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1. Sex education for students with severe learning difficulties......................................................................... 1

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Sex education for students with severe learning difficulties

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Resumen: Explores the sex education needs of school students with severe learning difficulties with reference
to curriculum content, teaching, resources and work with parents. Gives examples of a developmental approach
to the curriculum.

Texto completo: Ann Craft: Ann Craft in Massey, D. (Ed.), Sex Education Source Book: Current Issues and
Debates, Family Planning Association, London, 1995
David Stewart: David Stewart in Massey, D. (Ed.), Sex Education Source Book: Current Issues and Debates,
Family Planning Association, London, 1995
Angela Mallett: Angela Mallett is Head of Department for Students with Profound and Multiple Learning
Difficulties, Di Martin is Head of the Primary Department and Sue Tomlinson is Head of the Senior Department,
all at Shepherd Special School, Nottingham, UK
Di Martin: Di Martin is Head of the Primary Department and Sue Tomlinson is Head of the Senior Department,
all at Shepherd Special School, Nottingham, UK
Sue Tomlinson: Sue Tomlinson is Head of the Senior Department, all at Shepherd Special School, Nottingham,
UK
ACKNOWLEDGMENT: This article is based on a chapter by Ann Craft and David Stewart in Massey, D. (Ed.),
Sex Education Source Book: Current Issues and Debates, Family Planning Association, London, 1995.
In many ways, the health and sex education needs of children and young people with severe learning difficulties
are similar to those of any other young person. There are, however, important differences which require special
consideration. For example, there is likely to be a difference in the attitudes of significant adults such as
parents, teachers and school governors. Whereas youngsters without learning difficulties are expected
(eventually) to take responsibility for their own health and to become sexually active, therefore needing some
form of health and sex education, this is not the popular expectation for pupils with severe learning difficulties.
This is particularly so as far as sex education is concerned, for there is a widespread, albeit erroneous, belief
that individuals with intellectual disabilities are not sexual beings at all and possess an eternal, childlike
innocence. Even though their bodies are seen to mature physically, they are viewed as "children for ever", in a
limbo where they will never achieve the status of sexual adults. Echoes of this attitude can have a profound
effect on social development and opportunity.
A second difference lies in the degree of cognitive impairment present in children with severe learning
difficulties. That educational label subsumes a wide range of intellectual potential, communicative ability and
social skills, but the general characteristics of the population so described are likely to include a decreased
ability to make use of informal, unstructured social and sexual learning opportunities. They do not pick up cues,
ask questions or acquire information from friends in the same way that other youngsters do. This is
compounded by the often very sheltered lives that students lead outside school hours.
Two important similarities between children with and without severe learning difficulties are, first, that the vast
majority will reach puberty within normal parameters. By the time that they leave school, almost all youngsters
with severe learning difficulties will be at or near physical adulthood. Second, to a greater or lesser extent,
members of both groups are subject to teenage cultural pressures, whether their parents and teachers like it or
not.
Provision of sex education
The Health of the Nation[1] tells us that "Good personal and sexual relationships can actively promote health
and wellbeing". How, as a society, we formally teach any child to establish and maintain such good

