Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 35, Number 4, July/August 2003
DIGEST

Teenagers with Mental Disability Lack Reproductive Education and Knowledge; Still, Many Have Had Sex

Teenagers with mental disability report receiving less sex education in school than do their nondisabled peers, and their parents are more often reluctant to discuss reproduction and sexual health with them at home. Meanwhile, a considerable proportion of such teenagers--in particular, males--have had sexual intercourse, often without their parents' knowing. These findings come from an analysis of data from the National Longitudinal Study of Adolescent Health.1

Researchers analyzed data collected in 1994-1995 from a nationally representative sample of U.S. adolescents in grades 7-12 and, for a subsample, one of their parents. Adolescents were broadly categorized by mental ability on the basis of scores on a standardized picture vocabulary test, which are roughly comparable to IQ scores. The analyses included the 308 respondents the researchers classified as "mildly disabled" (those scoring 55-69) and the 114 they considered "more severely disabled" (those with a score of 54 or lower); some analyses involved comparison with respondents of "average intelligence" (those scoring 91-110). The mean age of the adolescent participants was 16-17 years. A significantly larger proportion of teenagers considered mentally disabled than of those considered average were nonwhite and came from socioeconomically disadvantaged families.

The adolescents were asked whether they had learned about AIDS or pregnancy in school and whether they had ever had sexual intercourse. Respondents aged 15 or older also answered questions measuring their knowledge of birth control and sex. Parents were asked about the degree to which they had discussed certain sex-related topics with their teenage child and about their attitudes on sex and sex education for their child. Parents were also asked whether they thought their child had ever had sexual intercourse, and the researchers compared the answers to this question with those of the teenagers.

A smaller proportion of adolescents with mental disability than of mentally average teenagers reported having learned about reproduction and sexual health at school. For example, 94% of males and 92% of females with average intelligence said they had been taught about AIDS in the classroom, compared with 78% of males and 85% of females with mild mental disability, and 65% and 59% with more severe disability. Similarly, exposure to classroom instruction on pregnancy was more prevalent among teenagers with average intelligence (85% of males and 90% of females) than among teenagers with mental disability (55-67% of males and 49-82% of females).

Responses on the parent survey indicated that teenagers with mental disability also receive less at-home instruction than do teen-agers with average intelligence. Reports of never discussing birth control were less common among parents with a son or daughter of average intelligence (16% of each) than among parents whose child had mild mental disability (26-44%) or more severe mental disability (61-62%). In addition, the proportions never discussing sex, pregnancy or sexually transmitted diseases with their adolescent differed significantly between parents with an average child (6-12%) and those whose child had mild (17-27%) or more severe (44-55%) mental disability.

The parent survey presented the following potential reasons why parents might choose not to discuss sex and birth control with their child: They did not know enough about these topics to be able to talk about them, they would find these topics difficult to explain, their child would be embarrassed by such talk, their child could get the information from another source and talking about sex would encourage sexual activity. Parents were asked to rate the extent to which they identified with each of these justifications on a scale of 1-5, in which one means strong agreement and five denotes strong disagreement. Scores for parents of a child with average intelligence, which ranged from 3.6-4.4, were generally higher than those for parents of a child with mental disability--3.4-4.0 for parents of a child with mild mental disability and 2.8-3.8 for parents of a child with more severe disability.

Using the same five-point scale, parents of a child with mental disability generally registered less-strong opposition than did other parents to their child's being sexually active. The level of disagreement with a statement indicating that parents disapprove of their child's having sex at the current time was higher among parents of a son with severe mental disability than among those whose son was of average intelligence (2.2 vs. 1.7); it also was higher among parents whose daughter had mild disability than among those with a daughter of average intelligence (2.1 vs. 1.6). Parents whose son had mild mental disability disagreed less strongly than parents of a son with average intelligence that they approved of their child's having sex with a "special friend" (3.4 vs. 4.1).

Overall, teenagers with mental disability demonstrated significantly poorer knowledge of fertility and birth control than teenagers with average intelligence. On an 11-point scale indicating level of knowledge (in which zero is the lowest possible score and 10 the highest), male respondents with average intelligence scored a mean of 6.0, whereas those with mild and more severe mental disability scored 2.8 and 1.8, respectively. For female participants, the mean scores were 6.2, 3.2 and 1.4, respectively.

Using responses from the parent and adolescent surveys, the researchers estimated that by age 16, 24% of the male teenagers with mental disability were sexually experienced--6% whose parent knew this and 18% whose parent was unaware. Using multinomial logistic regression, the researchers calculated that among male teenagers with mental disability, the risk for being sexually experienced despite a parent's assumption to the contrary was more than twice that for male teenagers with average intelligence (relative risk, 2.4). Among female teenagers with disability, approximately 3% had had sex by age 16, and their parent knew this; 6% had had sexual experience, but their parent did not know. Compared with females of average intelligence, females with mental disability were found to have a nonsignificantly higher relative risk for having sex without their parent's knowing (2.6).

According to the authors, this study demonstrates that youth with mental disability receive inadequate sex education in school and at home. They note that it is therefore "not surprising that mentally disabled boys and girls have largely incorrect knowledge of birth control and human fertility." The authors comment that the considerable proportion of adolescents with mental disability who are sexually active without their parents' knowledge are "particularly vulnerable to sexual health risks, unwanted pregnancy, and sexual exploitation." They conclude that a better understanding is needed of "parents' attitudes and the problems they encounter at home in providing sex education to their disabled children."--C. Coren

REFERENCE

1. Cheng MM and Udry JR, How much do mentally disabled adolescents know about sex and birth control? Adolescent & Family Health, 2003, 3(1):28-38.