SEXUALITY EDUCATION STRATEGIES FOR CAREGIVERS OF STUDENTS
WITH INTELLECTUAL DISABILITY
A Project
Presented to the faculty of the Graduate and Professional Studies in Education
California State University, Sacramento
Submitted in partial satisfaction of
the requirements for the degree of
SPECIALIST IN EDUCATION
in
School Psychology
by
Pa Her Dipad
Doua Her
SPRING
2013
SEXUALITY EDUCATION STRATEGIES FOR CAREGIVERS OF STUDENTS
WITH INTELLECTUAL DISABILITY
A Project
By
Pa Her Dipad
Doua Her
Approved by:
_____________________________________, Committee Chair
Catherine Christo, Ph.D.
__________________________
Date
ii
Pa Her Dipad
Students: Doua Her
I certify that these students have met the requirements for format contained in the
University format manual, and that this project is suitable for shelving in the Library and
credit is to be awarded for the Project.
__________________________, Department Chair ______________________
Susan Heredia, Ph.D.
Date
Graduate and Professional Studies in Education
iii
Abstract
of
SEXUALITY EDUCATION STRATEGIES FOR CAREGIVERS OF STUDENTS
WITH INTELLECTUAL DISABILITY
by
Pa Her Dipad
Doua Her
The authors collaborated and shared equal responsibility in all aspects of the
development of this project, which identifies how caregivers of students with an
intellectual disability (ID) can utilize evidence-based strategies when teaching sexuality
education. Students with ID have been historically believed to be asexual beings and did
not benefit from sexuality education; however, they are sexual beings, who will
experience sexuality development. This project aims to provide caregivers with a better
understanding of sexuality and the need to educate students with ID about their changing
bodies, emotions, and behaviors. Furthermore, this project is to develop a training
workshop about sexuality education and provide evidence-based strategies which
caregivers can use when teaching students with ID.
__________________________________, Committee Chair
Catherine Christo, Ph.D.
_____________________________
Date
iv
ACKNOWLEDGMENTS
We would like to acknowledge the kind help and encourage of our advisor, Catherine
Christo. We also give thanks to our professors, Stephen E. Brock and Melissa Holland.
Pa Her Dipad would like to thank her family and friends for their endless support. Most
importantly, she would like to thank her loving husband whose patience, optimism, and
support made it possible for her to continuously pursue her passions.
Doua Her would like to thank his parents for their undying love and encouragement in
addition to their evolving definition of what a school psychologist is. He would also like
to give gratitude to his seven siblings for their corrective criticisms and support through
thick and thin. Furthermore, he is grateful for his two nephews and three nieces for their
smiles, laughter, and humor. Lastly, he would like to express his dearest appreciation for
his grandparents, who not only taught him but modeled hard work, perseverance,
humility, and most importantly, the value of family and culture.
v
TABLE OF CONTENTS
Page
Acknowledgments…………………………………………………………………... v
Software Specifications……………………………………………………………... viii
Chapter
1. INTRODUCTION............................................................................................... 1
Background of the Problem........................................................................... 1
Purpose of the Project.................................................................................... 1
Definitions of Terms...................................................................................... 2
Limitations..................................................................................................... 3
Statement of Collaboration...........................................................................
4
2. LITEARTURE REVIEW.................................................................................... 5
Definition of Intellectual Disability............................................................... 6
Sexuality Development.................................................................................. 8
Sexuality Education....................................................................................... 12
Evidenced Based Strategies........................................................................... 17
Concluding Comments..................................................................................
21
3. METHODOLOGY.............................................................................................. 23
Research......................................................................................................... 23
Development of this Training Workshop...................................................... 24
4. RESULTS AND DISCUSSION.......................................................................... 25
vi
Workshop Objectives..................................................................................... 25
Discussion...................................................................................................... 26
Recommendations.......................................................................................... 26
Conclusion...................................................................................................... 27
Appendix A. Presenter’s Manual................................................................................ 28
Appendix B. Presentation Slides................................................................................ 34
Appendix C. Workshop Handouts............................................................................. 127
Comprehensive Sexuality Education Checklist.............................................. 128
Comprehensive Sexuality Education Curriculum Checklist........................... 129
Hints That Can Help You Talk with Your Child about Sex........................... 130
Guidelines for Parents for Talking about Sexuality........................................ 131
Glossary of Sexuality Terms........................................................................... 132
How to Review a Book for the Use with Bibliotherapy.................................. 143
ABC Chart....................................................................................................... 144
How to Write Your Own Social Stories.......................................................... 145
References................................................................................................................... 146
vii
SOFTWARE SPECIFICATIONS
The project appendix includes presentation note pages designed for utilization
with slides in a workshop presentation. Slides should be viewed using Microsoft ®
Power Point Software.
viii
1
Chapter 1
INTRODUCTION
Background of the Problem
Sexual development is a natural part of the human life cycle. It is an inescapable
fact for all individuals, regardless of their intellect. Teaching individuals about the
complexity of their sexual development and sexuality may be a challenging task for any
caregiver, that being a parent, guardian, and/or teacher. There are curricula, books, and
programs to help adolescents understand their changing bodies, emotions, and behaviors.
However, the same curricula, books, and programs may not be easily understood by the
student with an intellectual disability (ID) given their limited cognitive functioning. The
historical view of the sexually developing individual with ID has been primary negative
(DeMyer, 1979; Greenspan, 2002). The lack of sexuality education may increase an
individual’s risk of being sexually abused. Therefore, it is crucial that caregivers
understand the need for students with ID to be educated about their sexual development
and sexuality.
Purpose of the Project
This project aims to provide caregivers with a better understanding of sexuality
and the need to educate students with ID about their changing bodies, emotions, and
behaviors. The primary purpose of this project is to develop a training workshop about
sexuality education and provide evidence-based strategies which caregivers can use when
teaching students with ID.
2
Information in this project has been developed into two 90-minute training
workshops intended for caregivers of students with ID. The first session will introduce
participants to current research regarding sexuality development, sexuality education, and
evidence-based strategies. The second session will review the developmental stages of
students with ID, Comprehensive Sexuality Education, available curricula, and allow
participants to apply the evidence-based strategies learned to activities and vignettes. In
addition, a provided presenter’s manual and PowerPoint with presenter’s notes will allow
this training workshop to be delivered by any trained school psychologist or professional.
It is hoped that readers of this project or participants in this training workshop will obtain
the knowledge necessary to teach students with ID to understand their sexuality.
Definition of Terms
Abstinence-Only Sexuality Education (AO): Sexuality education that teaches students to
abstain from sex as the sole method of avoiding pregnancy and sexually transmitted
infections.
Age-appropriate: Information is suitable to a particular ages or age groups of children
and adolescents, and is based on their developing cognitive, emotional, and behavioral
capacity typical for the age or age group.
Applied Behavior Analysis (ABA): Examines behavior through a scientific approach and
relies on objectively defined observable behaviors.
Bibliotherapy: The use of books to address feelings and help solve problems (Forgan,
2002; Sridhar & Vaugh, 2000).
Caregiver: Parent, guardian, and/or teacher.
3
Cognitive Behavioral Therapy (CBT): Psychotherapeutic treatment that helps individuals
understands the thoughts and feelings that influence behaviors and emphasizes the role of
thinking in how they feel and what they do.
Comprehensive Sexuality Education (CSE): Sexuality education program that includes
medically accurate information on a broad set of topics related to sexuality including
human development, relationships, decision-making, abstinence, contraception, and
disease prevention that occurs throughout the life cycle (SIECUS, 2012).
Intellectual Disability (ID): Characterized as having significant limitations both in
intellectual functioning and in adaptive behavior as expressed in conceptual, social, and
practical adaptive skills; this disability originates before age 18 (AAIDD, 2010).
Sexuality: Consists of sexual knowledge, beliefs, attitudes, values, and behaviors of the
individual. It also deals with the anatomy, physiology, and biochemistry of the sexual
response systems; with roles, identity, and personality; and, with individual thoughts,
feelings, behaviors, and relationships (SIECUS, 2013).
Social Story: A short story with specific characteristics that describes a situation, concept,
or skill using a format that is idiosyncratic to the individual (Gray, 2000).
Limitations
This project has been designed to give caregivers a better understanding of the
need for sexuality education for students with ID, and the available resources and
strategies to address sexuality. The strategies and resources are recommendations of how
to teach sexuality education and should not be viewed as the only approaches to teaching
students with ID. In addition, when examples are given on how sexuality education
4
strategies might be used for a specific situation, not all situations could be addressed.
Furthermore, the authors were not able to review all sexuality education curricula and/or
programs. This project is an informational guide that provides recommendations as to
what should be included in a comprehensive sexuality education for students with ID.
Statement of Collaboration
This project was developed collaboratively by Pa Her Dipad and Doua Her, both
graduate students in the School Psychology program at California State University,
Sacramento. Each co-author had equal responsibility in the research, collection and
compilation of the project. All duties performed in the development of this project and
training workshop were shared equally.
5
Chapter 2
LITERATURE REVIEW
Until recently, society viewed individuals with intellectual disability (ID) as
unaware of their sexuality, as asexual, and uninterested in intimacy. In addition, these
individuals only sought out intimate relationships as a means to satisfy their sexual needs
(DeMyer, 1979; Greenspan, 2002). This population is viewed as being unaffected by
issues of intimate relationships and human sexuality. However, recent literature
(Hellemans, Roeyers, Leplae, Dewaele, & Deboutte, 2010; Rays, Marks, & BrayGarretson, 2004; Stokes & Kaur, 2005) indicates that this stereotype is inaccurate. In
fact, most students with ID do engage in sexual behaviors and desire meaningful intimate
relationships. These students are similar to their developing peers, undergoing normal
physical development including the emergence of secondary sexual characteristics during
puberty. The primary difference is the increased sexual urges and unbalanced emotions
that accompany puberty, as it may either be delayed or prolonged (Eaves & Ho, 1996;
Kijak, 2011). Equally important, a substantial proportion of these students experience
increased behavioral problems during adolescence (Eaves & Ho, 1996). The challenge
arises when inappropriate sexual behaviors are displayed at school and/or other public
settings.
Students with ID are often viewed as not benefiting from an educational course on
sexuality development because of their social and intellectual impairments (Tarnai &
Wolfe, 2008). A lack of sexuality education programs designed specifically to target this
special population of students greatly limits them from accessing the same information as
6
their nondisabled peers. Often, the default mode for educating an individual with ID
about their sexuality is the responsibility of the parent (Goldman, 2008; Sullivan &
Caterino, 2008). Goldman (2008) argued that parental led sexuality education often
inhibits or censors certain topics and lacks knowledge about preventive strategies. Due to
the lack of sexuality programs and resources that are available for students with ID and
their caregivers, this project will introduce evidence-based strategies for teaching
sexuality education.
Definition of Intellectual Disability
Historically, there have been many different descriptions of individuals with ID.
According to the American Association on Intellectual and Developmental Disabilities
(AAIDD), there was the social approach where an individual was identified as ID on the
basis of observable traits such as the failure to adapt socially within the environment.
The emergence of intelligence and mental testing in the early 1900s changed the
definition, emphasizing an individual’s functioning as reflected by their intelligence
quotient (IQ) score (AAIDD, 2010). In 1959, the American Association of Mental
Deficiency (AAMD) used the term mental retardation (MR) to describe this special
population of individuals. Mental retardation was defined as having subaverage general
intellectual functioning that originates during the developmental period and is associated
with impairments in one or more of the following: (a) maturation, (b) learning, and (c)
social adjustments. In 1961, the AAMD use the term adaptive behavior to take place of
maturation, learning, and social adjustment. In 1992, the definition of MR was defined as
substantial limitations in present functioning, characterized by significantly subaverage
7
intellectual functioning, existing concurrently with related limitations in two or more of
the following applicable adaptive skill areas: communication, self-care, home living,
social skills, community use, self-direction, health and safety, functional academics,
leisure, and work. Mental retardation must also manifest before age 18. In 2002, the
definition of MR was once again expanded. Mental retardation was defined as a
disability characterized by significant limitations in both intellectual functioning and
adaptive behaviors that are expressed in conceptual, social, and practical adaptive skills
(AAIDD, 2010). In recent handbooks published by AAIDD, the term MR has now been
changed to intellectual disability or ID. The new definition is characterized as
“significant limitations both in intellectual functioning and in adaptive behavior as
expressed in conceptual, social, and practical adaptive skills; this disability originates
before age 18 (AAIDD, 2010, p.5).”
In addition, when using the ID definition, AAIDD suggest that one must be
cognizant of five essential assumptions: “(a) limitations in present functioning must be
considered within the context of community environments typical of the individual’s age
peers and culture, (b) valid assessment considers cultural and linguistic diversity as well
as differences in communication, sensory, motor, and behavioral factors, (c) within an
individual, limitations often coexist with strengths, (d) an important purpose of
describing limitations is to develop a profile of needed supports, and (e) with appropriate
personalized supports over a sustained period, the life functioning of the person with
intellectual disability generally will improve (AAIDD, 2010, p.1).” When identifying
and developing strategies for this population, it is vital to consider these elements.
8
Sexuality Development
“The natural course of human development suggests that children will assume
responsibility for their own lives, including their bodies (National Information Center for
Children and Youth with Disabilities (NICCYD), 1992, p. 2).” This is an inescapable
fact for all parents and caregivers. Although their chronological age may differ
significantly from their developmental age, individuals with ID will progress through and
experience the stages of human development. “Parents and caregivers teach children the
fundamentals of life: the meaning of love, human contact and interaction, friendship, fear,
anger, laughter, kindness, self-assertiveness, and so on (NICCYD, 1992, p. 2).”
According to the National Guidelines Task Force for the Sexuality Information and
Education Council of the United States (SIECUS) (2012), sexuality consists of sexual
knowledge, beliefs, attitudes, values, and behaviors of the individual. It also deals with
the anatomy, physiology, and biochemistry of the sexual response systems; with roles,
identity, and personality; and, with individual thoughts, feelings, behaviors, and
relationships. In addition, sexuality is also a natural part of being human. Although
individuals with ID undergo sexuality development, society’s views and treatment of
these individuals have not always been positive.
Views about Sexuality
Society’s historical views of individuals with ID and their sexuality have
primarily been negative. The most evident example was during the Eugenics movement
in the early 1900s in the United States (DeMyers, 1979; Greenspan, 2002). This
movement focused on the forced and often uninformed or non-consensual sterilization of
9
individuals with ID. It was not until the mid-1980s that society began to accept
individuals with ID and examine views about forced sterilization (Gougen, 2009;
Greenspan, 2002). Although sterilization is no longer commonly practiced in the United
States, it is still a common practice in developing countries around the world. In some
developing countries, women with ID are required to take birth control as a means of
protecting them from unwanted pregnancies. Proponents argued that by using
contraceptives, women with ID are more able to explore their “sexual freedom” (Gougen,
2009; Greenspan, 2002). However, Gougen (2009) argues that statistics have shown that
birth control can be counter intuitive at promoting sexual freedom for women with ID.
His reasoning was that by preventing pregnancy, it also hides signs of sexual abuse such
as non-consensual sex or rape. Thus women with ID may be at greater risk of sexual
abuse. The lack of understanding of the individual with ID’s sexual development may be
the cause of their unjust treatment throughout history.
Development of Sexuality
Adolescence is often a difficult developmental stage for all individuals as it
transitions an individual from childhood to adulthood. During adolescence, preteens and
teens go through a period of heightened behaviors and emotions. In addition, subtle
changes in the body and mind reduce an individual’s regulatory capabilities (Eaves & Ho,
1996; Kijak, 2011). According to Dorn and Biro (2011), puberty is a process that results
from a complex series of coordinated hormonal changes leading to internal and external
physical changes in an individual’s sex and behaviors. During this process, hormones
stimulate the increase in size and structure of the breasts and uterine tissue in females,
10
and testes and phallus in males. In the vast majority of girls, breast development is
thought to be the first visible indicator of sexual development followed by the appearance
of pubic hair. In boys, the increase in testicular volume is generally first. Puberty
typically occurs between ages 8.5 and 13 for girls and between 9 and 14 for boys
(Meschke, Peter, & Bartholomae, 2012). Puberty is a process that all developing
individuals undergo, including students with ID.
Kijak (2011) indicated that although students with ID may experience delays in
their development, they are sexual beings who will experience puberty. The process of
puberty among individuals with ID usually starts later than their nondisabled peers. The
average age of first menstruation for females with ID occurs at the age of 14, as opposed
to an onset between 8.5 and 13 years of age among non-disabled peers (Kijak, 2011;
Murphy & Elias, 2006). Among males with ID, the first nocturnal emission or “wet
dreams” experience occurs at age 15, as opposed to an onset between 9 and 14 years of
age among typically developing peers (Kijak, 2011; Murphy & Elias, 2006). The
development of sexual features such as pubic hair, genitals, and breast is similar when
compared to the typically developing adolescent. Kijak stated that people with a medium
degree of disability are not a homogenous group and the occurrence of the first
menstruation or nocturnal emission may take place even three years later than among the
typically developing individual. Students with ID notice these physical changes within
their bodies; however, these changes are not understood and often are not explained.
Therefore, it is crucial to prepare students with ID to understand the physical, emotional,
11
and behavioral changes that are connected with their sexuality development. This further
suggests the need for sexuality education for the ID population.
Sexual Abuse
The lack of adequate sexuality education may contribute to the growing
population of individuals with ID who are sexually abused. These individuals lack the
understanding of how to appropriately engage in sexual behaviors and recognizing or
reporting sexual abuse. Graham (1996) defined sexual abuse as a multitude of behaviors
including: (a) forced sexual contact of any kind, (b) sexual contact with a person who is
unable to give consent by virtue of age, immaturity, or intellect; (c) the victim may be
forced, bribed, or coerced into sexual contact; (d) when age-appropriate sexual
exploration or experimentation is replaced by dynamics of fear, secrecy, confusion,
intimidation and/or domination; and (e) preoccupation with sexual issues. The California
Child Abuse Training and Technical Assistance Centers (CATTA) (2012) expands acts
of sexual abuse to include sexually explicit photography, filming, showing of or forced
participation in pornographic acts, prostitution, and sexual slavery.
There are several factors that put students with ID at risk for sexual abuse.
Students with ID are more likely to be sexually abused when compared to their
nondisabled peers because they are often separated from their families and
accommodated in settings where they encounter multiple caregivers throughout the day
(Brown, 2010). The students are also targeted by caregivers due to their visible
differences and/or vulnerability. Mandell, Wallarth, Manteuffel, Sergo, & Pinto-Martin
(2005) found that social and communication impairments and the lack of exposure to
12
appropriate peer interactions often lead to misinterpreting social cues and sexual
behaviors of their predators. Therefore, they may not be aware of when a sexual
encounter is abuse.
The long term effects of sexual abuse include: fear, anxiety, depression, hostility,
poor self-esteem, and a tendency towards substance abuse. These students are more
likely to engage in inappropriate sexual behaviors, self-injurious or suicidal behaviors,
and running away. They are also more likely to be hospitalized in psychiatric institutions
(Brown, 2010; Mandell et al., 2005). Often times, these students’ experiences may
manifest in sexual fixations and obsessions resulting in stalking, frottage (“dry
humping”), fondling, paraphilias, compulsive masturbation, and sexual assault (Rays, et
al., 2004). Prevention strategies such as sexuality education may decrease the
occurrences of inappropriate sexual behaviors.
Sexuality Education
Although there are various sexuality education programs, curricula, and resources
that are available, it is dependent on the local education agencies to decide which
program is most appropriate. In addition, there have been numerous sex education
legislations at the State and National level that involved the requirement of sexuality
education for all students. However, the numerous attempts have failed, were vetoed, or
are currently pending (National Conference of State Legislatures, 2012). Another
controversy over sexuality education in schools is whether or not the programs address
all necessary areas of sexuality development, what programs should be adopted, and the
13
appropriateness of the program for its intended audiences (Goldman, 2008; Haracopos &
Penderson, 1992; Stanger-Hall & Hall, 2011; Swango-Wilson, 2010).
Current Trends
The two pre-eminent approaches that dominate the educational politics on
sexuality education in the United States are Abstinence-Only Sexuality Education (AO)
and Comprehensive Sexuality Education (CSE) programs (Lesko, 2010). An AO teaches
students to abstain from sex as the sole method of avoiding pregnancy and sexually
transmitted infections (SIECUS, 2012). CSE includes medically accurate information on
a broad set of topics related to sexuality including human development, relationships,
decision-making, abstinence, contraception, and disease prevention that occurs
throughout the life cycle (SIECUS, 2012).
As of August 2011, 33 States across the nation mandate HIV education in their
schools; however, only 20 States mandate a sexuality education curriculum to be
implemented (Stanger-Hall & Hall, 2011). Using the 2005 national data from States with
information on sexuality education laws and/or policies, Stanger-Hall and Hall found that
the increasing emphasis on AO programs is positively correlated with teen pregnancy and
birth rates. Abstinence-Only Sexuality Education programs are ineffective in preventing
teenage pregnancy and may actually be contributing to high teenage pregnancy rates in
the United States. On the other hand, States which taught CSE programs that cover
abstinence along with contraception and condom use tend to have the lowest teen