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relationships is a matter for ongoing debate.
Many parents experience difficulties in talking to their children about sex. This reluctance may be increased
when a child has severe learning difficulties because the parent does not feel confident about what to say, or
how to say it. Indeed, parents may have thought that there would be no need to say anything at all.
However, the implementation of the 1986 and 1993 Education Acts, Guidance Circulars 11/87 and 5/94, and the
requirements of the National Curriculum, have brought about significant changes in the provision of school sex
education for students with learning difficulties. The duty of school governors to produce a written statement has
encouraged forethought and planning so that sex education is seen as an ongoing part of the curriculum rather
than something which, at worst, was only given in a crisis situation or, at best, was yet one more area to be
tackled in an overcrowded timetable for school leavers. The National Curriculum, with health education as a
cross-curricular theme, and sex education as part of science, has also increased children's access to learning
about social and sexual relationships.
Sex education for adults with learning disabilities has been discussed elsewhere[2]. The needs of students with
profound and multiple learning difficulties are explored in a forthcoming publication[3].
Sex education in perspective
"Sex education" is an emotive phrase, perhaps particularly so when applied to students with severe learning
difficulties. Biological aspects obviously have a place but, clearly, sex education should embrace much more
than that. Not only are there social and moral dimensions[4], but the wider context is adulthood and a personal
sense of worth and esteem. Pupils need to learn about social interactions and relationships in general, not just
about sexual relationships. They need to be clear about the crucial differences between public and private
places and behaviours. They need knowledge about how bodies work, but also teaching about personal
hygiene and personal presentation. They need knowledge and skills relating to health issues and to keeping
safe.
Many schools do place sex education in this wider context by including it in health education or personal and
social education. Students also learn about making choices, about taking decisions and their consequences.
Exercising choice helps children to assume control and responsibility and has an important effect on
assertiveness and self-protection.
Staff preparation and training
It is important for the success of a school sex education programme that, besides the necessary support of
senior management and governors, thought and time is given to staff preparation and training. Needs will vary,
owing to the variety of educational settings in which children with learning difficulties receive their schooling and
the differences in confidence and expertise that teachers have in approaching sex education themes.
For example, if secondary age students with severe learning difficulties are integrated, how will the teacher
"pace" the delivery of sex education? If the setting is an all-age special school, it has to be made clear that all
staff have a contributory role, because elements of sex education begin as soon as a child enters the school
nursery. Formal and informal learning about self-care, hygiene, names for body parts, personal identity as a girl
or a boy, the give and take of getting on with other people, about choices and consequences and personal
value, all have a part in sex education.
Staff training opportunities have to be ongoing because members of staff leave and new ones come, each with
their own views, attitudes and past experience. Periodic training opportunities serve to remind all staff of the
importance of this area of the curriculum. A helpful resource is Sex and Staff Training[5].
The spiral curriculum
A clearly stated developmental approach serves as a reminder to both teachers and parents that pupils with
severe learning difficulties will grow and change, will acquire secondary sexual characteristics, will eventually
leave school, and will become adult men and women.
The experience of starting school immediately widens the child's social horizons. She/he has to share, to await

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turns, to work and play co-operatively, to negotiate, and perhaps learn a new vocabulary or new signs for
indicating personal wants and for parts of the body. All of these elements, approached both formally in the
classroom and informally through games and play, are the foundation of later and continuing work on
relationships and interpersonal behaviour (see, for example, the lesson plans outlined in Figure 1).
As almost all children with severe learning difficulties will reach puberty within the normal age parameters, it is
important to prepare pupils for the bodily and emotional changes that will occur. This will include work on
gender recognition, on similarities and differences, and on the way they have grown physically and changed in
their interests from the time they were babies. Encouraging respect for individual choices and differences helps
to encourage tolerance and affirms individual self-esteem.
Teenagers will need revisions and extensions of earlier work, along with an increased emphasis on socially
appropriate behaviour as their independence increases. Television soap operas provide frequent inspiration for
work on family, social and sexual relationships! Students should also be helped to look beyond school to locate
and become familiar with community resources which are available to them for future support and advice. Some
examples and outlines are suggested below.
Curriculum organization
In an all-age school, the existence of a detailed and developmental curriculum is essential in ensuring that all
areas are covered and that there is no avoidance of the more "problematical" areas. There is a danger that
some members of staff may stick to what are perceived as "safe" topics, so that students will know about all the
body parts save the sexual ones, or all about teeth cleaning and nothing about genital hygiene.
Once an overall programme is in place, both staff and pupils have a structure within which to talk honestly about
sensitive topics such as contraception, parenthood, masturbation and homosexuality. For example, learning
about contraception leads to a discussion about condoms and on to their part in "safer sex" activities. This in
turn raises the topic of same-sex relationships.
At the Shepherd School, the guiding principles for the sex education programme are that it should encourage
the students to feel good about themselves, enable them to live fuller, more satisfying lives and enable them to
take more control over their lives. The programme's main components are:
- Knowledge and information about the physical self. This is timed to anticipate the physical changes of puberty
such as menstruation, erections and ejaculations.
- Exploration and understanding of feelings and emotions. This provides an opportunity to explore mood swings,
sexual feelings, feelings about disability and, very importantly, chances to explore ways in which to express
feelings in an appropriate manner.
- Developing values. They need opportunities to consider their own values and those of other people, to
enhance respect for themselves and for others.
- Learning appropriate behaviour. This encompasses a range of sociosexual skills, including assertiveness.
- Decision making. Students need chances to consider what they want for themselves now and as adults. With
the rights they assume, they need to be aware of the responsibilities and aware that choices have
consequences.
While a developmental structure has many general advantages, the curriculum should also take account of
individual needs and situations. A teenager may not have learned all the names for sexual parts of the body, but
may need urgent advice because she/he is vulnerable, or is thought to be at the point of entering into a sexual
relationship.
Targeting topics
Much health or personal and social education may well be covered in a cross-curricular approach, but there will
be times when teachers wish to target certain areas with specific groups of pupils.
Teaching can be organized in different ways, by age or ability (see Appendices). It is often helpful (although not
always possible) for sessions to be run by two members of staff, either two teachers, or a teacher with an

