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Lifelong Sexual Development

Chapter 5. Lifelong Sexual Development
Tools for Parents of Children with Special Needs
By: James J. Messina, Ph.D., CCMHC, NCC, DCMHS

A.    What are the lifelong sexual development needs of children with special needs?


Parents of children with special needs have to recognize that their children have sexual developmental needs which need to be addressed. This is important because of the following realities about the sexual development of children with special needs:

  • Their lifelong sexual development process is similar to that of "normal" children.
  • They need to recognize the similarities in their sexual awareness and feelings.
  • They need to recognize their bodily sensations, feelings, and urging over their lifetime as ''normal.''
  • They need to understand the sexual functions and relationships of the human race.
  • They need to understand reasonable, appropriate, and healthy sexual experimentation as they grow to adulthood.
  • They need to deal with the emotional impact their special need has on their ability to function at an adult level of sexuality.
  • They need to recognize the obligation, responsibility, and societal norms involved in sexual relationships.
  • They need to be assisted in dealing with relationships with their peers.
  • They need to be encouraged to perceive of themselves as sexual beings throughout their entire lives.
  • They need to have parents willing to provide lifelong sex education for them.

B.  What concepts are suggested for the sex education of children with special needs?

The following is a list of concepts which is essential for the healthy development of sexuality in children with special needs. It is important for parents to work on teaching their children these concepts from the time they are preschool age.


1.  Awareness of self - becoming a boy, becoming a girl

a. Relating to the environment:

  • responses of parents and siblings
  • physical comfort - holding, feeling, bathing, changing
  • emotional comfort: tolerance for behavior, warm nurturing in spite of no response from infant
  • sensory motor stimulation - playing, vocalization, kinesthetic, mobility, spatial awareness.

b. Recognizing parts of the body:

  • responds to direction involving naming body parts: knees, toes, mouth, eyes, ears, nose, hands, tummy, head, shoulders, arms, legs, fingers, elbows.
  • indicates hand and other body parts in response to commands. (No concern for teaching function at this time.)
  • tactile and kinesthetic stimulation
c. Identifying body processes with proper names and not using slang words:
  • eating
  • sleeping
  • elimination

d. Toilet training:

  • vocabulary with proper names and not using slang words
  • association - dry, bathroom, stool
  • reinforcement of schedule
  • management of clothing

e. Identifying body parts with appropriate use of names and not using slang words:

    mouth               back

    eyes                 fingers

    ears                  toes

    nose                 abdomen

    hands               stomach

    legs                  navel

    neck                 breasts

    head                 buttocks

    shoulders         penis/vagina

f. Independent care of body needs:

  • hygienic care: wipe nose, wash hands, wash face, bathe, wash hair, brush teeth, wipe after toilet use
  • clothing: choosing, play clothes, night clothes, dressing, undressing

g. Knowledge of body parts as related to body image (as opposed to merely recognizing body parts)

h. Verbalizing feelings and sensations: inference is made here to body orientation and  response to environmental factors, not sexual stimulation.

I. Awareness of self in relation to others

  • family
  • group member

j. Awareness of emotional self and basic need for:

  • security
  • social approval
  • belonging and acceptance
  • self-esteem
  • achievement
  • affection
  • independence

k. Awareness of self as a person capable of influencing others.


2. Physical changes and understanding of self:  becoming a man, becoming a woman

a. Sexual differences - physical, external using proper names and not slang words:

     boys -  genitals           scrotum

                  penis               rectum


     girls - breasts              vagina

                vulva                  urethra

                abia                   rectum


b.  Identification with same sex and understanding opposite sex and  exposure to nonsexist attitudes concerning:

  • activities, toys, sports
  • dress, clothing, hairstyles
  • interpersonal relationships with parent or parent substitute of same sex
  • traditional masculine or feminine role models vs. nontraditional equal rights role models

c.  Social role of child:

(1). in the family

  • family composition: sizes and types
  • purposes of family group: protection, security
  • parent-child relationships
  • sibling relationships

(2). beyond family

  • extended family
  • peers: others with developmental disabilities as well as "normal" others
  • other adults
  • organized activities

d.  Awareness of individual differences:

  • physical height, weight, size, appearance
  • behavioral attitudes
  • family likenesses, growth and development patterns

e.  Preparation for changes in self:

  • origin of life
  • understanding growth/puberty changes

(1) pubertal changes in boys

  • broadening of shoulders
  • growth of hair on face, armpits, pubic area
  • skin/hormones
  • later growth spurts
  • muscular development
  • change in voice pitch
  • development of reproductive system

(2) pubertal changes in girls (changes occur earlier than in boys)

  • breast development
  • growth of hair in pubic area and armpits
  • broadening of hips
  • skin/hormones
  • change in voice pitch
  • development of reproductive system
  • menstruation

f. Acceptance of changes:

