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Background:
Systematic Review

Sex Education for Individuals with Intellectual Development Disorder (IDD): A Scoping Review

by
Célia Oliveira
*,
Sarah Ozorio
,
Verónica Gomes
,
Soraia Araújo
and
João Lopes
Faculty of Psychology and Education, Lusófona University, 4000-098 Porto, Portugal
*
Author to whom correspondence should be addressed.
Educ. Sci. 2025, 15(6), 685; https://doi.org/10.3390/educsci15060685
Submission received: 20 March 2025 / Revised: 26 May 2025 / Accepted: 29 May 2025 / Published: 31 May 2025
Browse Figure
Review Reports Versions Notes

Abstract

:
(1) Background: The experience of sexuality by individuals with Intellectual Development Disorder represents a significant challenge for themselves, as well as for parents, educators, and researchers. (2) Methods: Eighteen studies exploring sexual education programs aimed at individuals with ID and their caregivers were analyzed in the context of a scoping review. (3) Results: The prevention of sexual abuse, the development of healthy relationships, and the promotion of sexual autonomy are the main themes of the reviewed programs. The interventions include multimodal approaches, such as visual materials, practical activities, and role-playing, resulting in significant gains in participants’ sexual knowledge. Some limitations in conceptualization, participant recruitment, program variability, and the lack of follow-up were found. (4) Conclusions: Our study emphasizes the importance of expanding the research into sexual education for individuals with IDD and of designing programs with clearer theoretical frameworks, structure, and goals.

1. Introduction

Intellectual Development Disorder (IDD) is characterized by deficits in intellectual functioning and adaptive behavior, impacting conceptual, social, and practical areas (APA, 2013). According to Schaafsma et al. (2013), individuals with IDD face specific challenges about sexuality, often due to a lack of knowledge about issues related to disability and sexuality (Fitzgerald & Withers, 2013). Additionally, stereotypes and misconceptions frequently influence their experiences, perpetuating negative attitudes and limiting their right to sexual expression (Franco et al., 2012; Olavarrieta et al., 2013).
In 2006, the United Nations Convention on the Rights of Persons with Disabilities recognized that individuals with disabilities have the right to access information and education about family planning and sexuality (United Nations, 2006). Despite this recognition, sex education targeting individuals with intellectual development disorders remains limited and insufficiently examined in the literature (Gil-Llario et al., 2018; Borawska-Charko et al., 2017).
One major problem for Individuals With Intellectual Disorder (IWIDs) is infantilization—they are often perceived as devoid of sexuality or incapable of understanding it (Frawley & O’Shea, 2020; Pownall et al., 2012). Such perceptions hinder their development, increasing their vulnerability to sexual abuse and inappropriate behavior (Sinclair et al., 2015). Lack of access to sexual health education also increases the risk of sexual health problems, as these individuals have a limited understanding of their sexuality and are more susceptible to abuse (Sinclair et al., 2015).
Children with an intellectual disability are at a significantly higher risk of experiencing sexual abuse, with rates reported to be twice as high as those of their peers without disabilities, according to Wissink et al. (2015). This heightened vulnerability might stem from a limited ability to recognize risky situations, leaving IDD adolescents particularly susceptible to abuse.
Baines et al. (2018) acknowledged that young people with intellectual disabilities are more likely to engage in risky sexual behavior, especially at older ages, and that girls with IDD are more likely to have unwanted pregnancies due to a lack of adequate information about sexuality. In addition, Isler et al. (2009) found that most adolescents with IDD have inaccurate knowledge about sexual development, such as the physical changes that occur during puberty.
Another common challenge is inadequate access to information on contraception, which is often not adapted to the cognitive abilities of these people (Gil-Llario et al., 2018). The lack of formal education on sexuality, evidenced in research such as that by Retznik et al. (2021), suggests that many adolescents with IDD do not discuss these topics with family members but gather information from friends, the media, or the internet, which can lead to inaccurate conceptions about the subject.
Sex education might expand knowledge and influence behavior on key issues such as reproductive decisions, sexual health, morality, the expression of sexuality, and the prevention of sexual violence (Kramer, 2019). Some authors (e.g., Charpentier & Carter, 2023; Löfgren, 2024) stress that it is especially important that people with disabilities can experience full romantic and sexual experiences, exploring their sexuality safely and satisfyingly.
Several studies (e.g., Kamaludin et al., 2022; Lee et al., 2025; Oti-Boadi et al., 2023) show that sex education can increase the ability of individuals with intellectual disabilities to make informed sexual decisions. In addition, sex education is an effective tool for reducing vulnerability to sexual assault and abuse while strengthening decision-making skills related to sexuality, promoting positive sexuality, and empowering people with intellectual disabilities to act on their own choices (Hemati Alamdarloo et al., 2023; Wellington et al., 2025).
To freely express their sexuality and establish relationships, people with intellectual disabilities depend on the support and education provided by support professionals and family members (Brown & McCann, 2018). The attitudes of these professionals and family members seem more decisive concerning the freedom of sexual expression for people with intellectual disabilities than the individuals’ abilities and attitudes (Medina-Rico et al., 2018; Whittle & Butler, 2018).
Parents play a crucial role in the sexual education of young people with IDD, as these children tend to depend on parental support and guidance during the transition to adulthood (Pownall et al., 2012). However, many parents report low self-efficacy in dealing with sexuality issues with their children with intellectual disabilities (Top, 2022). Parents’ lack of sexual knowledge directly impacts their children’s understanding of the subject (Hemati Alamdarloo et al., 2023; Rashikj-Canevska et al., 2023). Research indicates that parents often avoid discussing sexual issues until problems arise, taking a reactive rather than a proactive approach to their children’s sex education (Isler et al., 2009; Pryde & Jahoda, 2018).
Formal caregivers, including support professionals and institutional staff, play a crucial role in the sexual education of individuals with IDD. Research suggests that, similarly to parents, these professionals often hold conservative or defensive views on sexuality. Furthermore, due to insufficient training, they may inadvertently impose restrictions that limit opportunities for individuals under their care to explore and develop their sexuality (Frawley & Wilson, 2016). On the other hand, caregivers who have more experience or specific training on sexuality issues tend to be more willing to provide sex education and adequate support (Retznik et al., 2021; Schaafsma et al., 2014). However, inadequate training seems to be a recurring barrier (Atkinson et al., 2022; Steuperaert & Michielsen, 2022). Many caregivers report discomfort or a lack of confidence in addressing sexuality topics, which results in inconsistent and ineffective interventions (Leclerc & Morin, 2022).
Regarding teachers, de Reus et al. (2015) found that while acknowledging the importance of sex education for students with intellectual disabilities, teachers lack confidence in delivering it. Many teachers perceived such students as having a limited capacity for understanding, leading them to omit important details on sexuality. Some studies show that while there are positive attitudes from teachers in providing comprehensive sexual education, they find it easier to discuss soft topics such as hygiene (Chirawu et al., 2014). Other studies found that some programs for teachers focus on risks, not on desire or intimacy (Löfgren-Mårtenson, 2012).

