Abstract

Data from the National Longitudinal Transition Study—2 (SRI International, 2002) were analyzed to identify variables that predicted whether individuals with intellectual disability (ID) received sex education in public schools across the United States. Results suggested that individuals receiving special education services without ID were only slightly more likely to receive sex education than students with mild ID (47.5% and 44.1%, respectively), but the percentage of students with moderate to profound ID that received sex education was significantly lower (16.18%). Analysis of teacher opinions and perceptions of the likelihood of the students benefiting from sex education found that most teachers indicated that students without ID or with mild ID would benefit (60% and 68%, respectively), but the percentage dropped to 25% for students with moderate to profound ID. Finally, across all students, the only significant demographic variable that predicted receipt of sex education was more expressive communication skills. Results are discussed in terms of ensuring equal access to sex education for students with ID in public schools.

In the United States, many parents have historically entrusted schools with their children's sex education. In fact, the trend appears to be increasing for parents to default to schools for this important task, as demonstrated by empirical research in the past decade as well as public opinion polls (e.g., Eisenberg, Bernat, Bearinger, & Resnick, 2008; Ito et al., 2006). The overwhelming support that parents demonstrate for sex education in school instead of at home could stem from many reasons, such as religion of the parents or parental fear that communicating about sex will adversely influence sexual behaviors (Troth & Peterson, 2000). For example, National Abstinence Education Association (2007) indicated that approximately 90% of parents support sex education in schools. It is therefore important that public schools make available to students the most appropriate, comprehensive, and effective sex and reproductive-health education programs (Kirby, 2002). Regardless of the diverging opinions about the scope and sequence of sex education (e.g., Darroch, Landry, & Singh, 2000; Eisenberg et al., 2008; Howard-Barr & Johnson-Moore, 2007; Landry, Darroch, Singh, & Higgins, 2003; Lindberg, Santelli, & Singh, 2006; Santelli et al., 2006), it is clear that the majority of parents in the United States expect the public school system to provide sex education in the schools.

In the extant literature, the prevalence rate of sex education has been encouraging. A report by the Kaiser Family Foundation (KFF; 2002) indicates that, upon completion of the 12th grade, 89% of public-school students had received some form of sex education. Moreover, a subsequent report by the Centers for Disease Control and Prevention (Martinez, Abma, & Copen, 2010) found that of 2,767 teenagers nationwide from ages 15 to 19, 96% of female students and 97% of male students had received formal sex education by the age of 18. While both reports appear encouraging, it is difficult to ascertain if children with intellectual disability (ID) have been accounted for in their samples, nor can it be determined if the sex education was offered at school or in an alternate setting. Children with disabilities, whether physical or mental, have been excluded from sex education due to the misconception that they are asexual (DiGiulio, 2003; Rohleder, 2010; A. Sullivan & Caterino, 2008). Acknowledging that these children do not differ significantly from their peers without disabilities in developing their own sexuality, researchers have noted some unique challenges associated with the receipt of sex education by children with ID. In particular, the sexual expressions of individuals with ID have been perceived as a potential danger (Howard-Barr, Rienzo, Pigg, & James, 2005) because those individuals are conceived of as either asexual or oversexed and lacking control (Ballan, 2001).

Since the enactment of the Individuals With Disabilities Education Act in 1975, along with its subsequent revisions and amendments (U.S. Department of Education, 1995), the percentage of children with disabilities receiving an inclusive education in schools has risen from 20% in 1970 to 95% in 2011 (National Center for Education Statistics, 2011). The issue of patterns for characteristics of students that do and do not receive sex education thus merits much attention, considering the increasing proportion of children with ID included in the public school system. A review of peer-reviewed literature failed to provide clarity on this issue, sparking our interest in determining the prevalence of sex education in public schools among children with ID.

