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The Birds, Bees, and Special Needs: Making Evidence-Based Sex Education Accessible for Adolescents with Intellectual Disabilities

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Adolescents with intellectual disabilities (ID) represent an invisible at-risk population for multiple negative health outcomes. Much like their non-disabled peers, promoting healthy behaviors during adolescence has the potential to improve quality of life later on in life (McPherson et al. in J Appl Res Intellect Disabil 30(2):360, 2017). Many studies have analyzed disparities in obesity (Phillips et al. in Matern Child Health J 18(8):1964, 2014; Stancliffe et al. in Am J Intellect Dev Disabil 116(6):401, 2011), mental health (Charlot and Beasley in J Ment Health Res Intellect Disabil 6(2):74, 2013), and health care access (Baller and Barry in J Disabil Policy Stud 27(3):148, 2016), however sexual health needs further research and translation to practice. Access to sexual health education is limited for many youth with ID (Barnard-Brak et al. in Ment Retard 52(2):85–97, 2014). Studies have shown that students with ID experience higher rates of sexual abuse and assault than their non-disabled peers (Haydon et al. in J Interpers Violence 26(17):3476, 2011; Mahoney and Poling in J Dev Phys Disabil 23(4):369, 2011). Sexually active youth with ID are at a higher risk for contracting sexually transmitted infections compared to their non-disabled peers (Cheng and Udry in J Dev Phys Disabil 17(2):155–172, 2005; Mandell et al. in J School Health 78(7):382–388, 2008). Additional barriers exist including stigma and misperceptions around disability and sexuality and the assumption that the developmental status of the student will prevent sex education comprehension (Sinclair et al. in Educ Train Autism Dev Disabil 50(1):3–16, 2015). Qualitative studies of adult providers (Linton et al. in Sex Disabil 34(2):145–156, 2016; Murphy et al. in J Genet Couns 25(3):552, 2016), parents (Kok and Akyuz in Sex Disabil 33(2):157–174, 2015), and adolescents with ID (Löfgren-Mårtenson in Sex Disabil 30(2):209–225, 2012) have found overwhelming support for tailored sexual risk reduction interventions (Swango-Wilson in Sex Disabil 27(4):223, 2009). Developing evidence-based, inclusive curricula to prevent sexual coercion as well as promote sexual health self-determination for this vulnerable population is long overdue (McDaniels and Fleming in Sex Disabil 34(2):215, 2016). This study demonstrates the use of Universal Design for Learning (UDL), an educational framework, guidelines, and checklist tools (Eagleton, Universal Design for Learning (UDL), Salem Press, Ipswich, 2015; Center for Applied Special Technology, UDL curriculum self-check 2011 (updated 2011), 2011. http://udlselfcheck.cast.org/resources.php) to increase accessibility in HIPTeens, an evidence-based sexual risk reduction intervention (Morrison-Beedy et al. in J Assoc Nurses AIDS Care 13(1):21–27, 2002; Res Nurs Health 28(1):3–15, 2005; AIDS Behav 10(5):541, 2006; J Assoc Nurses AIDS Care 21(2):153–161, 2010; West J Nurs Res 33(5):690–711, 2011; J Adolesc Health 52(3):314–321, 2013; J Assoc Nurses AIDS Care 28(6):877–887, 2017). As a result, supplemental curriculum components were developed with UDLguided technology use recommendations. A UDL-integrated evidence-based sexual risk reduction intervention could increase accessibility and, with additional research, could help inform inclusive policy.

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  1. 1.

    Krahn, G.L., Walker, D.K., Correa-De-Araujo, R.: Persons with disabilities as an unrecognized health disparity population. Am. J. Public Health 105(Suppl 2), S198–S206 (2015)

  2. 2.

    Krahn, G.L., Fox, M.H.: Health disparities of adults with intellectual disabilities: what do we know? What do we do? J. Appl. Res. Intellect. Disabil. JARID 27(5), 431–446 (2014)

  3. 3.

    McPherson, L., Ware, R.S., Carrington, S., Lennox, N.: Enhancing self-determination in health: results of an RCT of the Ask Project, a school-based intervention for adolescents with intellectual disability. J. Appl. Res. Intellect. Disabil. 30(2), 360 (2017)

  4. 4.

    Phillips, K., Schieve, L., Visser, S., Boulet, S., Sharma, A., Kogan, M., et al.: Prevalence and impact of unhealthy weight in a national sample of US adolescents with autism and other learning and behavioral disabilities. Matern. Child Health J. 18(8), 1964 (2014)

  5. 5.

    Stancliffe, R.J., Lakin, K.C., Larson, S., Engler, J., Bershadsky, J., Taub, S., et al.: Overweight and obesity among adults with intellectual disabilities who use intellectual disability/developmental disability services in 20 U.S. States. Am. J. Intellect. Dev. Disabil. 116(6), 401 (2011)

  6. 6.

