People with learning disabilities and autistic people want to have relationships and relationships are an important part of everyone’s lives. However, institutional and attitudinal barriers may prevent them from exercising and enjoying this fundamental human right. In this article, Clinical Psychologists Dr Kelly Asagba and Dr Sophie Doswell discuss the factors that can help people with learning disabilities and autistic people develop positive relationships.
Kelly: People with learning disabilities and autistic people have the right to develop intimate relationships like anyone else. Research shows that relationships can have a positive impact on mental health by reducing the risk of depression, anxiety, and stress. Relationships also give that person a positive sense of wellbeing and happiness. Some research also suggests positive relationships can protect against physical health problems.
Sophie: There are lots of barriers that can make it more challenging for people with learning disabilities and autistic people to access positive relationships. Historically, it was thought that people with learning disabilities and autistic people were not interested in relationships, which is ridiculous. This attitude was held quite strongly and as a result individuals were not given access to sex education and support to engage in positive relationships. Some of these old-fashioned views are still held today, leading to people with learning disabilities and autistic people not being treated as individuals with sexual desires and interests. There is also a view that individuals should be protected, which leads to families and carers being more risk averse, which can be a significant barrier.
There are also lots of social barriers. For example, this might include the lack of social opportunities for people to go out and build relationships, not just intimate relationships, but friendships too. People with learning disabilities and autistic people might not have a lot of disposable income. If they live in staffed accommodation, they might be reliant on staff to facilitate opportunities, for example shifts being flexible enough to support a night out. This is in addition to other potential organisational barriers to intimacy, such as access to privacy and rules and restrictions surrounding guests.
Kelly: This will depend on an individual’s needs and abilities. There is a combination of things that can be done. This might include access to sex and relationships education that is adapted to the knowledge and needs of the person, such as their social, cognitive and communication skills. This could be led by professionals, family members or other important people in their lives. It could be done formally, such as sex and relationships education sessions, or informally, such as more ‘real time’ conversations and reflections on different social situations and interactions.
A wide variety of adaptations could be used, one example is ‘circles of intimacy’, which is a way of explaining the social rules and boundaries in different types of relationships. Social Stories are particularly useful in explaining specific social scenarios and practicing them in advance. You could also use scenes from soap operas and films, then talk to the person afterwards about what the actor did in that situation. Role playing different social scenarios can be helpful in exploring social interactions that would happen in the real world, for example asking someone on a date. It is also important to support individuals to practice in the real world, and then reflect on their experiences.
Sophie: A positive attitude from supporters, whether this is paid staff, families or professionals, is important. Another factor is helping people develop social and communication skills to enhance their ability to say what they want in a relationship. An individual may not have the skills or resources to foster relationships independently, so it is important to give people the opportunity to build relationships, make friends and feel confident in engaging socially.
Kelly: There is evidence to suggest that autistic people have a wider range of sexual preferences and needs and might be more likely to identify as LGBTQIA+. There might be a risk of people with learning disabilities and autistic people who identify as LGTBQIA+ facing double discrimination, based on the intersection of their neurodiversity and sexual identity. There maybe greater barriers to appropriate healthcare, social care and education for these individuals due to a lack of knowledge and awareness, but also attitudinal barriers. It is important that professionals, healthcare, social care and education providers are aware and accepting of a person’s sexual identity, so that inclusive language is used, as well as equal access to support that facilitates people with learning disabilities and autistic people to lead fulfilling and meaningful lives.
Sophie: Another challenge is that sex education, if it is offered, often isn’t inclusive of the wide range of sexual interests. In addition, some of the people that I’ve worked who were interested in exploring their sexual interests faced barriers, such as staff being worried that family members were not aware of their sexual identity, so they didn’t think it was appropriate to support them to explore their sexuality. We still have a long way to go to make sure people’s sexuality and preferences are supported.
Kelly: Although there are many practical and useful resources being developed that guide professionals on how to deliver sex and relationships education, there is still limited guidance for staff who work directly with individuals with learning disabilities and autistic people day-to-day to feel comfortable and confident in enabling individuals to explore intimate relationships. This may come down to challenges in how to navigate issues around consent and mental capacity, as well as balancing supporting human rights and positive risk taking with protecting individuals from potential risk of abuse and exploitation.
Sophie: In relation to the law, individuals over the age of 16 are assumed to have the capacity to engage in sexual activity. That is our starting point and then if there is a reason to think perhaps that isn’t the case, a Mental Capacity Assessment needs to be done. I think it is important that we don’t assume people lack capacity, and then just write them off and say they can’t be a sexual being for the rest of their lives. Case law has set the bar low for capacity for sexual activity because it’s considered a human right. If someone is deemed not to have capacity, there is a responsibility to provide education. It is also important people have the right to make unwise decisions. The Supportive Loving website has a helpful section on capacity, recognising this is an area that causes supporters concern.
It is also important to think about consent, including helping people understand that they have to ask, and that people can say no in lots of different ways, for example verbally or as a physical reaction. We also need to help people with learning disabilities and autistic people to understand what they like and don’t like and how to be assertive in letting partners know this.
Kelly: Inclusive and adapted sex and relationships education is one way that can help to people with learning disabilities and autistic people to recognise signs of potential abuse or exploitation, and how to give and gain consent from others around intimate relationships. In addition to this, dynamic risk assessments are important to ensure staff are able to safeguard individuals that might be at risk of abuse and exploitation. Education for both staff and individuals can be one preventative measure, however, it is important that support and training is provided around spotting the signs of abuse and exploitation early, and steps taken to safeguard and support individuals to learn about consent and safe relationships.
Kelly: The first thing is that the support should be individualised as there are likely to be a wide range of abilities, needs and preferences. There are lots of resources and tools for families and professionals to adapt sex and relationships education and ensure it is accessible. Also, when talking about relationships it can often involve fairly abstract and complex concepts and social rules. So, there are a wide range of adaptations that could be used to teach sex and relationships education in a way that is more concrete and using communication methods that are more accessible. This might include Talking Mats, Social Stories or using visual resources such as the real objects (e.g. condoms, sanitary wear).
Sophie: It is also about being creative and flexible. We should think about an individual’s communication needs, how that person typically interacts, and what their level of understanding already is about relationships.
Sophie: Funding cuts to social care mean that people with learning disabilities and autistic people have seen a reduction in social opportunities, as they do not have individualised support to go out and meet people. Also, because of funding cuts, roles that focus on sex and relationships in community teams have not necessarily been prioritised. The National Development Team for Inclusion (NDTi) did some research on this, published in 2019, and asked people with learning disabilities about the barriers that they face to having an intimate relationship. This is crucial research. We make a lot of assumptions, but people with lived experience have to say what the gaps are. The most positive thing that we can do is take their agenda forward and embed advice from people with learning disabilities and autistic people within services.
Box 1. Recommendation from NDTi
