Sexuality and Acquired Brain Injury

Disclaimer: This information sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

What is Sexuality?

Sexuality is a healthy and natural part of living. A child's sexuality reflects his/her personality, encompassing thoughts, feelings, values, physical development, actions and drives. It is more than sexual activity and behaviour. As a child progress towards adolescence, sexual development and maturity encompasses additional issues of physical and hormonal changes, relationships, body image, sexual characteristics and sexual preference.

While issues of sexuality impact on a child from the time of birth to adulthood, it is during the transition period of adolescence that the impact of sexual development and disability can become a concern for children, families, school and community.

Sexuality Issues for Children/Young People with Acquired Brain Injury

Parents and teachers may be concerned that the child's brain injury may impact on normal sexual development and behaviour. For some young people the brain injury will have no effect or little impact and will not cause physical changes or interfere with the child's ability to learn about sexuality or to make friends and develop relationships. However, for some children physical, cognitive, psychological, emotional and behavioural changes or difficulties following brain injury may impact on sexual development or behaviour.

Physical considerations

Following brain injury some children with moderate to severe physical disabilities may have specific problems which will impact on their sexuality and possibly, sexual activity. Some severe physical problems could directly affect a young person's ability to engage in and enjoy normal sexual activities or to manage menstruation. Additionally, reduced or poor self-image can occur if the social impact of physical impairments affects the young person's ability to be accepted by others and develop more socially mature relationships.

Occasionally, after severe brain injury, puberty may begin earlier than would normally be expected ie under the age of 9 or 10 years. Development of sexual interest and growth spurt is part of this precocious puberty. Managing these physical and emotional changes can cause problems for the child, family, peers and school.

Strategies to assist

• Assessment and appropriate counselling focussing on physical disabilities and options for engaging in social and sexual activities.
• Specialist advice regarding precocious puberty is recommended. Assistance from the child's paediatrician, Social Worker and Occupational Therapist from the Brain Injury Service, FPA NSW (Family Planning) regarding adjustment issues, sex education and menstruation management is available.

Behavioural aspects

Some young people may behave in a disinhibited or sexually inappropriate behaviour way following brain injury. Sexual innuendoes, inappropriate touching or comments may lead to peer rejection, ridicule or liable to punishment at school. Sometimes this disinhibited behaviour, together with poor awareness and impaired social skills may place a child in a vulnerable social situation where s/he could be subject to exploitation or sexual abuse.

Strategies to assist

• Ensure that the child has received and understands the key issues of sex education including protective behaviours.
• Seek assistance from the rehabilitation team to determine appropriate intervention
• Discuss behaviour with young person, family, school to gain a clear picture of the context of behaviour, where and how it occurs and its consequences
• Reach agreement between parents, teachers and young person about the approach to be taken to change the behaviour to ensure consistency between home and school.
• Give clear explanations about which behaviours are not appropriate and why not. Outline consequences for unacceptable behaviour

Psychological Considerations

The ability for young people to develop relationships and acquire appropriate social skills may be affected by physical and psychological impairments. S/he may feel less attractive and socially capable than their peers which can impact on the ability to develop and maintain relationships, contribute to low self esteem and lowered self confidence. Together with problems of impaired memory, planning and organisation, decreased intellectual skills can also affect a young person's ability to learn about sexuality and appropriate behaviours.

Strategies to assist

• Look for ways to enhance self-esteem in a variety of home, school and social situations
• Focus on the young person's strengths
• Consider whether sex education can be specifically tailored to the needs of the child with impaired memory, planning and organisational skills.
• Link with rehabilitation and school programmes offering social skills training to address: meeting other people, making friends, anger management and protective behaviours.
• Contact the brain injury team (Clinical Psychologist and/or Social Worker) with concern about sexuality issues.

Ref: Dawson, H., Hendy J., Simons, M., Epps A., (1999), Sexuality and Acquired Brain Injury in Children and Adolescents. A Guide for Health Professionals and for the Family, The New Children's Hospital, NSW.

Rehabilitation Department The Children's Hospital at Westmead Cnr Hawkesbury Rd & Hainsworth St, Westmead Locked Bag 4001, Westmead, 2145 Tel: (02) 9845 2132 - Fax: (02) 9845 0685 http://www.chw.edu.au/rehabilitation/