Sexuality of children and adolescents with developmental disabilities

Looking Through a Cultural Perspective: Autistic Young Adults' Experiences and Expectations in Sexuality and Relationship Education in the U.S

Although students with diverse cultural backgrounds need sexuality and relationship education (SRE), the perspectives of those from different cultural groups with neurodevelopmental conditions are often under-investigated. The autistic population, in particular, may have communication and sensory preferences that can be unsupported by the current SRE for non-autistic people, and the cultural relatedness of the SRE they received are often unrecognized. To better understand autistic individuals' insights, nine autistic young adults from different cultural groups between 20 and 35 years old (four cis-males, two cis-females, three non-binaries) were interviewed to learn about their previous experiences and future expectations in sexuality and relationship education. Results of the inductive (i.e., bottom-up) thematic analyses indicated a low consideration of cultural aspects in their SRE experiences reported by autistic adults. The results highlighted the need for a diverse, consistent, and tailored SRE for the autistic population, with more efforts made from the education system to promote cultural adaptations of SRE. Suggestions are provided for the education systems, professionals, parents, and researchers to develop more tailored SRE for the autistic population.

Examining Permanent Contraception for Children, Adolescents, and Young Adults With Intellectual Developmental Disorder: Ethical, Legal, and Medical Considerations: Clinical Report

There have been significant advances in the medical and surgical options available for contraception and management of menses for individuals, including those with intellectual developmental disorder. This new statement frames the ethical, legal, and medical issues of permanent contraception in children, adolescents, and young adults with intellectual developmental disorder, emphasizing the importance of utilizing long-acting reversible and minimally invasive treatments, whenever possible. The historical use and abuse of permanent contraception is briefly reviewed, providing the foundation for ongoing ethical and legal considerations, including issues of informed consent. The authors then discuss medical decision-making and patient preferences that should be considered and make recommendations to providers who are contemplating permanent contraception therapies in this population.

Parents' perceptions of risk and protective factors for problematic sexual behaviour in young Korean individuals with developmental disabilities

BACKGROUND

Limited data exist on problematic sexual behaviour (PSB) in youth with developmental disabilities in South Korea.

METHOD

Sixty-one parents of children with intellectual disabilities or autism spectrum disorder (aged 13-30) reported children's PSB and emotional, behavioural, cognitive, and interpersonal factors. The frequency of PSB in children with developmental disabilities was verified, and various factors' effects on PSB were examined through multiple linear regression analysis.

RESULTS

There were no significant differences in PSB levels between children based on sex and age group. The externalising tendency and a history of family conflict predicted higher PSB. In contrast, protective factors had no significant predictive effects.

CONCLUSIONS

PSB may vary depending on emotional and interpersonal factors, as well as cognitive deficits. Our findings emphasise the importance of interventions for PSB that consider both intrapersonal and interpersonal aspects.

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.

Affectivity and Sexuality in Adolescents with Autism Spectrum Disorder from the Perspective of Education and Healthcare Professionals: A Qualitative Study

People with autism spectrum disorder (ASD) present several different characteristics that predispose them to greater difficulties with intimate emotional and sexual relationships. This qualitative study uncovers the perspective of education and healthcare professionals on the affective and sexual needs of young people with ASD by analysing their narratives in semi-structured focus group sessions. Professionals highlight the inadequate training they receive in this aspect of health. They consider it should be commonplace for professionals working with autistic people as it would aid their collaborative efforts when treating children and adolescents with ASD. They show that, by working together with the families to establish joint objectives, these professionals can appropriately address sex and affective education, preventing risky behaviours among young people with ASD, and improving the interactions these individuals have with others. Sex and affective education is described as an indispensable tool at this stage of development and should be specially adapted for those with ASD.

Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida

BACKGROUND

Spina bifida (SB) may differentially impact adults' participation in solo and partnered sexual behaviors, but little research investigates this topic.

AIM

Describe solo and partnered sexual behaviors among an international sample of adult men and women with SB.

MAIN OUTCOME MEASURES

Ever participated (no/yes) and recent participation (>1 year ago/within last year) in solo masturbation, cuddled with a partner, held hands with a partner, kissed a partner, touched a partner's genital, had genitals touched by a partner, gave a partner oral sex, received oral sex from a partner, vaginal sex, anal sex, and sex toy use.

METHODS

Data were drawn from a larger cross-sectional, internet-based survey assessing the sexual behaviors of an international sample of men and women with SB. We used logistic regression to examine the impact of background (gender, age, independent living, and relationship status) and health (shunt status, ambulation, and genital sensation) factors on each outcome.

RESULTS

The sample consisted of 345 respondents aged 18-73 years from 26 nations. Very few (<3%) had no lifetime experience with any solo or partnered behaviors; 25.0% reported participating in all behaviors at some point in their lives. The median number of past year sexual behaviors (of 16 total) was 7. Lifetime and recent participation were associated with demographic and health factors.

CLINICAL IMPLICATIONS

Despite impairment, adults with spina bifida do participate in solo and partnered sexual behaviors. Medical personnel who work with this population should include discussions about sexuality as part of routine care.

STRENGTHS & LIMITATIONS

Although this research measured solo and partnered sexual behavior in large international sample of adults with spina bifida, it is limited by its cross-sectional retrospective design and non-clinical convenience sample.

CONCLUSION

Despite disability, many adults with SB participate in solo and partnered sexual behavior. Medical and psychosocial supports are needed to help adults in this population enjoy sexuality in a healthy and safe manner. Hensel DJ, Misseri R, Wiener JS, et al. Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida. J Sex Med 2022;19:1766-1777.

Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy

Cerebral palsy (CP) is the most common motor disorder of childhood, with prevalence estimates ranging from 1.5 to 4 in 1000 live births. This clinical report seeks to provide primary care physicians with guidance to detect children with CP; collaborate with specialists in treating the patient; manage associated medical, developmental, and behavioral problems; and provide general medical care to their patients with CP.

Opinions of special education teachers on inappropriate sexual behaviors in adolescents with intellectual disabilities

Inappropriate sexual behaviors may be observed in individuals with intellectual disabilities (ID), especially during adolescence. There are several undesired consequences of exhibiting such behaviors in public spaces, such as schools. The competencies and attitudes of special education teachers, who are responsible for the education of individuals with ID, are of significant influence. This study was conducted to investigate the views of special education teachers working with adolescents with ID on inappropriate sexual behaviors exhibited in educational settings. Accordingly, semi-structured interviews were conducted with 12 special education teachers. The phenomenological research design, one of the qualitative research methods, and thematic analysis were used in this study. Five themes were identified after the analysis of the findings of the study, namely, common behaviors, teacher attitudes, teacher competencies, teacher interventions, and educational content. The findings were discussed on the basis of the relevant studies in the literature and a number of conclusions were reached. Accordingly, the inappropriate sexual behaviors that special education teachers encounter the most frequently are masturbation, undressing, and touching, and when these behaviors are exhibited aggressively, teachers have difficulty in intervening. Participants regard themselves to be incompetent in terms of sexual education and consider relevant educational content inadequate.

Determination of sexual developmental characteristics of adolescents with intellectual disabilities

This cross-sectional study was carried out in order to determine the opinions of mothers on sexual development in children with intellectual disabilities. The sampling of this study included mothers of children aged 10-19 years with moderate and severe intellectual disabilities. Of the mothers, 45.7% stated that they felt incapable of providing sexual education to their adolescent children with disabilities and 97.6% stated that they had received no information on this subject themselves. Based on the mothers' opinions, the mean score for the sexual development of adolescent children was 11.33 ± 16.18. In the sub-dimensions of sexual arousal (20.97 ± 5.71), sexual harassment (12.22 ± 3.13), sexual satisfaction (15.79 ± 3.85) and sharing sexual issues (12.74 ± 2.67) the mean score of the scale was found to be high. The knowledge levels of the mothers concerning the sexual development of their children with intellectual disabilities were found to be low, and they required education on this issue.

Caregiver reports of physician risk counseling for adolescents with special health care needs

BACKGROUND

Research has indicated disagreement between physicians, caregivers, and adolescents with special health care needs regarding appropriate risk counseling.

OBJECTIVE

The study examines caregivers' perceptions of adolescent risk counseling. We hypothesize caregivers of adolescents with special healthcare needs will perceive a lower rate of risk counseling.

METHODS

Data come from the 2016 National Survey of Children's Health. The sample included 13,542 adolescents. Analysis completed using logistic regression with odds ratios.

RESULTS

The results indicate no difference in caregiver perceptions of risk counseling for adolescents with special healthcare needs. Gender, race/ethnicity, and relationship between caregiver and provider influenced perception of receipt of risk counseling, regardless of health status.

CONCLUSIONS

Although adolescents with special healthcare needs perceive their risk behavior counseling to be lacking in quantity/quality, caregivers perceive such counseling does occur. These results highlight the need for comprehensive risk counseling for groups at risk of known health disparities.

PRACTICE IMPLICATIONS

Physicians and providers should be provided with the training and resources needed to be comfortable to engage in risk counseling. Adolescents need the opportunity to see their provider privately, and education to advocate for information risky behaviors. Parents, providers, and adolescents should be included in future risk counseling intervention plans.

Development and psychometric evaluation of Sexual and Reproductive Health Assessment Scale for women with educable intellectual disability (SRH-WIDS): a sequential exploratory mixed-method study

BACKGROUND

Women with Intellectual disability have many problems in their sexual and reproductive health due to their special mental and physical conditions caused by disability. This study aimed to develop and evaluate the psychometric properties of Sexual and Reproductive Health Scale for Women with Educable Intellectual disability.

METHODS

This sequential exploratory mixed-method study was conducted at two qualitative and quantitative stages in Tehran, from 2018 to 2020. At the qualitative stage, in-depth and semi-structured interviews were conducted with 21 parents and caregivers of women with intellectual disability to explain the concepts and to generate items. Thereafter, the item pool was formed based on the concepts and themes extracted from the qualitative phase as well as the review of literature. At the second stage, psychometric properties of the scale were assessed. Finally, responsiveness, interpretability, and feasibility of the scale were determined.

RESULTS

An item pool containing 95 items was produced at the first stage. At the second stage, the final version of scale was developed. The psychometric properties of this final version were then assessed and the results showed that the instrument has good validity and reliability. The results of exploratory factory analysis showed that the instrument contains seven factors. Accordingly, these factors explained 53% of the total variance of the instrument variables.

CONCLUSIONS

The results show that the SRH-WIDS with 25 items has sufficient validity and reliability, so it could be easily used by caregivers to assess the sexual and reproductive health of Women with Educable Intellectual disability. Ethical code: IRI.TUMS.VCR.REC 1397.340.

Reproductive Health and Substance Use Education for Autistic Youth

BACKGROUND

We provide an update on reproductive health education (RHE) and substance use prevention education (SUPE) participation for autistic youth compared with other youth with and without individualized education plans (IEPs) and 504 plans. The 800 000 autistic youth served by the US special education system need education to make informed decisions about reproductive health and substance use.

