‘As Normal as Possible’: Sexual Identity Development in People with Intellectual Disabilities Transitioning to Adulthood

Empowering Young People with Special Educational Needs to Recognize and Report Child Sexual Exploitation and Abuse: A Mixed-Methods Review

Young people with special educational needs (SEN), such as intellectual disability and/or autism, are particularly vulnerable to child sexual exploitation and abuse (CSEA). This mixed-methods systematic literature review consolidates findings in respect to how young people with SEN are currently being taught about CSEA in the UK, incorporating empirical and practice-based findings to counteract publication bias. Key databases were searched, and relevant organizations were contacted regarding studies published between 2015 and 2022 (inclusive). Thirteen articles met the inclusion criteria. Of these, 10 adopted a qualitative methodology, and three a mixed-methods approach. The thematic synthesis of the qualitative studies identified the following themes: (a) beliefs and stereotypes about CSEA, vulnerability. and risk have led to young people with SEN being misinformed and misunderstood, and (b) anxiety about the topic of sex and abuse creates polarized views regarding CSEA education in adult guardians of young people with SEN. Themes are discussed in the context of societal biases in respect to vulnerability and risk, and these biases are considered to have a negative effect on how young people with SEN are supported. The findings of this review encourage providers of CSEA awareness education to be mindful of not endorsing harmful stereotypes, and to involve parent-carers as much as possible. This review additionally encourages services and organizations to increase focus on practitioner reflexivity and regular training to counteract potential biases in respect to gender, vulnerability, and risk.

Sexual health and safety of adolescents with intellectual disability: Challenges and concerns among special educators in India

Sexual health education among adolescents with intellectual disabilities is an area of concern among parents and educators. Special educators play a vital role in teaching sexual health and safety to their students with disabilities. The present study explores special educators' concerns in teaching sexual health among adolescents with intellectual disabilities. The participants included 35 special educators working with adolescents with intellectual disabilities in India. Summative content analysis of the data collected using a semi-structured interview schedule highlights the neglect of the issues related to sexual health among adolescents with disabilities. Special educators reported the challenges in providing sexual health education. Teachers lacked skills in imparting sexual health education. Developmentally and culturally appropriate sexual health education can help adolescents with a disability learn healthy life skills. The paper emphasizes the need for professional support and training among special educators on sexual health education.

"My whole life has been a process of finding labels that fit": A Thematic Analysis of Autistic LGBTQIA+ Identity and Inclusion in the LGBTQIA+ Community

Background

Being nonheterosexual and noncisgender appears to be more common among autistic people. This intersection of identities is often stigmatized in research and society. However, we know that community involvement can protect against negative mental health outcomes associated with being a minority; researchers found this effect in separate studies examining participation in the autistic and Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual plus other gender and sexual orientation-based identity (LGBTQIA+) communities. This study examined how autistic LGBTQIA+ individuals navigate their multiple marginalized identities and the LGBTQIA+ community.

Methods

Twelve autistic LGBTQIA+ people from the United Kingdom took part in semistructured interviews. Questions focused on identity and community. We analyzed the interviews using reflexive thematic analysis.

Results

We identified four overarching themes-Identity (Re)Development, Navigating Authenticity, Exclusion from Community Spaces, and Creating Change. Participants viewed accessing a community of similar others as a means of increasing understanding, self-knowledge, and self-acceptance. We identified several barriers to inclusion, including accessibility and gatekeeping. Participants discussed strategies to combat these obstacles, such as the creation of intersectional community spaces and activism and representation as a means of increasing autism understanding.

Conclusions

This study suggests that similar to other marginalized groups, autistic LGBTQIA+ individuals are motivated to engage in communities relevant to their identities. However, community spaces for autistic LGBTQIA+ are often inaccessible due to social, sensory, and identity-based barriers. Participants highlighted autism understanding as a barrier to coming out both in community and noncommunity settings. This suggests that improving autism acceptance and understanding is crucial to achieve accessible, intersectional, and inclusive community spaces.

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.

'Exploring the perspectives of young adults with developmental disabilities about sexuality and sexual health education'

BACKGROUND

Sexuality is important in everyday lives; it contributes to a sense of self. Everyone has a right to access sexual experiences, form relationships, and obtain sexual health education. There is limited literature from the perspective of people with developmental disabilities about their sexuality and particularly how, or if, societal attitudes influence their sexuality and their opinions about sexual health education. The aim of this study was to explore the experiences of young adults with developmental disabilities about their sexuality, their perceptions about how their sexuality was viewed by the community, and about the sexual education that is required and how it should be delivered.

