Aunos, M. & Feldman, M.A,

2002,

Reviewed by Dr Susan McGaw,
Cornwall Partnership (NHS) Trust.

Methodology

A literature review was conducted of attitudes and opinions held by a) personnel working with people with intellectual disabilities, b) teachers, c) university students, d) parents of children with intellectual disabilities and e), people with intellectual disabilities, across areas of sexuality, sterilisation, procreation and parenting by people with intellectual disabilities. Most of the empirical studies were conducted after 1970's, following the introduction of the principles of normalization and role valorization.

Overall, the paper identified pejorative attitudes and behaviour that still remain; especially concerning sexual deviancy, asexual behaviours, the inability of adults with disabilities to form long-term relationships and the sexual exploitation that many people with intellectual disabilities suffer.

Critical appraisal

This interesting review spans several decades of research, and updates our understanding of opinions and attitudes of parents, service workers, teachers and persons with intellectual disabilities on sexuality, sterilization, marriage and parenting of persons with intellectual disabilities. Whilst attitudinal comparison was difficult to gauge across the studies in the absence of a constant measure, the study was nonetheless informative and of interest as it draws our attention to an ongoing attitudinal problem. The main difficulty encountered by the authors (which they acknowledge), was that many more recent studies were needed across the various sample groups to make an accurate attitudinal comparison.

Towards the latter end of the paper, the authors offer a useful hypothetical interactional model to explain how attitudinal and social factors, and related experiences, influence the ability and competency of a parent with intellectual disability. Although this parenting model is currently under evaluation, it appears extremely useful as a theoretical concept.

Key findings

• Special education teachers and university students appear to hold more positive attitudes towards sexuality and sexuality education programmes than parents and service workers.
• People with intellectual disabilities hold conservative attitudes towards sexual intercourse and homosexuality, but may be accepting of intimate contact by familiar persons.
• Some parents and teachers of persons with intellectual disabilities hold ambivalent or restrictive attitudes and appear to support involuntary sterilization as a form of contraception, despite the ban, and especially for persons with severe intellectual disabilities.
• Overall, it appears that attitudes towards parenting by persons with intellectual disabilities remain negative, and these attitudes may adversely affect the provision of competency-enhancing support and services for parents with intellectual disabilities and their children.
• The authors recommend that new studies should be undertaken, comparing attitudes across different groups involved with persons with intellectual disabilities and examining the impact of prejudicial attitudes on sexual expression and parenting by persons with intellectual disabilities.

Practice implications

This study has implications for social care practice and in particular, for social workers, whose work entails them to assess the quality and availability of family and professional support for parents with intellectual disabilities. The paper draws our attention to variation between special education teachers and university students compared to parents and service workers. The former groups appear to hold a more positive attitude towards sexuality and sexuality education programmes than the latter group, who favour the prevention of pregnancy in sexual education programmes rather than its facilitation.

Policy implications

The review set out to gauge attitudinal changes post normalisation' in the hope that society in general had accepted that persons with intellectual disabilities have the same sexual needs and desires, and rights to parent, as persons without intellectual disabilities. Currently, the UK Government are striving to ensure that positive attitudes towards the rights of people with intellectual disabilities are central to policy and practice (Va luing People White Paper, 2001). Replication of this study within the UK would be useful, especially if it included the attitudes of social workers working within children's and learning disabilities services.