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assistant or the school nurse. Paired teaching offers support and is invaluable for later assessment.
For some lessons, girls and boys can be taught separately if this seems to facilitate the learning process. It is
important that both pupils and staff feel comfortable. However, staff should ensure that such a strategy does not
lead to the creation of "mysteries". Each sex needs to be aware of the topic areas being covered, although work
on practical skills may differ.
Less able students will need a great deal of support, particularly as their cognitive and expressive language is
so limited. In many schools, Makaton signing is used to aid learning. The Makaton core vocabulary is being
extended and will include sociosexual areas[6].
Sessions may need to be repeated often to ensure that students recall and understand what is being taught. For
those whose understanding is very minimal, the main emphasis may be on training and reinforcement. For
example, the reasons for the differences in public and private behaviour may never be fully or even partially
grasped, but have to be situationally reinforced.
A variety of teaching approaches can be employed with the groups of older pupils to try to ensure that each
session involves several different activities; for example, a few slides, a discussion and a simple quiz. Drama
and art work, or puppets, can be invaluable to help students in recognition and expression of emotions and in
exploring different roles and outcomes.
Extending the teaching programme
As with any health education, work on sex education themes can be extended by making visits and by links with
a variety of community services. Visitors to the classroom can also be helpful; they need to be prepared for the
level of information required, just as the pupils need to be prepared for what will be said.
At Shepherd School, for example, older pupils go on visits to the local genito-urinary medicine clinic and family
planning clinic and, on occasion, staff have visited the school. Parents have been supportive of this, pleased
that their teenagers are learning about good practice. Pupils have become more confident and have more
understanding about the purpose and procedures involved in intimate physical examinations. A local health
promotion officer responsible for HIV/AIDS education came into school over the course of a year, undertaking
work with both students and staff. Students from the school helped to design signs and posters for a teenage
health clinic in town to make it more user friendly to people with learning difficulties.
Teaching resources
There is now a range of audiovisual resources which can be used to help students with learning difficulties learn
about themselves, their bodies and sexuality[7]. A teaching programme such as Living Your Life[8] is flexible
enough in structure to offer a variety of different ways through the material according to the needs of older
students. However, there is currently no corresponding programme for younger children with severe learning
difficulties.
In recent years, increasing attention has been paid to aspects of child safety and the environments and
education which underpin this. Concerns about the vulnerability of children with severe learning difficulties to
sexual exploitation and abuse led staff from Shepherd School to develop a teaching package[9].
No teaching resource is perfect and teachers are advised to be both critical and selective - imaginative
adaptations may be needed for particular groups of students. For example, some resources may not offer
positive or realistic images of ethnic groups, or of people with disabilities. Additional illustrations or activities can
help students to identify with the message of the material.
Assessment and evaluation
Assessment and evaluation are essential if the sex education programme is to be kept relevant, up to date and
responsive to student needs.
Each student should be included as closely as possible in evaluating her/his own progress. Having personal
folders can help students be reflective about their own learning and review their work over time. Living Your
Life[8] includes a review sheet which can be photocopied to record students' comments at the end of each

