual disabilities: findings from a UK wide qualitative study

BACKGROUND

Relationships and sexuality education (RSE) programmes are widely taught in schools, however for children and young people with intellectual disabilities, these programmes appear to be limited regarding information on relationships, informed choices and decision making. The purpose of this study was to seek the views and understanding of children and young people with intellectual disabilities, and those involved in their care and education, to identify best practice and approaches to the delivery on relationships and sexuality education.

METHODS

This study used a qualitative design with 37 pupils from five special schools from across the United Kingdom (UK) participating. In-depth semi-structured interviews were held online, or in person. All interviews were recorded and transcribed verbatim. Transcripts were anonymised, assigned a pseudonym and subjected to inductive thematic analysis.

FINDINGS

Four themes emerged from the data: (i) enthusiasm and inquisitiveness to acquire knowledge; (ii) dynamics of positive friendships; (iii) experiences and understanding of supportive relationships and sexuality; and (iv) valuing the exchange of knowledge and information. The findings highlight that children and young people with intellectual disabilities want education, support and information on matters relating to their relationships and sexuality.

CONCLUSIONS

This is the largest study to date providing a voice to children and young people with intellectual disabilities regarding their relationships and sexuality. While special schools provide relationships and sexuality education, there is a requirement for a programme and resources specific to the needs of pupils with intellectual disabilities to be developed and evaluated. Such education should continue beyond school and be embedded in adult services.

LGBTQIA health in medical education: a national survey of Australian medical students

PURPOSE

Lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA) individuals experience poorer health outcomes than other individuals. Insufficient LGBTQIA health education of doctors in existing medical curricula contributes to these outcomes. We sought to explore medical students' experiences of content coverage and mode of delivery, as well as their preparedness, attitudes and learning needs regarding LGBTQIA health education in Australia.

METHODS

Using a conceptual framework specific to curricular development, we adapted a previous cross-sectional national survey. This included 28 questions (analysed statistically) and 5 free text responses (analysed deductively using Braun and Clarke's thematic analysis framework). Data was compared between LGBTQIA and non-LGBTQIA respondents, and clinical and preclinical students.

RESULTS

There were 913 participants from 21 of 23 medical schools, with most preclinical (55%) and clinical (89%) students reporting no teaching specific to LGBTQIA health. Reported content coverage was highest for sexual history taking (30%), and especially low for transgender and intersex health (< 16%), and intersectional LGBTQIA health (< 7%). Participants had positive attitudes towards LGBTQIA health, with 89% agreeing LGBTQIA topics were important and need to be covered in detail. Students desired longitudinal integration of LGBTQIA content, and LGBTQIA community involvement and case-based teaching that allows for interaction and questions. Self-perceived competency was low in all LGBTQIA health topics, although LGBTQIA participants reported higher preparedness than non-LGBTQIA participants.

CONCLUSIONS

Majority of survey participants reported limited teaching of LGBTQIA health-specific content, highlighting the limited coverage of LGBTQIA health in Australian medical schools. Participants expressed positive attitudes towards LGBTQIA content and broadly agreed with statements supporting increased integration of LGBTQIA health content within medical curricula.

The Potential Use of Sex Robots in Adults with Autistic Spectrum Disorders: A Theoretical Framework

Although the importance of the sexual sphere for the health of all human beings has been recognized at an international level, often this is underestimated when it comes to disabilities and even more to intellectual disabilities. In fact, the idea that subjects with intellectual disabilities are not aware of their bodies and of their wishes in the sexual and emotional field is still widespread in our society, in such a way that they are considered as children in need of constant supervision. Moreover, further hints of criticism that can be raised are about the poor level of sexual education that is dedicated to these subjects, both by family members and by therapists. The last decades have been characterized by a considerable growth in the technological sector and many new instruments have been successfully used in the field of healthcare of weak or disabled subjects. A particularly fruitful branch has been robotics which, in subjects with autistic spectrum disorders (ASD), has revealed itself as an excellent support to stimulate communication and develop social skills. As in recent years the field of robotics has also been characterized by a strong interest in the sphere of sexuality, building and implementing what we now define as sex robots or sexbots, it could be interesting to start a debate on the potential that these new generation artificial agents could have in the field of care of subjects with ASD. These robots, possessing a technology based on stimulating verbal and nonverbal interaction, could be useful for an education that is not only sexual but also psycho-emotional in subjects with ASD.

Increasing Opportunities for Healthy Sexual Socialization in LGBTQ+ People with IDD: The Role of LGBTQ+ Organizations and Community

In the current intersectionality-focused discourse within sexuality research, individuals existing at the convergence of intellectual and developmental disabilities (IDD) and lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) are often overlooked. Individuals with IDD face difficulties acquiring sexual knowledge and skills due to limited opportunities for sexual socialization, misconceptions concerning sexuality and IDD, lack of comprehensive sexual education, restricted support from staff and caregivers, and a lack of community experiences that facilitate the development of healthy sexuality. When an individual with IDD identifies as LGBTQ+, these disability-related barriers can exacerbate the stigma and discrimination some LGBTQ+ people experience. Using the intimate justice framework, we explore avenues to support and foster inclusivity within the LGBTQ+ community for members with IDD. Several recommendations were identified from the literature search, including logistical considerations and using accessible language for outreach events, presentations, workshops, training, and other activities and opportunities for sexuality education while challenging disability-related stigma in LGBTQ+ spaces.