According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013), ID is evidenced in individuals by both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. Since the publication of the DSM-5, the term intellectual disability has replaced the term mental retardation (MR) that was used in earlier editions of the DSM. Consistent with the earlier edition (DSM-IV-TR; APA, 2000), the DSM-5 classifies ID into four levels according to severity: mild, moderate, severe, and profound. While the DSM-5 emphasizes the role of adaptive functioning over IQ scores “because it is adaptive functioning that determines the levels of supports required” (p. 33), levels of MR/ID appear to be similar in the DSM-IV-TR and DSM-5, respectively, especially with regard to the level of support an individual with ID may need for achieving social and academic tasks. Mild ID represents approximately 85% of all cases; individuals with mild ID have the potential of developing academic skills that may be equivalent to those of a typically developing child in early middle school. Children with moderate ID account for approximately 10% of all cases and typically attain academic and language skills equivalent to those exhibited by a second-grade child. Finally, individuals diagnosed with severe or profound ID constitute approximately 4%–5% of all cases of ID and typically benefit the most from an adaptive-skills curriculum that focuses on teaching independent self-help skills, as opposed to more traditional academic content.

Given the high inclusion rates of children with mild to moderate ID in public schools, compliance with federal law to meet their sex education needs is mandatory. Beyond its being a matter of the law, several reasons arise for providing children with ID access to developmentally appropriate sex education. Kempton and Stiggall (1989) suggested that sex education is essential for children with ID, as it provides a basis of knowledge and skills that enhance quality of life and aids in the prevention of deleterious experiences associated with sexual activity and the broader implications of being aware of sexuality issues (see also Smart, 2009). As indicated by previous studies, individuals with developmental disabilities including ID are at a greater risk of being sexually abused (e.g., Baladerian, 1991; Brunnberg, Bostrom, & Berglund, 2009; Hershkowitz, Lamb, & Horowitz, 2007; Levy & Packman, 2004; Sobsey & Doe, 1991). Chamberlain, Rauh, Passer, McGrath, and Burket (1984) indicated that the incidence of experiencing sexual abuse among children with ID is 25%, while others (e.g., P. M. Sullivan & Knutson, 2000) have found that children with ID are 4 times more likely to experience sexual abuse than are typically developing children. Complicating these findings is the notion that individuals with ID are likely victims of repeated offenses, which often are underreported or not reported at all (Sobsey & Doe, 1991). Further evidence of inappropriate sexual interaction that children with ID may experience is the high incidence of sexually transmitted infections (STIs) reported among this population. For example, Mandell et al. (2008) found that, in a sample of 51,234 children ages 12–17, those receiving special education services were at a greater risk of being diagnosed with an STI. Specifically, they identified that girls with ID were 37% more likely to contract an STI than were girls without ID.

Moreover, a lack of appropriate sex education is cited as a culprit in exacerbating the deleterious sexual experiences of children with ID. In a study that assessed the sexual knowledge of individuals with ID, Galea, Butler, Iacono, and Leighton (2004) found deficiencies in information pertaining to various areas of sexual health including safer-sex practices, puberty, menstruation, and menopause. The authors suggest that these knowledge deficits be countered with better or more adequate human-relations interventions and sexual education programs, as the knowledge deficits present are indications either that these individuals are not involved in a sex education program or that the knowledge being taught in the programs is not being understood and internalized. While the study only involved adult participants, it is important to consider the series of events that did or did not occur that led these participants to the knowledge that they had. Sex education for children can promote awareness and knowledge construction of sexual behaviors, STIs, and protection.

While sparse, there is evidence supporting the efficacy of sex education programs for individuals with ID (e.g., Caspar & Glidden, 2001; Lumley, Miltenberger, Long, Rapp, & Roberts, 1998; McDermott, Martin, Weinrich, & Kelly, 1999). For example, Caspar and Glidden (2001) concluded that, after sex education courses had been tailored to adults with learning disabilities, the participants demonstrated an increase in knowledge about sexuality. Nonetheless, few studies have examined the receipt of sex education among children with ID utilizing a nationally representative data set, especially according to levels of severity (mild, moderate, etc.). Such evidence is necessary for enhancing our understanding of the topic.

Teacher perceptions of sex education for children with ID are of interest based on the Pygmalion effect, a term describing the effects of interpersonal expectations (Rosenthal & Jacobson, 1992). An experimental study by Rosenthal and Jacobson (1992) demonstrated that higher expectations from the teacher enhance students' learning because the teacher tends to create a warmer socioemotional climate, teach more material, give greater opportunities for responding, and provide more differentiated feedback. Such evidence is pertinent to the current topic because teachers have been found to be unprepared to handle sexuality issues with students with disabilities, or to report a low comfort level in addressing sexuality topics (Howard-Barr et al., 2005). Taken together with the common misunderstanding that sex education is not necessary for children with disabilities, teacher perception of the efficacy of sex education may influence how teachers organize sex education courses (e.g., classroom climate, expectation, and feedback) for students with ID.