METHODS

Data were from the National Longitudinal Transition Study-2012, a survey designed to yield nationally representative estimates of the experiences of US youth. Autistic youth (n = 390) who received RHE and SUPE were compared with youth with all other IEP classifications (n = 4420), with a 504 plan (n = 350), and with no IEP or 504 plan (n = 980). All youth were ≥14 years old and able to self-report on a survey. Bivariate and multivariate regression analyses were performed for each group to identify characteristics associated with RHE and SUPE receipt.

RESULTS

Autistic youth reported a significantly lower rate of RHE (47.4%) and SUPE (49.6%) inclusion versus students with no IEP or 504 plan (59.2% and 57.4%, respectively). Autistic girls were more than twice as likely to report RHE receipt than autistic boys (55.1% vs 45.9%). For autistic youth, no markers for receipt of SUPE were identified.

CONCLUSIONS

Autistic youth are underserved when it comes to school-based RHE and SUPE, potentially undermining self-determination and leading to poorer lifespan health trajectories. Research and policy advocacy are needed to ensure that these youth have access to RHE and SUPE.

Experiences of parents of adolescents with intellectual disabilities regarding the transition to sexual development: A transitions theory-based qualitative study

BACKGROUND

To describe of the experiences of parents regarding the transition to sexual development of their adolescents with intellectual disabilities who are 15-19 years old.

METHODS

This study employs a descriptive interpretative approach and uses Meleis's transitions theory as its theoretical frame of reference. This study uses purposive sampling methods for recruitment. We collected data through individual semi-structured interviews (n = 11) and researcher observations between February 2021 and April 2021 and employed an inductive content analysis approach.

RESULTS

Three main themes emerged from the data: parental factors driving the transition process, parents' needs regarding the transition process, and outcomes of the transition process. In addition, most parents struggled to remodel their identities following the transition due to concerns over their adolescent's ability to cope with the challenges of adulthood.

CONCLUSION

Considered in the context of middle-range transitions theory, we suggest that parental experiences regarding adolescents' transition to sexual development stem from varying levels of uncertainty and depend on the situation, preferences, and family needs of each individual parent. It is useful to utilise Meleis's transitions theory to understand deeply and explore the impact of the sexual development of adolescents with intellectual disabilities on parents.

Health-care Transition: A Vital Part of Care, Growth, and Change for Pediatric Patients

Preparing all youth for the transition to adult-oriented care, adulthood itself, and a greater responsibility for their own health and health-care is an essential part of pediatric care. This process, typically described as health-care transition, can occur throughout ongoing pediatric health-care to prepare patients for transfer to an adult clinician and integration into adult care. Gaps remain in practice and in outcomes research regarding health-care transition. This review discusses recent literature, details best practices, and recommends guidance and tools to assist pediatric clinicians in providing a smooth transition process and a successful transfer to adult care for youth with and without special health-care needs.

Regulating, fostering and preserving: the production of sexual normates through cognitive ableism and cognitive othering

People with cognitive disabilities are commonly positioned as risky sexual subjects. This article discusses the discursive production of sexual normates in the form of desirable and normative able-minded sexual subjects, in scientific research on the sexuality and cognitive disabilities of younger and older individuals (in particular those with dementia). We identify three interrelated discourses: regulating sexuality; fostering sexuality; and preserving sexuality. The first of these, regulation, pathologises sexuality of people with cognitive disabilities as faulty and in need of restriction. The second discourse, fostering, is more affirmative and argues for educating for a 'healthy' sexuality of people with cognitive disabilities, to mitigate risks of abuse. This discourse is more salient with younger people. The third discourse, preservation, in contrast, is more visible with older people with dementia and affirms sexuality so long as it is consistent with a 'genuine' or 'authentic' sexuality of the past. In conclusion, scientific research reinforces the cultural ideal of the rational and autonomous individual (and as such the mature/adult) capable of making independent decisions and engaging in healthy, good sex, based on stable sexual identities. Findings demonstrate how age intersects with cognitive ableism to intensify the cultural anxiety that exists around the sexualities of people with cognitive disabilities.

Sexual Experiences and Perspectives of Adolescents and Young Adults With Intellectual and Developmental Disabilities

The purpose of this study is to understand the sexual experiences and perspectives of adolescents and young adults (AYA) with intellectual or developmental disabilities, how they are receiving sexual education, and how sexual education can be tailored to their needs. This qualitative study utilized semi-structured focus groups and interviews with eight AYA with intellectual or developmental disabilities from January 14 to May 7, 2019. Data were analyzed using a constant comparative approach. Participants reported a diverse range of sexual experiences and an interest in marriage and parenting in the future. Two themes emerged for how AYA are learning about sexual health information: through formal (school, doctors’ visits, or from caregivers) and informal education (peers, siblings, self-exploration, or Pop Culture). Sexual education can be tailored to this population by addressing educational gaps (pregnancy, contraception, sexually transmitted infections, intimacy, and sexual activity) and by implementing specific participant recommendations (proactive, inclusive education with real-life examples). With a growing emphasis on disability rights to sexual education among individuals with intellectual or developmental disabilities, it is vital to understand AYA’s experiences, perspectives, and current understanding of sexual health information so that we can design a program specifically tailored to meet their unique needs.