  • observes changes in others
  • compares self with others
  • has ego strength to accept his status

g. Changes in relationships and social expectations

  • changed roles
  • increased responsibilities

h. Emotional responses to the opposite sex

i. Virginity

  • value of being a virgin
  • holding off from sexual intercourse
  • marry at appropriate time

j.  Conception and contraception

  • reproductive purposes
  • review of male and female reproductive organs and their functions
  • existence of continence regarding the act of sexual intercourse
  • contraception and abortion
  • social implications

k. Pregnancy

  • selecting a doctor
  • following doctors orders
  • bodily changes in the mother
  • growth of the fetus

l. Childbirth

  • types of delivery
  • natural
  • cesarean
  • multiple births
  • post-birth care

m. Informational areas

  • masturbation
  • homosexuality
  • indecent exposure
  • sexually transmitted diseases: cause, how spread, symptoms, treatment, consequences


3.  Peer-group relationships

a.  Development of self-respect

  • success in achievement
  • attention to appearance
  • privacy
  • personal privacy
  • confidentiality of personal information
  • self-control
  • acceptance of responsibility
  • poise

b.  Respect for others

  • property rights
  • privacy
  • opinions
  • feelings

c.  Peer expectations and APeer Pressure@

  • influence of individuals
  • influence of groups
  • behavior of friends

d.  Responsibilities to groups

  • using groups for support
  • using groups as challenges
  • need for success in groups
  • concern for the overall good of groups

e.  Prelude to group relations

  • courtesy
  • thoughtfulness
  • values of the rights of individuals
  • values of group membership
  • standards of behavior
  • self-discipline

f.  Identifying with the same and with the opposite sex:

  •  masculinity and femininity

g.  Acceptance of changing roles in relation to others; the family as a societal unit:

  • family problems
  • sibling relationships
  • rights of individual members of the family
  • responsibilities of individuals

h.  Acceptance of the role as an employee, subordinate role:

  • boy with male boss
  • boy with female boss
  • girl with male boss
  • girl with female boss

i.  Social heterosexual relationships; preparation for dating:

  • selecting companions
  • arranging a date
  • accepting a date

dating behavior:

  • courtesy
  • self-respect
  • thoughtfulness of others
  • petting

j. Classification of premarital intercourse

  • abstinence
  • double standard


4.  Responsibility to society

  • single life
  • independent living
  • social relations
  • preparation for marriage
  • selection of a mate
  • financial obligations of marriage
  • husband/wife relations
  • contraception
  • responsibility of care for a household
  • child care
  • personal resources; getting help

C.  What are the life-cycle tasks for healthy sexuality in children with special needs?

Children with special needs can use the following list of tasks to determine if their lifelong sexual development is progressing in a healthy manner. The age levels for attainment of these tasks may need to be altered based on each child's intellectual and physical ability. The children will be able to answer affirmatively as to the attainment of each task if their parents are involved in appropriate sex education and sexual development activities with them.


1.  CONCEPTION: When I was conceived,

  • a loving relationship existed between those who conceived me.
  • the couple had made a commitment toward permanence in their relationship.
  • it was a planned pregnancy.
  • I was wanted by the couple.
  • my mother was physically healthy and emotionally prepared.


2.  PREGNANCY:  When my mother was pregnant with me,

  • I was provided adequate nourishment.
  • a sound, emotional and stress-free womb environment existed.
  • it was a shared experience by my parents.
  • I was a full-term baby with no medical complications.


3.  BIRTH:  When I was born,

  • my birth was a shared parental experience.
  • my healthy delivery was shared by my parents.
  • my birth was a joyful experience for my parents.
  • both of my parents prepared for my arrival. My new home was waiting for me.


4.  BIRTH to 2 YEARS:  Between my birth and becoming a toddler,

  • my awareness of self was encouraged by my parents.
  • my body awareness was stimulated by my parents.
  • my awareness of others was encouraged by my parents.
  • I was able to give accurate recognition of my body parts.
  • I was able to label my body parts with accurate names.
  • both my parents and I accepted my nude body.


5.  2 to 5 YEARS:  Before I entered elementary school,

  • I was able to identify my body processes.
  • my toilet training was healthy, spontaneous, and appropriate.
  • I labeled bodily processes accurately, avoiding the use of slang.
  • good hygiene was encouraged and expected of me by my parents.
  • I was given recognition in the role of interpersonal relationships.
  • I was given identification of human feelings, and I was trained to recognize them in myself and in others.
  • I was given responsible child management and discipline by my parents.
  • accepting personal responsibility for my own actions was encouraged by my parents.


6.  5 YEARS to ADOLESCENT YEARS:  When I was in elementary and middle school,

  • I recognized and accepted the sexual differences between boys and girls.
  • I recognized and accepted the need for self-esteem, peer recognition, security, achievement, and altruism.
  • I recognized the need to give, to share with, to be open with, and to respect others.
  • I was prepared for the physical changes that were to occur in my body.
  • I had an understanding of sexual stereotypes and roles in society.
  • I had an understanding of social roles in family, peer group, school, and community.
  • I recognized the need for responsible sexual relationships.
  • I had been given accurate information on masturbation, homosexuality, virginity, birth control, and sexually transmitted diseases.