pregnancy rates.
14
Opponents of AO programs such as the SIECUS, criticize AO programs for
overemphasizing negative messages including fear and shame. Abstinence-Only
Sexuality Education programs also withhold and distort information on puberty, anatomy,
human reproduction, sexual orientation, and gender identity. Lastly, it offers exclusively
religious Anglo-Saxon views on sex and abortion (Lesko, 2010). These religious views
generally cast human sexuality in a negative light and students are subjected to a strict
legal, social, and moral control. In addition, contraception, safe sex practices,
masturbation, homosexuality, and pre-marital sexual relations are generally disapproved
(Levesque, 2000). The SIECUS advocates for using a CSE because it incorporates the
medically accurate and age-appropriate information on sexually transmitted infections
and contraception, and it also empowers the students about their sexuality (Lesko, 2010).
Content Areas for Sexuality Education
It is necessary for caregivers and other professionals to provide appropriate
learning opportunities and training to help students with ID to increase their functionality.
When developing sexuality education programs, it is important that the following be
considered: (a) the lack of understating about sexuality, both by the individual and
caregivers of the individual, (b) the lack of adequate education in sexual mores which
frequently result in incidents of sexual abuse, and (c) the rate of sexual abuse and assault
perpetrated against this population (Swango-Wilson, 2010). Therefore, a quality
sexuality education, or CSE, should encompass a range of components including: (a)
sexual, biological, and reproductive health, (b) self-management and safety, (c)
interpersonal relationships, (d) sexual identity, (e) communication and negotiation skills,
15
(f) body image and self-esteem, (g) decision-making, and (h) moral/ethical values
(Goldman, 2008; Haracopos & Pederson, 1992; SIECUS, 2013; Stanger-Hall & Hall,
2011). Although these are specific components that have been identified as elements of a
quality sexuality education program, they may not be addressed in commercially
available curricula.
Available Curricula and Programs
There are commercially available sexuality education curricula for students with
ID; however, choices are limited. These curricula include a comprehensive approach that
provides guidelines similar to those of the SIECUS. Leslie Walker-Hirsch and Marklyn
P. Campagne developed The Circles Program in the late 1980s to teach intellectually
impaired adolescents and adults appropriate social/sexual behaviors. Over the years,
additional topics have been added to address the various sexuality needs of individuals
with intellectual impairments. The program consists of four curricula that address
sexuality health and development. Circles I: Level 1, Intimacy and Relationships teaches
social distance and how it can change over time. Circles II: Level 2, Intimacy and
Relationships teaches students to apply what they have learned in Level 1 to contrived
scenarios. Circles: Stop Abuse explores safety issues and self-protection. Lastly,
Circles: Safer Ways teaches individuals about sexually transmitted infections,
HIV/AIDS, and preventative strategies (Stanfield, 2013; Stepping Stones, 2012).
David Hingsburger developed an explicit, easy-to-understand videotape and print
guide on both female and male masturbation entitled Finger Tips for females and Hand
Made Love for males. Finger Tips discusses the myths about sexuality and provides a
16
photographic essay about masturbation with an emphasis on privacy. Hand Made Love
discusses the myths associated with masturbation and explores masturbation as a means
of health and pleasure (Stepping Stones, 2012).
The Learn About Life Curriculum is a sexuality education and social skills
program that emphasizes the developing body, being a woman, being a man, pregnancy,
relationships, and safety. This program includes candid graphics and simple text to aid
better understanding of sexual issues (Stepping Stones, 2012).
Lastly, The Life Horizons I and II curriculum is a CSE program developed by
Winifred Kempton for individuals with developmental disabilities. It teaches individuals
about the physiological and social aspects of human sexuality. The Life Horizons I: The
Physiological and Emotional Aspects of Being Male and Female explore parts of the
body, the life cycle, human reproduction, birth control or regulation of fertility, and
sexual transmitted illnesses. The Life Horizons II: The Moral, Social and Legal Aspects
of Intimate Relationships focuses on attitudes and behaviors that promote good
relationships and responsible behaviors (Stanfield, 2012; Kempton, 1999).
Although these curricula and programs provide students with ID an opportunity to
participate in learning about their sexuality, they may also be overly technical. This
approach may be ineffective because it fails to be meaningful to the students as it does
not consider relational experiences such as emotions and the student’s strengths
(Boehning, 2006; Gordon & Ellingson, 2006). According to Gougen (2009), sexuality
education for individuals with ID in its current form, promotes sexual incompetence as it
fails to address all components of sexuality. In addition, these commercially available
17
curricula may not be the most effective sexuality programs as it does not promote
generalization of taught skills.
Evidence Based Strategies
There are several evidence-based strategies that caregivers can use in conjunction
with a CSE curriculum to teach sexuality development and to generalize learned skills.
Evidenced-based strategies that have shown to be effective when working with
individuals with disabilities include: social stories, bibliotherapy, counseling, and
behavior training.
Social Stories
Lack of social skills for students with ID can be particularly significant in the
areas of intimate relationships and sexuality. Typically, sexuality education lacks
components that address the unique social skills needed by students with ID. Recently
there has been a push for the use of social stories to teach students who have limited
intellectual and/or social abilities (Tarnai & Wolfe, 2008). Social stories are short stories
with specific characteristics that describe a situation, concept, or skill using a format that
is idiosyncratic to the student. The goal of a social story is to provide the student with
practical and tangible social information. Social stories also elicit cues or prompt that
calls for appropriate social responses (Gray, 2000; Tarnai & Wolfe, 2008). Furthermore,
each story is designed to teach the student how to manage their own behavior during a
given social situation by describing (a) where the activity will take place, (b) when it will
occur, (c) what will happen, (d) who is participating, and (e) why the student should
behave in the appropriate behavior (Gray, 2000; Tarnai & Wolfe, 2008). For example,
18
“My name is Amanda. I am 13. My body is growing and changing. My mom knows
about growing up. Sometimes, girls get breasts when they are 13. Soon I will have
breasts too….” (Gray, 2000; Wolfe, Condo, & Hardaway, 2009 p. 55).
According to Barry and Burlew (2004), social stories are not only useful because
of their versatility to teach a variety of topics, but because they also make use of
evidence-based practices. For example, teachers who implement social stories to teach
appropriate behaviors often times incorporate the following evidenced-based practices:
explicit teaching, demonstrations, instructions, and extensive active practice with
feedback; opportunities to learn/practice; organizing questions for review; independently
useable/accessible strategies; and plan of action.
Counseling
Students with ID may also benefit from mental health counseling to address the
challenges of sexuality development through prevention and intervention. Cognitive
Behavioral Therapy (CBT) is a type of psychotherapeutic treatment that helps individuals
understand the thoughts and feelings that influence behaviors and emphasizes the role of
thinking in how they feel and what they do. Taylor, Lindsay, and Wilner (2008)
discusses the historical exclusion of individuals with ID from receiving and participating
in CBT. However, there is emerging evidence suggesting that individuals with mild ID
have the ability to engage in and benefit from CBT. Individuals with mild ID have the
skills necessary for CBT’s cognitive components such as: the ability to identify
cognitions that are associated with their emotions and behaviors, identify and
differentiate emotions, and recognize the role of cognition in mediating emotion. CBT
19
can be modified in practice for students with varying cognitive abilities. The
effectiveness of CBT within the ID population is not whether the student is capable of
participating; rather it is the skilled practitioner’s competence in working with student
with ID.
Peckham, Corbett, Howlett, McKee, and Pattison (2007) examined the
effectiveness of group counseling for intellectually disabled female survivors of sexual
abuse and their caregivers. The CBT counseling approach utilized patience, repetition,
videos, dolls, and drawings to discuss sexual interactions. The researchers concluded that
the female participants were successful in improving their sexual knowledge, and
reducing trauma and depression. Despite these findings, there continues to be a need for
more comprehensive sexuality education groups for males and females with ID.
Behavior Training
Caregivers of students with ID can teach social appropriate sexual behaviors and
promote generalization of learned skills through behavior skills training. In a study by
Miltenberger et al. (1999), the researchers implemented behavioral skills training that
focused on sexual abuse intervention for five females with mild to moderate ID. After 10
sessions of behavioral skills training and situational practices, the participants had
acquired the skills; however, they could not generalize them outside of the artificial
setting. According to Alberto and Troutman (2006), one strategy to generalize skills is to
use principles of applied behavior analysis (ABA). In its simplest form, ABA examines
behavior through a scientific approach and relies on objectively defined observable
behaviors. Basic principles often used are modeling, prompts, and cues. They may
20
involve: teaching skills/behaviors; chaining or sequencing steps; and the fading of
prompts/cues once the individual has acquired the skills/behavior. For example,
caregivers can decrease the frequency of certain sexual behaviors such as inappropriate
public fondling or masturbation through a task analysis or shaping. When conducting a
task analysis, it is important that caregivers understand the function of the student’s
behavior and what the behavior is trying to obtain (Alberto & Troutman, 2006). Once the
function of the behavior is identified, the socially appropriate behavior that serves the
same function is broken down into smaller component parts (Wolfe, Condo, &
Hardaway, 2009). The individual is slowly taught successive steps until they are able to
perform the socially appropriate behavior. With inappropriate touching at school, key
steps can include the student verbally asking or gesturing to be excused to use the
bathroom when he/she needs sexual gratification and then engaging in proper hygiene
afterwards. Task analysis can also be used to teach personal hygiene such as using a
condom and changing a menstrual pad (Wolfe, Condo, & Hardaway). As with any
behavioral strategy being considered, caregivers should be involved in the planning and
implementation of all phases of the process.
Bibliotherapy
The use of books to address feelings may assist caregivers in educating students
with ID about sexuality and generalizing learned skills. Bibliotherapy is the use of books
to help solve problems. It is also helpful for students who are experiencing difficulties or
may encounter problems similar to those discussed in the literature (Forgan, 2002;
Sridhar & Vaugh, 2000). Bibliotherapy demonstrates to the student that he or she is not
21
the only person to encounter such a problem. It may also help the student to develop a
positive self-concept (Sridhar & Vaugh). Additionally, to promote learning from books,
caregivers may instruct social skills within the natural setting by using real-life examples
and incidental learning, such as the “teachable moment”, and to capitalize on naturally
occurring events (Gresham, Sugai, & Horner, 2001).
Similar to sexuality education, there is a lack of books that are specifically written
for students with ID. Therefore, it is important that caregivers be selective and adopt
books that match their student’s present level of functioning (Forgan, 2002). Books that
can help caregivers introduce puberty include: The What’s Happening to My Body? series
for boys and girls by Linda and Area Madaras (2007 & 2009), What’s Happening to Me?
A Guide to Puberty (by Peter Mayle (1975), and The Playbook for Kids About Sex by
Joani Blank (1981). For books aimed at introducing sex, caregivers may consider, What
Your Child Needs to Know About Sex (And When) by Dr. Fred Kaeser (2011) and Great
Answers to Difficult Questions about Sex by Linda Goldman (2010). Books that address
adolescent’s sexual feelings are: Forever by Judy Blume (2007), Someone To Love Me by
Jeanette Eyerly (1987); Breaktime by Aidan Chambers (2008) and Teen Angel and other
stories of young love by Marianne Gingher (1989).
Concluding Comments
Students with ID have the same rights to sexual experiences as the rest of society.
In addition, there are many changes occurring during adolescence that students with ID
may not be aware of. It is recommended that caregivers be equipped to provide students
with information about sexual, biological, and reproductive health; self-management and
22
safety; interpersonal relationships; sexual identity; communication and negotiation skills;
body image and self-esteem; decision-making; and moral/ethical values (Goldman, 2008;
Haracopos & Pederson, 1992; SIECUS, 2013; Stanger-Hall & Hall, 2011). Students with
ID need to be educated about their sexuality to ensure a healthy and safe transition into
adulthood. Therefore, the purpose of this project is to provide caregivers with
developmentally appropriate and evidence-based strategies to address sexuality in
students with ID.
23
Chapter 3
METHODOLOGY
Research
Several techniques were utilized in researching this project and also in developing
this training workshop. The Academic Search Premier and Education Resource
Information Center (ERIC) databases were the two primary search engines for peer
reviewed journal articles. Key words that were used for the search include “sexuality
education” and “intellectual disability.” These two key words were used in conjunction
with terms including: students, curriculum, historical, and abuse. Furthermore, specific
behavioral techniques and therapeutic interventions were searched within the database,
including: applied behavior analysis, social story, cognitive behavioral therapy, and
bibliotherapy. The articles found were categorized by themes and topics according to an
initial outline considered by the authors. This outline served as the basis of the literature
review and content area for this training workshop.
Websites such as the American Association on Intellectual and Developmental
Disabilities (AAIDD) and Sexuality Information and Education Council of the United
States (SIECUS) were also used as additional resources. Commercially available
sexuality education curricula and books focused on sexuality and sexual development
including puberty were used to supplement specific areas within the literature review.
Life Horizon I by Winifred Kempton (1999) and The Circles Project by Lesile WalkerHirsch and Marklyn P. Champagne (1991) were the sexuality education curricula that the
authors reviewed. Books that were used include the Playbook for Kids about Sex (Joani
24
Blank, 1981), What Your Child Needs to Know about Sex (And When) (Fred Kaeser,
2011), Great Answers to Difficult Questions about Sex (Linda Goldman, 2010), and the
What’s Happening to My Body? series (Linda and Area Madaras, 2007 & 2009). These
same books were also evaluated in terms of their appropriateness for use in bibliotherapy.
Development of this Training Workshop
This training workshop is intended for caregivers of students with an intellectual
disability (ID) to foster the need for a comprehensive sexuality education and evidencebased strategies on how to teach sexuality. This training workshop is designed to be
given in two 90-minute sessions with a combination of direct instruction and interactive
activities. The first session of this training workshop will introduce current research
regarding sexuality development, sexuality education, and evidence-based strategies.
The primary objective will focus on the need for a comprehensive sexuality education for
students with ID and how evidence-based strategies can be used to facilitate teaching and
generalize skills. The second session of this training workshop includes activities to
further develop the caregivers’ understanding of the discussed strategies and provide the
opportunity to practice. Furthermore, this training is presented in parent friendly
language so that it can be delivered by any trained school psychologist or professional.
The PowerPoint presentation and notes for presenters are located on the enclosed CD and
in the Appendix.
25
Chapter 4
RESULTS AND DISCUSSION
The information obtained during the literature review was used to create a training
workshop for caregivers of students with an intellectual disability (ID). This training
workshop consists of two 90-minute sessions. The first session will introduce current
research regarding sexuality development, sexuality education, and evidence-based
strategies. The second session will further discuss the specific strategies that can be used
to teach students with ID about their sexuality and practice these strategies through
interactive activities. The materials contained in this research project (i.e., the presenter’s
manual, PowerPoint slides with presentation notes, and handouts) are included in the
appendices. This research project is designed to be straight-forward and manageable for
any trained school psychologist or professional to act as a presenter.
Workshop Objectives
The goal of this training workshop is to provide caregivers with the knowledge
and skills to effectively support their student with ID’s sexuality development. It is
hoped that this training workshop helps caregivers identify the need for a Comprehensive
Sexuality Education, and evidence-based strategies that they can utilize when teaching
their student with ID about their sexuality. The training workshop presentation includes
parent friendly language and requires audience participation. Visual aids and handouts
are also included to assist in the discussion of sexuality and sexuality education
strategies.
26
Discussion
Considering the limited research on sexuality education programs, curricula, and
resources for students with ID, it is understandable that some caregivers may have
difficulty identifying how best to address sexuality. The decision to address sexuality
education in schools is further complicated when the decision is dependent on local
education agencies. Although all students will undergo sexuality development, it is
difficult to accept that there is a significant lack of evidence-based procedures that
address sexuality development in students with ID. This workshop identifies evidencebased strategies that can be used to teach sexuality education. It is clear that there
remains a need for further research in this area of educating students with ID about their
sexuality and to also ensure their sexuality needs are addressed.
Recommendations
This project provides a convenient resource for caregivers interested in teaching
students with ID about their sexuality. It is important for the presenter to engage in
thoughtful preparation prior to facilitating this training workshop and understand the
content of this project. The presenter should be familiar with the strategies that were
identified in this workshop. Further collaboration with other professionals
knowledgeable about the strategies discussed is encouraged. It is also important for any
presenter to convey to the audience the potential individual circumstances and uniqueness
of each student with ID, such as how to teach the student about their sexuality given their
developmental-age, strengths, and abilities. Furthermore, the presenter may need to
adapt or modify the content of this training workshop to meet the diverse needs of the
27
target audiences, as all local education agencies differ. Finally, although the current
literature generally indicates that a Comprehensive Sexuality Education is most
appropriate, further empirically based research is needed to address how this can be
achieved.
Conclusion
Educating caregivers about a Comprehensive Sexuality Education for students
with ID and teaching students how to manage their sexual development is a vital life
skill. The lack of appropriate and ongoing sexuality education has been linked to
negative outcomes from the student with ID being the victim, to being the perpetrator of
sexual abuse. By way of this project, the authors hope to provide caregivers of students
with ID a better understanding of sexuality development and how to address it.
28
Appendix A
Presenter’s Manual
29
Sexuality Education Strategies for Caregivers
of Students with Intellectual Disability
Presenter’s Manual
Created by Pa Her Dipad and Doua Her
30
Introduction
Teaching students with an intellectual disability (ID) to understand their sexuality
development can be overwhelming for caregivers. Often times, parents, guardians,
teachers, and other prominent educators who care for students with ID do not have a full
understanding of what to teach their students, how to teach their students, and/or why it is
important to teach their student about sexuality. A competent understanding of the
importance of a Comprehensive Sexuality Education is important to ensuring their
overall well-being and the awareness of their changing body, emotions, and behaviors.
As all individuals, including students with ID will undergo sexuality development.
This manual and PowerPoint presentation is designed to provide caregivers with a
guideline and understanding of why it is important to educate students with ID about their
sexuality and to provide caregivers with sexuality education resources and evidencebased strategies. The information gathered is based on a literature review completed
between September 2012 and March 2013.
Nature of Presentation
This presentation has been created for caregivers of students with ID, which may
include parents, guardians, family members, educators, school psychologist, and other
staff members who work directly with students. They may find the information helpful
to understand their student’s sexuality development and how to teach sexuality.
The presentation is designed to last at least three hours and is divided into two 90minute training workshop sessions. Although the content of the presentation and
instructions for the presenter is available in the presenter’s notes, the presenter is
31
encouraged to use appropriate and engaging presentation techniques such as pausing for
questions, demonstrating active listening, and validating audience input throughout the
workshop. Prior to the workshop, the presenter will need to make copies of the
PowerPoint slides and handouts for each participant. The presenter must also be flexible
to listen to alternative perspectives of the local education agency or agencies where the
workshop may be taking place. This is important because each local education agency
may have varying perspectives and/or sexuality education policies.
In preparation for giving this workshop, the presenter should study the
presentation slides and accompanying notes thoroughly so they have a comprehensive
knowledge of the content. On the first PowerPoint slide, there is space where the
presenter may insert his/her name. It is imperative that the presenter be familiar with the
articles referenced at the end of the presentation as well as the corresponding handouts.
Guidance to Presenters
The presentation may be delivered by one or multiple presenters. A change in
presenters should occur at natural times: after breaks or when presenting a new section or
topic. All presenters should introduce themselves prior to starting the workshop.
Presenters may choses to divide the presentation into sections prior to starting the training
workshop sessions.
The training workshop presentation is presented as a series of Microsoft
PowerPoint slides. Each slide has all general information needed to discuss each slide.
The presenter’s notes are included and labeled as Sample Presentation Language, which
is provided in italics. The Sample Presentation Language is written as a script format to
32
aid the presenter’s fluidity when presenting. Also included on various slides are
Optional/Additional Discussion Topics which provide the presenter with an opportunity
to further the discussion topic, if necessary. The Optional/Additional Discussion Topics
are also provided in italics. Information placed in brackets indicates specific presenter
actions. However, the presenter may choose to use their own words when discussing the
slide topic. The second half of the training workshop consists of activities that are
embedded within the session. These activities provide participants the opportunity to
practice the discussed evidence-based strategies. Therefore, the presenter should be
familiar with each activity and possible outcomes.
A recommended timeline for the workshop presentation follows:
Slides
Topic
Duration
#1-4
Workshop 1: Introduction
10 minutes
#5-12
Students with ID
20 minutes
#13-26
Sexuality Education and Law
25 minutes
#27-36
Evidence-Based Strategies
25 minutes
#37
Questions
10 minutes
#38-39
Workshop 2: Introduction & Review
5 minutes
#40-42
Developmental Stage
5 minutes
#43-51
Comprehensive Sexuality Education
10 minutes
#52-56
Sexuality Curricula
10 minutes
#57-68
Evidence-Based Strategies and Vignettes
50 minutes
#67
Questions and Closing
10 minutes
33
About the Authors
Pa Her Dipad and Doua Her are both students in the School Psychology Graduate
Program at California State University, Sacramento. This training workshop was created
to satisfy requirements for their Education Specialist program. Pa Her Dipad and Doua
Her have their Masters in School Psychology from California State University,
Sacramento.
34
Appendix B
Presentation Slides
35
Slide 1
SEXUALITY EDUCATION STRATEGIES
FOR CAREGIVERS WORKING WITH
STUDENTS WITH AN INTELLECTUAL
DISABILITY
Presenter A
(If applicable, insert Presenter B)
[Presenter should insert his/her name on this slide. Presenter make introduction to
the audience and highlight his/her experiences working with students with an
intellectual disability].
Presentation Legend:
Sample Presentation Language – Writings in italicized is an example of a script the
presenter may choose to use.
[ ] – Commands are listed in brackets. Presenter follows the command.
Optional/Additional Discussion Topic – Discussion points or questions the presenter may
ask.
36
Slide 2
AGENDA
90 minutes
 Workshop 1 will focus on foundational
information.
 Workshop 2 will focus on the application.

