11 minute read
Talking about sex education
FOR CHILDREN AND YOUNG PEOPLE WHO HAVE ADDITIONAL LEARNING NEEDS
Fiona Boorman is a paediatric continence nurse and former special school nurse. Fiona works with the BBUK team at Disabled Living.
Fiona, found she was able to explain and demonstrate ‘embarrassing’ body events in a way both families and pupils could understand, to help demystify and promote healthy living. This opened the door to becoming very involved in health, puberty, sex and relationships education too.
This is a subject which historically people commonly ignored because it proves difficult to talk about for many reasons, such as • Fear of how to broach it and what level to pitch the information at. • Fear of opening a ‘can of worms’, encouraging experimentation or maybe even starting a new obsession in some young people. Parents and carers may feel that the child will not require the information- • they will never be able to experience sexual feelings. • they will always need 24 hour care - so will not be alone. • they will always remain as a child and they would not be able to become pregnant.
Let’s look at these ideas
There are a very small number of conditions in which the young person will not experience hormonal and bodily changes as they progress through puberty. With some children these changes occur even earlier than for their peers.
For a child who is unable to question what is happening to their body and emotions, or access information on the internet as their neuro typical peers might, these changes may well produce fear, as they are unsure what is happening to them. They may become more isolated and sometimes depressed.
Even a child who struggles with social contact may change over time, it is important to help them to prepare for appropriate contact, particularly to learn what is acceptable behavior for themselves and others.
Sexual experimentation often starts with our own bodies, it is good to help these children to understand what behavior is acceptable in
the society they live in, to learn what can be done and where. They need reassurance to comprehend the urges and feelings that they experience as a normal part of maturing.
Many parents of children with disabilities, may view their child as unlikely to become an adult, imagining them as perpetually dependent and ‘childlike’, they may be protective and not wanting them to grow up. Unfortunately, since the demise of the crystal ball, most of us are unable to give accurate predictions of the future and reality generally turns out to be little like we thought.
It is a common misconception that girls with a learning disability are unlikely to become pregnant. The vast majority have fully
functioning sexual organs and without appropriate education are more at risk of allowing sexual contact through ignorance or abusive contact. At one time these young women were put on the ‘pill’ as routine to prevent unwanted pregnancy, currently contraception is normally prescribed after a more individual risk assessment, discussion with the family and an appropriate chat with the woman herself. However, contraceptive medication does not prevent sexually transmitted disease and the trauma of abuse.
Another misconception is that a young person will never be alone, they maybe in need of 24-hour supervision/care, so they will be prevented from having sexual contact. We are not keeping that child protected from abuse by ‘carers’ or as is sometimes a problem – other clients in care settings.
Parents have also told me that they will always look after their child – we live in an era of change, life expectancies of those with disabilities are greatly improved, this may not happen.
So why accept the challenge of Sex Education?
• To help the child understand their body/emotional changes i.e. periods, breast development, body changes, ‘wet dreams’, masturbation, voice changes, attraction, lust and so much more • To provide a safe environment for them to explore their own bodies • To make them safer from others • To keep others safe from their unwanted approaches • To help in understanding boundaries/appropriate behavior • To enable reporting of undesirable body changes, such as lumps, rashes or infections
Selecting children for lessons
I was previously a special school nurse, working with youngsters who had severe or profound and multiple learning disabilities. This was one lesson where we decided to educate them within mixed sex groups with similar cognitive abilities. Our experience was that some needed shorter sessions due to concentration span, it was a struggle to achieve the learning outcomes we proposed, we needed more sessions.
Preparation
We started by ensuring the learners understood the differences between sexes and ages. I cut pictures of people out of magazines/catalogues, asked the children to group them according to apparent sex and then into age order. We chatted about what ages body changes had happened to those people. This helps you to gauge their understanding.
I used a basket of washing to help discussion about why we wear clothing. Prompting talk about selfcare, spots and smells!