METHOD

A qualitative interpretative phenomenological approach using a purposive sample was used to explore the perspectives of young adults, aged between 18 and 32 years old with developmental disabilities, to explore their perspectives on their sexuality, societal attitudes, and access to sexual health education. Seven semi-structured interviews were conducted and analysed using an interpretative phenomenological approach.

RESULTS

Five main themes were developed from the data: (1) sexuality is multidimensional and important, (2) the challenges and fear of expressing sexuality, (3) societal views need to change, (4) close support enables sexuality, and (5) sexual health education needs to be individualised.

CONCLUSION

Participants suggested that sexuality was important to them, and they had the same expectations about sexuality and relationships as many young adults. However, their autonomy and self-determination to set sexuality goals were constrained by societal attitudes. Supportive family and friends enabled opportunities, but they believed the knowledge and attitudes about disability, and about disability and sexuality, of community members, service providers, funders, and educators needed to change to enable increased opportunity to express their sexuality. Participants reported a need for individualised sexual health education provided by professionals with expertise.

Parents perception and experience of transitioning to adulthood for their child diagnosed with an intellectual disability

Definitions of adulthood for people with intellectual disability are often complicated, with milestones being markedly different for this population. This is then associated with difficulties for both the people with intellectual disability and their parents, who are closely involved in this transitional period. This paper aims to report on parents' perception and experience of adulthood for their son or daughter with an Intellectual Disability (ID). Qualitative data were collected through 30 - 60-minute phone interviews with eight parents of a person with an intellectual disability aged 15 or older (mean parent age = 60; mean child age = 23). Thematic analysis found that Perception of Adulthood encompassed themes of Independence and Normality. Experiences of Adulthood were categorised under Government Services, Responsibility and Social Supports. Findings of this research provide information for the growing literature around adulthood for people with intellectual disability, as well as how to amend policies and procedures for services that cater to people with intellectual disability and their parents during this transition.

'I don't want to get in trouble': a study of how adults with intellectual disabilities convert and navigate intellectual disability sexual fields

Drawing on interviews with 46 adults with intellectual disabilities in Ontario, Canada, this article suggests a different starting point in understanding the constraints that limit which sexual fields are available to people with intellectual disabilities. Because of surveillance, infantilisation and control, people with intellectual disabilities sometimes have to claim and convert other spaces such as day programmes, group homes and other residential settings into sexual fields. Without understanding these experiences, we may not recognise these intellectual disability sexual fields as settings for the pursuit of intimacy and love. These are valuable insights that bring into view how some marginalised sexual actors may covert social fields into sexual fields as a means of responding to lack of access to and exclusion from mainstream sexual fields.

Sexuality, Education and Support for People with Intellectual Disabilities: A Systematic Review of the Attitudes of Support Staff and Relatives

Support staff and relatives are uncertain about multiple aspects of the sexuality of people with intellectual disabilities. Given that their attitudes embody positive and negative views, they can respectively support and restrict free sexual expression among people with intellectual disabilities and their potential for (intimate) relationships. A qualitative systematic literature review was conducted on the attitudes of support staff and relatives toward the sexuality of people with intellectual disabilities. A systematic search strategy was deployed across seven databases. The identified articles were screened on predetermined inclusion and exclusion criteria, and assessed on quality, which resulted in 31 included studies. A metasynthesis of these studies resulted in two major themes emerging, namely (a) attitudes toward the sexuality of people with intellectual disabilities, and (b) attitudes toward the sex education and support. Themes represented both positive and restrictive attitudes among support staff and relatives. The findings suggest that despite a general acceptance of the sexual rights of people with intellectual disabilities, certain forms of sexuality were approached more cautiously. Moreover, the sexual needs of some subgroups of people with intellectual disabilities received scarce attention. Those support staff and relatives holding rather restrictive attitudes appear to emphasize sexual risks. Finally, support staff and relatives stressed the importance of providing sex education and support for people with intellectual disabilities, while, simultaneously, expressing insecurity over the subject. The findings can help to improve the support provided to support staff and relatives to promote sexual health among people with intellectual disabilities.