Sample Presentation Language: This training will be divided into two workshops. Each
workshop will be 90 minutes in length. The first workshop will focus on foundational
information, which includes the background about students with an intellectual
disability, the laws about sexuality education, and current research on evidenced-based
strategies. The second workshop will focus in-depth about the discussed evidencedbased strategies and provide opportunities to apply those strategies.
37
Slide 3
WORKSHOP 1


90 minutes
Background of Students with an Intellectual
Disability


Sexuality Education



Definition
Laws
Available Curricula
Evidenced-Based Strategies




Cognitive Behavioral Therapy
Behavior Training
Social Stories
Bibliotherapy
Sample Presentation Language: This first workshop will be 90 minutes long and 10
minute breaks will be provided between each topic. The three topics that I/we will be
covering includes: the background of students with an intellectual disability. This topic
will cover the definition of what intellectual disability is, the students’ sexual
development, and why a sexuality education is important. The second topic will be on
sexuality education laws and curricula. Lastly, the third topic will focus on evidencedbased strategies and current research.
38
Slide 4
PURPOSE

Ways to teach sexuality education to students
with an intellectual disability using evidencedbased research strategies
Sample Presentation Language: The purpose of this training workshop is to introduce
evidenced-based strategies that caregivers can utilize when teaching sexuality education
to students with an intellectual disability.
39
Slide 5
1.
2.
3.
Students with an
Intellectual
Disability
Sexuality Education:
Law, Polices, and
Curricula
Evidence-Based
Strategies
Sample Presentation Language: [Show the slide]. The first topic that will be discussed
in this workshop is who are students with an intellectual disability.
40
Slide 6
INTELLECTUAL DISABILITY (ID)

Significant limitations both in intellectual
functioning and in adaptive behavior as
expressed in conceptual, social, and practical
adaptive skills; this disability originates before
age 18.
Source: (AAIDD, 2010).
Sample Presentation Language: According to the American Association on Intellectual
and Developmental Disabilities, an individual with intellectual disability is characterized
as having [read from the slide]. It is important to mention that mental retardation was
previously used to describe this special population.
Optional/Additional Discussion Topics: “Mental retardation" focused on a failure to
adapt socially to the environment. Later definitions added a medical approach that
considered heredity and pathology. It called for individuals with ID to be segregated.
The rise of the cognitive testing brought an emphasis on measuring intellectual
functioning by intelligence quotient (IQ) score. In its 1959 definition and classification
manual, AAIDD first attempted a dual-criterion approach: a definition that mentioned
both intellectual functioning and “impairments in maturation, learning, and social
adjustment.” In the 1961 manual, the “impairments” description was re-termed
“adaptive behavior,” a term still used today. The definition was refocused in 1992 to
reflect a new way of understanding and responding to the condition. AAIDD moved
away from a diagnostic process that identified deficits solely on the basis of an IQ score
and began considering social, environmental, and other elements as well. Most crucially,
the emphasis shifted from providing programs to individuals with ID to designing and
delivering support tailored to each individual to help them reach their highest level of
functioning. The third element of the definition involves age of onset. Early definitions
mentioned “the developmental period.” AAIDD’s 2002 definition clarified that the
disability originates "before the age of 18.”
41
Slide 7
FIVE ESSENTIALS WHEN WORKING WITH
INDIVIDUALS WITH ID





(1) Limitations in present functioning must be
considered within the context of community
environments typical of the individual’s age peers and
culture.
(2) Valid assessment considers cultural and linguistic
diversity as well as differences in communication,
sensory, motor, and behavioral factors.
(3) Within an individual, limitations often coexist
with strengths.
(4) An important purpose of describing limitations is
to develop a profile of needed supports.
(5) With appropriate personalized supports over a
sustained period, the life functioning of the person
with intellectual disability generally will improve.
Source: (AAIDD, 2010, p.1)
Sample Presentation Language: It is important that when working with students with
ID, one should be cognizant of these five essentials as outlined by AAIDD. [Read from
the slide]. These assumptions will help us as educators and caregivers to adopt a
growth mindset that these students can benefit from a course on sexuality education.
We need to be cognizant that students with ID have strengths which can be use to help
them understand sexuality education. Each student is different and will have different
needs that goes beyond what sexuality education can provide. And lastly, with support,
students with ID’s functioning can improve; the same can be said about sexuality
education or sexual development.
42
Slide 8
HISTORICAL VIEWS

Individuals with ID...
 Asexual and unaware of their sexuality
 Only seek out intimate relationships to satisfy
their sexual needs
 Unaffected by issues of intimate relationship
and human intimacy
 Do not benefit on sexuality education because
of their social and intellectual impairments
Source: (DeMyers, 1979; Tarnai & Wolfe, 2008).
Sample Presentation Language: Historically, individuals with ID have been viewed
negatively in all aspect of society. The common stereotype is that these individuals are
“child-like” in nature despite their growing and changing body or their older appearance.
These individuals are also unable to learn and would not benefit from education. These
same stereotypes also have shifted into how society viewed the sexual development of
individuals with ID. [Read from the slide]
Optional/Additional Discussion Topics:
1. In the early 1900’s, there was the Eugenics Movement that was based on the work of
influential American geneticist Charles B. Davenport. Davenport’s idea was to
“improve the race by inducing young people to make a more reasonable selection of
marriage mates; to fall in love intelligently.” It was common for forced and
uninformed sterilization of individuals that were considered “feeble-mindedness.”
During that time, IQ testing was one of the many techniques used to determine
“feeble-mindedness.”
2. In some developing countries, women with ID are required to use birth controls as a
way to prevent unwanted pregnancies. Proponents of these laws argue that
contraceptives allow women with ID to experience sexual freedom without the fear
of pregnancy.
43
Slide 9
TYPICAL BIOLOGICAL DEVELOPMENT
All individuals will undergo sexuality
development, including individuals with ID.
 During adolescence, preteens and teens go
through a period of heightened behaviors and
emotions.
 Breast development is thought to be the first
visible indicator of sexual development followed
by the appearance of pubic hair in females.
 The increase in testicular volume is the generally
first indicator of sexuality development in males.

Sample Presentation Language: “The natural course of human development suggests
that children will assume responsibility for their own lives, including their bodies
(National Information Center for Children and Youth with Disabilities (NICCYD), 1992, p.
2).” This is an inescapable fact for all parents and caregivers. [Read 1st bullet point].
Although their chronological age may differ significantly from their developmental age,
individuals with ID will progress through and experience the stages of human
development. “Parents and caregivers teach children the fundamentals of life: the
meaning of love, human contact and interaction, friendship, fear, anger, laughter,
kindness, self-assertiveness, and so on (NICCYD, 1992, p. 2).” [Read 2nd bullet point]. In
addition, subtle changes in the body and mind reduce an individual’s regulatory
capabilities (Eaves & Ho, 1996; Kijak, 2011). According to Dorn and Biro (2011), puberty
is a process that results from a complex series of coordinated hormonal changes leading
to internal and external physical changes in an individual’s sex and behaviors. [Read 3rd
and 4th bullet point]. Puberty occurs between ages 8.5 and 13 for girls and between 9
and 14 for boys (Meschke, Peter, & Bartholomae, 2012). Puberty is a process that all
developing individuals undergo, including individuals with ID.
44
Slide 10
ONSET OF SEXUALITY DEVELOPMENT
The average age of first menstruation for females
with ID occurs at the age of 14, as opposed to an
onset between 8.5 and 13 years of age among
typically developing peers.
 Among males with ID, the first nocturnal
emission or “wet dreams” experience occurs at
age 15, as opposed to an onset between 9 and 14
years of age among typically developing peers.

Source: (Kijak, 2011; Murphy & Elias, 2006).
Sample Presentation Language: Kijak (2011) indicated that, although students with ID
may experience delays in their development, they are sexual beings who will experience
puberty. The process of puberty among individuals with ID usually starts later than their
non-disabled peers. [Read from the slide]. The development of sexual features such as
pubic hair, genitals, and breast is similar when compared to the typically developing
adolescent. Kijak stated that people with a medium degree of disability are not a
homogenous group and the occurrence of the first menstruation and nocturnal emission
may take place even three years later than among the typically developing individual.
Individuals with ID notice these physical changes within their bodies; however, these
changes are not understood and often are not explained.
45
Slide 11
WHAT IS SEXUALITY?

Sexuality consists of




Sexual knowledge, beliefs, attitudes, values, and
behaviors of the individual
Anatomy, physiology, and biochemistry of the sexual
response systems
Roles, identity, and personality
Individual thoughts, feelings, behaviors, and
relationships
Sample Presentation Language: “Parents and caregivers teach children the
fundamentals of life: the meaning of love, human contact and interaction, friendship,
fear, anger, laughter, kindness, self-assertiveness, and so on (NICCYD, 1992, p. 2).”
According to the National Guidelines Task Force for the Sexuality Information and
Education Council of the United States (SIECUS) (2012), sexuality consists of sexual
knowledge, beliefs, attitudes, values, and behaviors of the individual. It also deals with
the anatomy, physiology, and biochemistry of the sexual response systems. Further, it
includes roles, identity, personality, individual thoughts, feelings, and relationships. In
addition, sexuality is also a natural part of being human and students should be made
aware of their changing body, emotions, and behaviors.
46
Slide 12
SEXUAL ABUSE
At-risk for being sexually abuse compared to non
disabled peers.
 Targeted because of their visible differences and
vulnerability.
 Misinterpreting social cues and sexual behaviors
of predators due to social and communication
impairment and lack of exposure to appropriate
peer interaction.
 Lack of sexuality education.