7.  ADOLESCENT YEARS (10 to 22):  When I was in junior high school, high school, college, or in a training program:

  • I made responsible exploration of sexual and interpersonal relationships.
  • I recognized commitment to another in sexual relations with all of its incumbent consequences.
  • I received the proper vocational training to prepare myself to accept the consequences of reproductivity, e.g., trained to get a job and work to earn enough money to raise children.
  • I nurtured and established healthy and responsible relationships with members of the opposite sex.
  • I was able to accept the alternative sexual orientations of others.


8.  ESTABLISHMENT YEARS (22 to 50):  After I was gainfully employed and married:

  • I experienced an enriching sexual experience in a loving interpersonal relationship with my spouse.
  • I provided role modeling of a responsible sexual relationship for the younger generation.
  • I was able to address and remediate sexual dysfunction if and when it occurred
  • I prepared myself for the physiological and psychological changes coming due to age, health, and other factors.
  • I recognized the impact of career, leisure, recreation, and interpersonal relationships on adequate sexual function and vice versa.
  • I believed in and practiced responsible conception, pregnancy, delivery, and rearing of children.


9.  DECLINING YEARS (50 +):  In later life once my family is grown:

  • I make realistic plans in regard to health and financial requirements.
  • I accept my role as a model of adequate healthy sexual functioning.
  • I accept menopause and its consequences for myself and my spouse.
  • I am willing to share the wisdom of years with younger generations.


This model assumes we are looking at an individual's lifelong sexual development. All phases of the life cycle depend on adequately meeting the goals of each of the previous stages of sexual development. Parents of children with special needs can utilize this chart to determine their own sexuality and identify gaps in their life span development which they would need to address if they were to be successful in assisting their children to develop into healthy sexual beings.

D.  What steps can be taken to encourage the lifelong sexual development of children with special needs?


Step 1:  Before you can encourage the healthy sexual development of a child with special needs, you must assess your beliefs concerning this area of life.  Answer the following questions in your journal:

  • How comfortable am I regarding my target child as a sexual being?
  • How comfortable am I with my own sexuality?
  • How openly can I discuss sexual issues with: (1) my spouse, (2) my other children,  (3) my parents, (4) my friends, (5) my target child? .
  • How realistic is it to assume that the sexual development of a child begins at the child's conception?
  • How willing am I to provide sex education from birth on to my target child and to my other children?
  • What are my fears about my target child's sexual development?
  • What religious, moral, and ethical beliefs may interfere with my providing sexual education to my children?
  • How realistic is it to expose human sexuality to children who will never be able to handle marriage in their lifetime? What is the value? What is to be gained in providing these children with as normal a sexual education as possible?
  • How comfortable am I or will I be in handling questions and comments from my target child about sexual issues in which my child  will never be able to become fully involved, physically or emotionally?
  • How does the sexual development of my child open the old wounds of unresolved  grief, anger and lack of acceptance of my child's special needs?


Step 2:  To be a healthy provider of lifelong sexual education to your children, assess how you (and your spouse) have fulfilled the life cycle tasks listed in this chapter.  Answer the following questions in your journal:

  • What does it mean to my sexuality if I was unable to accomplish the necessary tasks for healthy sexuality in my early years?
  • What steps can I take now to remediate this?
  • How am I preparing myself for future changes in my sexual functioning?
  • Am I a good role model of healthy sexual functioning for my children? If not, how can I become one?
  • How can I judge how normal and healthy my sexuality is?
  • Am I doing everything I can to ensure ongoing sexual maturity in myself? If not, what plan of action can I develop to change this?
  • Are some of my current sexual difficulties related to lack of accomplishment of certain life cycle tasks for healthy sexuality?
  • What impact on my current life has my past sexual development had?
  •  How comfortable am I in talking with my parents about my sexuality and the impact of the life-cycle tasks on it?
  • How open am I in talking with my children about their sexuality life-cycle tasks?


Step 3:  Now that you have explored the status of your own sexuality and how you will relate to your target child's sexuality, how will you encourage your target child's lifelong sexual development?  Develop the following plan of action in your journal:


Plan of Action to Encourage My Child's Lifelong Sexuality

My child's special need is:

This special need will impede my child's sexual development in the following ways:

I will provide the following sexual role modeling to my child:

I will provide the following sexual education concepts to my child:

     1. from birth to preschool:

     2. from preschool to 5 years:

     3. during elementary years:

     4. during adolescent years:

     5. in adulthood:


Step 4:  If you still have problems developing or implementing the "plan of action" in Step 3, go back to Step 1 and begin again.