Sex: What Is the Big Deal? Exploring Individuals' with Intellectual Disabilities Experiences with Sex Education

This article offers perspectives shared by self-advocates in the first phase of a community-based participatory research project untaken to address barriers that individuals with intellectual disabilities face with respect to sexual health knowledge. Using descriptive qualitative methods, we interviewed 19 individuals with intellectual disability about their experiences and knowledge related to sexual health. The research question guiding this project was: What are self-advocates' with intellectual disabilities experiences learning about sexual health and sexuality? The findings highlight that participants faced barriers and lack of access to sexual health education, and while they learned about sexual health through formal sexual health education, frequently this knowledge came through lived experience. Finally, the findings underscore that participants knew what they wanted with respect to sexual health education and offered recommendations. The importance of accessible sexual health education for self-advocates that supports their rights and desires to express their sexuality and sexual agency is highlighted.

Attitudes towards sexuality and related caregiver support of people with intellectual disabilities: A systematic review on the perspectives of people with intellectual disabilities

BACKGROUND

Sexual health remains at risk for people with an intellectual disability. Attitudes towards sexuality, its support and education have an important role in promoting sexual health. The current review aims to provide an overview of the current research on supportive and restrictive attitudes towards sexuality and its support of people with intellectual disabilities themselves.

METHOD

A systematic review was conducted, searching across eight databases. The quality of the studies was assessed with the Mixed-Method Appraisal Tool.

RESULTS

Six themes emerged from the data: sexual behaviour, sexual identity, intimate relationships, barriers to sexual expression, sex education and support by caregivers. Supportive and restrictive attitudes were reported throughout.

CONCLUSIONS

Attitudes regarding sexuality of people with intellectual disabilities are heterogeneous and people with intellectual disabilities seem to be able to express their sexual desires, needs and attitudes. Findings allow for improved individual support and in-depth research questions.

"They don't think I can cope, because I have got a learning disability…": Experiences of stigma in the lives of parents with learning disabilities

BACKGROUND

Parents with learning disabilities report facing a widely held 'presumption of incompetence', placing them under pressure to prove their parenting competence. In collaboration with a learning disability theatre company, an inclusive research methodology explored experiences of parenting with learning disabilities, with a specific focus on the operation of stigma in parents' lives.

METHOD

Interviews with 17 mothers and 5 fathers who self-identified as having learning disabilities were co-facilitated by learning-disabled co-researchers, and analysed using thematic analysis, with input from people with learning disabilities.

RESULTS

Thematic analysis generated four key themes; (1) positions of powerlessness, (2) assumptions of incompetence, (3) challenging assumptions and proving competence and (4) claiming power.

CONCLUSION

Parents reported experiencing stigma and disempowerment within their networks, yet continued to embrace their valued parental identity and drew strength from involvement with self-advocacy organisations. The research informed arts-based performance pieces and resources aimed at training professionals and raising public awareness.

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.

The Lived Experience of Sexuality Among Adults With Intellectual and Developmental Disabilities: A Scoping Review

IMPORTANCE

Sexuality is an important part of the human experience. However, little is known about the experience of sexuality from the perspective of adults with intellectual and developmental disabilities (IDD).

OBJECTIVE

To review evidence about the lived experience of sexuality among adults with IDD to inform future research and practice.

DATA SOURCES

We located articles using search terms summarized into three categories: intellectual disability, sexual activity, and feelings/opinions. Articles were indexed in the following electronic databases: CINAHL, Scopus, PubMed, and PsycINFO. Study Selection and Data Collection: Arksey and O'Malley's methodology was used to review scientific literature published between 2008 and 2018. The studies were in English, were located in peer-reviewed journals, and described the experience of sexuality from the perspective of people with IDD or observations of expressed sexuality.

FINDINGS

Seventeen articles met inclusion criteria. Four main themes emerged: intimate relationships, oppressed sexual activity, knowledge, and identity. Findings indicate that sexuality is a part of the lives of many adults with IDD, regardless of their engagement in sexual activity.

CONCLUSIONS AND RELEVANCE

Barriers to expression of sexuality exist for people with IDD. Some of these barriers are internal, although many are external. The results provide support for addressing sexuality among adults with IDD. What This Article Adds: This review provides evidence to support occupational therapy practitioners in including sexuality as a part of their holistic view of clients and as an area for advocacy.

'Love makes me feel good inside and my heart is fixed': What adults with intellectual disabilities have to say about love and relationships

BACKGROUND

Adults with intellectual disabilities have historically been hindered, rather than supported, in their desire to form loving relationships. This paper sought to explore with them what kinds of support they wanted in the 21st Century.

