Skip to main content

Capacity to Consent: Policies and Practices that Limit Sexual Consent for People with Intellectual/Developmental Disabilities


Consent determination is a common practice that has been championed as a logical approach (Lyden in Sex Disabil 25(1):3–20, 2007) to the sexual activity of individuals with intellectual and/or developmental disabilities. These practices are paternalistic and ineffectual, and need to be replaced with viable alternatives, such as sex-education provision. In this piece, I deconstruct the logic of this practice utilizing the case of Ashley X, contemporary research findings, an analysis provided by Perlin and Lynch (Sexuality, disability, and the law: beyond the last frontier?, Palgrave Macmillan, London, 2016) and Deborah Stone’s policy analysis framework (Stone in Policy paradox: the art of political decision making, 3rd edn, Norton, New York, 2012). I argue that prevention of sexual activity is not synonymous with protection from sexual harm—and, in fact, may paradoxically cause harm to this population. I dispute the notion that people without intellectual disabilities are more equipped to make sex-related decisions for this population. Additionally, the notion of consent in this population is treated as flexible, and primarily bends to facilitate the needs of people without disabilities. I conclude with several recommendations, including a request for protective civil rights legislation to defend the sexual and relationship rights of people with intellectual and developmental disabilities.

This is a preview of subscription content, access via your institution.


  1. 502 S.E.2d 492, 232 Ga. App. 556 “Baise v. State.” (1998). Accessed May 2018

  2. Ailey, S.H., Marks, B.A., Crisp, C., Hahn, J.E.: Promoting sexuality across the life span for individuals with intellectual and developmental disabilities. Nurs. Clin. North Am. 38, 229–252 (2003)

    Article  Google Scholar 

  3. Bottoms, B.L., Nysse-Carris, K.L., Harris, T., Tyda, K.: Jurors’ perceptions of adolescent sexual assault victims who have intellectual disabilities. Law Hum. Behav. 27(2), 205–227 (2003)

    Article  Google Scholar 

  4. Campbell, M.: Disabilities and sexual expression: a review of the literature. Sociol. Compass 11(9), 1–19 (2017)

    Article  Google Scholar 

  5. Dukes, E., McGuire, B.E.: Enhancing capacity to make sexuality-related decisions in people with an intellectual disability. J. Intellect. Disabil. Res. 53(8), 727–734 (2009)

    Article  Google Scholar 

  6. Eastgate, G.: Sex, consent and intellectual disability. Aust. Fam. Physician 34(3), 163–166 (2005)

    PubMed  Google Scholar 

  7. Eastgate, G., Van Driel, M., Lennox, N., Scheermeyer, E.: Women with intellectual disabilities: a study of sexuality, sexual abuse and protection skills. Aust. Fam. Physician 40(4), 226–230 (2011)

    PubMed  Google Scholar 

  8. English, B., Tickle, A., das Nair, R.: Views and experiences of people with intellectual disabilities regarding intimate relationships: a qualitative metasynthesis. Sex. Disabil. 20, 149–173 (2017)

    Google Scholar 

  9. Feely, M.: Sexual surveillance and control in a community-based intellectual disability service. Sexualities 19(5–6), 725–750 (2016)

    Article  Google Scholar 

  10. Fischel, J.J., O’Connell, H.R.: Disabling consent, or restructuring sexual autonomy. Columbia J. Gend. Law 30(2), 402–528 (2016)

    Google Scholar 

  11. Gilbert, N., Terrell, P.: Dimensions of Social Welfare Policy. Pearson, Berkeley (2012)

    Google Scholar 

  12. Gill, M.: Rethinking sexual abuse, questions of consent, and intellectual disability. Sex. Res. Soc. Policy 7(3), 201–213 (2010)

    Article  Google Scholar 

  13. Gilmore, L., Malcolm, L.: “Best for everyone concerned” or “Only as a last resort”? Views of Australian doctors about sterilisation of men and women with intellectual disability. J. Intellect. Dev. Disabil. 39(2), 177–187 (2014)