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completed block of work. This package also has a photocopiable review sheet for teachers to use after each
unit. Thus, at the appropriate place in the programme, a note can easily be kept of ideas and improvements to
be tried next time the unit is taught. Formal records of achievement can feature an individual student's work in
this curriculum area.
Parental concerns
Parents of youngsters with severe learning difficulties often have anxieties relating to the sexuality of those
children. Concern may be expressed because of perceived vulnerability to abuse and exploitation or about the
danger of their son or daughter getting into trouble because they do not understand the "rules" which apply to
sociosexual behaviour. Anxieties may peak around puberty when it becomes obvious that the child is growing
up physically, with all that this entails.
The school has a very important part to play in reassuring parents that physical and emotional developments
are normal and nothing out of the ordinary. It is in this context that particular parental worries can be addressed
and individual student needs considered. Ideally, this is the approach which the school has adopted from the
beginning, when the child enters the school, so that changes at puberty do not come as a crisis point for
youngster or parent.
Parental involvement in school sex education programmes, encouraged by the 1986 Education Act, can be very
beneficial for students, parents and teachers[10]. Parents tend not to exercise their right to withdraw children
from sex education where trust has been established.
Meetings for parents
Parents' meetings on themes relating to sex education may take many forms. Parents may be invited to look at
the teaching resources to be used; they may be given an outline of the programme so that they are aware of the
topic areas and can answer questions from their daughter or son; they may come together to explore particular
areas of concern.
At Shepherd School, the sex education monitoring group (a standing committee with a membership drawn from
governors, teachers, parents and outside professionals) has arranged a series of morning meetings for parents.
At the first of these, which focused on teaching resources, the parents were asked to suggest topics for further
meetings. Menstruation and masturbation were important concerns, and the meetings which followed were
judged by the parents to be extremely helpful. Anxieties were shared and, in the discussions, parents gave each
other helpful and practical advice and support.
As a result of this sharing, the monitoring group has produced several small booklets for parents[11]. Subjects
include menstruation, masturbation, child protection, HIV/AIDS, and children with profound learning difficulties.
The remit of the monitoring group and the scope of the meetings have widened to include other personal and
social issues, such as bereavement.
Individual advice
Parents may turn to the school for help or advice about particular anxieties relating to the sexuality of their child.
The head, class teacher, school nurse or doctor can all be sources of support. Such support is most usefully
given in the context of general co-operation with parents built up over time by the school. In relation to
sociosexual concerns, this will mean that the parents of younger children have been encouraged in all kinds of
ways to see their daughter or son as a growing and developing individual with changing needs.
Besides responding to parental requests for advice, the school can also take a proactive role. For example, it
may be possible to put a child's approaching puberty on to the parent's agenda in a way that avoids the
development of a crisis - by, for example, a mention at a school medical, or by a class teacher along the lines of
"Karen is ten now, have you thought yet about how to prepare her for the start of her periods? We have got one
or two books in school that you might like to borrow."
Conclusion
There are encouraging signs that the needs of young people with severe learning difficulties for positive and

