CLINICAL REPORT Sexuality of Children and Adolescents With Developmental Disabilities

Children and adolescents with developmental disabilities, like all children, are sexual persons. However, attention to their complex medical and functional issues often consumes time that might otherwise be invested in addressing the anatomic, physiologic, emotional, and social aspects of their developing sexuality. This report discusses issues of puberty, contraception, psychosexual development, sexual abuse, and sexuality education specific to children and adolescents with disabilities and their families. Pediatricians, in the context of the medical home, are encouraged to discuss issues of sexuality on a regular basis, ensure the privacy of each child and adolescent, promote self-care and social independence among persons with disabilities, advocate for appropriate sexuality education, and provide ongoing education for children and adolescents with developmental disabilities and their families. INTRODUCTION SEXUAL DEVELOPMENT IS a multidimensional process, intimately linked to the basic human needs of being liked and accepted, displaying and receiving affection, feeling valued and attractive, and sharing thoughts and feelings. It not only involves anatomic and physiologic functioning, but it also relates to sexual knowledge, beliefs, attitudes, and values. Sexuality should be considered in a context that extends beyond genital sex to include gender-role socialization, physical maturation and body image, social relationships, and future social aspirations.1 Like all adolescents, teens with disabilities may express desires and hopes for marriage, children, and normal adult sex lives. In fact, adolescents with physical disabilities are as sexually experienced as their peers without disabilities.2 However, parents and health care professionals are often pessimistic regarding the potential of children with disabilities to enjoy intimacy and sexuality in their relationships.3 People with disabilities are often erroneously regarded as childlike, asexual, and in need of protection. Conversely, they may be viewed as inappropriately sexual or as having uncontrollable urges.4 People without disabilities are more willing to accept people with disabilities as fellow employees or casual friends and less willing to accept them as dating, sexual, or marriage partners.5 Societal and psychosocial barriers may be more of a hindrance to an adolescent’s sexual development than the limitations of the disability itself.3 www.pediatrics.org/cgi/doi/10.1542/ peds.2006-1115 doi:10.1542/peds.2006-1115