Social inclusion of LGBTQ and gender diverse adults with intellectual disability in disability services: A systematic review of the literature

BACKGROUND

Lesbian, gay, bisexual, transgender, queer (LGBTQ) and gender diverse adults with intellectual disability experience exclusion within disability services.

OBJECTIVE

This review explores the experiences of social inclusion/exclusion of this cohort in the context of disability services.

SEARCH METHOD

A systematic search was conducted of peer-reviewed research published between January 2014 and April 2019. Five databases returned 66 articles plus three from hand searches.

APPRAISAL AND SYNTHESIS

Nine articles were included in this review. The Critical Appraisal Skills Programme tool was used to assess the quality of the research. NVivo 12 was used as a tool to organise the articles.

RESULTS

Marginalisation of LGBTQ adults with intellectual disability in western societies is mirrored in disability organisations. There remains a dearth of research into experiences of transgender people with intellectual disability who use disability services.

CONCLUSIONS

Research into interventions that support the inclusion of this cohort in disability support services is needed.

Evidences of an Implemented Training Program in Consensual and Responsible Sexual Relations for People with Intellectual Disabilities

(1) Background: While there is a growing awareness of the rights of individuals with intellectual disabilities, very limited progress has been made in supporting these people to create and maintain intimate and personal relationships. (2) Methods: This paper reports the results from a program aimed at promoting responsible and consensual sexual relations of adults with intellectual disabilities. Of the 44 participants, 31.8% were women and 68.2% were men aged 22 to 67 years. Pre and post measurements regarding the attitudes toward sexual relations were taken, and difficulty and discrimination indexes were calculated. (3) Results: Statistically significant improvements were identified in the overall measurements, as were they for the domains of privacy, safety, and respect. The difficulty index changed from 0.67 to 0.79 in a pre-post assessment, denoting more positive attitudes. This and other results support the relevance and usefulness of the intervention program and encourage further intervention efforts.

Women and Stigma: A Protocol for Understanding Intersections of Experience through Body Mapping

This paper outlines a research and dissemination protocol to be undertaken with specific groups of marginalised women in Australia. Women impacted by significant mental distress, disability, or refugee status are among society’s most vulnerable and disenfranchised groups. They can experience significant social exclusion, marginalisation and stigma, associated with reduced help seeking, deprivation of dignity and human rights, and threats to health, well-being and quality of life. Previous research has assessed the experiences of discrete groups of women but has to date failed to consider mental health–refugee–disability intersections and overlaps in experience. Using body mapping, this research applies an intersectional approach to identify how women impacted by significant mental distress, disability, and refugee status negotiate stigma and marginalisation. Findings on strategies to cope with, negotiate and resist stigmatised identities will inform health policy and yield targeted interventions informed by much-needed insights on women’s embodied experience of stigma. The women’s body maps will be exhibited publicly as part of an integrated knowledge translation strategy. The aim is to promote and increase sensitivity and empathy among practitioners and policy makers, strengthening the basis for social policy deliberation.

A deviation too many? Healthcare professionals' knowledge and attitudes concerning patients with intellectual disability disrupting norms regarding sexual orientation and/or gender identity

BACKGROUND

People with intellectual disability (ID) have few role models for sexual expression and behaviour, and those who identify as LGBTQ experience dual marginalization. The aim of this study is to explore knowledge and attitudes concerning patients with both ID and norm-breaking sexuality and/or gender identity among healthcare professionals in habilitation centres.

METHOD

Data were collected from four focus group interviews that included 19 healthcare professionals from child and adult teams at two Swedish habilitation centres. Data were analysed using thematic analysis.

RESULTS

Three themes were identified as follows: heteronormative treatment in health care, barriers for inclusion and possibilities for inclusion.

CONCLUSIONS

Norm-breaking sexuality and gender identity are still relatively invisible in habilitation centres. People with ID are still predominately desexualized and perceptions regarding their sexuality are lagging behind the rest of society. Conditions that allow for more LGBTQ-affirmative practice were described by the teams that have undergone LGBTQ training.

A narrative review of the literature about people with intellectual disability who identify as lesbian, gay, bisexual, transgender, intersex or questioning

This narrative review of the research literature presents a summary about the key issues facing people with intellectual disability (ID) who identify as lesbian, gay, bisexual, transgender, intersex or questioning (LGBTIQ). The aim of this review was to consolidate research of the topic; to identify whether any pilot studies reporting social/sexual/educational interventions had been published; and to offer some perspective on the type of future research required to better inform policy, practice and theory that may lead to better outcomes for people with ID who identify as LGBTIQ. Almost all of the research literature on the topic is either exploratory or descriptive which serves to outline the range of issues faced by people with ID who identify as LGBTIQ. Urgently needed as the next step, however, is a concerted effort to conduct a range of innovative educational and social interventions with collection of targeted and appropriate outcomes data.