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relevant education about personal relationships and sexuality are being addressed. Such students have a great
deal in common with other youngsters. This commonality should be the basis for those with and without
experience of students with learning disabilities to make links in the quest for best practice in health and sex
education.
References
1. Department of Health, The Health of the Nation, HMSO, London, 1992.
2. Craft, A., "Issues in sex education for people with learning disabilities in the United Kingdom", Sexual and
Marital Therapy, Vol. 9 No. 2, 1994, pp.145-57..
3. Downs, C. and Craft, A., Sex in Context: Approaches, Strategies and Safeguards concerning the Sexuality of
Children and Adults with Profound and Multiple Impairments, Pavilion Publishing, Brighton, in press.
4. Ware, J., "The development of a morals and ethics curriculum for students with severe learning difficulties", in
Craft, A. (Ed.), Mental Handicap and Sexuality: Issues and Perspectives, Costello Press, Tunbridge Wells,
1987, pp. 84-110.
5. McCarthy, M. and Thompson, D., Sex and Staff Training, Pavilion Publishing, Brighton, 1994.
6. Walker, M. and Parratt, J., "The Makaton Resource Vocabulary", The Makaton Vocabulary Development
Project, Camberley, forthcoming.
7. Health Education Authority, Health-related Resources for People with Learning Disabilities, HEA, London,
1995.
8. Craft, A. and members of the Nottinghamshire SLD Sex Education Project, Living Your Life: A Sex Education
and Personal Development Programme for Students with Severe Learning Difficulties, Learning Disabilities
Association (LDA), Cambridge, 1991.
9. The Shepherd School, The Protection Pack, LDA, Cambridge, 1994.
10. Craft, A. and Cromby, J., Parental Involvement in the Sex Education of Students with Severe Learning
Difficulties: A Handbook, Department of Mental Handicap, University of Nottingham Medical School, 1991.
11. Shepherd School Sex Education Monitoring Group, Now They're Growing Up..., a series of booklets for
parents, available in English, Urdu and Punjabi. Contact David Stewart, Shepherd School, Harvey Road,
Nottingham NG8 3BB.
Appendix 1. Teaching focus 1 - example of a lesson plan on language and PSE for 5 to 6 year olds
Aims
The aims of the lesson are:
- to promote awareness of self and others;
- to give each pupil the opportunity to be the centre of attention;
- to focus on individual children--names, appearance, feelings, etc.;
- to give pupils the opportunity to become aware of others.
Activities
Activities include:
(1) Song - Peep Boo. Each child to hide under material and to appear when name is called.
(2) Song - Pass the Mirror:
- Pupil looks in the mirror while the other pupils watch.
- Pupils are asked to talk/indicate features of the pupil with the mirror.
- Pupil with the mirror then passes the mirror to a friend.
(3) Song - Pass the Hug:
- Pupil passes the hug to a friend, who in turn hugs someone else.
- Pupils are asked to talk/indicate how they feel after a hug (pictures of happy/sad face).
(4) I spy. Teacher holds up pictures/name cards of pupils. Pupils name the person, who is then given the
opportunity to decide on an activity for the rest of the pupils. (For example, Can you wave your hand like me?

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Yes I can.)
(5) Song - Thank You for My Friends.
Appendix 2. Teaching focus 2 - module on friendship for 12-14 year olds
Note that this framework is flexible: issues/developments may occur which demand modification of the module
for some or all of the students.
Week 1
(1) Exploration:
- Who is your friend?
- Who do you like to be with?
(2) Discussion/diagrams of friendship groups/drawings of friends and description of what they are doing - by the
students.
Week 2
(1) Greeting friends - demonstration by staff - appropriate and inappropriate greetings - discussion about the
receiver's feelings when greetings are appropriate/inappropriate.
(2) Students to role play appropriate greetings (video this).
Week 3
See lesson plan below on listening and caring in friendships:
(1) Focus on listening/caring skills.
(2) Review of previous lesson using video.
(3) Role play by staff - discussion about feelings when listening/caring behaviour is inappropriate. Draw up a list
of these feelings, illustrated by drawings by students.
Week 4
(1) Review week 1: Who do you like to be with? You can use the drawings, etc. from that session again.
(2) Pupils choose an activity with a named friend - see week 1.
(3) Focus on appropriate greeting/listening/ caring, keeping interruption by staff to a minimum.
(4) Students then talk about how they felt during the activity.
Week 5
(1) Discussion of different kinds of friendship - use of photos/line drawings to show range of friendship
situations, e.g. parents/child, young children, adolescents, same sex adults, different sex adults.
(2) To which drawings do the students relate?
(3) Which show people like themselves?
Week 6
(1) Discuss feelings of sadness/anger during friendships.
(2) Review listening/caring focus, but develop the perception that friendship is not simple/straightforward.
(3) Use video/photos/line drawings to explore the range of responses to sadness/anger in a friendship.
(4) Discuss which responses are appropriate or inappropriate.
Lesson plan for Week 3 on listening and caring in friendships
Objectives
- To recall previous lesson about friends and greetings.
- To recognize appropriate listening/caring in role play by others.
- To describe, through speech, sign, pictures, etc., the feelings that people have during
appropriate/inappropriate listening/caring interactions.
Resources
- Video of greetings from previous lesson.
- Symbol cards showing emotions.
Lesson

