INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
©AAIDD
2014, Vol. 52, No. 2, 85-97
DOI: 10.1352/1934-9556-52.2.85
Predictors of Access to Sex Education for Children With Intellectual Disabilities in Public Schools Lucy Bamard-Brak, Marcelo Schmidt, Steven Chesnut, Tianlan Wei, and David Richman
Abstract Data from the National Longitudinal Transition Study—2 (SRI International, 2002) were analyzed to identify variables that predicted whether individuals with intellectual disabiUty (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 puhlic schools. Key Words:
intellectual disabilify; sex education; 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, Bemat, 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 tbat approximately 90% of parents support sex education in schools. It is therefore important that public schools make available to students tbe most appropriate, comprehensive, and effective sex and reproductive-bealtb education programs (Kirby, 2002). Regardless of tbe diverging opinions about tbe scope and sequence of sex education (e.g., Darroch, Landry, & Singb, 2000; Eisenberg et al, 2008; Howard-Barr & Jobnson-Moore, 2007; Landry, Darrocb, Singb, & Higgins, 2003;
L. Barnard-Brak et al.
Lindberg, Santelli, & Singb, 2006; Santelli et al, 2006), it is clear tbat tbe majority of parents in tbe United States expect tbe public scbool system to provide sex education in the schools. In tbe extant literature, tbe prevalence rate of sex education bas been encouraging. A report by tbe Kaiser Family Foundation (KFF; 2002) indicates tbat, upon completion of tbe 12th grade, 89% of public-school students bad received some form of sex education. Moreover, a subsequent report by tbe 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 bad received formal sex education by tbe age of 18. While both reports appear encouraging, it is difficult to ascertain if cbildren witb intellectual disability (ID) bave been accounted for in tbeir samples, nor can it be determined if tbe sex education was offered at scbool or in an alternate setting. Cbildren witb disabilities, wbetber pbysical or mental, bave been excluded from sex education due to tbe misconception tbat tbey are asexual (DiGiulio, 2003; Robleder, 2010; A. Sullivan & Caterino, 2008). Acknowledging tbat tbese
85
INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014, Vol. 52, No. 2, 85-97
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 (Bailan, 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), tbe DSM-5 classifies ID into four levels according to severity: mild, moderate, severe, and profound. While the DSM-5 emphasizes tbe 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-ÍV-TR and DSM-5, respectively, especially with regard to the level of support an individual witb 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 Eind
86
©AAIDD DOI: 10.1352/1934-9556-52.2.85
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 tbeir sex education needs is meindatory. 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 tbe 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, McCrath, and Burket (1984) indicated that tbe 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 STL 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 witb ID, Calea, Butler, Iacono, and Leighton (2004) found deficiencies in information pertaining
Sex Education
©AAIDD
INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
DOl; 10.1352/1934-9555-52.2.85
2014, VoL 52, No. 2, 85-97
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 humanrelations 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 heing 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
L. Bamard-Brak et al.
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, iSiWehmeyer, 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 heing 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-hased 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 heing 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,
87
INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014, Vol. 52, No. 2, 85-97
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. 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 schoolprogram 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: nprlA4a_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: nprlA4b_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
©AAIDD DOI: 10.1352/1934-9556-52.2.85
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 schoolprogram 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,
Sex Education
INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
©AAIDD DOI: 10.1352/1934-9556-52.2.85
2014, Vol. 52, No. 2, 85-97
Table 1 Demographics According to Degree of Intellectual Disability (ID)
Degree of ID Demographics
No ID (n = 3,820)
Mild ID (n = 590)
Moderate to profound ID (« = 660)
Age (years) 14 15 16 17-18
650 940 1,000 1,240
Gender Male Female No information
2,460 (64.3%) 1,330 (34.7%) 40 (1.0%)
330 (57.0%) 250 (42.7%)
©AAIDD
2014, Vol. 52, No. 2, 85-97
DOI: 10.1352/1934-9556-52.2.85
Predictors of Access to Sex Education for Children With Intellectual Disabilities in Public Schools Lucy Bamard-Brak, Marcelo Schmidt, Steven Chesnut, Tianlan Wei, and David Richman
Abstract Data from the National Longitudinal Transition Study—2 (SRI International, 2002) were analyzed to identify variables that predicted whether individuals with intellectual disabiUty (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 puhlic schools. Key Words:
intellectual disabilify; sex education; 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, Bemat, 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 tbat approximately 90% of parents support sex education in schools. It is therefore important that public schools make available to students tbe most appropriate, comprehensive, and effective sex and reproductive-bealtb education programs (Kirby, 2002). Regardless of tbe diverging opinions about tbe scope and sequence of sex education (e.g., Darroch, Landry, & Singb, 2000; Eisenberg et al, 2008; Howard-Barr & Jobnson-Moore, 2007; Landry, Darrocb, Singb, & Higgins, 2003;
L. Barnard-Brak et al.
Lindberg, Santelli, & Singb, 2006; Santelli et al, 2006), it is clear tbat tbe majority of parents in tbe United States expect tbe public scbool system to provide sex education in the schools. In tbe extant literature, tbe prevalence rate of sex education bas been encouraging. A report by tbe Kaiser Family Foundation (KFF; 2002) indicates tbat, upon completion of tbe 12th grade, 89% of public-school students bad received some form of sex education. Moreover, a subsequent report by tbe 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 bad received formal sex education by tbe age of 18. While both reports appear encouraging, it is difficult to ascertain if cbildren witb intellectual disability (ID) bave been accounted for in tbeir samples, nor can it be determined if tbe sex education was offered at scbool or in an alternate setting. Cbildren witb disabilities, wbetber pbysical or mental, bave been excluded from sex education due to tbe misconception tbat tbey are asexual (DiGiulio, 2003; Robleder, 2010; A. Sullivan & Caterino, 2008). Acknowledging tbat tbese
85
INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014, Vol. 52, No. 2, 85-97
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 (Bailan, 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), tbe DSM-5 classifies ID into four levels according to severity: mild, moderate, severe, and profound. While the DSM-5 emphasizes tbe 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-ÍV-TR and DSM-5, respectively, especially with regard to the level of support an individual witb 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 Eind
86
©AAIDD DOI: 10.1352/1934-9556-52.2.85
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 tbeir sex education needs is meindatory. 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 tbe 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, McCrath, and Burket (1984) indicated that tbe 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 STL 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 witb ID, Calea, Butler, Iacono, and Leighton (2004) found deficiencies in information pertaining
Sex Education
©AAIDD
INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
DOl; 10.1352/1934-9555-52.2.85
2014, VoL 52, No. 2, 85-97
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 humanrelations 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 heing 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
L. Bamard-Brak et al.
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, iSiWehmeyer, 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 heing 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-hased 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 heing 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,
87
INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014, Vol. 52, No. 2, 85-97
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. 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 schoolprogram 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: nprlA4a_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: nprlA4b_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
©AAIDD DOI: 10.1352/1934-9556-52.2.85
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 schoolprogram 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,
Sex Education
INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
©AAIDD DOI: 10.1352/1934-9556-52.2.85
2014, Vol. 52, No. 2, 85-97
Table 1 Demographics According to Degree of Intellectual Disability (ID)
Degree of ID Demographics
No ID (n = 3,820)
Mild ID (n = 590)
Moderate to profound ID (« = 660)
Age (years) 14 15 16 17-18
650 940 1,000 1,240
Gender Male Female No information
2,460 (64.3%) 1,330 (34.7%) 40 (1.0%)
330 (57.0%) 250 (42.7%)