    Article  Google Scholar 

  14. Kafer, A.: At the same time, out of time: Ashley X. In: Davis, L.J. (ed.) The Disability Studies Reader, pp. 282–304. Routledge, New York (2017)

    Google Scholar 

  15. Lyden, M.: Assessment of sexual consent capacity. Sex. Disabil. 25(1), 3–20 (2007)

    Article  Google Scholar 

  16. McRuer, R.: Crip Theory: Cultural Signs of Queerness and Disability, vol. 9. New York University Press, New York (2006)

    Google Scholar 

  17. Murphy, G.H., O’Callaghan, A.: Capacity of adults with intellectual disabilities to consent to sexual relationships. Psychol. Med. 34(7), 1347–1357 (2004)

    Article  Google Scholar 

  18. National Association of Councils on Developmental Disabilities: Councils on developmental disabilities addressing sexual violence & neglect. Retrieved from (2017). Accessed May 2018

  19. Perlin, M.L., Lynch, A.J.: Sexuality, Disability, and the Law: Beyond the Last Frontier?. Palgrave Macmillan, London (2016)

    Book  Google Scholar 

  20. The ‘Ashley treatment’ and the wellbeing of ‘pillow angels’. Retrieved from (2017). Accessed May 2018

  21. Pollock, A.J., Fost, N., Allen, D.B.: Growth attenuation therapy: practice & perspectives of pediatric endocrinologists. Retrieved from (2015). Accessed May 2018

  22. Rape, Abuse & Incest National Network (RAINN): State Law Database. Retrieved from (2018) Accessed May 2018

  23. Schaafsma, D., Kok, G., Stoffelen, J.M.T., Curfs, L.M.G.: Identifying effective methods for teaching sex education to individuals with intellectual disabilities: a systematic review. J. Sex Res. 52(4), 412–432 (2015)

    Article  Google Scholar 

  24. Schaafsma, D., Kok, G., Stoffelen, J.M.T., Curfs, L.M.G.: People with intellectual disabilities talk about sexuality: implications for the development of sex education. Sex. Disabil. 35(1), 21–38 (2017)

    Article  Google Scholar 

  25. Starogiannis, H., Hill, D.B.: Sex and gender in an American State School (1951–1987): the Willowbrook class. Sex. Disabil. (2008).

    Article  Google Scholar 

  26. Stone, D.: Policy Paradox: The Art of Political Decision Making, 3rd edn. Norton, New York (2012)

    Google Scholar 

  27. Thompsona, V.R., Stancliffea, R.J., Broomb, A., Wilsonc, N.J.: Clinicians’ use of sexual knowledge assessment tools for people with intellectual disability. J. Intellect. Dev. Disabil. 41(3), 243–254 (2016)

    Article  Google Scholar 

  28. Turner, G.W., Crane, B.: Sexually silenced no more, adults with learning disabilities speak up: a call to action for social work to frame sexual voice as a social justice issue. Br. J. Soc. Work 46, 2300–2317 (2016)

    Article  Google Scholar 

  29. Waxman, B.F.: Up against eugenics: disabled women’s challenge to receive reproductive health services. Sex. Disabil. 12(2), 155–171 (1994)

    Article  Google Scholar 

  30. Winges-Yanez, N.: Why all the talk about sex? An authoethnography identifying the troubling discourse of sexuality and intellectual disability. Sex. Disabil. 32(1), 107–116 (2014)

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Andrea Onstot.

Ethics declarations

Conflict of interest

Author Andrea Onstot declares that she has no conflict of interest.

Ethical Approval

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Onstot, A. Capacity to Consent: Policies and Practices that Limit Sexual Consent for People with Intellectual/Developmental Disabilities. Sex Disabil 37, 633–644 (2019).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • Policy
  • Consent
  • Capacity
  • Intellectual
  • Developmental
  • United States