Closely related to teacher perceptions and preparation is students' readiness to learn sex education materials (Agran, Alper, &Wehmeyer, 2002). The rationale is that limited cognitive or language functioning (APA, 2013) of students with ID may impede their understanding of sex education content. That being the case, students' expressive and receptive communication abilities, along with their perceived life skills, may also serve as predictors for the receipt of sex education. As children with disabilities are entitled to a free and appropriate education that meets their specific needs in the least restrictive environment, this includes sex education that is available through the general education curriculum for those that are included in general education classes. The purpose of the current study was to contribute to the empirical research base on sex education for people with ID by examining the patterns for the receipt of that education. To achieve this purpose, three research questions were examined. The first research question concerned the frequency of receipt of sex education according to level of ID: no ID, mild ID, or moderate to profound ID. The second research question concerned examining teacher perceptions of the possible benefit to those individuals not currently receiving sex education of receiving that education. The third research question concerned identifying the predictors of whether an individual receives sex education, according to level of ID.

Method

Sample

The data utilized for the present study were derived from the National Longitudinal Transition Study-2 (NLTS2; SRI International, 2002). The data set contains information of a total of 9,230 youths with disabilities across the United States as a nationally representative and community-based sample. Of the 9,230 youths, approximately 54.9% (n  =  5,070) had information regarding levels of intellectual functioning and thus formed the sample of the present study. Among the 5,070 participants, 55.3% (n  =  2,800) were reported as being male, 32.0% (n  =  1,620) were reported as female, and 12.7% (n  =  640) did not have gender information. In terms of ethnicity as termed in the NLTS-2, 63.2% (n  =  3,200) were reported as being White, followed by 17.4% (n  =  880) as African American, 12.6% (n  =  640) as Hispanic or Latino, 3.0% (n  =  150) as American Indian or Alaska Native, 2.2% (n  =  110) as Asian, 0.5% (n  =  20) as Native Hawaiian or other Pacific Islander, and 5.1% (n  =  260) as another race or ethnicity. The sum of participants across ethnic groups exceeds the sample size, as the respondents were permitted to indicate more than one ethnicity. The average age of the youths was 15.7 years old (SD  =  1.1). In addition, 11.6% (n  =  590) had mild ID and 13.0% (n  =  659) had moderate to profound ID; the remaining 75.4% (n  =  3,820) reported no ID. This information regarding level of ID was reported from the student's Individualized Education Program (IEP) via the student's school-program questionnaire. The collapsed category of moderate to profound ID is typically used for the purposes of statistical analysis because of the low incidence rates for the categories of severe and profound ID. Table 1 provides demographic variables for individuals receiving special education services, grouped by level of ID.

Table 1

Demographics According to Degree of Intellectual Disability (ID)

Demographics According to Degree of Intellectual Disability (ID)
Demographics According to Degree of Intellectual Disability (ID)

Measures

All measures were derived from the NLTS2. All data were obtained from the first wave of the NLTS2, with information regarding the receipt of sex education being ascertained by the special education teacher. The variable of ID was reported by the parent and corroborated by the school-program survey. To examine the receipt of sex education, the NLTS2 contained an item responded to by special education teachers regarding whether the student received sex education or reproductive-health education (variable name: npr1A4a_a). For the whole sample of students with disabilities, approximately 43% (n  =  2,140) were reported as receiving sex education, while approximately 57% (n  =  2,830) were reported as not. To examine teacher perceptions of the possible benefit of the receipt of sex education, the NLTS2 contained an item (variable name: npr1A4b_a) responded to by special education teachers regarding whether students not receiving sex education or reproductive-health education could benefit from such education (“For any activity this student does not take part in, please indicate in Column B whether you believe he or she could benefit from it. … Reproductive health education or services”). For those who were not receiving reproductive-health or sex education in the sample, approximately 54% (n  =  1,450) were reported by special education teachers as having the potential to benefit from such education, while approximately 46% (n  =  1,240) were reported as not having that potential.