Sexual Behavior Problems in Adolescents with Intellectual Disabilities: A Systematic Review

BACKGROUND: Several studies conducted on adolescents with intellectual disabilities (ID) have reported various problems of sexual behavior that occurs in the group, including HIV-related risky sexual behavior and other health-related concerns. AIM: This review aims to synthesize studies on the problems regarding sexual behavior in adolescents with ID to obtain data on the types of risky sexual behavior problems. MATERIALS AND METHODS: Synthesis was conducted on nine studies of children aged 10–20 years old with intellectual disabilities as subjects who have no other psychiatric comorbidities and met the appraisal criteria based on the checklist for analytical cross-sectional studies of the Joanna Briggs Institute (JBI). RESULTS: Several behaviors were found in the group of adolescents with ID. Masturbation is the type of solitary behavior that appears the most, besides other behaviors like touching genitals and getting naked in public places. Sexual intercourse is the most widely reported in the type of “involving other persons.” Sexual intercourse with more than 1 person without using contraception to protect against sexual transmitted disease (STD) is at risk for HIV infection or other infectious diseases. CONCLUSIONS: The results of this review have indicated that adolescents with ID have sexual needs and experience sexual behavior problems similar to ordinary adolescents in general. They actually have a higher risk for having risky sexual behavior because they lack understanding of sexuality. These findings emphasize the need for sex education so that young people with disabilities can have healthy sexual behavior and a safe life.

Sexual behaviours and education in adolescents and young adults with Down syndrome: A grounded theory study of experiences and opinions of their mothers in Turkey

This study aimed to gain a deeper understanding of the experiences and opinions of mothers about sexual behaviours and sexual education of their children with DS who are AYAs in Turkey. The study utilised a classic grounded theory approach. In-depth interviews were conducted with 12 mothers. Data were analyzed by the constant comparative method. Mothers expressed that they could not address the sexual needs of their child because they did not feel they could provide sufficient care to their child. Mothers used pressure and control tactics and neglect of the sexuality to cope with their children's sexuality. Mothers described their meaning of the sexuality, fear of stigmatization and gender issues as determinant factors on the dealing with the sexuality. They stated their knowledge about sexuality is not enough to provide sexual education. Many cultural issues such as gender, meaning of the sexuality and burden of care was described as determinant factors and difficulties to providing sexual education. Therefore, educational and supportive programmes for parents should be conducted. Comprehensive, valid and individualized sexual education program also should be provided AYAs with DS.

Comparing the effect of two educational interventions on mothers' awareness, attitude, and self-efficacy regarding sexual health care of educable intellectually disabled adolescent girls: a cluster randomized control trial

BACKGROUND

Sexual problems of intellectually disabled adolescents are associated with their inability to understand sexuality. Given the important role of parents in forming the attitude of their adolescents towards sexuality, the present study aimed to compare the effect of two educational interventions on mothers' awareness, attitude and self-efficacy regarding sexual health care of intellectually disabled adolescent girls.

MATERIALS AND METHODS

This cluster randomized control trial was conducted in six intellectually disabled adolescent education centers in Isfahan, Iran in 2018. The centers were randomly assigned to intervention groups (group training and training through booklet) and control group. Mothers of educable intellectually disabled adolescent girls (n = 81) were entered into the three groups using convenience sampling and their awareness, attitude and self-efficacy regarding sexual health care of adolescent girls were assessed using questionnaires before and after the educational intervention. Data were analyzed using descriptive and inferential statistical methods.

RESULTS

The mean score of mothers' awareness, attitude and self-efficacy in each of the "group training", "training through booklet group" and "control group" was significantly different after the intervention compared to before the intervention (p < 0.05). The mean score of mothers' awareness and self-efficacy after the intervention in the "group training" was higher than the "control group" and "training through booklet group" (p < 0.001). The mean score of mothers' awareness and self-efficacy after the intervention in the "training through booklet group" was higher than in "control group" (p = 0.005, p = 0.02). Also, after the intervention, the mean score of mothers' attitude in the "group training" was higher than the "control group" and the "training through booklet group" (p < 0.001), but there was no significant statistical difference between the mean score of mothers' attitude in "control group" and "training through booklet group" (p > 0.05).

CONCLUSION

Implementation of the group training intervention for mothers of intellectually disabled adolescent girls in comparison with training through booklet was associated with a greater increase in their awareness, attitude and self-efficacy regarding sexual health care of adolescent girls. Therefore, group training is suggested as a suitable way to educate mothers about sexual health care of intellectually disabled adolescent girls. Trial registration IRCT, IRCT20160224026756N5. Registered 22 June 2018, https://en.irct.ir/user/trial/31704/view .

Autism Spectrum Disorder and Substance Use Disorder: A Dual Diagnosis Hiding in Plain Sight

Individuals with autism spectrum disorder (ASD) have a significantly higher risk for developing a substance use disorder (SUD) than the general population yet literature addressing cooccurring ASD and SUD is scarce. This article explores connections between ASD and SUD and the impact on development, screening and treatment. The article proposes culturally constructed narratives associated with both diagnoses may be responsible for the dearth of research and literature. Constructed narratives of ASD and SUD do not naturally intersect and the resulting disconnect can create a cognitive dissonance that could allow the medical and general community to neglect this life-threatening dual diagnosis.

Gynecological Care and Contraception Considerations in Women with Cerebral Palsy

The purpose of this literature review was to further explore gynecological care and contraceptive use in women with cerebral palsy. We address barriers to pelvic examinations for cervical cancer screenings and current contraceptive methods in severely debilitated patients with cerebral palsy.

Sexual and Reproductive Health Service Utilization and Sexuality for Teens on the Autism Spectrum

OBJECTIVES

Health care providers and educators play critical roles in supporting healthy sexuality development for youth with autism spectrum disorder. There is limited information about the sexual behavior of these youth, especially girls, and about their access to sexuality education or health care services.

METHODS

This study addressed these gaps by surveying parents of youth with autism aged 12-18 years (N = 298, 52.7% boys) with a range of intellectual functioning.