Perspectives on Queer Music Therapy: A Qualitative Analysis of Music Therapists' Reactions to Radically Inclusive Practice

Background

The queer music therapy model was designed by Bain, Grzanka, and Crowe in 2016 as a novel therapeutic approach to affirm and empower LGBTQ+ identity through music. No data have been generated on how this model might actually be implemented, or the strengths and limitations of the model according to music therapy professionals.

Objective

The purpose of this study was to build on Bain and colleagues' work by collecting music therapists' perspectives on queer music therapy and using these data to critically evaluate the model.

Methods

Semi-structured qualitative interviews were conducted with twelve music therapists who identify as LGBTQ+ or have experience working with LGBTQ+ clients. Participants were prompted to discuss their music therapy backgrounds, experiences with LGBTQ+ clients, and reactions to the queer music therapy model. Interviews were analyzed using a critical discourse analysis approach.

Results

The qualitative findings revealed major strengths of the queer music therapy model and ways in which it could be improved by attending to: (a) the structural limitations of the music therapy discipline, including the demographic composition of the field and lack of critical perspectives in music therapy training; and (b) intersectional considerations of ageism and ableism within diverse LGBTQ+ populations.

Conclusions

Queer music therapy has positive implications for future work with LGBTQ+ individuals, but it must more substantively integrate intersectionality theory to serve a diverse range of LGBTQ+ clients. Further, it must critically attend to the structural limitations of the music therapy discipline itself.

Women Who Love: An Explorative Study on Experiences of Lesbian and Bisexual Women with a Mild Intellectual Disability in The Netherlands

Empirical research that addresses sexual orientation in people with an intellectual disability (ID) is limited, and very little is known regarding the personal experiences of lesbian and bisexual women with ID. This study set out to answer the question: What are the experiences of lesbian and bisexual women with a mild intellectual disability in the Netherlands? Ten lesbian and bisexual women (average age of 33 years) with a mild intellectual disability took part in our study comprising of semi-structured interviews. Participants reported that they had found it hard to talk to others about sensitive subjects such as their sexuality, and had been left to figure out information regarding their sexual orientation without support or guidance. Our results point to a lack of information, sexual education and role models when it comes to lesbian sex and women with an intellectual disability. Social contact was often limited, and participants experienced difficulties finding a partner. Furthermore, participants often had to cope with mental health problems and had struggled with loneliness, depression and addiction. Last but not least, our participants reported that they had been discriminated against. Coming out (revealing your sexual orientation) is not easy when you have an intellectual disability. To enable women with ID who have lesbian or bisexual feelings to understand and secure their sexual rights in their daily lives is important. Therefore, it is necessary to provide support in the following domains: sexual education and training, social contact and assertiveness.

Experiences of adults with intellectual disability who identify as lesbian, gay, bisexual, transgender, queer or questioning, intersex or asexual: a systematic review protocol

REVIEW OBJECTIVE/QUESTION

The purpose of this systematic review is to identify, appraise and synthesize the best available qualitative evidence on the lived experiences of adults with intellectual disability who identify as lesbian, gay, bisexual, transgender, queer or questioning, intersex or asexual in mainstream society.

Women with intellectual disabilities talk about their perceptions of sex

BACKGROUND

Sexuality is learned through sexual socialisation that women with intellectual disabilities (IDs) understand and express. Rules of sexual engagement for these women can include barriers for their socialisation, intimate partner selection, and sexual expression. These rules can become more limiting when coupled with rules of femininity that encourage sexual restraint for women.

METHODS

This ethnography explored how women with IDs perceived their sexuality and how sexuality functioned in their lives. Sources of data included 48 multiple and in-depth interviews and observations with 14 women. This article specifically describes how the women constructed 'sex' and how they described experiencing sex as two of their multiple expressions of sexuality in this study.

RESULTS

Most of the women had very limited and exclusively heterosexual sexual experiences, and the majority of women reported practicing abstinence. Criteria they identified for sex included having protected sex, marital and monogamous sex for the purpose of procreation or parenting, and having feelings for a sexual partner. Most held negative perceptions of sex they attributed to fear of the first act, fear of experiencing negative consequences, physiological concerns about the act, and perceived or actual lack of pleasure.

CONCLUSIONS

  Although the women displayed some sense of self-determinism in their sexual behaviour, negative perceptions of sex resulted in self-imposed abstinence predicated by fear of intercourse, intimacy, or outcome. Central to their sexuality education then is increasing self-efficacy perceptions and performance of safer sex practices to prevent negative sexual consequence. Sexuality education from a positive perspective that enhances their sexual self-determinism and encourages sexual health is recommended.