In the examination of the receipt of sex education among the sample, several potential predictors were included. These predictors of receipt of services included typical demographic variables such as age, household income (categorical version of the variable), and gender. Other predictors included receptive and expressive communication abilities, inclusive education, level of social skills, and receipt of physical education. The variable of receptive communication ability was measured by teacher rating from the school-program survey of how well the student understood, with values ranging from 1 (indicating that the student did not seem to understand at all) to 4 (indicating that the student understood just as well as other children), as reverse-coded to aid in interpretation. The variable of expressive communication ability was measured by teacher rating of how clearly a child was observed to speak from the school-program survey, with values ranging from 1 (indicating that the student did not speak at all) to 4 (indicating that the student had no trouble speaking clearly), as reverse-coded to aid in interpretation. We considered it important to use teacher perceptions, practically speaking, as teachers may be considered as (a) more objective than parents and (b) gatekeepers in referring for many services that parents may not know about or have ever considered. The variable of inclusion was created to represent a student's having instruction in at least one of the following core academic content areas in the general education classroom: language arts, mathematics, science, and social studies. Approximately 59% of the sample had instruction for one or more of these classes in the general education classroom. The variable of classroom social skills was an existing scale in the NLTS2 measuring in-class social behaviors as rated by the teacher, with values ranging from 3 to 12 (M  =  9.21, SD  =  1.96) for the sample. Each item was rated on a four-point scale by teachers and covered areas such as how well the student got along with his or her peers, followed directions, and controlled behavior. When data were obtained from general and special education teachers, they were averaged to produce a composite, as noted by Griffin, Taylor, Urbano, and Hodapp (2014). Finally, as previous literature has indicated that sex education is either taught or desired to be taught in the context of physical education (e.g., Darroch et al., 2000; Harrison & Hillier, 1999; Hilton, 2003), the variable of whether the student received physical education in the general education setting was included as a predictor in our analyses.

Analyses

All analyses were performed in SPSS (v. 16.0) and MPlus (v. 6.0). In applying weights to adjust for the underestimation of standard errors, we specifically utilized the school-program weight. Missing data were handled using the full-information/maximum-likelihood method of estimation. Missing data primarily resulted from our conceptual selection of variables; for example, we limited our sample of students with ID to those that also had information reported regarding level of ID. To answer the first and second research questions, we performed a 2 × 3 χ2 analysis for each question. A Φ coefficient was calculated as the measure of association. Values of 0.10, 0.30, and 0.50 for the Φ coefficient are considered to be small, medium, and large, respectively (Cohen, 1988). Upon a finding of statistically significant results, standardized residuals were evaluated for each cell. Standardized residuals larger than the absolute value of 1.96 were considered as statistically significant at the .05 level or less. To answer the third and final research question, a hierarchical logistic regression was conducted to separately predict the receipt of sex education for the categories of no ID, mild ID, and moderate to profound ID. Standardized regression coefficients with levels of statistical significance, along with odds ratios (eB), will be reported and interpreted in this article. The expression eB represents the odds that a certain factor of the regression model influences the likelihood of receiving sex education within the respective group (e.g., mild ID), with an eB greater than 1 indicating an increase in the probability of receiving sex education and an eB less than 1 indicating a decrease in probability. An eB of 1 means that the odds of occurrence are 1 ∶ 1, which is to say equal likelihood of occurrence; an eB of 2 suggests that the odds of occurrence are 2 ∶ 1, which translates to a 100% increase in probability that it will occur (see also Bland & Altman, 2000).

Results

Does the Presence and Level of ID Affect the Proportion of Students Receiving Sex Education?

From the column marginal frequencies, 43% of individuals with and without ID received sex education. However, individuals without ID (47.5%) were slightly more likely to receive sex education than individuals with mild ID (44.12%) and were significantly more likely than individuals with moderate to profound ID (16.18%), χ2(2)  =  221.65, p < .001, Φ  =  0.21. Even though there were observed differences in sex education between students without ID and students with mild ID, they were nonsignificant, χ2(1)  =  2.298, p  =  .12, Φ  =  0.02. Table 2 provides the observed frequencies along with values of standardized residuals for each cell.

Table 2

Distribution for Degree of ID and Sex Education Received

Distribution for Degree of ID and Sex Education Received
Distribution for Degree of ID and Sex Education Received

Are Teacher Perceptions About the Student′s Ability to Benefit From Sex Education Associated With Receipt of Sex Education?

