Journal of Intellectual Disability Research, 1992, 36, 531-539

Increases in knowledge following a course of sex education for people with intellectual disabilities W. R. LINDSAY,' E. BELLSHAW,^ G. CULROSS,^ C. STAINES^ & A. MICHIE' 'Department of Clinical Psychology, Strathmartine Hospital, ^Dudhope Resources Centre, and ^Tayside Social Work Department, Dundee, Scotland ABSTRACT. Althou^ sex education programmes are thought to be useful in reachitig people with intellectual disabilities, tbere is very little evidence tbat the material taught is retained by clients. This paper reports data whicb has been collected routinely on a sex education programme. Forty-six subjects were assessed on their level of sexual knowledge in seven areas: parts of the body, masturbation, male puberty, female puberty, intercourse, pregnancy and childbirth, and birth control and venereal disease. They were retested after a 9-month sex education programme and tested again at a 3-month followup. A control group of 14 subjects were tested on two occasions, 4 months apart. There were significant and substantial increases in sexual knowledge on all areas for the experimental group. The control group showed no corresponding increases in knowledge.

INTRODUCTION Sex education has become an accepted part of services for people with intellectual disabilities. Several authors have attested to the importance of sex education (Craft, 1983; Kempton, 1983) and some authors have taken the somevfhat extreme view that everyone needs sex education including the clients, parents and professionals (Stevens etai, 1988). Despite this accepted view, very httle is known about the effectiveness of sex education courses. We know little about the kind of clients who benefit most from a general education course; we do not know whether different methods are more effective with different clients; there is no evidence on which clients, if any, do not benefitfi-omsex education; and at a very simple level, there is little evidence that clients learn anything from a sex education course. The little we do know suggests that people with intellectual disabilities have a generally conservative attitude towards sexual relationships (Edgerton & Dingman, 1964; Watson & Rodgers, 1980). Clients who have been institutionalized for some years tend to have less sexual knowledge than non institutionalized clients (Hall & Morris, 1976). Two studies suggest that clients will increase their sexual knowledge following a sex education or human relations course. Bender et al. (1983) assessed a group of young adults before and after a course on human relations. The areas assessed were knowledge of physiology, pregnancy, the sexual act, masturbation, contraception. Correspondence: Dr W. R. Lindsay, Department of Clinical Psychology, Strathmartine Hospital, Dundee, Scotland. 531

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varieties of sexuality and venereal disease. The group receiving the course showed an increase in sexual knowledge at retest while a control group showed only random changes. Penny & Chataway (1982) assessed the effects of a sex education programme using a sex vocabulary test. Subjects were split into seven groups according to place of training and level of ability. They found an improvement in sexual knowledge of all groups and this improvement was maintained to follow-up testing at 2 months. This study gives a fairly strong suggestion that people with intellectual disabilities can acquire knowledge about sexuality following a sex education course and that this knowledge will maintain after the cessation of the programme. Unfortunately, these authors did not include a control group and they acknowledge that this methodological problem prevents them from making firm conclusions. The present paper reports evaluations of the acquisition of sexual knowledge taken during the course of routine clinical work. METHOD Subjects

All subjects in this study had mild or moderate intellectual disabilities. All were referred to the senior author for a sex education programme. Group I. Forty-six subjects were seen in groups of six to eight and received a programme of sex education lasting around 9 months. Thirty-two subjects lived at home and attended day placements, and 14 subjects lived in hospital and attended groups run on the ward. Characteristics were as follows: average age 28-7 years (range 17-49 years); average IQ 58-3 (IQ scores were available for 37 subjects); 26 M and 20 F. Group 2. Fourteen subjects served as a control group. They were simply tested and retested 4 months later. All control subjects then went on to a sex education programme. Characteristics are as follows: eight subjects lived at home and attended on a day basis, six lived in hospital; average age 26-2 years (range 18—43 years) average IQ 58-1; seven M and seven F. Design

Group 1. All subjects were tested before and after the programme. Twenty-three subjects were tested at 3 months follow up. Group 2. All subjects were tested and re-tested after a 4-month interval. Assessments

The assessments were based on those published by Fisher et al. (1973). The questionnaire comprised of seven sections corresponding roughly to the sex education programme.

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The first section dealt with parts of the body. Subjects were asked to name 20 body parts and a further five sexual body parts for both men and women. In the results section, only data on the naming of sexual body parts is reported. The second section deals with knowledge of masturbation and includes questions such as 'What can happen to someone if they masturbate?' and 'Can a woman make a baby by masturbating?'. TTie third and fourth sections deal with male and female puberty. Subjects are asked questions about the age of onset of puberty and changes which occur during puberty and menstruation. The fifth section covers the topics of intercourse, pregnancy and childbirth. Here subjects are asked questions such asr'How does a baby get inside the mother?' 'Do all married people have to have children?' '^X^at does the father do to make the baby start growing inside the mother?' and 'Where does the man put his penis if the man and woman are having sex?' The six and seventh sections deal with birth control and venereal disease, respectively. The client is asked questions such as 'What is a condom?' 'Can a woman take any kind of pill to stop her having a baby?' 'What is it called when someone has an operation to make sure they cannot have a baby?' 'Can a person get V.D. from a cup/toilet seat/sexual intercourse/shaking hands?' 'What can you do to stop getting V.D. if you have intercourse?' and 'If someone thinks something is wrong with their penis/vagina, who is the most important person to tell?' The reader may notice that there are no questions on dating, relationships or homosexuality. These questions were covered during the assessment, but the answers represent attitudes rather than knowledge. The correct answer to questions such as 'Is it okay for two men to hug and kiss each other without any clothes on?' depends on the individual's values. Therefore, these sections are not reported in this paper which deals simply with acquisition of sexual knowledge rather than changes in sexual attitude. These issues are reported elsewhere (Lindsay et al., 1992). Procedure

The sex education programme followed the course of Sexuality, Education for the Lower Functioning Mentally Handicapped (Concord Films Council Ltd, Ipswich, England). The slide series includes sections on parts of the body (male and female), male puberty, female puberty, social relationships, human reproduction, birth control, venereal disease and marriage. To supplement this material and vary the form of the groups, the present authors occasionally use films about the growth of a foetus, sex education from the Scottish Health Education Group, and roleplays of asking people out, saying 'no' to strangers and friends, accepting invitations for a date and conversations while out on a date. Group 2 received no training at all. They did not receive a follow-up assessment, but rather went on to join a sex education programme themselves. It was felt unreasonable to expect clients to wait in a control condition for as long as 8 months after they had been referred for requiring sex education. RESULTS The results in Figs 1-4 show the average scores for groups 1 and 2 at each time of testing.

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Post Follow-up Pre Figure I. The average number of sexual body pans answered correctly: (O) group 1; and (•) group 2.

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o' 1 J 1 ^ Pre Post Follow-up Figure 2. The average number of questions answered correctly on masturbation: (O) group 1; and (•) group 2.

Figure 1 shows the number of questions answered correctly for groups 1 and 2 on sexual parts of the body. There werefivequestions on women and five on men. In this section, only three clients scored less than 2 at baseline. As can be seen, there is a substantial increase in the correct identification of body parts for group 1. This increase maintains to 3-month follow-up. There is no corresponding increase for group 2. An analysis of variance conducted on these scores reveals a significant group times assessment phases variation (/•=26-98, P

Increases in knowledge following a course of sex education for people with intellectual disabilities.

Although sex education programmes are thought to be useful in teaching people with intellectual disabilities, there is very little evidence that the m...
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