RESULTS

According to parent report, most youth experienced sexual attraction and were interested in relationships, including same-sex attraction or relationships (13.2%). Girls were more likely than boys to have had a romantic relationship and less likely to have experienced school or legal consequences for sexual behavior. Around one-fifth of youth had engaged in a socially inappropriate sexual behavior, whereas 6.4% had a known sexual abuse history and 14.5% were bullied by peers for lack of sexual knowledge. Almost 40% received no sex education in school or in the community, including 60.9% of youth with parent-reported intelligence quotient under 70. Some parents consulted with school personnel (36.4%) or health care providers (55.9%) about sexuality issues, whereas 19.5% reported taking no action aside from talking to their child about sexuality. Utilization models including predisposing, enabling, and needs-related factors were applied to parent consultation with providers and use of school-based sexuality education programming.

CONCLUSION

The results suggest unmet needs for sexual and reproductive health services, particularly among youth who are younger, those who have co-occurring intellectual disability, or those who are homeschooled or who attend private, charter, or therapeutic versus public schools.

Sexual Health in Child and Adolescent Psychiatry: Multi-Site Implementation Through Synchronized Videoconferencing of an Educational Resource Using Standardized Patients

Objective: Matters of sexuality and sexual health are common in the practice of child and adolescent psychiatry (CAP), yet clinicians can feel ill-equipped to address them with confidence. To address this gap in training and practice, we developed, implemented, and evaluated an educational module enhanced by videotaped depictions of expert clinicians interacting with professional actors performing as standardized patients (SPs). Methods: We developed an educational resource highlighting common issues of sexual health relevant to CAP practice, including sexual development, psychotropic-related side effects, and sexuality in children with autism. We wrote original scripts, based on which two clinicians interacted with three SPs. Digital recordings were edited to yield 5 clips with a cumulative running time of 20 min. The clips were interspersed during a 90-min session comprising didactic and interactive components. Due to the COVID-19 pandemic, we used synchronous videoconferencing, which allowed content dissemination to several training programs across the country. Results: We recruited 125 learners from 16 CAP training programs through the American Academy of CAP's Alliance for Learning and Innovation (AALI). Routine inquiry into adolescent patients' sexual function was uncommon, reported by only 28% of participants, with "awkward" and "uncomfortable" the most common terms mentioned in reference to the clinical task. The didactic intervention led to measurable improvements after 2 weeks in skills and knowledge (p = 0.004) and in attitudes (p < 0.001). The three items with the greatest improvement were: (a) availability of developmentally tailored resources; (b) comfort in addressing sexual development with underage patients; and (c) with parents or guardians of neuroatypical or developmentally disabled patients (p < 0.001 for each). Conclusions: A sexual health curriculum enriched by video-based examples can lead to measurable improvement in outcomes pertinent to the clinical practice of CAP. These educational materials are available for distribution, use and adaptation by local instructors. Our study also provides proof-of-principle for the use of multisite educational initiatives in CAP through synchronized videoconferencing.

A study protocol for a randomized controlled trial of a cross-systems service delivery model to improve identification and care for HIV, STIs and substance use among justice-involved young adults

BACKGROUND

Justice-involved young adults (JIYA) aged 18-24 are at significant risk for HIV and problematic substance use (SU) but are unlikely to know their HIV status or be linked to HIV or SU treatment and care. Intensive efforts to increase screening and improve linkage to HIV and SU services for JIYA are needed that address youth as well as justice and health/behavioral health system-level barriers.

METHODS

MoveUp is a four-session intervention that integrates evidence-based protocols to promote HIV and STI testing, HIV and SU behavioral risk reduction and engagement in treatment for JIYA. MoveUp is delivered onsite at an alternative sentencing program (ASP) by HIV testing outreach workers from a youth-focused medical and HIV treatment program. N = 450 youth are randomized following baseline assessment into two groups: MoveUp or standard of care. Youth are followed for 12 months following the intervention; unprotected sexual behavior, substance use, HIV and STI testing as well as treatment linkage will be assessed at 3, 6, 9 and 12-months.

DISCUSSION

This study is one of the first to systematically test an integrated screen/testing, prevention intervention and linkage-to-care services program (MoveUp), using evidence-based approaches to address the overlapping HIV/STI and substance use epidemics in JIYA by providing on-site services to identify HIV/STI and SU risk and treatment need within justice-settings as well as linkage to services in the community. This approach, capitalizing on health and justice partnerships, represents an innovation that can capitalize on missed opportunities for engaging JIYA in health care.

Family Sexuality Communication: Parent Report for Autistic Young Adults Versus a Comparison Group

Families are a critical context for healthy sexuality development. This study characterized family sexuality communication for autistic adults (age 18-30) without intellectual disability (n = 117) versus a neurotypical comparison group (n = 319). Parent-reported number of sexuality topics covered did not significantly differ by gender or autism/comparison group. Parents of autistic adults who covered few or no topics (31%) reported higher religiosity, lower comfort and self-efficacy, and were less likely to say that the adult expressed attraction or desire for relationships. Parents of autistic adults were more likely than comparison parents to perceive their young person as being uninterested or not ready to learn about sexuality topics. These results suggest that families of autistic people require support to convey sexuality-related knowledge and values.

Barrier Protection Use by Adolescents During Sexual Activity

Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This technical report discusses the new data and trends in adolescent sexual behavior and barrier protection use. Since 2017, STI rates have increased and use of barrier methods, specifically external condom use, has declined among adolescents and young adults. Interventions that increase availability of or accessibility to barrier methods are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research informs public health interventions for adolescents that increase the consistent and correct use of barrier methods and promote dual protection of barrier methods for STI prevention together with other effective methods of contraception.

Autism Spectrum Disorder and Substance Use Disorder: A Dual Diagnosis Hiding in Plain Sight

Individuals with autism spectrum disorder (ASD) have a significantly higher risk for developing a substance use disorder (SUD) than the general population yet literature addressing cooccurring ASD and SUD is scarce. This article explores connections between ASD and SUD and the impact on development, screening and treatment. The article proposes culturally constructed narratives associated with both diagnoses may be responsible for the dearth of research and literature. Constructed narratives of ASD and SUD do not naturally intersect and the resulting disconnect can create a cognitive dissonance that could allow the medical and general community to neglect this life-threatening dual diagnosis.