From the column marginal frequencies, approximately 54% of the teachers reported that a student would benefit from sex education based upon previous courses completed. However, a much higher percentage of teachers believed that the benefit would only be for those students without ID (60% of all without ID) or for those with mild ID (68% of all with mild ID), compared to those with moderate to profound ID (25% of all with moderate to profound ID), χ2(2)  =  233.13, p < .001, Φ  =  0.30. While the difference between students with no ID and students with mild ID was statistically significant, χ2(1)  =  6.86, p < .01, the association was small (Φ  =  −0.06). The difference in teacher-perceived likelihood of a benefit from sex education between students with mild ID and students with moderate to profound ID was significant, χ2(1)  =  150.355, p < .001, Φ  =  0.42. These results suggest that some teachers may be making judgments about students' ability to benefit from sex education curriculum, instead of assessing each student's current level of sex education and designing individualized instructional programs to meet those students' needs. Table 3 provides the observed frequencies along with the values of standardized residuals for each cell.

Table 3

Teacher Perceptions of Benefit of Sex Education for Students Not Receiving It

Teacher Perceptions of Benefit of Sex Education for Students Not Receiving It
Teacher Perceptions of Benefit of Sex Education for Students Not Receiving It

Do Student Demographic Variables Influence the Probability of Receiving Sex Education?

In answering the third research question, we examined potential predictors of the receipt of sex education. To assess model fit, values of Nagelkerke R2 were evaluated for each model. These values were .021, .057, and .181 for the models with no ID, mild ID, and moderate to profound ID, respectively. These values of R2 indicate acceptable model fit for the social sciences, with values of .01, .09, and .25 indicative of small, medium, and large divergence, respectively, according to Gravetter and Wallnau (2010). For students with disabilities but without ID, only receipt of physical education was a statistically significant predictor of the receipt of sex education. The odds ratio was eB  =  1.11, indicating a slight but statistically significant increase in the likelihood of receiving sex education. That is, as physical education increases by one unit, there is an 11% increased probability that a student without ID will receive sex education (Table 4).

Table 4

Parameter Estimates From Logistic Regression Analyses by Model

Parameter Estimates From Logistic Regression Analyses by Model
Parameter Estimates From Logistic Regression Analyses by Model

For students with mild ID, both expressive communication and social skills emerged as significant predictors from analyses. The odds ratios were 1.36 for expressive communication and 0.72 for social skills, indicating that as expressive communication ability increases by one unit, there is a 36% increased probability that a student with mild ID will receive sex education, and that as social skills increase by one unit, there is a 28% decreased probability that the student will receive sex education. For students with moderate to profound ID, household income (eB  =  1.46), expressive communication (eB  =  1.43), and physical education (eB  =  1.33) emerged as statistically significant predictors from our analyses. The odds ratios indicate larger influences of the predictors on the receipt of sex education among students with moderate to profound ID. For example, as expressive communication ability increases by one unit, there is a 43% improved probability that a student with moderate to profound ID will receive sex education.

Discussion

One of the most striking findings from this study is that a relatively high percentage of students receiving special education services (via ID educational classification) did not receive any formal sex education. For students without ID receiving special education services, approximately 53% had not received sex education, which is similar to the 56% of students with mild ID. The similarity in these percentages suggest that individual teachers, schools, or school districts may be influenced by factors other than the particular level of intellectual functioning when determining who will receive sex education. Students with moderate to profound ID were much less likely to receive sex education than were other students with ID; approximately 84% of them did not receive sex education. With approximately 90% of students receiving sex education by graduation (KFF, 2002), it is still possible for students without ID and with mild ID to receive some sort of sex education before they complete the 12th grade or from another source outside of the public school; however, the significantly lower receipt by students with moderate to profound ID is likely to continue through graduation, especially given that we statistically controlled for age in our analyses. The stark differences in receipt of sex education (between 53% and 84%) would suggest that as the limitations in cognitive functions and adaptive behaviors become more severe, the likelihood of receiving sex education decreases dramatically.