    Charlot, L., Beasley, J.B.: Intellectual disabilities and mental health: United States-based research. J. Ment. Health Res. Intellect. Disabil. 6(2), 74 (2013)

  7. 7.

    Baller, J.B., Barry, C.L.: State variation in school-based disability services financed by medicaid. J. Disabil. Policy Stud. 27(3), 148 (2016)

  8. 8.

    Schwartz, R.J., Robertson, R.E.: A review of research on sexual education for adults with intellectual disabilities. Career Dev. Transit. Except. Individ. (2018). https://doi.org/10.1177/2165143418756609

  9. 9.

    Decker, M.J., Berglas, N.F., Brindis, C.D.: A call to action: developing and strengthening new strategies to promote adolescent sexual health. Societies 5(4), 686 (2015)

  10. 10.

    Barnard-Brak, L., Schmidt, M., Chesnut, S., Tianlan, W., Richman, D.: Predictors of access to sex education for children with intellectual disabilities in public schools. Intellect. Dev. Disabil. 52(2), 85–97 (2014)

  11. 11.

    Haydon, A.A., McRee, A.-L., Tucker, H.C.: Unwanted sex among young adults in the United States: the role of physical disability and cognitive performance. J. Interpers. Violence 26(17), 3476 (2011)

  12. 12.

    Mahoney, A., Poling, A.: Sexual abuse prevention for people with severe developmental disabilities. J. Dev. Phys. Disabil. 23(4), 369 (2011)

  13. 13.

    Mandell, D., Eleey, C., Cederbaum, J., Hutchinson, M., Jemmott, L.S., Blank, M.: Sexually transmitted infection among adolescents receiving special education services. J. Sch. Health 78(7), 382–388 (2008)

  14. 14.

    Cheng, M.M., Udry, J.R.: Sexual experiences of adolescents with low cognitive abilities in the U.S. J. Dev. Phys. Disabil. 17(2), 155–172 (2005)

  15. 15.

    Sinclair, J., Unruh, D., Lindstrom, L., Scanlon, D.: Barriers to sexuality for individuals with intellectual and developmental disabilities: a literature review. Educ. Train. Autism Dev. Disabil. 50(1), 3–16 (2015)

  16. 16.

    Linton, K.F., Rueda, H.A., Williams, L.R., Sandoval, A., Bolin, S.: Reproductive and sexual healthcare needs among adults with disabilities as perceived by social workers. Sex. Disabil. 34(2), 145–156 (2016)

  17. 17.

    Murphy, C., Lincoln, S., Meredith, S., Cross, E.M., Rintell, D.: Sex education and intellectual disability: practices and insight from pediatric genetic counselors. J. Genet. Couns. 25(3), 552 (2016)

  18. 18.

    Kok, G., Akyuz, A.: Evaluation of effectiveness of parent health education about the sexual developments of adolescents with intellectual disabilities. Sex. Disabil. 33(2), 157–174 (2015)

  19. 19.

    Löfgren-Mårtenson, L.: “I want to do it right!” A pilot study of swedish sex education and young people with intellectual disabilities. Sex. Disabil. 30(2), 209–225 (2012)

  20. 20.

    Swango-Wilson, A.: Perception of sex education for individuals with developmental and cognitive disability: a four cohort study. Sex. Disabil. 27(4), 223 (2009)

  21. 21.

    Martinello, E.: Reviewing strategies for risk reduction for sexual abuse of children with intellectual disabilities: a focus on early intervention. Sex Disabil. 32, 167–174 (2014)

  22. 22.

    McDaniels, B., Fleming, A.: Sexuality education and intellectual disability: time to address the challenge. Sex. Disabil. 34(2), 215 (2016)

  23. 23.

    Winges-Yanez, N.: Discourse analysis of curriculum on sexuality education: FLASH for special education. Sex. Disabil. 32(4), 485–498 (2014)

  24. 24.

    Eagleton, M.: Universal Design for Learning (UDL). Salem Press, Ipswich (2015)

  25. 25.

    Meyer, A., Rose, D., Gordon, D.: Universal Design for Learning: Theory and Practice. CAST Professional Publishing, Wakefield, MA (2014)

  26. 26.

    Smith, S.J., Lowrey, K.A.: Applying the universal design for learning framework for individuals with intellectual disability: the future must be now. Intellect. Dev. Disabil. 55(1), 48 (2017)

  27. 27.

    Center for Applied Special Technology: UDL curriculum self-check 2011 (updated 2011). http://udlselfcheck.cast.org/resources.php. Accessed 22 Jan 2018

  28. 28.

    Morrison-Beedy, D., Carey, M.P., Aronowitz, T., Mkandawire, L., Dyne, J.: Adolescents’ input on the development of an HIV risk reduction intervention. J. Assoc. Nurses AIDS Care 13(1), 21–27 (2002)

  29. 29.