Source: (Brown, 2010; Mandell et al, 2005)
Sample Presentation Language: Compared to non-disabled peers, students with ID are
at a greater risk for being sexually abused. Statistics show that they are twice as likely to
be abused; however, the true rate may be higher or greater because it is underreported.
There are several factors that put students with ID at -risk for sexual abuse. Students
with ID are at-risk because of the increased likelihood that they are often separated from
their families and accommodated in settings where they encounter multiple caregivers
throughout the day. The students are also targeted on account of their visible
differences and/or vulnerability by caregivers. Because of social and communication
impairment and the lack of exposure to appropriate peer interactions, which are typical
of students with ID, they are likely to misinterpret social cues and sexual behaviors of
their predators. When sexual abuse occurs, the long term effects can include fear,
anxiety, depression, hostility, poor self-esteem, and even substance abuse. Students with
ID are more likely to engage in inappropriate sexual behaviors, self-injurious or suicidal
behavior, and running away (Brown, 2010). Their experiences can also manifest into
sexual fixations and obsessions resulting in compulsive masturbation, stalking, and
sexual assault (Rays et al, 2004). And often times, sexualized behaviors may be acted
out at school. The lack of adequate sexuality education may contribute to the growing
number of students with ID who cannot engaged appropriately in sexual behaviors, and
also recognizing or reporting sexual abuse. Therefore, it is crucial that students with ID
be taught about their sexuality throughout the life span. [Ask participants about their
reactions and experiences. Summarize the response(s)].
47
Slide 13
1.
2.
3.
Students with an
Intellectual
Disability
Sexuality Education:
Law, Polices, and
Curricula
Evidence-Based
Strategies
Sample Presentation Language: [Show the slide]. The second topic that will be
discussed in this workshop is laws and policies regarding sexuality education, the two
common approaches to sexuality education, and commonly available curricula for
students with disabilities.
48
Slide 14
SEXUALITY EDUCATION LAW (FEDERAL)

Abstinence Only



Title V Abstinence-Only-Until-Marriage Program
Community-Based Abstinence Education
Comprehensive Sexuality



Family Life Education Act
Teen Pregnancy Prevention Initiative (TPPI)
Personal Responsibility Education Program (PREP)
Sample Presentation Language: The two pre-eminent approaches that dominate the
educational politics on sexuality education in the United States are Abstinence Only (AO)
and Comprehensive Sexuality Education (CSE) (Lesko, 2010). Listed are well known
sexuality education laws that will be discussed.
49
Slide 15
c2
c1
Title V, Abstinence-Only-Until-Marriage
Program
The term “abstinence education” means an educational or motivational
program which:
A.
Has as its exclusive purpose teaching the social, psychological, and
health gains to be realized by abstaining from sexual activity;
B.
Teaches abstinence from sexual activity outside marriage as the
expected standard for all school-age children;
C.
Teaches that abstinence from sexual activity is the only certain way
to avoid out-of-wedlock pregnancy, sexually transmitted diseases,
and other associated health problems;
D.
Teaches that a mutually faithful monogamous relationship in the
context of marriage is the expected standard of sexual activity;
E.
Teaches that sexual activity outside of the context of marriage is
likely to have harmful psychological and physical effects;
F.
Teaches that bearing children out-of-wedlock is likely to have
harmful consequences for the child, the child’s parents, and society;
G.
Teaches young people how to reject sexual advances and how
alcohol and drug use increase vulnerability to sexual advances, and
H.
Teaches the importance of attaining self-sufficiency before engaging
in sexual activity.
TITLE V, § 510(B)(2)(A-H) OF THE SOCIAL SECURITY ACT, P.L. 104-193:
Sample Presentation Language: This act includes provide grants to States for abstinenceonly programs aimed at young people. The most controversial component of Title V is
the A-H definition of “abstinence education” contained in Section 510, which contains
biased, inappropriately moralistic and unsubstantiated requirements; which are listed
here. It is important to mention that States which receive Title V funding for sexuality
education, may choose which programs/curriculums to implement at their discretion.
However, when using that program for teaching, the lesson plans must adhere to the A-H
definitions of “abstinence education” set forth by the Social Security Act.
Optional/ Additional Discussion Topic: This tightening of program requirement including
the new directive to target adults, has been contributed to the emerging revolt against
abstinence-only sex education. States have now turned down millions of dollars in
federal grants. The number of states that refuse title V funding have grown from 1
(California) in the first year to 8 (California, Connecticut, Maine, New Jersey, Montana,
Ohio, Rhode Island, and Wisconsin) in 2007.
50
Slide 16
Teen Pregnancy Prevention Initiative
(TPPI)

Program goals are—




Reduce the rates of pregnancies and births to youth
in the target areas.
Increase youth access to evidence-based and
evidence-informed programs to prevent teen
pregnancy.
Increase linkages between teen pregnancy prevention
programs and community-based clinical services.
Educate stakeholders about relevant evidence-based
and evidence-informed strategies to reduce teen
pregnancy and data on needs and resources in target
communities.
Sample Presentation Language: The Teen Pregnancy Prevention Initiative (TPPI) is
considered a comprehensive sexuality education program. TPPI was put forth into federal
law by the Obama administration in 2010. Funding for TPPI will continue until 2015. The
purpose of TPPI is to demonstrate the effectiveness of innovative, multi-component,
community-wide initiatives in reducing rates of teen pregnancy and births in
communities with the highest rates, with a focus on reaching African American and
Latino/Hispanic youth aged 15–19 years. The program goals are listed here [read from
the slide].
51
Slide 17
Personal Responsibility Education
Program (PREP)
The program is designed to educate adolescents on—
 Both abstinence and contraception for the prevention of pregnancy
and sexually transmitted infections, including HIV/AIDS, consistent
with the requirements of the following:






The program replicates evidence-based effective programs or
substantially incorporates elements of effective programs that have been
proven on the basis of rigorous scientific research to change behavior,
which means delaying sexual activity, increasing condom or
contraceptive use for sexually active youth, or reducing pregnancy
among youth.
The program is medically-accurate and complete.
The program includes activities to educate youth who are sexually
active regarding responsible sexual behavior with respect to both
abstinence and the use of contraception.
The program places substantial emphasis on both abstinence and
contraception for the prevention of pregnancy among youth and
sexually transmitted infections.
The program provides age-appropriate information and activities.
The information and activities carried out under the program are provided
in the cultural context that is most appropriate for individuals in
the particular population group to which they are directed.
Sample Presentation Language: The Personal Responsibility Education Program (PREP) is
considered a comprehensive sexuality education program. PREP provides funds to
evidence-based programs that educate adolescents on both abstinence and
contraception to prevent pregnancy and sexually transmitted infections, and on other
adulthood preparation topics such as healthy relationships, communication with parents,
and financial literacy. PREP funding targets youth at greatest risk of teen pregnancy and
geographic areas with high teen birth rates. All PREP programs funded must be
medically accurate and age appropriate. Listed here are components of what a PREP
programs include. In addition, as a part of the Affordable Health Care Act of 2010, or
the Health care reform, congress authorized the PREP, which is first federal funding for
programs that teach about comprehensive sexuality education. PREP provides funding
of $75 millions per year for 5 years (2010-2014).
Optional/Additional Discussion Topic:
0. Which State(s) receives the most PREP funding? California is currently receiving $14
million, followed by New York ($12 million) , Florida ($11 millions) out of the $75
million in PREP funding.
1. Which State(s) receives the least amount of PREP funding? Rhode Island ($250K),
Montana ($250K), Maine ($250K), and New Hampshire ($250K).
52
Slide 18
c1
PREP CONTINUED…

The program must also teach at least 3 of the
adulthood preparation subjects described below






Healthy relationships, including marriage and family
interactions
Adolescent development, such as the development of
healthy attitudes and values about adolescent growth and
development, body image, racial and ethnic diversity, and
other related subjects
Financial literacy
Parent-child communication
Educational and career success, such as developing skills
for employment preparation, job seeking, independent
living, financial self-sufficiency, and workplace
productivity
Healthy life skills, such as goal-setting, decision making,
negotiation, communication and interpersonal skills, and
stress management
Sample Presentation Language: These are the adult preparation subjects to prepare
young people for adulthood. It addresses: healthy activities, positive adolescent
development, financial literacy, parent-child communication skills, education and
employment preparation skills, and healthy life skills.
53
Slide 19
SEXUALITY EDUCATION ACROSS THE
NATION
22 states and the District of Columbia require
public schools to teach sex education including
HIV education.
 33 states and the District of Columbia require
students receive instruction about HIV/AIDS.
 18 states require sex education curricula to be
“medically accurate” and/or age appropriate.

Source: www.ncsl.org
Sample Presentation Language: According to the National Conference of State
Legislatures, as of 2012, there are 22 States and also the District of Columbia (DC) that
require public schools to teach sexuality education including HIV prevention. There are
33 States and DC that require students to receive instructions about HIV/AIDS. Eighteen
States require sexuality education curricula to be “medically accurate” and/or “age
appropriate.” It is important to note that State policies vary in their determination of
“medically accurate.” Some require that State health departments review curricula,
while others require that the facts taught come from “published authorities upon which
medical professionals rely on.” [Pass out “Glossary of Terms”]. This handout is for
caregivers to further their understanding of sexuality terminology. It is important that
caregivers working with the school established a common language when addressing
sexuality and sexual development.
54
Slide 20
c1
SEXUALITY EDUCATION LAW
(CALIFORNIA)
California Ed. Code § 51930-51939
School districts may provide comprehensive, ageappropriate sex education from kindergarten through
grade 12. The information must be medically
accurate, factual, and objective. In grade seven,
information must be provided on the value of
abstinence while also providing medically accurate
information on other methods of preventing
pregnancy and STIs. A school district that elects to
offer comprehensive sex education earlier than grade
seven may provide age-appropriate and medically
accurate information.
http://www.siecus.org/index.cfm?fuseaction=page.viewp
age&pageid=487


Sample Presentation Language: So what is the sexuality education policy in California?
According to California Education Code, school districts in California “may provide
comprehensive and age appropriate sexuality education for students in Kindergarten to
12th grade.” Again, the information has to be “medically accurate” which includes
factual medical information regarding sexual development, STI, HIV/AIDs information,
and contraceptive use. It must also be objective.
Optional/Additional Discussion Topic: Anyone curious to see what the sexuality
education policy is in their state? [Click on the link below, and select the desired state.
The link shows what sexuality education policy is in the selected state].
55
Slide 21
WHAT IS SEXUALITY EDUCATION?

Sexuality education is a lifelong process of
acquiring information and forming attitudes,
beliefs, and values. It encompasses sexual
development, sexual and reproductive health,
interpersonal relationships, affection, intimacy,
body image, and gender roles.
Source: Sexuality Information and Education Council of the United States
Sample Presentation Language: [Have participants discussed among themselves “what
is considered sexuality education?” and “what does it consist of?” After 5- 10 minutes,
have the group share]. According to the Sexuality Information and Education Council of
the United States or SIECUS, [read from the slide]. It is important to keep in mind that
this is only one definition of what sexuality education is, as each state and local
education agency will define it differently depending if it is an Abstinence-Only Sexuality
Education or Comprehensive Sexuality Education approach.
56
Slide 22
ABSTINENCE SEXUALITY EDUCATION
Abstinence-based: Programs that emphasize
the benefits of abstinence. These programs also
include information about sexual behavior other
than intercourse as well as contraception and
disease-prevention methods. These programs are
also referred to as abstinence-plus or abstinencecentered.
 Abstinence-only: Programs that emphasize
abstinence from all sexual behaviors. These
programs do not include information about
contraception or disease-prevention methods.

Source: Sexuality Information and Education Council of the United
States
Sample Presentation Language: When talking about sexuality education, there is the
question as to what approach will it be based on, whether it being abstinence only or
rather comprehensive. According to the SIECUS, there are two types of Abstinence-Only
Sexuality Education. There is the Abstinence-Based which is [read 1st bullet point], and
the Abstinence-Only [read 2nd bullet point]. Although, these two types of AbstinenceOnly Sexuality Education program may be similar, their orientation and objective is
different.
57
Slide 23
COMMONLY USED ABSTINENCE
CURRICULA
Me, My World, My Future
 Choosing the Best, The Big Talk Book
 Why kNOw
 WAIT Training

Sample Presentation Language: These are some of the commonly and commercially
available curricula, and not an exhausted lists. These programs focused on abstinence
and are intended for the general education population.
Optional/Additional Discussion Topic:
2. Has anyone used any of the listed programs?
3. If yes, how was it? Did you like it?
4. Does anyone know of other abstinence sexuality education curricula not listed on this
slide?
58
Slide 24
c1
COMPREHENSIVE SEXUALITY EDUCATION
(CSE)
Sexuality education programs that start in
kindergarten and continue through 12th grade.
These programs include age-appropriate,
medically accurate information on a broad set of
topics related to sexuality including human
development, relationships, decision-making,
abstinence, contraception, and disease
prevention.
 They provide students with opportunities for
developing skills as well as learning information.

Source: Source: Sexuality Information and Education Council of the United
States
Sample Presentation Language: Comprehensive Sexuality Education is the other type of
approach to teaching students about sexuality. According to SIECUS, a CSE program is
[read 1st bullet point]. In addition, a CSE program also [read 2nd bullet point]. This is
especially important when working with students with ID as it is often more difficult for
them to generalize the learning to real life. Current research indicated States which
taught CSE programs that cover abstinence along with contraception and condom use
tend to have the lowest teen pregnancy rates (Stanger-Hall & Hall, 2011).
59
Slide 25
COMPONENTS OF CSE
Sexual, biological, and reproductive health.
 Self-management and safety.
 Interpersonal relationships.
 Sexual Identity.
 Communication and Negotiation Skills.
 Body Language and Self-Esteem.
 Decision Making.
 Moral/Ethical Values.

Source: (Goldman, 2008 ;Haracopos & Penderson, 1992; StrangerHall & Hall, 2011)
Sample Presentation Language: [Pass out the “Comprehensive Sexuality Education
Checklist”]. Researches identify these as the essential components that a CSE program
must take into account. These components are: [read from the slide].
Optional/Additional Discussion Topic: As caregivers, what vital skill(s) would your
student need know in each of the content areas?
60
Slide 26
COMMONLY USED COMPREHENSIVE
CURRICULA
Life Horizons I & II
 The Circles Program
 Learn About Life

Sample Presentation Language: These are some of the commercially available CSE
programs that are commonly used with students with developmental disabilities
including students with ID. The Life Horizons and The Circles Program will be discussed
in-depth in the second workshop.
Optional/Additional Discussion Topic:
1. Has anyone used any of the listed programs?
2. If yes, how was it? Did you like it?
3. Does anyone know of other comprehensive sexuality education curricula not listed on
this slide?
61
Slide 27
1.
2.
3.
Students with an
Intellectual
Disability
Sexuality Education:
Law, Polices, and
Curricula
Evidence-Based
Strategies
Sample Presentation Language: [Show the slide]. The last topic that will be discussed in
this workshop is evidenced-based strategies that caregivers can use when teaching
students with ID. These strategies may supplement areas in which commonly used
comprehensive sexuality education curricula may not address.
62
Slide 28
WHY USE EVIDENCE-BASED STRATEGIES?
Students with ID do not gain understanding of
social rules through the informal process of
socialization as most teens and adults do.
 Mores and expectations must be explicitly taught
to these students.
 Effective with individuals with low cognitive
functioning and social impairment.

Source: (Koller, 2004).
Sample Presentation Language: Unlike their non-disabled peers, [read 1st bullet point].
Additionally, students with ID would require the lesson to be explicitly taught. This
includes mores, ethics, values, and expected, or appropriate sexual behavior and
relationships. Lastly, evidenced-based strategies such as social stories, bibliotherapy,
counseling, and behavior training has been shown to be effective with individuals who
have low cognitive functioning and/or social impairment, which is also characteristic of
students with ID.
63
Slide 29
COGNITIVE BEHAVIORAL THERAPY (CBT)
Psychotherapeutic treatment that helps
individuals understand the thoughts and feelings
that influence behaviors and emphasize the role
of thinking in how they feel and what they do.
 Emerging evidence suggesting that individuals
with mild ID have the ability to engage in and
benefit from CBT.
 Effectiveness of CBT within the ID population is
not whether the individual is capable of
participating; rather it is the skilled
practitioner’s competence in working with
individuals with ID.

Sample Presentation Language: Cognitive Behavioral Therapy is a [read 1st bullet point].
Individuals with ID experiencing mental health and emotional problems have in the past
previously been excluded from research that examined the effectiveness and efficacy of
cognitive and behavioral psychotherapies. However, there is emerging evidence
suggesting that the individuals with mild ID have the ability to engage in and benefit
from cognitive behavioral interventions. Conversely, it still is less acceptable for those
with moderate to profound intellectual disabilities as their abilities and communication
skills are limited. Practitioners may work from a traditional CBT framework that only
aims to identify and correct distortions in the content of thoughts, assumptions and
beliefs. However, this is not considered the best approach. The emerging research
supports the use of a cognitive deficit model when working with an individual with ID.
The cognitive deficit model is based on self-management interventions such as selfmanagement, self-monitoring, and self-instructional training that focus on deficiencies in
how information is acquired and processed. Most importantly is that [read 3rd bullet
point]. The competent practitioner understands that when working with individuals with
ID, the procedures need to be adapted and simplified so the individual and a variety of
mental health problems can benefit from interventions that retain all the key elements of
cognitive therapy.
64
Slide 30
PECKHAM, HOWLETT, AND CORBETT
(2007)
CBT approach was used with survivors of sexual
abuse.
 Group met once a week for 20 weeks.
 The challenging behaviors got worse before they
got better.
 Survivors were successful in improving their
sexual knowledge and in reducing their
depression.

Sample Presentation Language: In this study, a CBT approach was used in a group
setting to examine the effectiveness of group counseling for intellectually disabled
female survivors of sexual abuse and their caregivers. The counseling approach utilized
patience, repetition, videos, dolls, and drawings to discuss sexual interactions. The
researchers concluded that the female participants were successful in improving their
sexual knowledge, and reducing trauma and depression. Despite these findings, there
continues to be a need for more comprehensive sexuality education groups for males and
females with ID. Again, the effectiveness and use of CBT within the ID population is not
whether the individual is capable of participating; rather it is the skilled practitioner’s
competence in working with individuals with ID.
65
Slide 31
BEHAVIOR TRAINING
Applied Behavior Analysis examines behavior
through a scientific approach and relies on
objectively defined observable behaviors.
 Basic principles often used are modeling,
prompts, or cues.
 They may involve: teaching skills/behaviors;
chaining or sequencing steps; and the fading of
prompts/cues once the individual has acquired
the skills/behavior.