The receipt of sex education, like any other kind of education, tends to be founded in the fallacy of perceptions of student “readiness” to learn the content. For many teachers, the types and sophistication of communicative exchanges are important factors in deciding student readiness for general curriculum (Agran et al., 2002). Expressive communication, in addition to class social skills, is prevalent in predicting receipt of sex education for students without ID and with mild ID. Expressive communication only provides an impression of an individual's ability to understand others or receive communication by reciprocating via expression. Individuals with ID may suffer from expressive-communication deficits, and teachers may thus also assume that the students have the same difficulties with receptive communication; however, receptive communication is typically more developed (Dykens, Hodapp, & Evans, 2006). The perception that an individual's level of expressive communication represents his or her level of receptive communication is also flawed when considering the varied developmental patterns of students in general regarding the use of language (see also Rathus, 2011). Piaget (1976) believed that cognitive representations and development came before language development and use. This is supported by Nelson (2005), who contends that individuals develop linguistic abilities to describe what already has a cognitive presence. Receptive communication is difficult to directly evaluate, but trying to infer it as equal to the expressive communication abilities of students might lead to students not receiving sex education because they are perceived as not being ready or able to understand content. This approach is fundamentally flawed also. That is, we argue that every student has the potential to benefit from some form of sex education as long as the instructional trials are matched to the individual student's strengths and weaknesses, just like in any other educational content area. The goal is that sex education not be viewed as a question of “Are they ready to learn this information?” but instead be approached as another skill that needs to be taught through an IEP.

In addition to the number of students with ID who did not receive sex education, the percentage of special education teachers who believed that these students would not benefit from sex education is a substantial concern. For all the students without ID that did not receive sex education, 40% of the teachers believed that they would be unlikely to benefit from sex education. Additionally, 32% of special education teachers of students with ID believed that sex education would not benefit students with mild ID, and 75% of them believed that it would not benefit students with moderate to profound ID. Yet prior research in sex education for individuals with ID has clearly demonstrated that these individuals have low prior knowledge about, and are given fewer opportunities to learn about, sexual behaviors and the potential health risks associated with engaging in these behaviors (Chen & Udry, 2002; McCabe, 1999). While only 7% of the special education teachers reported having any professional preparation for dealing with sex education, 54% of them believed that sex education would be beneficial for students (Howard-Barr et al., 2005). However, the discrepancies between teacher perceptions of benefit to students without ID, those with mild ID, and those with moderate to profound ID require further investigation to understand the underlying factors and perceptions of the teachers about their students.

In examining the need for sex education for students receiving special education services who do not have ID, who have mild ID, and who have moderate to profound ID, the ramifications of not providing that education should be considered. For instance, individuals with ID have been reported as 3 times more likely to be sexually assaulted that individuals without ID (Duh, 1999). The perpetrators of this abuse have typically been peers and caregivers (Crossmaker, 1991). The vulnerability of individuals with ID appears to be exacerbated by communication difficulties that may interfere with reporting instances of abuse (Sobsey & Doe, 1991), along with difficulties discriminating what behaviors constitute abuse and risk taking with regards to unplanned pregnancies and STIs. Moreover, promoting positive attitudes is also an essential component of sex education, given that individuals with ID appear to be significantly less accepting of sociosexual situations as compared with peers who do not have ID (Lunsky & Konstantareas, 1998). Teachers and parents may be able to help prepare these individuals to develop healthy relationships, founded upon what is learned from sex education, in an attempt to protect themselves from risky situations (Howard-Barr et al., 2005). Of parents and teachers, special education teachers would ostensibly be best able to provide an objective assessment of a student's current understanding of sexual behaviors and his or her risk, so that they could design an individualized approach to teaching sex education to individuals with substantial deficits in communication, intellectual abilities, and adaptive behavior. An analysis of many studies concerning the sexual behaviors of students with and without disabilities has shown that sexual education interventions delay sexual behaviors and increase the use of contraceptives and condoms (Kirby, Laris, & Rolleri, 2007). However, educators may feel unprepared to teach this content or may believe that teaching the content may promote sexual behaviors (Howard-Barr et al., 2005).

Results of the current study, in combination with findings from past studies, should be of concern, given recent findings that individuals with moderate ID, when taught sex education, exhibit increased capacity to make sexually related decisions (Dukes & McGuire, 2009). Dukes and McGuire individually taught four participants sex education based on Living Your Life: The Sex Education and Personal Development Resource for Special Education Needs—Revised Edition (Bustard, 2003). After adapting the curriculum and instructional modality to suit the one-on-one format of delivery and individual abilities, they used the Sexual Consent and Education Assessment Knowledge and Safety scales to assess potential post–sex education gains in (a) knowledge of sexual safety practices, (b) knowledge of the physical self, (c) knowledge of sexual functioning, and (d) knowledge of sexual choices and consequences associated with each choice. Dukes and McGuire found that all four participants with moderate ID showed an increase in knowledge across all content areas based on a relatively low-dosage intervention (i.e., positive intervention effects were observed after 1 or 2 weeks of twice-weekly individual 45-min teaching sessions).