Emerging Issues in Male Adolescent Sexual and Reproductive Health Care

Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, discussing healthy sexuality, performing an appropriate physical examination, providing patient-centered and age-appropriate anticipatory guidance, and administering appropriate vaccinations. These services can be provided to male adolescent patients in a confidential and culturally appropriate manner, can promote healthy sexual relationships and responsibility, can and involve parents in age-appropriate discussions about sexual health.

Sexual health and education guidelines for the care of people with spina bifida

Sexual development is not only comprised of the changes to a person's body during puberty; it is a part of social development and should be considered in the context of basic and routine human desires for connectedness and intimacy, beliefs, values and aspirations. As is true for everyone, it is important that individuals with spina bifida have opportunities to acquire developmentally appropriate, relevant and accurate sexual health knowledge. Those with spina bifida need to be able to negotiate sexual desire, intimacy and sexual expression. They also need education about their sexual health and how to limit the negative outcomes of sexual activity related to sexually transmitted infections, unplanned pregnancy or sexual coercion, violence, abuse or exploitation. This article discusses the Spina Bifida Sexual Health and Education Healthcare Guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida using the World Health Organization's framing of sexual health and reviews the literature on sexual health and education for individuals with spina bifida.

Sexual History and Contraception Documentation in Hospitalized Adolescents: Are Technology-Dependent Patients Overlooked?

OBJECTIVES

Adolescents are at high-risk for sexually transmitted infections and pregnancy, yet many do not receive regular preventive care. Hospitalization represents an opportunity for providing sexual and contraception counseling for this high-risk population. Our aim in this study was to assess the frequency of sexual and contraception history documentation in hospitalized adolescents and identify subgroups that may benefit from more vigilant screening.

METHODS

A retrospective chart review of adolescent patients 11 years of age and older who were discharged from the pediatric hospitalist service at an urban, academic children's hospital from July 2017 to June 2018 was conducted. Patient and admission characteristics were analyzed for presence of sexual and contraception history documentation. Technology-dependent patients were analyzed separately. In addition, technology-dependent patients were assessed by chart review for developmental appropriateness for screening.

RESULTS

Twenty-five percent of patients (41 of 165) had a sexual history documented, and 8.5% (14 of 165) had a contraception history documented. Among patients with any technology dependence, 0 had a sexual history documented and only 1 had a contraception history documented, whereas 31.5% (12 of 38) were deemed developmentally appropriate for screening. Female and older patients were more likely to have sexual and contraceptive histories documented than male and younger patients. Patients transferred from the PICU had lower rates of sexual history documentation compared with direct admissions.

CONCLUSIONS

Hospitalized adolescents, especially those with technology dependence, did not have adequate sexual and contraception histories documented. Improving documentation of these discussions is an important step in providing adolescents with preventive medicine services while hospitalized.

Emergency Contraception

Despite significant declines over the past 2 decades, the United States continues to experience birth rates among teenagers that are significantly higher than other high-income nations. Use of emergency contraception (EC) within 120 hours after unprotected or underprotected intercourse can reduce the risk of pregnancy. Emergency contraceptive methods include oral medications labeled and dedicated for use as EC by the US Food and Drug Administration (ulipristal and levonorgestrel), the "off-label" use of combined oral contraceptives, and insertion of a copper intrauterine device. Indications for the use of EC include intercourse without use of contraception; condom breakage or slippage; missed or late doses of contraceptives, including the oral contraceptive pill, contraceptive patch, contraceptive ring, and injectable contraception; vomiting after use of oral contraceptives; and sexual assault. Our aim in this updated policy statement is to (1) educate pediatricians and other physicians on available emergency contraceptive methods; (2) provide current data on the safety, efficacy, and use of EC in teenagers; and (3) encourage routine counseling and advance EC prescription as 1 public health strategy to reduce teenaged pregnancy.

Contraceptive Practices and Reproductive Health Considerations for Adolescent and Adult Women with Intellectual and Developmental Disabilities: A Review of the Literature

Whereas progress has been made on increasing access to comprehensive healthcare for individuals with intellectual and developmental disabilities (I/DD), disparities continue in health outcomes, including those related to the reproductive health of adolescent and adult women with I/DD. This review summarizes reproductive care considerations for adolescent and adult women with I/DD and current practices regarding the delivery of contraceptive services to these women. Forty-seven (47) articles based on research conducted in the US between 1999 and 2019 were selected for inclusion in the review. Primary themes discussed include (1) common reproductive health concerns for adolescent and adult women with I/DD, other than pregnancy prevention; (2) contraceptive methods and disability-related concerns; (3) informed consent and reproductive decision-making; and (4) provider knowledge and education. The management of menses and hormonal dysregulation were identified as concerns that providers encounter among patients with I/DD and their families. Disability-related concerns with regard to use of contraception in general and considerations regarding certain methods in particular include challenges with prescription adherence, physical effects of hormonal therapies, drug interactions for individuals with additional health conditions, and legal and ethical concerns involved with decision-making and consent. The results of this review also suggest that focused efforts in partnership with health care providers may be needed to address barriers that adolescent and adult women with I/DD face when trying to obtain quality reproductive health services and contraceptive guidance.