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(1) With the whole group seated in a semi circle, watch the video and recall the previous lesson.
(2) The staff enact an inappropriate listening/caring activity. For example, one adult may speak at same time as
another, with no eye contact, and no common content. Or one adult may ignore another when the first adult is
urgently trying to communicate something. Or one adult may refuse to compromise or agree with the other over
which activity they should do together.
(3) Students discuss their feelings/responses to these scenarios with appropriate staff support in groups with
one member of staff per group. Staff note these responses and students draw pictures/symbols at the side to
illustrate these.
(4) Staff enact an appropriate listening/caring activity as above.
(5) Students discuss their feelings/responses to these appropriate interactions with support in groups with one
member of staff per group. Staff note these responses and students draw pictures/symbols at the side to
illustrate these.
Follow up
In the following lesson, students choose a friend from the group and carry out an activity using appropriate
listening/caring skill.
Appendix 3. Teaching focus 3 -relationships
This exercise is designed for use with a small group of girls aged 11-14 years with profound and multiple
learning difficulties and sensory impairments, together with staff. The theme is "Preparing to meet people -
personal presentation (hands)".
Equipment required
Bowls, water, soap, glycerine, hand cream, a selection of rings and a selection of bracelets.
Objectives
There are four main objectives:
(1) For students to be aware of and to have sensory experience of their own hands.
(2) For students to be aware of and to have sensory experience of another's hands.
(3) For students to use hands to greet another person.
(4) For students to hold hands in a group - and to practise a party activity.
Method
The session opens with the statement: "There's a barn dance on Friday - let's make sure our hands look nice -
let's start by washing our hands in glycerine water."
Steps
(1) Wash hands - physical prompt if necessary.
(2) Visually examine own hands - physical prompt if necessary.
(3) Feel all over own hands - physical prompt if necessary.
(4) Put cream on own hands - physical prompt if necessary.
(5) Smell own hands - physical prompt if necessary.
(6) Try on rings - physical prompt if necessary.
(7) Try on bracelets - physical prompt if necessary.
(8) Look at everyone's hands in turn - physical prompt if necessary.
(9) Smell and touch others' hands - physical prompt if necessary.
"At the barn dance people will see how nice our hands are - especially when we greet them. Let's think what it
will be like."
Steps
(10) Shake hands.
(11) One person to take other person's hand - then place opposite hand on top - physical prompt if necessary.
(12) Gently grasp one hand and give a gentle squeeze in greeting.

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"We'll probably have to hold hands to do a dance - let's do that."
Steps
(13) All hold hands in circle.
(14) Play barn dance music - and everyone moves hands in and out.
"At the end of the evening when it's time to leave - we'll use our hands to wave goodbye. Let's do that now..."
Cross-curricular links can be made with science, PE, music, religious education, listening skills, and drama.
Illustration
Caption: Figure 1; Simply beginning school widens a child's social horizons. The cross-curricular approach can
provide firm foundations for later and continuing work on relationships and personal behaviour, as this topic web
on "friends", for 5 to 6 year olds, shows

Materia: Curricula; Sex education; Students; Handicapped people;

Título: Sex education for students with severe learning difficulties

Autor: Craft, Ann; Stewart, David; Mallett, Angela; Martin, Di; Tomlinson, Sue

Título de publicación: Health Education

Tomo: 96

Número: 6

Páginas: 11-18

Número de páginas: 0

Año de publicación: 1996

Fecha de publicación: 1996

Año: 1996

Editorial: Emerald Group Publishing, Limited

Lugar de publicación: Bradford

País de publicación: United Kingdom

Materia de publicación: Physical Fitness And Hygiene, Men's Health

ISSN: 09654283

Tipo de fuente: Scholarly Journals

Idioma de la publicación: English

Tipo de documento: Feature

ID del documento de ProQuest: 214702298

URL del documento:

http://ezproxy.eafit.edu.co/login?url=http://search.proquest.com/docview/214702298?accountid=45662

Copyright: Copyright MCB UP Limited (MCB) 1996

Última actualización: 2014-05-16

Base de datos: ProQuest Education Journals

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