Sexuality is a healthy and natural part of living. A child's sexuality reflects their personality and encompasses thoughts, feelings, values, physical development, actions and drives. It is more than sexual activity and behaviour. As a child progresses towards adolescence, their sexual development and growing maturity include the 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 young people with a brain injury

Parents and teachers may be concerned 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. It 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, the physical, cognitive, psychological, emotional and behavioural changes or difficulties following brain injury may impact on sexual development or behaviour.

Physical considerations

After a brain injury, some children with moderate to severe physical disabilities may have specific problems which will impact on their sexuality and possible 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. The social impact of physical impairments can affect a young person's ability to be accepted by others and develop more socially mature relationships. For many young people, this can result in reduced or poor self-image.

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

Ways to help

• Assessment and appropriate counselling, focussing on physical disabilities and options for engaging in social and sexual activities.
• Specialist advice regarding precocious puberty is recommended. Help from the child's paediatrician, social worker and occupational therapist regarding adjustment issues, sex education and menstruation management is available.

Behavioural aspects

Following a brain injury, some young people may behave in a disinhibited or sexually inappropriate way. Sexual innuendoes and comments and/or inappropriate touching may lead to peer rejection, ridicule or 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 they could be the subject of exploitation or sexual abuse.

Ways to help

• Ensure the child has received and understands the key issues of sex education including protective behaviours.
• Seek help from the rehabilitation team to determine appropriate intervention.
• Discussions about the behaviour should occur between the young person, their family and school to gain a clear picture of the context of the behaviour, where and how it occurs and its consequences.
• Reach agreement between parents, teachers and the 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 learn appropriate social skills may be affected by physical and psychological impairments. They may feel less attractive and socially capable than their peers and these feelings can impact on their ability to develop and maintain relationships. It could also 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.

Ways to help

• Look for ways to improve 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 programs offering social skills training to address: meeting other people, making friends, anger management and protective behaviours.
• Contact the rehabilitation team to discuss any concerns about sexuality issues.

More information

• The Royal Children's Hospital
  Paediatric Rehabilitation Service
  T: (03) 9345 9300
  E: rehab.service@rch.org.au
• The Children's Hospital at Westmead Brain injury Service
• Kids Health Info series of fact sheets listed under 'Brain injury'

Developed by The Royal Children's Hospital Paediatric Rehabilitation Service based on information from the Brain Injury Service at Westmead Children’s Hospital. We acknowledge the input of RCH consumers and carers.

Reviewed September 2020.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.