Autism and Adult Sex Education: A Literature Review using the Information-Motivation-Behavioral Skills Framework

Adults on the autism spectrum report comparable levels of desire for sex and sexual satisfaction as adults who are not on the spectrum. However, there has been little empirical focus on the need for sexual and relationship-oriented education for youth on the spectrum as they transition to adulthood. In this review, we use the Information-Motivation-Behavioral Skills Model of sexual health behavior change as a lens through which to understand the experiences of adults on the autism spectrum. We present those insights infused with emerging data and best practices in the field. Overall, it appears clear from the extant literature that providers need to recognize the specific characteristics of autism when developing sexual education curricula. Specifically, the social communication and sensory profile of people on the autism spectrum appears to interact with access to information, motivation to engage in healthy sexual activities, and the development of skills needed to engage in healthy sexual behavior. Finally, the voice of adults on the spectrum is essential to guide the emerging understanding of healthy sexuality.

Restrictions, Power, Companionship, and Intimacy: A Metasynthesis of People With Intellectual Disability Speaking About Sex and Relationships

Examining literature that tells us what people with intellectual disability (PWID) think and feel about their sexual lives may enable families and professionals to offer a more person-centered approach to education and support. Examining the voices of many individuals across several studies may provide more convincing evidence about the experiences of these individuals-turning a solo into a chorus. Thus, the purpose of this article is to describe the results of a metasynthesis of qualitative studies highlighting the voices of PWID with respect to relationships and sexuality. Combining the results of 16 qualitative studies, 271 participants with intellectual disability were interviewed individually or in focus groups about their feelings and experiences regarding intimate relationships. Studies were conducted across Europe, in Australia, China, and in the United States. A little more than half of the participants were male; ages ranged from 13 to 89. Results revealed two competing themes of control and desire. Participants across studies desired friendships and close interpersonal relationships, yet were restricted from developing these relationships by policies, program staff, and family members.

Psychosocial Factors in Children and Youth With Special Health Care Needs and Their Families

Children and youth with special health care needs (CYSHCN) and their families may experience a variety of internal (ie, emotional and behavioral) and external (ie, interpersonal, financial, housing, and educational) psychosocial factors that can influence their health and wellness. Many CYSHCN and their families are resilient and thrive. Medical home teams can partner with CYSHCN and their families to screen for, evaluate, and promote psychosocial health to increase protective factors and ameliorate risk factors. Medical home teams can promote protective psychosocial factors as part of coordinated, comprehensive chronic care for CYSHCN and their families. A team-based care approach may entail collaboration across the care spectrum, including youth, families, behavioral health providers, specialists, child care providers, schools, social services, and other community agencies. The purpose of this clinical report is to raise awareness of the impact of psychosocial factors on the health and wellness of CYSHCN and their families. This clinical report provides guidance for pediatric providers to facilitate and coordinate care that can have a positive influence on the overall health, wellness, and quality of life of CYSHCN and their families.

Contraception for Adolescents with Medically Complex Conditions

Both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have developed, published, and updated evidence-based guidelines to support medical providers in the provision of contraceptives to patients with specific medical conditions or characteristics. The goal of these guidelines is to provide recommendations on the safe use of contraceptives with the goal of removing unnecessary medical barriers to access and use of contraceptives, thus decreasing the number of unintended pregnancies. Many medical conditions increase a patient's risk of venous thromboembolism; a risk that may also be increased with specific contraceptives. Specific conditions that require more enhanced contraceptive counseling due to their frequency in adolescence and their association either with adverse events during pregnancy or with increased risk for specific contraceptives are detailed by the WHO and CDC and are summarized herein. Adolescents with morbid obesity, migraine headache, cardiac conditions, hypertension, diabetes mellitus, hyperlipidemia, systemic lupus erythematosus, sickle cell anemia, cystic fibrosis, inflammatory bowel disease, or seizure disorders would benefit from greater attention to the urgency of exploring highly effective contraceptive methods. Details of the considerations that should be used in providing contraceptive care to adolescents with each of these medical conditions, as per WHO and CDC guidelines, are provided in this review. The ultimate goal in contraceptive counseling is the balancing of risk and benefit to arrive at the best therapeutic option, maintaining patient preference as a priority, as that will enhance adherence and comfort with the contraceptive method. Each patient must be assessed for pregnancy risk and be allowed full risk reduction and education regarding contraceptive options.

A cross-sectional study of sexual function and fertility status in adults with congenital genitourinary abnormalities in a U.S. tertiary care centre

INTRODUCTION

We aimed to evaluate sexual function, sexual knowledge, and fertility status in adult patients with congenital genitourinary abnormalities (CGUA).

METHODS

Adult patients with CGUA who were referred to a single transitional urology clinic between 2014 and 2017 were prospectively recruited to participate in the study. Questionnaires about general demographics, bowel and bladder continence, fertility, and sexuality were gathered. Validated questionnaires, including the Sexual Health Inventory for Men (SHIM) and Brief Index of Sexual Functioning for Women (BISF-W), were also collected.

RESULTS

A total of 167 adults with CGUA were referred to our clinic within the defined time frame. Sixty patients (25 males, 35 females) with a mean age of 25.4 years (range 18-75) met inclusion criteria and responded to questionnaires pertaining to sexuality and fertility. Forty-five (75%) responded to the fertility questionnaire; 26 (58%) had never heard of assisted reproductive technologies, and only one had received prior fertility counselling. Fifty-eight participants (97%) responded to the sexuality questionnaire; 21 (36%) reported a history of sexual activity, with 12 (21%) being currently sexually active. Twenty (34%) wanted to learn more about sexuality and/or fertility. The SHIM response rate was 44%, and only three females (9%) completed the BISF-W in its entirety.

CONCLUSIONS

Adults with CGUA desire more sexuality and fertility education, yet they are uncomfortable completing current questionnaires. Our sexuality and fertility questionnaires are too challenging for this patient population to complete despite assistance. Thus, modifications are urgently needed. Additionally, medical providers should discuss sexual and reproductive health with these patients earlier and in more detail.