METHOD

Semi-structured in-depth interviews were conducted with 40 adults with intellectual disabilities in the United Kingdom.

RESULTS

Participants placed a high value on having a partner and being supported to maintain and develop a loving relationship. The factors which constrained them in achieving this included a lack of social opportunities, barriers created by social care services and limits on them exercising autonomy. Facilitating factors included access to specialist dating agencies, strong family and staff support and opportunities to learn about relationships.

CONCLUSIONS

The importance of a loving relationship as a source of pleasure and meaning in the lives of adults with intellectual disabilities who are often disadvantaged in many other spheres of life is emphasised.

Facial attraction: an exploratory study of the judgements made by people with intellectual disabilities

BACKGROUND

Although romantic or sexual attraction is a major research topic in the general population, little is known about people with intellectual disabilities' (ID) views of attractiveness.

METHODS

Fifty-eight participants (16-40 years) took part in this exploratory study, 29 with ID and 29 without ID. Participants were shown 50 images of men or women's faces and asked to rate how attractive they thought the faces were.

RESULTS

A strong association was found between what men and women with ID and those without ID considered attractive in romantic partners. However, people with ID were more likely to consider themselves desirable to others.

CONCLUSIONS

The findings suggest that people with mild ID make the same subtle judgements about facial attraction as other individuals.

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.

Awareness of Sexual Rights and Empowerment: Quantitative and Qualitative Evaluation of a Sexual Health Intervention for Adults with Intellectual Disability

Young people with intellectual disability (ID) rarely have opportunities to form intimate relationships or receive long-term interventions promoting their sexual health and awareness of sexual rights. To promote sexual health in adults with ID in Taiwan, we utilized intervention research and inclusive research to introduce three interventions that involved adults with ID, their parents, and service workers. This paper primarily evaluates the outcomes of a two-year intervention to promote sexual and reproductive health knowledge/positive attitudes and quality of life for adults with ID. A non-equivalent multiple-groups with replications design was used to gather data from 87 adults with ID. In-depth interviews and focus groups were used to collect the experiences and perspectives of adults with ID, service workers and parents. Although the experimental groups did not show a strong quantitative increase in sexual knowledge and sexual attitudes, the qualitative data indicated that the dialogues with and among the participants transformed their perceptions of sexual needs from being sexual problems to being sexual rights, which was empowering for adults with ID. Involving parents and service workers in the intervention and facilitating dialogue between these groups are essential to transform sexual problems of adults with ID into sexual rights.

'Conflict versus Congruence': A Qualitative Study Exploring the Experience of Gender Dysphoria for Adults with Autism Spectrum Disorder

An emergent evidence base indicates a higher prevalence of autism exists amongst people attending gender identity clinics. This qualitative study explored adults' with autism experiences of coming to understand and address their gender dysphoria (GD). Data were collected and analysed using Grounded Theory. Ten adults with autism and GD undertook semi-structured interviews. A tentative theoretical framework of common processes involved in understanding and addressing GD for individuals with autism was developed. The experience is captured in the core category-Conflict versus Congruence. A key finding was the impact of autism as a barrier but sometimes a protective factor in participants' understanding and addressing GD. Participants appeared to achieve greater personal congruence and wellbeing upon transition. Nevertheless, conflicts remained as they navigated the social world with a continuing fear of hostility and sense of difference due to having two stigmatised identities.

The views and experiences of families and direct care support workers regarding the expression of sexuality by adults with intellectual disabilities: A narrative review of the international research evidence

BACKGROUND

There is a growing and evolving research evidence base regarding sexuality issues and adults with intellectual disabilities. However, the experiences and views of families and direct care support workers and their support and development needs in the topic area are unclear.

AIMS

The aim of this narrative review was to explore the views and experiences of families and direct care support workers in relation to the expression of sexuality by adults with intellectual disabilities and to identify their distinct support and development needs.

METHODS AND PROCEDURES

A comprehensive search of relevant databases from May 1998 to June 2018 was undertaken. Included studies had to address specific criteria: peer reviewed papers, the use of appropriate research methods, and focus exclusively on the individual views and opinions of families and direct care support workers. The search of relevant databases yielded 313 hits. Following the application of explicit inclusion and exclusion criteria, 11 papers were deemed suitable for the review. The PRISMA checklist was utlised in the process. Quality was assessed using a recognized framework.