Similarly, McDermott et al. (1999) evaluated a 1-year individualized intervention program for women with ID and found that an increase in sexual knowledge was directly associated with a greater number of instructional contacts. Lumley et al. (1998) provided further light on the benefits of sex education targeted to women and girls with mild to moderate ID by demonstrating that these individuals exhibited gains in knowledge from a program focusing on the training of behavioral skills (e.g., verbally rejecting an abduction lure, leaving the person and scene, telling a familiar adult about the incident) for preventing sexual abuse. Taken together, these findings seem to suggest that including sex education in IEPs along with concentration on social/behavioral skills may be a promising direction for future sex education for children with ID. Lastly, whereas Dukes and McGuire implemented these interventions with a single individual at a time, future research in this area should focus on ascertaining the effect size of small-group teaching formats that more closely resemble a special education instructional setting, documenting variables that facilitate maintenance of intervention gains, and moving beyond simply showing a change in knowledge by measuring overt behavior during role plays.

Although the analysis of secondary data sets, such as the NLTS2, can provide generalizable findings due to their breadth of coverage, the data are collected before the development of experimental questions by individual researchers. Generalizability is viewed as the capacity of the results from a study to be transferred to other studies and other contexts. While generalizability may be a strength of data sets like these, the generalizability of the findings also needs to be considered with careful attention. The collection of data before the development of research questions implies that certain variables, had we decided they were important to the current study, might not be included in the analysis due to their lack of presence in the data set.

The coverage of variables and diverse contexts allows the NLTS2 to be generalizable to other institutions wishing to provide sex education to students with ID. Future research should consider examining these research questions across time, given the longitudinal nature of NLTS2, which could further describe the pattern of receipt of sex education across time. However, as most intervention programs that will be used to promote sex education for these students will be small in size, it is important to recognize the diversity of the students involved. Individuals with ID have very different strengths and weaknesses. The way in which future curriculum on sex education is taught needs to be focused on the abilities of the student at hand and not on the general population. Additionally, the geographic boundaries of data collection (i.e., students located in the United States) limited the scope of the study to the context of one nation. While an international perspective may bolster the findings of this study, the cultural norms and perspectives regarding special education in the United States limit the ability to translate findings to other regions of the world.

In conclusion, many special education teachers often feel unprepared to handle sexuality issues with students with ID or to teach them sex education. In addition to beliefs about benefit and ability to teach sex education, many caregivers and educators have infantilized individuals with ID (Smart, 2009), which may prevent the introduction of sex education, as these individuals are viewed according to their “mental age” instead of their chronological age. However, it is important to recognize that students with ID have a right to know about their bodies' functions and to be taught how to increase hygienic behaviors and promote safe, healthy relationships with others. Many parents want to have their child in an environment that emphasizes basic living and functional skills (Palmer, Fuller, Arora, & Nelson, 2001). Smart (2009) claims that sex education is a vital part of this environment in ensuring a quality of life that allows individuals with ID to have meaningful and safe intimate experiences. The findings from this study suggest that many students do not receive sex education and that many teachers believe that sex education would benefit these students. In order to increase the number of students receiving sex education, professional development should include collaboration between health educators and special education teachers. In providing developmentally appropriate sex education for special education students, special education teachers may need health education collaborators with this area of content expertise to learn how to impart this knowledge effectively. Instead of searching for alternatives to sex education, it is important to reiterate that “parents, special education instructors, and institutions open the door to abuse by shying away from any biological instruction either from a misplaced sense of propriety or an unawareness of the importance of such instruction in preventing sexual abuse” (Morano, 2001, p. 129).

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Author notes

Lucy Barnard-Brak (e-mail: lucy.barnard-brak@ttu.edu), Texas Tech University, Educational Psychology and Leadership, P.O. Box 41071, Lubbock, TX 79409, USA; Marcelo Schmidt, Steven Chesnut, Tianlan Wei, and David Richman, Texas Tech University.