Sample Presentation Language: Behavior training is another way in which sexuality
education can be taught to students with ID. As mentioned before, students with ID will
require the lessons to be explicit. One type of behavior training that has been shown to
be effective with students with low cognitive functioning and/or social impairment, is
Applied Behavior Analysis, or ABA. ABA [read 1st bullet point]. In ABA, [read 2nd and 3rd
bullet point].
Optional/Additional Discussion Topic:
1. Has anyone used ABA with students they worked with?
2. What behavior(s) addressed?
3. What technique(s) was used and why?
66
Slide 32
MILTENBERGER ET AL (1999)
Implemented behavioral skills training focusing
on sexual abuse intervention for five females
with mild to moderate ID.
 After 10 sessions of behavioral skills training and
situational practices, the participants had
acquired the skills.
 They could not generalize them outside of the
artificial setting.

Sample Presentation Language: So why is ABA needed? In a study by Miltenberg and
colleagues, the researchers wanted to see if females with ID, who are also survivors of
sexual abuse, can benefit from behavioral skills training. The researchers implemented
10 sessions of behavioral skills training in which the participants were taught to identify
inappropriate sexual interactions, advocate against sexual abuse, and report potential
abuse. In each session, the participants were put into a situation and observed if they
could perform the acquired skills. The researchers concluded that the participants had
acquired the skills through behavioral training. However, the participants could not
generalize it outside of the clinical setting. This is where ABA can be utilized to help
generalize learned behaviors into practice. It is important that all skills individuals
learned will have to be maintained and practiced.
67
Slide 33
SOCIAL STORIES
Specific characteristics that describes a situation,
concept, or skill.
 Format is idiosyncratic to the individual.
 Goal is to provide the individual with practical
and tangible social information.
 Elicits cues or prompt that call for appropriate
social responses.

Source: (Gray, 2000; Tarnai & Wolfe, 2008).
Sample Presentation Language: Social stories is also another strategy that is useful
when teaching social skills for students with low cognitive functioning and/or social
impairments. A Social story is a strategy that is often used in conjunction with ABA to
help generalize the socially appropriate behavior. For example, teaching a student with
an intellectual disability appropriate behaviors during a date. In its simplistic form, social
stories contain [read 1st bullet point]. The situation and setting in which the story is
written about is idiosyncratic to the individual. The goal is to provide the individual with
practical experiences and to help generalize what is learned in sexuality education.
Social stories can aid the student to make an appropriate response in a specific given
situation especially when the response is explicitly stated in the story.
Optional/Additional Discussion Topic: Has anyone used social stories with students they
worked with?
68
Slide 34
c1
SOCIAL STORY EXAMPLE

“My name is Amanda. I am 13. My body is
growing and changing. My mom knows about
growing up. Sometimes, girls get breasts when
they are 13. Soon I will have breasts too….”
Source: Council for Exceptional Children, 2009 p. 55; Gray, 2000).
Sample Presentation Language: Furthermore, each story is designed to teach the
student how to manage their own behavior during a given social situation by describing
(a) where the activity will take place, (b) when it will occur, (c) what will happen, (d) who
is participating, and (e) why the student should behave in the appropriate behavior
(Gray, 2000; Tarnai & Wolfe, 2008). For example, “My name is Amanda. I am 13. My
body is growing and changing. My mom knows about growing up. Sometimes, girls get
breasts when they are 13. Soon I will have breasts too….” (; Gray, 2000; Wolfe, Condo, &
Hardaway, 2009 p. 55).
69
Slide 35
BIBLIOTHERAPY
Bibliotherpay is the use of books to help solve
problems.
 Helpful for students who are experiencing
difficulties or may encounter problems similar to
those discussed in the literature.

Source: (Forgan, 2002; Sridhar & Vaugh, 2000)
Sample Presentation Language: The last of the evidenced-based strategies that will be
covered in depth during the second workshop is bibiliotherapy. Bibiliotherapy is using
books to help solve problems or address issues that individuals may face in their day-today life. It is important to clarify that bibliotherapy is not limited to just only books; it
can be comic books, magazines, or other forms of literature. The main things to keep in
mind is the appropriateness of the material, is it developmentally appropriate for the
student’s cognitive functioning, and will it send a positive message about the issue you
want to discuss.
Optional/Additional Discussion Topic:
1. Has anyone used bibliotherapy with students they worked with?
2. What topic(s) discussed?
3. What was the outcome of that experience?
70
Slide 36
BIBLIOTHERAPY
Books that can help caregivers introduce puberty include:
 The What’s Happening to My Body? series for boys and girls by Linda
and Area Madaras (2007 & 2009)
 What’s Happening to Me? A Guide to Puberty (by Peter Mayle (1975)
 The Playbook for Kids About Sex by Joani Blank (1981).
For books aimed at introducing sex, caregivers may consider:
 What Your Child Needs to Know About Sex (And When) by Dr. Fred
Kaeser (2011)
 Great Answers to Difficult Questions about Sex by Linda Goldman
(2010)
Books that address adolescent’s sexual feelings are:
 Forever by Judy Blume (2007)
 Someone To Love Me by Jeanette Eyerly (1987)
 Breaktime by Aidan Chambers (2008) and Teen Angel and other
stories of young love by Marianne Gingher (1989).
Sample Presentation Language: Similar to sexuality education, there is a lack of books
that are specifically written for students with ID. Therefore, it is important that
caregivers be selective and adopt books that match their student’s present level of
functioning (Forgan, 2002). Books that can help caregivers introduce puberty include:
The What’s Happening to My Body? series for boys and girls by Linda and Area Madaras
(2007 & 2009), What’s Happening to Me? A Guide to Puberty (by Peter Mayle (1975),
and The Playbook for Kids About Sex by Joani Blank (1981). For books aimed at
introducing sex, caregivers may consider, What Your Child Needs to Know About Sex (And
When) by Dr. Fred Kaeser (2011) and Great Answers to Difficult Questions about Sex by
Linda Goldman (2010). Books that address adolescent’s sexual feelings are: Forever by
Judy Blume (2007), Someone To Love Me by Jeanette Eyerly (1987); Breaktime by Aidan
Chambers (2008) and Teen Angel; and other stories of young love by Marianne Gingher
(1989).
71
Slide 37
END OF SESSION ONE
Questions?
 Comments?

Sample Presentation Language: Are there any questions or comments about what has
been introduced so far?
72
Slide 38
SEXUALITY EDUCATION STRATEGIES
FOR CAREGIVERS WORKING WITH
STUDENTS WITH AN INTELLECTUAL
DISABILITY
Workshop 2
Sample Presentation Language: This will be the second portion of this training
workshop. Does anyone have any question(s) or need clarification about the material(s)
covered from the first workshop? [Allow at least 5 – 10 minute for discussion].
73
Slide 39
WORKSHOP 2
90-minutes
 Developmental Stages
 Comprehensive Sexuality Education
 Evidenced-Based Strategies





Cognitive Behavioral Therapy
Behavior Training
Social Stories
Bibliotherapy
Sample Presentation Language: This second workshop will be 90 minutes long and 10
minute breaks will be provided between each topic. The three topics that I/we will be
covering includes: Developmental Stages of students with ID, Comprehensive Sexuality
Education, and Evidenced-Based Strategies.
74
Slide 40
1.
2.
3.
4.
Developmental Stages
Comprehensive
Sexuality Education
Sexuality Education
Curricula
Evidence-Based
Strategies and
Vignettes
Sample Presentation Language: [Show the slide]. The first topic that we will be
discussed in this workshop is Developmental Stages. We will look at how individuals with
ID are identified.
75
Slide 41
FRAMEWORK FOR IDENTIFYING STUDENTS
WITH ID



Age of Onset
 “manifested during the developmental periods”
Intellectual Functioning
 “significantly below average general
intellectual functioning”
Adaptive Functioning
 “deficits in adptative behaviors”
Source: (AAIDD, 2010)
Sample Presentation Language: [Presenter starts off by asking this question: How do
we identify students with an intellectual disability? Wait for the participants to
respond. Expand and/or summarize the responses that address the three key points
on the slide: age of onset; intellectual functioning; and adaptive functioning].
According to the Association of Americans with Intellectual and Developmental
Disabilities or AAIDD, an individual with ID is identified by their intellectual and adaptive
functioning and the age of onset, when the disability is first noticed. AAIDD, stress that
the age of onset would have to be during the developmental periods, or the first few
years of life. Individuals with ID usually have significantly below average intellectual
functioning and impairments in adaptive skills.
76
Slide 42
IQ SCORES




Mild
 IQ levels from 50 – 55 to approximately 70
Moderate
 IQ levels from 35 – 40 to 50 – 55
Severe
 IQ levels from 20 – 25 to 35 – 40
Profound
 IQ levels below 20 or 25
Source: American Psychiatric Association (2000)
Sample Presentation Language: Individuals with ID are categorized on the basis of their
intelligence quotient or IQ score. As you can see, a student who has mild intellectual
impairment has more intellectual capacity or cognitive functioning compared to
individuals with moderate, severe, and profound impairment. This is important because
educational placements and support services are also based on this paradigm. In
addition, even with similar cognitive profiles, no two students with ID will have the same
skill set, strengths, and weaknesses. Therefore, it is imperative to consider their unique
differences and individual needs.
77
Slide 43
1.
2.
3.
4.
Developmental Stages
Comprehensive
Sexuality Education
Sexuality Education
Curricula
Evidence-Based
Strategies and
Vignettes
Sample Presentation Language: [Show the slide]. The next topic that will be discussed
is a review of the components of a Comprehensive Sexuality Education.
78
Slide 44
COMPONENTS OF COMPREHENSIVE
SEXUALITY EDUCATION (CSE)
Sexual, biological, and reproductive health.
 Self-management and safety.
 Interpersonal relationships.
 Sexual Identity.
 Communication and Negotiation Skills.
 Body Language and Self-Esteem.
 Decision Making.
 Moral/Ethical Values.

Source: (Goldman, 2008 ;Haracopos & Penderson, 1992; StrangerHall & Hall, 2011)
Sample Presentation Language: A Comprehensive Sexuality Education program should
encompasses: [Read the bullet points and remind participants of the “Comprehensive
Sexuality Education Checklist”]. It is important that caregiver(s) teaching sexuality
education collaborate with the parent/guardian who has educational rights.
79
Slide 45
SEXUAL, BIOLOGICAL, AND
REPRODUCTIVE HEALTH
Reproductive and Sexual Anatomy
 Physiology
 Puberty
 Reproduction

Sample Presentation Language: These are essential topics of the Sexual, Biological, and
Reproductive Health component of a Comprehensive Sexuality Education. It is crucial
that all information taught is medically accurate and age-appropriate. Students with ID
will undergo sex development and need to be made aware of their changing bodies.
Some may have difficulty understanding their physical changes such as the onset of a
menstrual cycle or the appearance of pubic hair. Without knowledge and/or awareness
of these changes, it may be difficult for the student to understand the varying aspects for
their sexuality development which will continue to occur over the next few years. As a
caregiver, what are other reasons why you would or would not want to teach your
student with ID about their sexual, biological, and reproductive health? [Provide
participants a few minutes to share their thoughts].
80
Slide 46
SELF-MANAGEMENT AND SAFETY
Sexuality Throughout Life
 Masturbation
 Shared Sexual Behavior
 Sexual Abstinence
 Human Sexual Response
 Sexual Fantasy
 Sexual Dysfunction
 Sexuality and the Law

Sample Presentation Language: These are essential topics of the Self-Management and
Safety component of a Comprehensive Sexuality Education. It is crucial that all
information taught is medically accurate and age-appropriate. Students with ID will
undergo sex development and will likely experience behavioral changes. They will
develop into sexual beings and have sexual desires such as a need for self-gratification.
Due to their limited cognitive abilities, it is important for caregivers to understand that
the behaviors may not solely be the basis of their intellect; rather caregivers should
consider its relationship to their sexuality. Therefore, it is important to teach students
about the self-management of their sexuality and safe sexuality practices into adulthood.
As a caregiver, what are other reasons why you would or would not want to teach your
student with ID about their self-management and safety? [Provide participants a few
minutes to share their thoughts].
81
Slide 47
INTERPERSONAL RELATIONSHIP
Families
 Friendship
 Love
 Romantic Relationships and Dating
 Marriage and Lifetime Commitments
 Raising Children

Sample Presentation Language: These are essential topics of the Interpersonal
Relationship component of a Comprehensive Sexuality Education. The natural course of
human development suggests that children will assume responsibility for their own lives,
including their bodies (National Information Center for Children and Youth with
Disabilities (NICCYD), 1992, p. 2).” This is an inescapable fact for all parents and
caregivers. Although their chronological age may differ significantly from their
developmental age, students with ID will progress through and experience the stages of
human development. “Parents and caregivers teach children the fundamentals of life:
the meaning of love, human contact and interaction, friendship, fear, anger, laughter,
kindness, self-assertiveness, and so on (NICCYD, 1992, p. 2).” This is another area of their
sexuality development that students with ID need to develop an understanding of. It is
an in escapable fact that your student will want to become more independent and form
personal and intimate relationships with others. As a caregiver, what are other reasons
why you would or would not want to teach your student with ID about interpersonal
relationships? [Provide participants a few minutes to share their thoughts].
82
Slide 48
SEXUAL IDENTITY
Sexual Orientation
 Gender Identity
 Sexuality and Society
 Gender Roles
 Diversity

Sample Presentation Language: These are essential topics of the Sexual Identity
component of a Comprehensive Sexuality Education. Students with ID will develop a
sexual identity that consists of who they are as a female or male, who they are attracted
to, and learning the differences among themselves and others. It is important to teach
students about their identity to foster a positive self-concept: whether that be a
homosexual male or a heterosexual female. As a caregiver, what are other reasons why
you would or would not want to teach your student with ID about their sexual identity?
[Provide participants a few minutes to share their thoughts].
83
Slide 49
COMMUNICATION AND NEGOTIATION
SKILLS
Decision-making
 Communication
 Assertiveness
 Negotiation
 Looking for Help

Sample Presentation Language: These are essential topics of the Communication and
Negotiation Skills component of a Comprehensive Sexuality Education. Students with ID
need to be taught what to do to keep themselves safe on a daily basis within a variety of
settings and situations. There are several factors that put students with ID at-risk for
sexual abuse. Students with ID are at-risk because of the increased likelihood that they
are often separated from their families and accommodated in settings where they
encounter multiple caregivers throughout the day (Brown, 2010). Students are also
targeted on account of their visible differences and/or vulnerability by caregivers.
Mandell, Wallarth, Manteuffel, Sergo, & Pinto-Martin (2005) found that social and
communication impairments and the lack of exposure to appropriate peer interactions
often lead to misinterpreting social cues and sexual behaviors of their predators.
Therefore, students with ID need to be explicitly taught how to make a decision,
communicate their needs and wants, ask for help, negotiate with others, and be
assertive. These are vital life skills that not only benefit the student through their
sexuality development, but throughout life and its unpredictability. As a caregiver, what
are other reasons why you would or would not want to teach your student with ID about
communication and negotiation skills? [Provide participants a few minutes to share
their thoughts].
84
Slide 50
DECISION MAKING
Sexually Transmitted Diseases
 HIV and AIDS
 Sexual Abuse, Assault, Violence,
 and Harassment
 Reproductive Health
 Contraception
 Pregnancy and Prenatal Care
 Abortion

Sample Presentation Language: These are essential topics of the Decision Making
component of a Comprehensive Sexuality Education. It is crucial that all information
taught is medically accurate and age-appropriate. Students with ID need to be explicitly
taught how to make appropriate, safe, and healthy decisions when negotiating or
engaging in sexual relations with another person. The lack of adequate sexuality
education may contribute to the growing population of individuals with ID who are
sexually abused. Individuals with ID lack the understanding of how to appropriately
engage in sexual behaviors and recognizing or reporting inappropriate sexual behaviors.
Further suggesting the importance of why they need to be educated about the potential
risks and outcomes of sexual intercourse. As a caregiver, what are other reasons why
you would or would not want to teach your student with ID about to make informed
decisions about sexual behaviors? [Provide participants a few minutes to share their
thoughts].
85
Slide 51
BODY LANGUAGE AND SELF-ESTEEM
Body Image
 Display of Sexual Behavior

Moral/Ethical Values
Human Sexual Response
 Personal and Family Values

Sample Presentation Language: These are essential topics of the Body Language and
Self-Esteem, and Moral/Ethical Values component of a Comprehensive Sexuality
Education. It is imperative that caregivers teach students about maintaining a positive
self-esteem and body image. Students with ID need to be explicitly taught to recognize
how their own body language may send mixed-messages to others, and vice-versa.
Equally important is for parents and guardians to teach students with ID about personal
and family values. As a caregiver, what are other reasons why you would or would not
want to teach your student with ID about self-esteem and body language? [Provide
participants a few minutes to share their thoughts]. What are other reasons why you
would or would not want to teach your student with ID about morals and ethical values?
[Provide participants a few minutes to share their thoughts].
86
Slide 52
1.
2.
3.
4.
Developmental Stages
Comprehensive
Sexuality Education
Sexuality Education
Curricula
Evidence-Based
Strategies and
Vignettes
Sample Presentation Language: [Show the slide]. The next topic that will be discussed is
commonly used comprehensive sexuality education programs for students with
disabilities.
87
Slide 53
CURRICULA FOR STUDENTS WITH
DISABILITIES
The Circles Project
 Life Horizon

Sample Presentation Language: These are commercially available comprehensive
sexuality education curricula for students with disabilities. These curricula follow the
federal guidelines and also address many of the areas/topics that are required when
teaching a Comprehensive Sexuality Education. Content areas that are not addressed by
these curricula may be supplemented with evidenced-based strategies that will be later
discussed.
88
Slide 54
c1
THE CIRCLES PROGRAM
Leslie Walker-Hirsch and Marklyn P. Campagne
 Developed late 1980s
 Circles I: Intimacy and Relationships
 Circles II: Stop Abuse explores
 Circles III: Safer Ways

