The Unintended Invisible Hand: A Conceptual Framework for the Analysis of the Sexual Lives of People with Intellectual Disabilities

The Experiences of Young People with Intellectual Disability, Parents and Professionals in Relationships and Sexuality Education Programmes: Findings from a Qualitative Study

People with intellectual disability want friendships and meaningful relationships, and some want intimacy. However, the expression of sexuality is an area where potential freedoms are often limited and restricted compared to their peers. While some relationships and sexuality education programmes do exist for this population, most focus on knowledge acquisition regarding sexuality and sex but lack in their focus on relationships, informed choices and decision-making. The aim of this study was to identify good practices and methods of delivery in relationships and sexuality education for children and young people with intellectual disability. A qualitative design was undertaken. Information about our study was distributed to eight special schools in the UK. Semi-structured interviews and focus groups were employed for data collection. Data from 37 pupils with intellectual disability, 11 parents and 16 healthcare and other professionals were thematically analysed. Following data analysis, three themes emerged: (i) seeking and sharing information; (ii) protecting and keeping safe; and (iii) learning for the future. The findings highlight that pupils are keen to learn about life changes and societal influences and want reliable information. Parents and professionals recognise that children and young people with intellectual disability will develop into adults and may be vulnerable when they leave the security of the school setting. They recognise that children and young people need to know about socialising, puberty, consent and contraception. Evidence-based programmes should be designed with these stakeholders to ensure children and young people with intellectual disability receive developmentally appropriate information to make happy and safe decisions about their relationships.

Challenges in the delivery of sex education for people with intellectual disabilities: A Chinese cultural-contextual analysis

BACKGROUND

Staff members' views can have a significant impact on sexuality issues of people with intellectual disabilities. Research on the impact of sociocultural factors in this area in the Chinese context is sparse.

METHODS

Semi-structured interviews were conducted with seven professionals (social worker, nurse, life skills trainer and manager) to explore their experiences of and attitudes towards the sexual needs of people with intellectual disabilities by applying interpretative phenomenological analysis.

RESULTS

The study identified two major themes, each with two sub-themes: 1. Professional handling of the sexual needs of people with intellectual disabilities (sex education and intervention); 2. Barriers (incompatible approaches and parental resistance). Participants also experienced feelings of resignation facing the barriers they encountered. Collectivism and cultural view about sex are potentially the influencing factors.

CONCLUSION

This study highlights the need to adopt an evidence-based sex education programme whose content and delivery should take account of cultural factors.

'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.

Sexual Health Education and Life Satisfaction for People With Congenital Neurological Disabilities

People with disabilities are sexual beings, yet there is little research on sexuality in this population. The present study explored the impact of sex education for people with congenital neurological disabilities, largely, spina bifida and cerebral palsy, on sexual self-concept and life satisfaction. This study included 104 adults with spina bifida, cerebral palsy, and other congenital neurological disabilities. Hierarchical regression analysis was used to examine the relationships between demographic variables, sexual health education variables, and outcome variables (sexual self-concept and life satisfaction). Serial mediation analysis was conducted to examine the mediating relationship of sexual self-concept variables (sexual anxiety and sexual self-esteem) between social support and life satisfaction. Results indicated that sexual self-concept was significantly predicted by relationship status, disability impact, and satisfaction with sex education. Life satisfaction was significantly predicted by relationship status, social support, disability impact, and sexual self-concept. Sexual anxiety and sexual self-esteem formed a partial serial mediating relationship between social support and life satisfaction. The findings expand upon existing literature on sex education for people with disabilities, reinforcing the notion that satisfactory sex education and strong social support positively impact the life satisfaction of individuals with spina bifida and cerebral palsy. Implications for rehabilitation research and practice are discussed.

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.

Sexual knowledge and behaviour in 22q11.2 deletion syndrome, a complex care condition

BACKGROUND

There is limited information about sexual knowledge and behaviours in adults with complex care needs, including those with 22q11.2 deletion syndrome (22q) which represents a group predisposed to intellectual disabilities.

METHODS

We conducted sexual health assessments with 67 adults with 22q, examining whether those with knowledge deficits and a history of engaging in sexual activities with others would be more likely to engage in high-risk behaviours.

RESULTS

The majority (65.7%) of adults with 22q were sexually active with others; most (70.1%) had sexual knowledge deficits. Those with intellectual disabilities were more likely (p = .0012) to have deficits in certain topics. In the sexually active subgroup, most (81.8%) engaged in high-risk sexual behaviours, regardless of intellectual disability or knowledge deficits.

CONCLUSION

The results suggest a need for increased dialogue, repeated education, genetic counselling and preventive healthcare measures related to sexuality in 22q and potentially in other complex care conditions.

Securing sexual justice for people with intellectual disability: A systematic review and critical appraisal of research recommendations

BACKGROUND

People with intellectual disability contend with significant restrictions to their sexual expression and partnered relationships. This review examines the types of recommendations scholars offer in their qualitative research involving participants with intellectual disability discussing sexuality and intimate relationships.

METHOD

A systematic review of peer-reviewed studies published between 1972 and July 2018 yielded a sample of 26 studies. Thematic analysis was used to taxonomize scholars' recommendations.

RESULTS

Six distinct forms of recommendations were identified. The most frequently offered and most strongly emphasized recommendation across studies aimed to change individuals with intellectual disability. In contrast, a minority of studies prioritized engaging individuals as informants, eliciting individuals' wishes, enabling relationships and fostering ideological change. No studies placed the greatest weight on promoting systems change.

CONCLUSIONS

Recommendations in the literature have predominantly emphasized individual as opposed to environmental changes. I consider the ramifications of this and argue for a reorientation towards systems change.

'People with intellectual disabilities living in the communities is bad enough let alone…having sex': Exploring societal influence on social care workers' attitudes, beliefs and behaviours towards support for personal and sexual relationship needs

BACKGROUND

Services have a duty to uphold the personal and sexual relationship (P&SR) rights of adults with intellectual disability. However, little is known about how social care workers' (SCWs) perceptions of public views of intellectual disability and sexuality might affect their attitudes, believes and behaviours towards supporting P&SR needs. This exploratory study addresses this gap in knowledge.

MATERIALS AND METHODS

Qualitative interviews using critical incident technique were conducted with 18 SCWs. Data were transcribed and thematically analysed.

RESULTS

Four dominant themes were identified; socio-cultural, practice-policy gaps, fear and safety needs. These highlights how perceptions of public attitudes impact on SCWs' attitudes towards supporting development of P&SR both directly and through perceptions of organisational policies. This leads to prioritisation of safety needs over support for P&SR.

CONCLUSIONS

Public expectations strongly influenced SCWs' interpretation of organisational policy, emphasising a need for practice-based support to manage public expectations and reduce fear.