We talked very openly with the youngsters about which body parts they and their family members possessed, with interesting outcomes, including one child reporting his sister had a penis – she kept it in a drawer! We asked the children to comment on who they are safe to have these conversations with.
Terminology
Another early session was around our alternative names for body parts, many unrepeatable, but we decided to use the correct words, as a universal language that would be useful if they needed to report to a healthcare professional i.e. penis, breast, vagina.
Safe touch
Staff identified this as an area for work, students struggled with personal space, so we tried this as a role play, to see how close the children thought made them feel comfortable.
In teams we made full size bodies, cut from paper (Draw around child lying on a piece of paper roll-cut the body shape out) the learners decided who the person represented e.g. my mum, friend, teacher, policeman. The children then painted on in red (no touch) or green (can touch) orange (maybe) the areas they believe were safe. I have since tried this with red/ green/orange paper with double sided tape on the rear, the children stuck this to their own clothing or their friends. This approach can be used with touching animals, electrical equipment, items in a shop and more.
Visual learning
Children in mainstream schools are often taught about ‘Sex, puberty, relationships’, using video of cartoon characters or drawn people- to keep things ‘decent’. Sadly, many children with learning issues, appear unable to equate cartoon bodies with their own, managing better with photographs and sometimes models. To this end, I made felt body parts which I could hold against myself when leading the groups, to show the learners where the relevant parts were situated and their purpose.
A young lady with cerebral palsy admitted she could not abduct her legs and had no idea what her vaginal area looked like; I was able to demonstrate with my rather generic models! They have also proved useful when teaching bottom wiping skills- how can a child do that, if they don’t know where they are trying to wipe? Downloading suitable materials is a minefield to be negotiated- due to the fine line between education and pornography. But the information needs to be presented in a way that the child can access and comprehend, in order to teach the safety that is needed.
Pornography
Another issue that often affects families with learning disabled young people is how to regulate access to internet content. Several times I have come across youngsters being urged to access unsuitable online sites, by their peers (more common in mixed ability schooling) and having difficulty processing what they are viewing. This may be seen as amusing to more able children, or viewed as grooming. • It is important that parents, carers and staff maintain open dialogue with the child, • encouraging sharing of online content with their care providers, • holding non-judgmental discussion and • keeping access to computers and tablets in the family areas- rather than hidden away in bedrooms. ‘Parental controls’ can also be applied to online content to ensure it is suitable for the whole family. • Log on to internet provider or set on Google safe search
Consent
This is a concept that the young person may need help with. Showing ways that we give permission like smiling, nodding, allowing things to happen to us, going to venues, accepting gifts, it is not all about saying ‘yes’. Also, ways we can say ‘no’, shaking our heads, turning away, frowning, pushing people away, putting our arms around ourselves and head down, shouting ‘no’ or leaving.
Encourage the young person to practice these in context, ‘can I have one of your sweets?’ ‘do you want to stroke my dog?’ ‘can I touch your hair?’. Help them to interpret nonverbal messages, this is a challenge for many. It is helpful to use role play, to teach them how to respond to invasion of their personal space and how to alert others to unwanted approaches and how to recognize lack of consent in others.
Stranger danger
We often use this phrase with children, but we need to know who they see as strangers. I cut out many photos of people familiar or not and found that my learners often perceived them all as friendsnone as strangers, even famous footballers, pop stars and a friendly looking vicar.
The general rules of this type of education – probably all education, is to establish the current understanding of your audience as individuals, before you can go on to enable their learning. Make sure you are using materials that they can comprehend, keep going back to ensure they have got the point, before moving on. For children with limited understanding or a literal approach, covering a banana with a condom is inappropriate - that will not prevent pregnancy! They need to practice applying it on a model then see it in place on a human photograph.
Sex and relationships education is so important to all young people, it is vital that we help them to practice their life skills safely, by really doing the ground work well.
This is merely a brief introduction, but I hope it will spark thought and discussion to the benefit of our children, who I feel are often very lost in a mainstream sex education class - not a place where you submit yourself to ridicule by admitting you don’t understand.
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