Sample Presentation Language: Leslie Walker-Hirsch and Marklyn P. Campagne
developed The Circles Program in the late 1980s to teach intellectually impaired
adolescents and adults appropriate social/sexual behaviors. Over the years, additional
topics have been added to address the various sexuality needs of individuals with
intellectual impairments. The program consists of four curricula that address sexuality
health and development. Circles I: Level 1, Intimacy and Relationships teaches social
distance and how it can change over time. Circles II: Level 2, Intimacy and Relationships
teaches students to apply what they have learned in Level in contrived scenarios. Circles:
Stop Abuse explores safety issues and self-protection. Lastly, Circles: Safer Ways teaches
individuals about sexually transmitted infections and HIV/AIDS, and preventative
strategies (Stanfield, 2013; Stepping Stones, 2012). Some districts may use The Circles
Program to address sexuality education for students with moderate-to-severe intellectual
disability.
Optional/Additional Discussion Question:
1. Has anyone use The Circles Program with your students?
2. What did you like about it?
3. What did you are some content areas that were not covered?
89
Slide 55
LIFE HORIZONS
Created by Winifred Kemptom , M.S.W.
 First edition created in 1972
 Slide-script presentation
 Use dramatic play





Pantomime
Role play
Improvisation
There are two series:


I: Physiological and Emotional Aspect of Being Male
and Female
II: The Moral, Social, and Legal Aspects of Intimate
Human Relationship
Sample Presentation Language: Life Horizon was created in 1972 by Winifred Kempton,
whose primary goal was to create a curriculum that can teach students with
developmental disabilities about their sexual development. Life Horizon covers topics
such as anatomy of the sex organs, the human life cycle, sexual intercourse, pregnancy,
intimate relationships, sexually transmitted diseases, safe sex, and contraceptives. In all,
Life Horizon would be considered a comprehensive sexuality education program. Life
Horizon uses a slide-script presentation, where the instructor reads the script that
describes the picture. Kempton recommends that role play, improvisation, and
pantomime be considered in order to help students generalized what is taught. Life
Horizon is split into two series. Life Horizon I covers the physiological aspect and
emotional aspect, which includes: Set 1 – Parts of the Body; Set 2 – The Sexual Cycle; Set
3 – Human Reproduction; Set 4 – Birth Control; Set 5 – Sexual Health. In Life Horizons II,
the emphasis is on moral, social, and relationships. Topics includes: Set 1 – Building SelfEsteem and Establishing Relationship; Set 2 – Male Social – Sexual Behavior; Set 3 –
Female Social – Sexual Behavior; Set 4 – Dating ; Set 5 – Marriage; Set 6 – Parenting ; Set
7 – Preventing/ Coping with Sexual Abuse.
90
Slide 56
COMPARING CURRICULA
Components
The Circles Program
Life Horizons
Supplement Strategies/
Resource
X
Sexual, Biological, and
Reproductive Health.
Self-Management and Safety
X
X
Interpersonal Relationships
X
X
Communication and Negotiation
Skills
X
X
Body Language and Self-Esteem
X
X
Decision Making
X
X
Sexual Identity
Moral/Ethical Values
X
Sample Presentation Language: [Pass out the “Curricula Checklist”]. This is a checklist
that shows how each of these two curricula compared to one another, and do they cover
the essential components in a Comprehensive Sexuality Education. As you can see, there
are some blanks in the checklist. These blanks can be supplemented by using evidencedbased strategies that will be discussed later.
91
Slide 57
1.
2.
3.
4.
Developmental Stages
Comprehensive
Sexuality Education
Sexuality Education
Curricula
Evidence-Based
Strategies and
Vignettes
Sample Presentation Language: [Show the slide]. The last topic that will be discussed
are the Evidenced-Based Strategies that caregivers can use to teach students with ID
about sexuality.
92
Slide 58
COGNITIVE BEHAVIORAL THERAPY (CBT)

CBT is a type of psychotherapeutic treatment
that helps individuals understand the thoughts
and feelings that influence behaviors and
emphasizes the role of thinking in how they feel
and what they do.
Sample Presentation Language: [Read from the slide]. There has been a historical
exclusion of individuals with ID from receiving and participating in CBT. However, there is
emerging evidence suggesting that individuals with mild ID have the ability to engage in
and also benefit from CBT.
93
Slide 59
CBT
Individuals with mild ID have the skills necessary
for CBT’s cognitive components such as:



The ability to identify cognitions that are associated
with their emotions and behaviors
The ability to identify and differentiate emotions
The ability to recognize the role of cognition in
mediating emotion
Sample Presentation Language: Individuals with mild ID may have the skills necessary
for CBT’s cognitive components such as: the ability to identify cognitions that are
associated with their emotions and behaviors, identify and differentiate emotions, and
recognize the role of cognition in mediating emotions. CBT can be modified in practice
for individuals with varying cognitive abilities. The emerging research supports the use
of a cognitive deficit model when working with an individual with ID. The cognitive
deficit model is based on self-management interventions such as self-management, selfmonitoring, and self-instructional training that focus on deficiencies in the how
information is acquired and processed.
94
Slide 60
WHEN TO USE CBT

The effectiveness of CBT within the ID
population is not whether the individual is
capable of participating; rather it is the skilled
practitioner’s competence in working with
individuals with ID.
Sample Presentation Language: Parents may choose to use this strategy when teaching
their child about sexuality as there is evidence to suggest its effectiveness with students
with ID. It is recommended that caregivers work collaboratively with the mental
professional to meet the specific sexuality concerns of their child. Some students with ID
may benefit from CBT, [read from the slide].
95
Slide 61
BEHAVIOR TRAINING
 Applied



Behavior Analysis
Video Modeling
Visual Strategies
Task Analysis
Sample Presentation Language: These are the topics that will be covered in the behavior
training portion. These will help us understand the motive behind the student’s behavior
and how to teach them socially appropriate behaviors. Specific techniques in applied
behavior analysis or ABA, such as video modeling, visual strategies, and task analysis will
be discussed.
96
Slide 62
FUNCTIONAL ASSESSMENT– THE A-B-C
What is the function of the behavior?
 Antecedents


What happens before the behavior.

Behavior

Consequences


What is happening.
What is the result of the behavior.
Example:
After Ms. Tran (paraeducator) walked away from
helping Johnny. He then reaches down his pants to
touch himself.
Sample Presentation Language: Pass out handout “A-B-C Chart”]. In order to
understand how behavior training can be used to teach sexuality education for students
with an intellectual disability, we first need to understand what the function of the
behavior is. This will help us to find socially appropriate behaviors that we want students
to be able to do more of. The A-B-C method is one that often used by behaviorists and
school psychologists. A stands for Antecedent, or what is happening before the behavior.
B stands for behavior, what is happening. And C stands for Consequences, what is the
result of the behavior. For example, the bottom scenario. [Read the scenario. Ask
participants to fill out the “A-B-C Chart” for the example]. In this scenario, the
antecedent would be Ms. Tran being within Johnny’s proximity then leaving, the behavior
is Johnny touching himself, and the consequence is self-stimulation. By knowing the
function of Johnny’s behavior, we can find strategies to help Johnny achieve the same
consequence, self-stimulation in a more socially appropriate way.
97
Slide 63
IDENTIFYING A-B-C
While waiting in line, Chang rubbed himself
behind Chris, who got mad and pushed Chang.
Mr. Collins tried to explain to Chang about
having personal space. The next day, Chang sat
next to Mike and started scooting in closer.
Chang sat side by side with his shoulders
touching Mike’s. Mr. Collins had to physically
prompt Chang to move. Over that first week, Mr.
Collins observed that Chang likes to be
physically close with the other students.
Sample Presentation Language: Please read the following scenario and identify the
antecedent(s), behavior(s), and consequence(s). You will have 3 minute. You can work
independently or with the person next to you. [Presenter should summarize
participants’ responses].
98
Slide 64
APPLIED BEHAVIOR ANALYSIS (ABA)
Empirically based strategies for working with
students with autism spectrum disorders.
 Relies on objectively defined and observable
behaviors.
 Common strategies includes:
 Video Modeling
 Visual Strategies
 Task Analysis

Source: (Alberto & Troutman, 2006).
Sample Presentation Language: Applied Behavioral Analysis or ABA, examines behavior
through a scientific approach and relies on objectively defined observable behaviors.
Basic principles of ABA that are often used are modeling, prompts, or cues. They may
involve teaching skills/behaviors; chaining or sequencing steps; and the fading of
prompts/cues once the individual has acquired the skills/behavior. Examples may
include, but are not limited to video modeling and visual strategies. Video Modeling is
having the student watch a person performing the socially appropriate behavior and
have him/her imitate the behavior. Steps in video modeling include determining the skill
or socially appropriate behavior, writing the script, preparing the video, and watching
the video. Next, help the student to imitate and practice the socially appropriate
behavior observed in the video. Visual Strategies is a visual cue or stimulus that reminds
or prompts the student to engage in the socially appropriate behavior. Common visual
cues can include signs, pictures, and gestures. [Presenter emphasize that Task Analysis
will be cover in depth].
99
Slide 65
TASK ANALYSIS
Breaking the complex task into smaller
component parts.
 Useful for multistep instructional programs.
 Number of steps varies for each student.
 Components for a behavior chain, wherein
individual behaviors are linked together to form
a complex behavior.
 Each component is listed in order of occurrence.
 Teaches the student to perform the steps in
sequential order and in close temporal
succession.

Source: (Alberto & Troutman, 2006)
Sample Presentation Language: In task analysis, the socially appropriate behavior to be
taught is broken down into smaller components in a successive progression. Task
analysis is useful when instructing a student with low cognitive functioning to engage in
a socially appropriate behavior that requires multistep. [Read 3rd, 4th, 5th, and 6th bullet
points]. For example, a student asking to be excused from class to go into the bathroom
to relieve sexual pressure through masturbation and utilizing proper hygiene afterwards.
100
Slide 66
PRE-IMPLEMENTATION
Identify the socially appropriate behavior
Break the behavior/task into small steps
 Determine whether the student has the
prerequisite skills to perform each step
 List the steps in sequential order in which they
must be performed
 Determine the most efficient chaining procedures
 Identify the implementation modality


Source: (Alberto & Troutman, 2006).
Sample Presentation Language: The first step in task analysis is to identify the socially
appropriate behavior. After identifying the behavior, break it down into small
manageable steps. It is crucial to list the steps in sequential order based on what we
know about the student, such as his/her cognitive strengths and limitations. Caregivers
must also determine how the skill will be taught based on the student’s learning style,
whether it is visual, verbal, and/or when physically prompted. For example, if a student
learns best through visual cues, then a visual schedule depicting each manageable small
steps can be use.
101
Slide 67
IMPLEMENTATION

Forward Chaining
 1st step  reinforcement
 1st + 2nd Step  reinforcement
 1st + 2nd + 3rd Step  reinforcement
 Continue until behavior is learned
Sample Presentation Language: In task analysis, behavior chaining is a strategy that is
commonly used. In Forward Chaining, each step is taught in sequential order. The
student receives reinforcement after the first step is performed successfully. Next, the
student receives reinforcement after the first two steps are performed successfully.
Continue this reinforcement pattern when teaching the behavior. Once all steps are
performed successfully, the student has learned the behavior. It is important to note that
depending on the student’s skill set, it may take multiple practices before the student can
performed any given step successfully.
102
Slide 68
TASK ANALYSIS
Name: Cindy
 Grade: 9th
 Functional age: 7
 Strengths: rote memory, able to read short words,
and eager to please

Cindy has just started her menstrual cycle and
needs to learn how to change her menstrual pad.
Sample Presentation Language: [Read the slide]. In small groups, your job is to develop
a sequential list of steps to teach Cindy how to change her menstrual pad. Keep in mind
Cindy’s strength when developing the list. [Allow 15 minutes for the activity. After the
allotted time, have the group discussed their strategy. The presenter’s example is on
the next slide].
103
Slide 69
EXAMPLE – CHANGING MENSTRUAL PAD














1. Identify need for menstrual bag.
2. Take bag to bathroom.
3. Remove necessary clothing.
4. Pull down underwear.
5. Sit on toilet.
6. Remove small sandwich bag from menstrual bag.
7. Remove soiled pad.
8. Place soiled pad in sandwich bag.
9. Determine if underwear is soiled.
10. If soiled, take plastic bag from menstrual bag.
11. Remove soiled underwear.
12. Place soiled underwear in plastic bag.
13. Take clean underwear from menstrual bag.
14. Get a new pad.
Sample Presentation Language: This is an example of steps that could be used to teach
Cindy how to change her menstrual pad. [Read each of the step]. Does anyone have a
question? [Read the following]. Now that we understand how to develop a task
analysis, as a group or by yourself, develop a task analysis for teaching David how to
shave his facial hair.
104
Slide 70
SOCIAL STORIES
Short stories with specific characteristics that
describes a situation, concept, or skill.
 Provide the individual with practical and
tangible social information.
 Elicit cues or prompt that calls for appropriate
social responses.
 Format is idiosyncratic to the individual.
 Consideration: Student may have difficult
reading the script and may require practice with
adult

Source: (Gray, 2000; Tarnai & Wolfe, 2008).
Sample Presentation Language: Social Stories are short stories with specific
characteristics that describe a situation, concept, or skill using a format that is
idiosyncratic to the individual. The goal of a social story is to provide the individual with
practical and tangible social information. Social stories also elicit cues or prompt that
calls for appropriate social responses (Gray, 2000; Tarnai & Wolfe, 2008). Students with
low cognitive functioning may have difficulty reading or speaking, and it is imperative
that caregivers work with the student when practicing.
105
Slide 71
GOALS OF SOCIAL STORIES

Designed to teach the individual how to manage
their own behavior during a given social situation
by describing
 Where the activity will take place.
 When it will occur.
 What will happen.
 Who is participating.
 Why the individual should behave in the
appropriate behavior.
Source: (Gray, 2000; Tarnai & Wolfe, 2008).
Sample Presentation Language: Furthermore, a social story is design to teach the
individual how to manage their own behavior during a given situation by describing (a)
where the activity will take place, (b) when it will occur, (c) what will happen, (d) who is
participating, and (e) why the individual should behave in the appropriate behavior
(Gray, 2000; Tarnai & Wolfe, 2008).
106
Slide 72
EXAMPLE OF A SOCIAL STORY

“My name is James. Sometimes I think about sex
and private areas. It’s okay to think about sex
and private areas. I will try to keep my thoughts
to myself. This is very important. I may ask my
mom or dad a question if I’m confused.”
Source: (Worbel, 2003) .
Sample Presentation Language: This is an example of what a social story is. [Read from
the slide].
107
Slide 73
TYPES OF SENTENCES USED IN SOCIAL
STORIES
Descriptive- Statement and facts.
 “I just kissed my boyfriend.”
 Directive- Positive statements that described a
desired response.
 “e.g. I wash my hands after I touch myself.”
 Perspective- Provide description about another
person’s thoughts, feelings, or reactions.
 “My mom thinks I’m in love with another boy.”

Source: (Council for Exceptional Children, 2009; Gray, 2000).
Sample Presentation Language: When writing a social story, there are 6 types of
sentence structures that should be used. They are descriptive, directive, perspective,
affirmative, control, and cooperative. A descriptive sentence is one that includes a
statement or fact. [Read example]. Directive sentences provide positive statements
which describes a desired response. [Read example]. And a perspective sentence
provides a look into another person’s thoughts, feelings, or reaction. In a way, showing
empathy. [Read example].
108
Slide 74
SENTENCES USED CONTINUED….



Affirmative- Describe an opinion that is commonly shared
by more than one person.
 “People wear a condom when they want to practice safe
sex.”
Control - Support recollection of a story.
 “when someone says ‘no’ after I ask them out, I can
think of a time when I had to walk away after my
neighbor did not want to buy candy from me.”
Cooperative - Describes how others might help the
individual during the social situation.
 “my teacher will ask me to return to the bathroom if I
forget to zip my pants.”
Source: (Council for Exceptional Children, 2009; Gray, 2000).
Sample Presentation Language: An affirmative sentence describes an opinion that is
commonly shared by more than one person. [Read example]. A control sentence is one
that supports a recollection of a story. [Read example]. And, a cooperative sentence
describes how others might help the individual during the social situation. [Read
example]. These sentence types are important when writing social stories.
109
Slide 75
GUIDELINES FOR WRITING A STORY
Write story with issue student is successful with
Identify situation or social skill that is difficult
for the individual
 Collect information about the situation and
environment
 Write story in 1st or 3rd person point of view
 Use developmentally appropriate and easy to
understand text
 Use 0-1 directive or control, to 2 -5 descriptive,
perspective, affirmative, or cooperative sentences


Source: (Gray, 2000).
Sample Presentation Language: When writing a social story, [read from the slide]. It is
important to keep in mind about the student’s strengths and weaknesses.
110
Slide 76
GUIDELINES FOR WRITING A STORY
Provide visual support to accompany the story
(e.g., photograph).
 Select a title that focuses on the goal of the story
(e.g., “Where can I take my clothes off?”
 Have the student help write a control sentence or
sentences.
 Have the student help write a cooperative
sentence or sentences.

Source: (Gray, 2000).
Sample Presentation Language: Here are some more guidelines. [Read from the slide].
Including the student in the process will allow them to have ownership of the story.
111
Slide 77
SOCIAL STORY ACTIVITY
Name: Kelly
 Grade: 10th
 Functional Age: 4

Kelly is going out to a school dance next week.
This is Kelly’s first dance without her parent
chaperoning.
Sample Presentation Language: [Pass out the “Social Stories Guideline”]. You will have
10 minutes to write a social story for Kelly. [Read from the slide. After the allotted time,
allow participants’ to share their social story].
112
Slide 78
BIBLIOTHERAPY
Stories, fables, and parables
 Francois Rabelis (1494 – 1553)
 Karl Menniger coined the term “bibliotherapy” in
his 1930 influential book, The Human Mind.
 Using books to heal the mind, empowering
individuals to resolve personal difficulties .