    Morrison-Beedy, D., Carey, M.P., Crean, H.F., Jones, S.H.: Risk behaviors among adolescent girls in an HIV prevention trial. West. J. Nurs. Res. 33(5), 690–711 (2011)

  30. 30.

    Morrison-Beedy, D., Carey, M.P., Crean, H.F., Jones, S.H.: Determinants of adolescent female attendance at an HIV risk reduction program. J. Assoc. Nurses AIDS Care 21(2), 153–161 (2010)

  31. 31.

    Morrison-Beedy, D., Carey, M.P., Kowalski, J., Tu, X.: Group-based HIV risk reduction intervention for adolescent girls: evidence of feasibility and efficacy. Res. Nurs. Health 28(1), 3–15 (2005)

  32. 32.

    Morrison-Beedy, D., Carey, M.P., Tu, X.: Accuracy of audio computer-assisted self-interviewing (ACASI) and self-administered questionnaires for the assessment of sexual behavior. AIDS Behav. 10(5), 541 (2006)

  33. 33.

    Morrison-Beedy, D., Grove, L., Ji, M., Baker, E.: Understanding the “why” for high-risk behavior: adolescent girls’ motivations for sex. J. Assoc. Nurses AIDS Care 28(6), 877–887 (2017)

  34. 34.

    Morrison-Beedy, D., Jones, S.H., Xia, Y., Tu, X., Crean, H.F., Carey, M.P.: Reducing sexual risk behavior in adolescent girls: results from a randomized controlled trial. J. Adolesc. Health 52(3), 314–321 (2013)

  35. 35.

    Morrison-Beedy, D., Carey, M.P., Côté-Arsenault, D., Seibold-Simpson, S., Robinson, K.A.: Understanding sexual abstinence in urban adolescent girls. J. Obstet. Gynecol. Neonatal. Nurs. 37(2), 185–195 (2008)

  36. 36.

    Morrison-Beedy, D., Nelson, L.E.: HIV prevention interventions in adolescent girls: what is the state of the science? Worldviews Evid Based Nurs. 1(3), 165–175 (2004)

  37. 37.

    Morrison-Beedy, D., Passmore, D., Carey, M.P.: Exit interviews from adolescent girls who participated in a sexual risk-reduction intervention: implications for community-based health education promotion for adolescents. J. Midwifery Women’s Health 58(3), 313–320 (2013)

  38. 38.

    U.S. Department of Health and Human Services Office of Adolescent Health: Teen pregnancy prevention evidence review: health improvement project for teens (hipteens)

  39. 39.

    Centers for Disease Control and Prevention: Compendium of evidence-based interventions and best practices for HIV prevention. http://www.cdc.gov/hiv/prevention/research/compendium/rr/hip.html. Accessed 22 Jan 2018

  40. 40.

    Center for Applied Special Technology: UDL Exchange 2012. http://udlexchange.cast.org/home. Accessed 22 Jan 2018

  41. 41.

    Fisher, J.D., Fisher, W.A.: Changing AIDS-risk behavior. Psychol. Bull. 111(3), 455–474 (1992)

  42. 42.

    Fisher, J.D., Fisher, W.A., Bryan, A.D., Misovich, S.J.: Information-motivation-behavioral skills model-based HIV risk behavior change intervention for inner-city high school youth. Health Psychol. 21(2), 177–186 (2002)

  43. 43.

    Shapiro, J.: The sexual assault epidemic no one talks about [Radio broacast episode and online article]. National Public Radio (2018). https://www.npr.org/2018/01/08/570224090/the-sexual-assault-epidemic-no-one-talks-about. Accessed 22 Jan 2018

  44. 44.

    Shapiro, J.: For some with intellectual disabilities, ending abuse starts with sex ed [Radio broadcast episode and web article]. National Public Radio (2018). https://www.npr.org/2018/01/09/572929725/for-some-with-intellectual-disabilities-ending-abuse-starts-with-sex-ed. Accessed 22 Jan 2018

  45. 45.

    W3C: Web Content Accessibility Guidelines (WCAG) 2.1 2018 (updated January 30, 2018). 2.1. https://www.w3.org/TR/WCAG21/

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Correspondence to Linsey Grove.

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The authors declare that they have not conflict of interest and authors Morrison-Beedy, Kirby and Hess were member of Grove’s doctoral dissertation committee.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Grove, L., Morrison-Beedy, D., Kirby, R. et al. The Birds, Bees, and Special Needs: Making Evidence-Based Sex Education Accessible for Adolescents with Intellectual Disabilities. Sex Disabil 36, 313–329 (2018). https://doi.org/10.1007/s11195-018-9547-7

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  • Sex education
  • Intellectual disability
  • Universal design for learning
  • Adolescents
  • Sexuality
  • Sexual health
  • Accessibility
  • United States