Talking to Children with Cognitive Disabilities

Sexuality education needs to suit your child's level of understanding.

Resources such as books, stories, DVDs, anatomically correct dolls and three dimensional models can help your child to understand.

All people, including those with cognitive disabilities (including intellectual disability, autism spectrum disorder and acquired brain injury), have the right to explore and express their sexuality in appropriate ways. Everyone needs ongoing and age-appropriate sexuality education to develop positive attitudes about their sexuality.

Comprehensive sexuality education can help people with cognitive disabilities to stay safe, reduce their risk of sexually transmissible infections (STIs) and help prevent an unplanned pregnancy. Many parents don't provide sexuality education because they mistakenly think their child will not need it. Other parents try, but struggle to present the information in a way their child can understand. Some parents are confident talking to their child with intellectual disability and can act as a resource for other parents.

Sexuality education should include information about:

• correct anatomical language (using appropriate names for body parts)
• developing social skills, including concepts such as public and private
• how to develop and maintain different types of relationships
• coping with relationship issues or rejection
• sex and relationships, including marriage and parenting
• protective behaviours
• the physical and emotional changes of puberty
• the biology of sex, including reproduction
• appropriate and inappropriate expressions of sexuality
• STIs
• safer sex and contraception
• masturbation
• same-sex attraction.

There isn't a standard model of sexuality education that suits all children with cognitive disabilities. Information needs to suit your child's level of understanding. For example, children with a moderate or severe cognitive disability may need more basic information (and in picture format) than children with a mild cognitive disability. This could include information about the differences between males and females, what kind of touch is appropriate or inappropriate, and how to behave in different social situations.

Suggestions for parents include:

• Make sure you have all the information you need and check any details that you are not sure about.
• Look at a range of books, DVDs and other resources on sexuality and disability online or by visiting Family Planning Victoria’s Resource Centre.
• Ask your child's teachers or carers about the sex education their school is providing. They may be able to give you advice or suggest useful resources.
• Talk to your disability association, Sexual Health Victoria and parents and carers from relevant support groups for suggestions and tips on how best to give your child the information.
• Work through any feelings of unease and embarrassment you may have, possibly with the help of a counsellor. It’s important to keep messages to children positive and non-judgemental.
• Decide beforehand which words you are going to use. This can be difficult, since names for reproductive body parts, such as the vagina and penis, tend to be either medical or slang. Avoid vague terms such as 'front bottom', as this can confuse your child or give them the impression that talking about genitals is shameful or embarrassing.

Make the most of situations where your child shows curiosity about sex. For example, they may see actors kissing in a movie on television and start asking questions. Suggestions for ways to talk about sex include:

• As with any child, sexuality education should be delivered over time. Give the simpler facts first and then continue to add to your child's knowledge as they grow older.
• Try to deliver information as simply as you can.
• Try to keep discussions light and fun.
• Anatomically correct dolls can help teach your child about the differences between males and females.
• Children with cognitive disabilities often have trouble thinking in abstract ways. It may be helpful to source a range of resources such as books with clear and simple pictures, DVDs, dolls and three-dimensional models of body parts.
• Read age and developmentally appropriate stories about sex and sexual issues together. Contact your disability association or Sexual Health Victoria for access to resources.
• Role play may be useful when discussing relationship skills or assertiveness. For example, help your child to practise saying 'no' to unwanted advances in different settings.
• Role play may also help your child to understand the difference between private and public places if they are having trouble.
• Use demonstrations where possible. For example, you could use dolls to show where babies come from or take your daughter with you to the toilet to demonstrate pad changing and disposal.
• Masturbation should be discussed as a healthy and natural way to explore and express sexuality on your own in a private place.

Some aspects of your child's sexuality education can be more difficult than others. Suggestions for dealing with issues include:

• Use praise and positive reinforcement when your child shows they understand a particular topic or displays the desired behaviour.
• If you don't know the answer to your child's question, say so. Suggest that you find out the information together, possibly online.
• It’s okay to be uncomfortable or embarrassed, as long as you are honest about it with your child.
• There is no single, right way to talk to your child about sex. It will be a process of ups and downs. Don't be discouraged or upset if a particular method doesn't work. Put it behind you and consider another approach.
• What works for some parents may not work for you and vice versa. It’s important to keep experimenting.
• If your child is having trouble grasping a concept, try breaking it down into smaller parts.
• Seek advice from your disability association, Sexual Health Victoria or relevant support groups.
• Try to use simple, concrete words and concepts.
• Use a range of methods for each topic to increase the likelihood of retention.

Suggestions for following up include:

• You may need to cover the same topic several times before your child fully understands, as some children will need constant reminding and reinforcement.
• Ask your child questions to make sure they have understood the information.
• Using dolls or puppets in the teaching process may help your child to show their understanding of sexuality without feeling pressured.
• Keep your child's carers informed and make sure that sexuality education provided by other sources gives the same messages that you provide.