Resource: (Forgan, 2002; Sridhar & Vaugh, 2000).
Sample Presentation Language: The idea of using books for therapy is not something
new, but rather one with a long history. The earliest traces can be found with the
concept of books itself. Stories, fables, and parables have been used for centuries, as a
means of passing wisdom and knowledge from one generation to the next. Rabelis, who
was a famous doctor, writer, and humanist during the French renaissance, often
prescribing literature for his patients as part of their treatment. Many times, his own
writings. Karl Menniger, American psychiatrist, was the first therapist to use the term
“bibliotherapy” in his book The Human Mind in 1930. There are numerous definitions of
bibliotherapy. However, bibliotherpay is often defined as the use of books to help solve
problems (Forgan, 2002; Sridhar & Vaugh, 2000).
113
Slide 79
BIBLIOTHERAPY
Increasing into a recognized therapeutic activity
aligning with the underlying of CBT.
 Often divided into two fields of practices


Therapeutic

Developmental


Mental health
Educators
Source: (Pehresson, 2006).
Sample Presentation Language: Bibilotherapy is slowing increasing as a recognizable
therapeutic activity to help students with their issues. It also aligns well with cognitive
behavior therapy. Bibliotherapy is often divided into two approaches, therapeutic and
developmental. In therapeutic, it is used by mental health personnel to provide specific
and targeted interventions. When used by educators, it is mostly to help students deal
with transitioning to difficult situations that occur in day-to-day life.
114
Slide 80
REVIEWING BOOK FOR BIBLIOTHERAPY
Grade/Interest Level
 Presentations of the Characters
 Context
 Illustrations/Pictures (if any)
 Author's Message

Source: Adapted from Rozalskl, Stewart, & Miller, 2010.
Sample Presentation Language: [Pass out the “How to Review a Book” handout]. Here
are a few of the suggestions when reviewing a book for bibliotherapy. [Read each bullet
point and the corresponding section in the handout].
115
Slide 81
COMPONENTS OF A GOOD BOOK
Developmentally appropriate
 Opens communication
 Reduce alienation and isolation
 Normalizes challenges
 Model desire behaviors
 Offer hopes

Sample Presentation Language: When selecting a book to be used with students with ID,
it is important to remember these six criteria: the appropriateness of the material to the
student’s developmental level; does the book have situations that can allow for
discussion?; and does the book reduce alienation and isolation, and offers hopes for
these students. Another aspect of developmental appropriateness is assessing the
student’s ability to read. Some students may have difficulty reading, however, a
discussion of the actions in picture is a way of adopting this method for students with ID.
116
Slide 82
LESSON PLANNING
Clearly identify the selected book’s core ideas and
teaching points.
 Specify supplies and materials needed for
activities following the story.
 Include organized questions to promote
discussion (pre and post).
 Identify activities to extend the story’s main
ideas into practical application.

Source: Gresham, Sugai, & Horner, 2001)
Sample Presentation Language: When using bibliotherapy, it is important to identify the
book’s core ideas and teaching points to the student with ID. Because of their low
cognitive functioning, it is recommended to make those ideas direct, such as using
visuals. Most importantly is to make the ideas and teaching points meaningful for the
students. Activities and discussion questions are two strategies that can be used. HHowever, one must be cognizant of the student’s developmental age.
117
Slide 83
POSSIBLE QUESTIONS & ACTIVITIES


Discussion Questions
 What happened to the character?
 Why did he/she do that?
 What would you do?
 Others?
Activities
 Role Playing
 Social Stories
Sample Presentation Language: Here are some examples of discussion questions and
activities that can be utilized with bibliotherapy to help the students generalized the
lesson into meaningful practices. [Read from the slide].
Optional/Additional Discussion Topic: Are there other activities or discussion questions
besides those on the slide?
118
Slide 84
SHARING STORIES WITH STUDENTS
Heighten the student’s interest.
 Reading the story aloud. Re-read important
sections if needed.
 Ask questions that lead to discussion.
 Include activity that stretches the story’s core
message into action.
 Solidify learning with an applied activity.

Sample Presentation Language: Here are some strategies that can be used to increase
the student’s interest in bibliotherapy. Heighten the student’s interest by asking carefully
posed questions, showing the cover of the book, and giving a short background of the
characters. When working with students with intellectual disability, it is important to
read the story out loud and re-read important sections if needed to. Ask simple and
direct questions (e.g. what is the boy doing?). And use activities to help generalize the
lessons into meaningful learning.
119
Slide 85
BIBLIOTHERAPY ACTIVITY