OUTCOMES AND RESULTS

The data were analysed and key findings highlighted issues for families and direct care support workers including: attitudes and beliefs; fear of abuse, exploitation and harm; new technologies; supporting developments in practice; and education and training programmes.

CONCLUSIONS AND IMPLICATIONS

Families and direct care support workers have specific support and education needs. Future healthcare initiatives need to be developed that are fully responsive to the identified concerns and requirements of families and direct care support workers.

Transitioning to adulthood with a mild intellectual disability-Young people's experiences, expectations and aspirations

AIM

Very little attention has been paid to the views and experiences of young people with mild intellectual disabilities on the broad topics of adulthood and adult identity. The following study was undertaken to explore how young adults with mild intellectual disabilities conceptualize, relate to, and experience the process of transition.

METHOD

Eight young adults with mild to borderline intellectual disabilities participated in semi-structured interviews. Results were analysed using interpretive thematic analysis.

RESULTS

Two umbrella themes were identified: "On a developmental pathway" and "Negotiations in the environment".

CONCLUSIONS

The participants concerns were surprisingly similar to those commonly expressed by young adults without disabilities. Self-perceived adult identity appeared to be affected by the participants' personal definitions of adulthood, as well as by social comparisons with both peers and adults. Finally, while concerns were expressed about their capacity to cope with responsibility, most felt optimistic about adopting full adult status in the future.

The Cloaked Self: Professional Decloaking and its Implications for Human Engagement in Nursing

PURPOSE

Much of our practice as nurses is predicated on the development of a trusting relationship between patient and nurse. Through this, the nurse and patient can identify the issues which are challenging health, the desired outcomes of care and the interventions that will be enacted, by both parties, in order to achieve these outcomes. Often, though, both nurses and patients find it difficult to put aside the relative roles that they play in health care and the level of engagement that is possible may not be achieved.

METHODS

In this theoretical paper, I will explore the importance of human engagement to nursing practice, drawing, in a reflective and personal manner, on experiences gained throughout my 30 years of providing nursing service.

CONCLUSIONS

Human engagement is central to the practice of nursing, but if engagement is to be valid, it must involve a dialogic transaction between the nurse and patient such that both parties are changed and there is a commitment to journey together, as humans, in the hope of finding positive outcomes for both.

PRACTICE IMPLICATIONS

In a time of increasing tendency to build boundaries between people and communities, it is imperative that nursing does not lose its most essential quality: the coming together of human beings in dialogic engagement.

Sexuality issues and the voices of adults with intellectual disabilities: A systematic review of the literature

BACKGROUND

There is a growing and evolving research evidence base regarding sexuality issues and adults with intellectual disabilities. Individuals can face challenges, including the right to express their sexuality and to access necessary education and supports.

AIMS

This systematic review explores sexuality experiences, the views and opinions of adults with intellectual disabilities and highlights areas for future practice developments.

METHODS AND PROCEDURES

A comprehensive search of relevant databases from January 2006 to December 2016 was carried out. Included studies had to address specific criteria including: peer reviewed papers, the use of appropriate research methods, and focused exclusively on the individual views and opinions of people with an intellectual disability. The search of relevant databases yielded 230 hits. Following the application of explicit inclusion and exclusion criteria, 23 papers were deemed suitable for the review.

OUTCOMES AND RESULTS

The data were analysed and key themes were identified that included: autonomy v's risk of harm, knowledge and sexuality, relationships and intimacy, self-determination and taking control, and encouragement and supports.

CONCLUSIONS AND IMPLICATIONS

Adults with intellectual disabilities need education and support to express their sexuality and to meet individual needs.

Sexuality, intellectual disability, and human rights legislation

Sexuality constitutes a central feature of what it is to be human, yet health practitioners, families, and caregivers frequently perceive romantic and sexually intimate relationships among persons with intellectual disabilities to be inappropriate tending to regard such individuals as either ‘asexual’ or ‘hyper-sexed’. A number of myths, stereotypes, and prejudices intersect in a manner that has deleterious consequences for persons with intellectual disabilities. This article reviews the literature on sexuality and barriers to sexual expression among persons with intellectual disabilities. Relevant legislative frameworks and human rights issues, in particular, the tensions between protecting persons with intellectual disabilities from exploitation, and the promotion of sexual autonomy also receive consideration. In addition, the article explores issues relating to competency to consent to sexual acts and concludes with a synthesis of the current knowledge.