A comprehensive sexual health care program for educable intellectually disabled adolescent girls: protocol for a mixed methods study

Background

Protection and promotion of sexual health is of great importance for educable intellectually disabled adolescent girls; since they are prone to high risk sexual vulnerabilities and consequences, such as unwanted pregnancy, sexually transmitted infections, and acquired immune deficiency syndrome. Although the rights of intellectually disabled adolescents have been emphasized through the recent years, their sexual health care is still a challenge for parents, teachers, caregivers, and service providers. This study aims to present a comprehensive sexual health care program for educable intellectually disabled adolescent girls.

Methods

This study is carried out by an exploratory sequential mixed qualitative-quantitative methods approach including three sequential phases. The researcher represents sexual health state of educable intellectually disabled adolescent girls using a qualitative approach. In the onset of the second phase, a comprehensive sexual health care program is designed for educable intellectually disabled adolescent girls. In this regard, in addition to qualitative studies, some related papers and texts are used. The suggested program of expert panel is approved based on prioritization guidelines. Then, in the third phase and after different stages of finalization of the program, its affectability is evaluated regarding improvement of sexual health state of educable intellectually disabled adolescent girls.

Discussion

It is expected that from the results of the present mixed methods study, by presenting a comprehensive sexual health program for educable intellectually disabled adolescent girls, lead to improvements in the sexual health of these girls. Moreover, it wants to reduce risky sexual behaviors, sexual abuse and harassment, and their consequences in adolescent girls in order to improve sexual health state of the society. If this program works, it can become one of the leading education and care guidelines for sexual health care of intellectually disabled adolescent girls.

Trial registration

IRCT20160224026756N5. Registered 22 June 2018.

Addressing sexual and reproductive health in adolescents and young adults with intellectual and developmental disabilities

PURPOSE OF REVIEW

This review provides support for promoting the sexual health of adolescents and young adults with developmental disabilities, and particularly those with intellectual disabilities. It offers guidance for pediatricians on incorporating counseling on sexuality and reproductive healthcare, socially appropriate behavior, and sexual abuse prevention for adolescents and young adults with developmental disabilities into healthcare visits. Additionally, it provides resources for developmentally appropriate sexuality education in the home and community to allow access to the comprehensive sexual and reproductive healthcare patients deserve.

RECENT FINDINGS

Adolescents and young adults with developmental disabilities often do not receive developmentally appropriate sexual health education, and this is associated with poor sexual health outcomes and increased rates of sexual abuse in this population.

SUMMARY

Pediatricians should discuss sexual health with all patients, including adolescents and young adults with developmental disabilities. They are well suited to provide sexual health education and inform families about appropriate sexual health resources.

Review of gynecologic and reproductive care for women with developmental disabilities

PURPOSE OF REVIEW

Care for women with developmental disabilities requires special consideration for unique needs related to their cognitive and physical abilities. These women and their caregivers require more support and guidance during reproductive health care. We review the literature and provide expert opinion surrounding gynecological issues for women with developmental disabilities to support healthcare providers better understand and care for this population.

RECENT FINDINGS

Women with developmental disabilities are more vulnerable to abuse and experience poorer gynecological healthcare outcomes. Many women with developmental disabilities are fertile and participate in sexual activity without adequate knowledge. They are at higher risk of pregnancy and birth complications. They are less likely to receive appropriate preventive screening.

SUMMARY

The review highlights important issues and practice suggestions related to the reproductive health care of women with developmental disabilities. Topics include clinic visits, menstruation, sexuality, sexual abuse, sexual health education, contraception, sexually transmitted infections, pregnancy, labor and delivery, and cancer screening/prevention. We emphasize the need for an individualized, comprehensive approach for these patients and review perceived and actual barriers to care. More education is needed on the aforementioned topics for women with developmental disabilities, their caregivers, and their providers.

Sexuality in Pediatric Spinal Cord Injury

Sexual development and sexuality in youth with pediatric spinal cord injury (SCI) are critical areas clinicians must be aware of and discuss when working with youth and their families. In addition to the general sexuality issues and challenges of adolescence and adult development, youth with SCI face unique physical and psychosocial issues. The goal of this article is to provide a developmentally based discussion of sexuality in individuals with SCI from infancy through emerging adulthood. An overview of psychosocial issues related to sexual development and sexuality are presented for each stage of sexual development along with recommendations for clinical practice, including patient and caregiver education and counseling. In order to establish expectations for youth with SCI, long-term outcomes related to sexuality and fertility of adults with pediatric-onset SCI are presented.

The Relationship Between Cognitive Ability and Experiences of Vaginal, Oral, and Anal Sex in the United States

Few studies have investigated the sexual development of populations with low cognitive abilities in the United States. This article examines the relationship between cognitive ability and various sexual experiences from adolescence (ages 12 to 18) to early adulthood (ages 28 to 34). Data were from 13,845 respondents interviewed at Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a probability sample of adolescents in the United States followed from adolescence to adulthood. Adjusted logistic regression models were used to study relationships between cognitive ability, approximated by the Add Health Picture Vocabulary Test (AHPVT), and experiences of vaginal, oral, and anal sex. After controlling for biological sex, age, race/ethnicity, and socioeconomic status (SES), individuals in the lowest cognitive ability group had significantly lower odds of experiencing each type of sex than those in the average ability group. Although individuals in the highest cognitive ability group had significantly lower odds of experiencing vaginal intercourse than those in the average ability group, this association did not remain significant when analyses were stratified by biological sex. These differences in experiences have implications for future health and warrant further study to understand policy implications for sexual health services and education.