Name: Antonio
Grade: 9th grader
Functional Age: 5
Antonio’s girlfriend of 3 months has just recently
broken up with him during class. Antonio appeared
depressed and did not engage in class assignment.
Antonio told Mr. Billy (paraeducator) that he is very
sad because no one likes him anymore and that he is
“ugly.” The next day, Antonio came to school with a
towel covering his face and did not want to take it off.
He became defiant when asked to take the towel off.
Antonio told Mr. Billy, that he is ugly and does not
want others to see him, especially his ex girlfriend.
Sample Presentation Language: In small groups, please identify what content is
necessary in a book to facilitate a discussion about relationships. Afterwards, generate a
list of practical activities to help Antonio apply the discussion topic.
120
Slide 86
CLOSING ACTIVITY
Chao is engaging in self-injurious behaviors. His
mother observed him pulling out his pubic hair.
Mrs. Jones is concern about her daughter Latoya
hand holding and long hugs with Kimberly. Mrs.
Jones wants Latoya to understand her romantic
feelings towards Kimberly.
Mr. Singh has noticed a drop in Mohammad’s
tone of voice. Hygiene has also been an issue
lately. Mr. Singh is recognizing signs that
Mohammad is going through puberty and wants
to teach him about his changing body.
Sample Presentation Language: Lastly, I/we would like you to think about all the
evidenced-based strategies you have learned today, and discuss amongst yourself or in
small groups what strategies you would use for each student. [Provide 15 minutes for
participants to work on this closing activity]. You may find that you can use any of the
strategies learned today to address the student’s behavior. It is important to keep in
mind that when using any of the strategies, you should be cognizant of the student’s
unique needs and strengths.
121
Slide 87
CLOSING
Sample Presentation Language: Before we end the training workshop, does anyone
have additional questions? Thank you for attending the workshop. If you would like to
contact me/us, please do so at [insert contact information]. Lastly, I/we enclosed one
last handout that provides hints and guidelines on how to facilitate a discussion with
your student about sexuality [Pass out “Hints” and “Guidelines” handout].
122
Slide 88
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
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
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
Blume. J. (2007). Forever. Simon Pulse Edition. New York, NY: Simon & Schuster Inc.
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Brown, H. (2010). Sexual abuse of children with disabilities. Chapter 7 in Protecting children with
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Chambers, A. (1978). Breaktime. London; England: Bodley Head.
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Eaves, L. C & Ho, H. H. (1996). Stability and change in cognitive and behavioral characteristics of
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Eyerly, J. (1987). Someone to love me. New York, NY: Harper Collins Children's Books.
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Slide 89
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Forgan, J. W. (2002). Using bibliotherapy to teach problem solving. Intervention in School and
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Goldman, L. (2010). Great answers to difficult questions about sex. London, England: Jessica
Kingsley Publishers.
Gray, C.A. (2000). Writing social stories with carol gray. Arlington, TX: Future Horizons.
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Kaeser, F. (2011). What your child needs to know about (and when). New York, NY: Crown
Publishing Group.
Kijak, R. (2011). A desire for love: Considerations on sexuality and sexual education of people with
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female. Santa Barbara, CA: James Stanfield Publishing Co.
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Slide 90
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Mandell, D. S, Wallarth, C. M., Manteuffel, B., Sergo, C., & Pinto-Martin, J. A. (2005). The
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Meschke, L., Peter, C., & Bartholomae, S. (2012). Developmentally appropriate practice to promote
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Miltenberger, R., Roberts, J., Ellingson, S., Galensky, T., Rapp, J., Long, E., & Lumley, V. (1999).
Training and generalization of sexual abuse prevention skills for women with mental retardation.
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National Information Center for Children and Youth with Disabilities. (1992). The development of
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Peckham, N. G., Corbett, A., Howlett, S., McKee, A., & Pattison, S. (2007). The delivery of a
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126
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
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127
Appendix C
Workshop Handouts
128
Comprehensive Sexuality Education Checklist
Components
Sexual, Biological,
and Reproductive
Health
Self-Management
and Safety
Interpersonal
Relationships
Sexual Identity
Communication and
Negotiation Skills
Body Language and
Self-Esteem
Decision Making
Moral/Ethical
Values
Strategies/Resource
129
Comprehensive Sexuality Education Curriculum Checklist
Components
Included in Curricula?
Sexual, Biological,
and Reproductive
Health
 Yes
 No
Self-Management
and Safety
 Yes
 No
Interpersonal
Relationships
 Yes
 No
Sexual Identity
 Yes
 No
Communication and
Negotiation Skills
 Yes
 No
Body Language and
Self-Esteem
 Yes
 No
Decision Making
 Yes
 No
Moral/Ethical
Values
 Yes
 No
If No, Supplement
Strategies/Resource
130
Hints That Can Help You Talk with Your Child about Sex
Learn to Listen
All children need to feel that their ideas or concerns about sex are worth listening to.
Look for natural opportunities to talk
You don’t have to wait until your child comes to you with suggestions or comments about sex.
He or she may be too embarrassed to ask you first. Take advantage of natural openings to talk
about sex, something you see in the newspaper, on television, animal behavior, pregnant relatives
or friends.
Listen carefully for hidden feelings
Many times children have trouble saying exactly what they mean, especially when it comes to
sex. Remember that your child may be afraid to talk about certain things. Let your child know
you will not get mad or upset about everything he or she brings up.
Try to avoid judging your child
Making harsh judgments or criticizing children’s attitudes about sex will most often out of
communication. Children will open up more quickly with parents who are willing to listen in an
understanding manner.
Let your child express his or her feelings freely
Many young people have values or opinions about sex that are different from their parents.
Remember, these may not be firmly held ideas or values, but only part of the sorting-out process
young people go through. First, listen to what your child has to say. If you agree with what your
child says, say so. If you disagree, then clearly state your own viewpoint, and why you feel that
way. However, let the child know that you will discuss it again, that he or she can freely express
that same opinion again.
Don’t cut off communication
Parents sometimes lose the chance to help young people think and talk about sex, because they
begin to nag, preach or moralize. This type of communication is usually destructive. The young
person needs to know that talking about sex is a two-way communication.
Questions
Avoid over-or-answering questions. Answer questions directly. Don’t assume that a simple
question about sex needs an answer far beyond what was asked! If you don’t know the answer to
a question, offer to find out. On the other hand, if the question deals mostly with values and
opinions, you may want to take some extra.
Adapted from the American Red Cross (2012)
131
Guidelines for Parents for Talking with Children or Teens about Sexuality
Be Honest
When talking about sexuality, it is best to be honest – not just about the facts of life but about
your feelings, attitudes, ignorance, and ambivalence. Children and teens can understand that
learning about sexuality is a lifelong process. Adults are still learning too.
Use Teachable Moments
There are many opportunities each day to talk about sexuality. Sexual issues are raised by film,
pop music, graffiti, magazines, T.V., etc. When a sexual issue is opened for use by one of these
media, we can use the chance to ask an open-ended question, begin a discussion, or make a
statement of information or value.
Make A Distinction Between Facts And Opinions
It is important for us to clearly label what we are saying as either fact, opinion, or belief. It is
important to state our own belief or value because teens and children need to know that values are
important to us; but we also need to acknowledge that other people may have different values.
There is very little consensus in this culture about many controversial issues in sexuality – and the
more controversial the issue, the more uncomfortable we are and the more likely we are to state
our opinions as though they were fact. Talk about the range of values, and basing safe and healthy
decisions on these values.
Don’t Hesitate To Set Limits
It is important to know what your own bottom line is: identify for yourself what you can accept;
what you have difficulty accepting but can tolerate or work on; and what you absolutely cannot
accept. Communicate these limits to the professionals with whom you work and with the rest of
your family- foster care children as well as natural children. When working with teens, see if you
can negotiate limits, encouraging communication, feedback, and flexibility. But once a limit is
set, stick to it until it is re-negotiated.
Learn All You Can About Sexuality
We as adults are still learning and growing regarding sexuality. New information is being
discovered all the time. We need to take the time to read, think, talk, and learn so we can be more
effective with your children and teens, and also for our growth and learning.
Take Some Time For You
Many of us haven’t had the time to really think about our own sexual values and attitudes so
when we try to communicate them, it’s confusing. Take the time to think.
Adapted from the American Red Cross (2012)
132
Glossary of Sexuality Terms
For teachers reference only- not to be distributed directly to the students.
Abstinence – Refraining from any behavior which places a person at risk for transmitting HIV;
choosing not to have sexual intercourse (anal, oral, or vaginal); choosing not to use drugs or share
needles; abstinence is the only 100% effective method to prevent teen pregnancy and the sexual
spread of HIV and other STDs.
Acne – A disease of the oil-secreting glands of the skin that often affects adolescents, producing
blackheads, and pimples on the face, neck, and shoulders that can leave pitted scars.
Acquired Immunodeficiency Syndrome (AIDS) – A result of human immunodeficiency virus (HIV)
infection, which makes the immune system less able to fight infection.
AIDS – See acquired immunodeficiency syndrome.
Alternatives – Two or more things that serve as other possible choices.
Ambiguous Genitalia – A set of medical conditions that feature congenital anomalies of reproductive
and sexual systems. That is, people who are born with sex chromosome, external genitalia, or internal
reproductive systems that are not considered “standard” for either male or female (formerly referred to
as inter-sex).
Amenorrhea – Absence of a menstrual cycle.
Anal Intercourse – Sexual intercourse in which the penis enters the rectum.
Androgynous – A person neither male nor female in appearance but having both conventional
masculine and feminine traits.
Antibody – A substance in the blood that defends the body against invading disease agents.
Anus – The ring of muscle that allows release of solid food waste or feces (i.e., a bowel movement)
from the body.
Asymptomatic – Showing no signs or symptoms of infection.
Bacteria – Infectious microorganism, germ; can be cured with antibiotics.
Barrier Method – Contraception methods that prevent pregnancy by physically preventing sperm
from entering the uterus through the penis in the cervix.
Bartholin’s Glands – Either of two small glands on either side of the lower vagina that secrete a
lubricating mucus during sexual stimulation.
Adapted from the American Red Cross (2012)
133
Basal Body Temperature Method – An unreliable method of contraception which involves
predicting a “safe period of time” for sexual intercourse based on changes in the women’s basal body
temperature during her menstrual period.
Birth Control – Voluntary limitation or control of the number of children conceived, especially by
planned used of contraceptive techniques.
Birth Control Pill – A pill, typically containing estrogen or progesterone, that inhibits ovulation
which prevents conception.
Bisexual – Being sexually attracted to persons of the same sex and of the opposite sex. Men and
women who have sexual and romantic attraction to both men and women. Depending on the person,
his or her attraction may be stronger to women or men, or they may be approximately equal.
Bladder – A triangular shaped, hollow organ or other body part for storing a liquid or gas, especially
the sac that stores urine (urinary bladder) or the sac that stores bile (gallbladder).
Bloodborne disease – An infection carried in the bloodstream.
Bood-to-blood contact – The mixing together of blood from two or more people. The primary ways
HIV is spread through blood-to-blood contact are the use of shared needles and syringes, blood
transfusions, receipt of blood components or clotting factors, and organ transplants (all rare since
1985), and transmission from mother to child during birth.
Bullying – Intimidating another by means of force or coercion.
Calendar Method – An unreliable method of contraception which involves predicting a “safe period”
for intercourse derived from the dates of a woman’s menstrual cycle (aka rhythm method).
Castration – Removal of a male’s testicles.
Casual Contact – Ordinary social contact, such as being around someone; sharing utensils, office
space, bathrooms, phones and swimming pools; shaking hands; and kissing on the cheek. People
cannot get HIV from causal contact.
CD4+ cell – See T-Cell.
Celibacy – Not having sexual intercourse for a long period of time for religious or personal choice.
Cervix – Narrow lower opening into the uterus.
Child Abuse – Mistreatment of a child by a parent, guardian, or other adult responsible for his or her
welfare, including physical violence, neglect, sexual assault, or emotional cruelty.
Clitoris – A small body of spongy tissue that is highly sensitive located between the top of the labia
minora and the clitoral hood.
Adapted from the American Red Cross (2012)
134
Co-infection – Having two or more infections simultaneously.
Commitment – The act of committing, pledging, or engaging oneself.
Condom – A sheath made of latex, polyurethane, or lamb intestine that fits over an erect penis. When
used correctly and consistently, latex condoms have been shown to greatly reduce the risk of HIV
infection. See also Female Condoms.
Confidential – Done or communicated in confidence; secret.
Confidential testing – Testing in which name and results are recorded, but are not given out without
permission of the person tested, except as required by state law.
Consequences – Something that follows logically or naturally from an action or condition.
Cooling Off Period – A period arranged by agreement to allow for negotiation and an abatement of
tension between disputing parties.
Cowper’s Gland – During sexual arousal, the tiny Cowper’s gland, or Bulbourethal Glands, secrete a
small amount of pre-ejaculate fluid (also called “pre-cum”) into the urethra, which appears on the tip
of the penis. This fluid neutralizes the acidity within the urethra in preparation for ejaculation.
Domestic Partner – One who lives with another person and who is emotionally and financially
connected in a supportive manner with another.
EIA (enzyme immunoassay) – A standard test used to detect the presence of HIV. When an EIA
detects antibodies to HIV, the result must be confirmed by the Western Blot test or
Immunofluorescence Assay (IFA) before a person is considered to have HIV. Formerly referred to as
ELISA.
Ectopic pregnancy – A pregnancy that occurs outside of the uterus, usually in the fallopian tube
(oviduct) often due to infection-related scarring of the tube.
Emergency Contraception (Plan B) – Contraceptive measures, that if taken after sex, may prevent
pregnancy.
Endemic – Common to a population.
Endometriosis – An irregularity of the endometrium (lining of the uterus) that can result in pain and
possible infertility.
Epidemic – The rapid spreading of a disease so that many people in a region have it at the same time.
Epididymitis – Inflammation of the sperm duct (tubules) on the surface of the testicle.
Erection – The stiffening and engorgement with blood of the penis or clitoris during sexual arousal.
Fallopian tube – Oviduct connecting the ovary with the uterus.
Adapted from the American Red Cross (2012)
135
Family Planning – Contraception; birth control.
Female Condom – A tube made of polyurethane, with a ring at each end, that lines the vagina and
covers the labia. Some people use the female condom for anal sex, although it has not been officially
approved or recommended for this use.
Foreskin/Prepuce – A roll of skin that covers the head of the penis in uncircumcised men. Also, is
the hood of the clitoris.
Friendship – A friendly relation or intimacy.
Gay – A man whose primary romantic and sexual attraction is to other males. Gay is also used as an
inclusive term encompassing gay man, lesbians, and people who identify as bisexual.
Gender Expression – Relates to how a person chooses to communicate their gender identity to others
through clothing, hair, styles, mannerisms, etc. This communication may be conscious or
subconscious. While most people’s understandings of gender expressions relate to masculinity and
femininity, there are countless permutations that may combine both masculine and feminine
expressions.
Gender Identity – Whether a person sees herself or himself as female or male. A person’s internal
sense of being male, female, or something in between. For many people, one’s gender identity
corresponds with their biological sex (i.e., a person assigned female at birth identifies as female or a
person assigned male at birth identifies as male), but this is not always the case.
Gender Role – Culturally-prescribed way to act (dress, talk, move) male or female.
Glans – The head of the penis, or the head of the clitoris.
Goal – An objective or desired outcome.
Gynecologist – A doctor who specialized in diseases of the female reproduction system.
Harassment – To disturb persistently, bother continually, or pester.
Healthy – A condition of physical, mental, and social well-being and of absence of disease or other
abnormal condition.
Heterosexual – Being sexually attracted to persons of the opposite sex.
HIV/AIDS – Human Immunodeficiency Virus attacks the T cells of the immune system with
debilitating effects, causing a syndrome called Acquired Immune Deficiency Syndrome.
Homophobia – Hatred or fear of homosexuals.
Homosexual – Being sexually attracted to persons of the same sex. Generally, the term ‘gay’ and
‘lesbian’ are seen as being less laden with negative implications than ‘homosexual.’
Adapted from the American Red Cross (2012)
136
Human Immunodeficiency Virus (HIV) – The virus that causes AIDS. HIV weakens several body
systems and destroys the body’s immune system, making it easier for life-threatening opportunistic
infections and cancers to invade the body.
Human Papilloma Virus (HPV) – A virus that infects the skin and mucus membranes that may cause
warts and/or cancer of the genital areas, or have no symptoms at all.
Hymen – The hymen is a very thin membrane that partially covers the opening to the vagina. While
considered the “hallmark of virginity” in girls and women, the hymen can be torn by vigorous exercise
or the insertion of a tampon, finger, or other object into the vagina.
Hysterectomy – An operation to remove a women’s uterus.
Immune System – A system of the body that helps it resist germs.
Impotence – The inability of a male to get an erection or to have an orgasm.
Incest – Sexual intercourse between two people too closely related to be legally married, e,g.,
father/daughter, uncle/niece, brother/sister. In many countries, including the U.S., incest is illegal and
the law applies to step relations and foster families.
Incubation – Used here to describe the period from the point of infection with HIV to the onset of
symptoms of AIDS.
Infertility – The inability to have children.
Injection drug use – The use of a needle and syringe to inject drugs into the body.
Intercourse – Any sexual act that can result in pregnancy or disease.
Intersex – A general term used for a variety of conditions in which a person is born with a
reproductive or sexual anatomy that doesn’t fit the typical definitions of female and male. For
example, a person may be born appearing to be female on the outside, but having mostly male typical
anatomy on the inside.
Intimacy – A close, familiar, and usually affectionate or loving personal relationship with another
person or group.
Intrauterine Device (IUD) – A birth control device, such as a plastic or metallic loop, ring, or spiral,
that is inserted into the uterus to prevent implantation.
Labia Majora – The two thick outer folds of skin that surround the clitoris, the opening of the
urethra, and the opening of the vagina of women and girls.
Labia Minora – The two small folds that lie immediately inside the labia majora of women and girls
and join at the front to form the hood of the clitoris.
Adapted from the American Red Cross (2012)
137
Lesbian – A women whose primary romantic and sexual attraction is to other females. However, may
women who are attracted to other may choose to use the term “gay” or “queer” to call themselves.
LGBT – A commonly used acronym for the Lesbian, Gay, Bisexual, Transgender, and questioning
community.
Like – To feel attraction toward or take pleasure in.
Love – An intense feeling of tender affection and compassion.
Male Condom – A sheath worm over the penis, which offers some potential against pregnancy and
sexually transmitted diseases.
Masturbation – Rubbing or massaging genitals for sexual pleasure.
Masculinity/Femininity – Gender role stereotypes, differing from culture to culture. Across cultures,
these roles are not innate to sexual orientation or gender-identity.
Men Who Have Sex with Men (MSM) – Men who engage in same-sex behavior, but who may not
necessarily self-identify as gay.
Menstruate – To discharge blood and other matter from the womb as part of the menstrual cycle.
Molest – To force unwanted sexual attentions on somebody, especially a child or physically weaker
adult.
Monogamy – Having sex with only one partner. Describes an HIV prevention strategy in which two
people, who do not have HIV or inject drugs, have sex only with each other over a period of time.
Mons Pubis/Veneris – A prominence caused by the pad of fat that overlies the junction of the pubic
bones in women and girls. The mons is usually covered with pubic hair after puberty, and is sexually
sensitive in women.
Mucous membranes – Moist lining of the body openings, susceptible to small abrasions and
infections.
Mutually monogamous relationships – A sexual relationship between two individuals who are
committed to a long-term relationship with each other, and have no other sexual partners.
Natural condoms – Condoms made from the intestinal lining of sheep. Adequate for birth control, but
not for disease prevention.
Nocturnal Emission – The involuntary ejaculation of semen during sleep.
Non-barrier Method – Contraception methods that prevent pregnancy other than by physically
preventing sperm from entering the uterus through the penis in the cervix. Includes birth control pills
and intrauterine devices.
Adapted from the American Red Cross (2012)
138
Options – Two or more things that serve as other possible choices.
Oral Sex – Sexual activity that involves using the mouth to stimulate a partner’s genitals.
Orgasm – The involuntary neuro-muscular contractions of the genitals during sexual stimulation.
Ovaries – Either of the two female reproductive organs that produce eggs and, in vertebrates, also
produce the sex hormones estrogen and progesterone.
Over the Counter (OTC) – Medications that can be legally bought without a physicians prescription.
Ovum – An egg reproduced by the ovary.
Partner – Either member of an established couple in a relationship either gay, heterosexual or
bisexual.
Passion – Strong amorous feeling of desire, love, or lust.
Penetrative Sex – Vaginal or anal intercourse.
Pandemic – Spreading over the entire continent or the whole world.
Penis – The male sex organ through which urine is eliminated and semen is ejaculated.
Pelvic Inflammatory Disease (PID) – Infection of the female upper reproductive organs (uterus,
fallopian tubes, ovaries) which can cause inflammation and scarring.
Perineum – The area between the anus and opening of the vagina (or the base of the scrotum, in
males). The perineum is sensitive to touch.
Phallus – An image of an erect penis. If something is described as phallic, it resembles an erect penis.
Plan – A program of action.
Platonic – A non-sexual relationship.
PLWA – Person living with AIDS.
Premature Ejaculation – A male orgasm reached too quickly.
Prescription – An order, especially by a physician, for the preparation and administration of a
medicine, therapeutic regimen, assistive or corrective device, or other treatment.
Promiscuity – Sexual intercourse with several different casual acquaintances over a short period of
time.
Adapted from the American Red Cross (2012)
139
Prostate Gland – A sex gland in males, which surrounds the neck of the bladder and urethra. The
prostate gland secretes a slightly alkaline fluid that forms part of the seminal fluid, a fluid that carries
sperm.
Puberty – The stage of pre-teen physical development during which increased production of sex
hormones results in secondary sex characteristics, as well as changes in emotions and social
relationships.
PWA – Persons with AIDS.
Protozoa – Microorganisms resembling a one-celled plant or animal.
Queer – Some, gay, lesbian, bisexual and transgender young people use the word queer as an
umbrella term to embrace all the members of the community including the children of LGBT parents
and other allies. There are still plenty of people in the community who find this term offensive and
degrading.
Rape – The crime of forcing someone to have sexual intercourse against their will.
Rectum – The lower end of the large intestine, leading to the anus.
Re-infection – Getting another infection with the same or similar microorganism after being treated.
Replicate – Used here to describe the ability of HIV to make copies of itself.
Reproduction – The production of offsprings of the same kind.
Rhythm Method – A method of birth control in which the couple abstain from sexual intercourse
during the period when ovulation is most likely to occur (aka calendar method).
Safe Haven Site – A location where a parent may legally surrender a newborn infant without having
to face any criminal prosecutions. A hospital, police station, or manned fire station.
Safe Surrender – A state of law that permits a parent, within 72 hours of birth, to legally and
confidentially surrender a newborn infant without the fear of arrest or prosecution of child
abandonment.
Safer Sex – Sexual practices (anal, oral, or vagina) that involve no exchange of blood, semen, or
vaginal fluid; often characterized by correct and consistent condom use.
Scrotum – The external pouch of skin and muscle containing the testes.
Semen – Whitish fluid containing sperm and white blood cells, which is pre-ejaculated/ejaculated
from the penis during orgasm. HIV can be spread through semen that is infected.
Seminal Vesicles – In men, the sac-like glands that lie behind the bladder and release fluid that forms
part of the semen. The seminal vesicles produce a high fructose fluid that mixes with fluid and sperm
to create semen.
Adapted from the American Red Cross (2012)
140
Seminiferous Tubules – The organs that generate sperm, within each testes.
Sex (also sexual intercourse) – Oral, genital, or digital control between individuals; contact with a
partner’s vagina, penis, or anus (male-female, female-female, or male-male). A biological and
physiological term dividing a species into male or female, usually based on sex chromosomes;
hormone levels, secondary sex characteristics, and internal and external genitalia may also be
considered criteria. Also, another term for sexual intercourse.
Sexual Contact – The touching of another person’s intimate parts, or the intentional touching of the
clothing covering the immediate are of a person’s intimate parts, if that intentional touching can be
reasonably constructed as being for the purpose of sexual arousal or gratification.
Sexual Harassment – Making unwanted sexual advances to someone; causing sex-related discomfort
in another through words or actions.
Sexual Orientation – Refers to one’s sexual and romantic attraction. All people have a sexual
orientation. You can be attracted to people of the opposite sex (straight) or people of the same sex
(gay or lesbian). You can also be attracted to people of either sex (bisexual). Orientation does not
equal action – you do not need to have had a sexual experience to know your orientation. Avoid using
sexual preference, as it implies a choice, or homosexuals, as it is a dated term that focuses on only sex
rather than love and relationships.
Sexuality – The complex range of components which make us sexual beings; includes emotional,
physical, and sexual aspects, as well as self-identification (including sexual orientation and sex),
behavioral orientations and practices, fantasies, and feelings of affection and emotional affinity.
Sexually Transmitted – Spread during sex, or through genital or close body contact between people.
Sexually Transmitted Disease (STD) – A disease that is spread during sex, or through genital or
close body contact between people; includes Chlamydia, gonorrhea, syphilis, herpes, and HIV
infection.
Shaft – The external portion of the penis leading from the body to the head (but not including the
head). The clitoris also has a shaft.
Simian Immunodeficiency Virus (SIV) – A virus similar to HIV that infects monkeys and other
primates in West and Central Africa.
Sodomy – Anal intercourse.
Sperm – The male reproductive cells, produced in the testicles from puberty throughout the male life
cycle.
Spermicidal Foam/Gel – An agent that kills spermatozoa, especially as a contraceptive.
Standard precautions – Guidelines that combine universal precautions and body substance isolation
procedures in hospitals.
Adapted from the American Red Cross (2012)
141
STD – See sexually transmitted disease.
Sterilization – A surgical procedure that prevents reproduction by total or partial removal or
modification of the reproductive organs.
Strategy – A plan of action intended to accomplish a specific goal.
Symptom – An indication of a disorder or diseases, such as pain, nausea or weakness. Symptoms may
be accompanied by objective signs of disease such as abnormal laboratory test results or findings
during a physical examination.
Syndrome – Used here to describe a group of related medical problems or symptoms.
T-cell – A type of white blood cell essential to the body’s immune system.
T-cell count (CD4+) – A marker that measures the effect of HIV infection on a person’s immune
system.
T-helper cell – See T-cell.
Testes/Testicles – The male gonad or sperm-producing gland (testes) usually with its surrounding
membranes, particularly in humans or other higher vertebrates.
Transgender – A broad term describing the state of a person’s gender identity which does not
necessarily match his/her give sex at birth.
Transmission – The spread of a microorganism from one person to another.
Transsexual – A person who has undergone surgical and hormonal treatment to change his or her
anatomical sex.
Tubal Ligation – A sterilization technique in which a woman’s fallopian tubes are tied to prevent ova
entering the uterus.
Urethra – The tube which transports urine from the bladder to the outside; in males, the urethra also
transports semen.
Uterus – Womb; pear-shaped organ in which a developing fetus grows.
Vagina – The passageway from the uterus to the outside of a woman’s body through which a baby is
born; the penis enters the vagina during vaginal intercourse.
Vaginal fluid – Fluid that provides moisture and lubrication in the vagina; vaginal of a HIV-infected
women can spread HIV.
Vas deferens – The tube that carries the sperm out of the scrotal sac located between the epididymis
and urethra.
Adapted from the American Red Cross (2012)
142
Vasectomy – A male sterilization technique, in which the vas deferens are cut and cauterized.
Viral – Caused by or related to a virus.
Viral load – The amount of HIV RNA in the blood; as viral load increases, the chances of illness
increases.
Virgin – Someone who has never had oral, anal, manual, or genital sexual intercourse.
Virus – A germ, much smaller than a bacterium, whose survival depends on cells in the host; a virus
such as the HIV destroys host cells.
Voluntary – Proceeding from the will or from one’s own choice or consent.
Vulva – The external female genitals.
Western Blot – A blood test that detects antibodies to HIV; used to confirm EIA results.
Window Period – The early period of infection before antibodies can be detectable (3 weeks to 6
months).
Withdrawal Method – An unreliable method of contraception in which the man withdraws his penis
from the vagina before he ejaculates.
Adapted from the American Red Cross (2012)
143
How to Review a Book for Use with Bibliotherapy
Determining
Appropriateness
Questions to Ask
Will my student(s) able to:
1. comprehend the concept of the book?
Grade/Interest Level 2. understand the vocabulary used in the book?
3. show interest in the book?
4. connect their own life experiences to the book?
Are the characters:
1. real?
2. change and grow throughout the book?
Presentation of
3. presented in a positive manner?
Characters
4. free from discriminatory or prejudicial descriptions?
Is my student(s) similar to the story, in terms of:
1. setting?
Context
2. correct age group
3. situation or problem
Do the illustrations/picture(s) help my student(s) to:
1. gain understanding of the text?
Illustrations/Pictures 2. portray the characters in positive ways my student(s)
can relate to?
(if any)
3. fair representation of ethnic and cultural views
4. capture and maintain the student’s engagement?
The author’s message:
1. encourage student(s) to reflect and engage in
discussions?
2. show feelings and actions my student(s) can relate to?
Author’s Message
3. offers hope for my student(s)?
4. provide strategies to cope with or solve difficult life
situations rather
5. advocate for the acceptance and well-being of all
children?
Adapted from Rozalski, Stewart, & Miller (2010)
144
(A) Antecedent (B) Behavior (C) Consequences Chart
Student: _________________ School: _________________ Teacher: ____________
Use this chart to record details about your student’s maladaptive behavior. It is also
helpful to note how often the behavior occurs.
Date
Time
Started
Setting:
Where did this
behavior
happened?
Antecedent:
What
happened
immediately
before the
behavior?
Behavior:
What did the
student do?
Be specific.
Consequences:
What happened
immediately
after the
behavior?
Time
Ended
145
How to Write Your Own Social Stories
Types of Sentences Use
Descriptive – Statements and facts
Directive – Positive statements that described a desired response
Perspective – Provide descriptions about another person’s thoughts, feelings, or reactions
Affirmative – Describes an opinion that is commonly shared by more than one person
Control – Support recollection of a story
Cooperative – describes how others might help the individual during the social situation
Guidelines/Formula:
 Write story in 1st or 3rd person point of view.
 Use developmentally appropriate and easy to understand text.
 Use 0 -1 directive or control, to 2 – 5 descriptive, perspective, affirmative, or
cooperative sentences.
Example: “Shaving Facial Hair”
When the hair on my face gets long I need to cut it.
It is important to have it short so I look good.
I will look different with facial hair short. Looking different is okay.
My facial hair will grow back again.
My mom will help me shave my facial hair.
When my mom finished, she will say “finished now” and I can get out of the chair.
I will look different and I will look good.
Example: “Thoughts of Masturbation”
My Name is Mary.
Sometimes I think about touching my private areas.
It’s okay to think about touching my private areas.
I will try to keep my thoughts to myself.
This is very important.
I may ask my mom or dad a question if I’m confused.
Adapted from Gray (2000); Worbel (2003)
146
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