The Present Study

The studies examining the implementation of sexual health education programs for individuals with IDD remain limited. Of the few studies published, the majority focus on the attitudes and shared experiences of teachers, parents, and caregivers about the sexuality of adolescents and young adults with mild to moderate IDD (e.g., Borawska-Charko et al., 2017; de Wit et al., 2022; Schwartz & Robertson, 2019; Strnadová et al., 2022). Moreover, programs or interventions vary significantly in content and format, with no clear guidelines or conceptualization.
The present study aims to identify the content, strategies, and outcomes of sex education programs for people with intellectual disabilities and to understand how sex education is currently being offered to parents, caregivers, and teachers. Additionally, this study aims to contribute to improving the research methodology in the field of sex education for people with intellectual disabilities by mapping current practices and identifying common conceptual and procedural limitations.
A scoping review was conducted for this purpose. This methodology synthesizes knowledge by mapping the evidence on a specific topic. Its goal is to pinpoint key concepts, theories, relevant sources, and existing gaps in the field (Munn et al., 2018; Tricco et al., 2018; Peters et al., 2020).

2. Materials and Methods

The scoping review used in this study is based on the guidelines proposed by the Joanna Briggs Institute (JBI) and the PRISMA-ScR checklist (“Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews”) (Tricco et al., 2018).

2.1. Search Strategy and Sources of Information

A preliminary search allowed us to identify the most common terms in the titles and keywords of relevant scientific articles and, subsequently, to define the following search equation: “sex*” OR “sexual health” AND “intellectual disabil*” OR “intellectual development disorder” OR “mental* retard*” AND intervention OR program* OR “sex education”. An initial survey was conducted in the Scopus database. Additionally, a manual search was performed by reviewing the reference lists of key articles in the field to identify further relevant studies.
We used only the SCOPUS database because of its broad disciplinary coverage, high-quality indexing standards, and advanced search capabilities. SCOPUS also offers advanced search functionalities (e.g., Boolean operators, citation tracking, and author disambiguation), facilitating a thorough and systematic identification of relevant studies. Moreover, many journals indexed in PubMed, Web of Science, and other specialized databases are also included in SCOPUS, reducing the risk of missing critical studies (Meho & Sugimoto, 2009). Previous scoping reviews have successfully used SCOPUS only, particularly when the topic is interdisciplinary (e.g., Jensen & Dikilitas, 2025; Imaduddin & Eilks, 2024).
The records of the documents retrieved from SCOPUS were imported into Rayyan (https://www.rayyan.ai/), an advanced web-based tool developed to streamline the screening process in systematic and scoping reviews. Rayyan was chosen due to its robust features, which enhance collaboration among multiple reviewers, and its support for blinding, a key function that helps to minimize potential unconscious bias during the screening process. This procedure ensures a more objective and transparent review, improving the overall quality and consistency of the decision-making process.

2.2. Eligibility Criteria

2.2.1. Inclusion and Exclusion Criteria

The PCC model (Population, Concept, and Context) was used to define the inclusion criteria. This model plays a crucial role in identifying the objective, concepts, and context of a scoping review (Peters et al., 2020). Regarding (1) population, the studies should include subjects with IDD or a previously used category/diagnosis (e.g., intellectual disability, mental disability), formal and/or informal caregivers, parents, or the school community working with these individuals. The (2) concepts encompass the interventions and/or educational programs carried out and developed in sex education. Concerning the (3) context, materials depicting schools, training spaces, clinics, and care institutions were analyzed. Additionally, the analysis was limited to studies published between 2014 and 2023 and written in English, Spanish, or Portuguese.
Materials that investigated the sexuality of people with disabilities from a predominantly medical (e.g., sexual dysfunction) or criminological (e.g., people with intellectual disabilities and sexual crimes) perspective were excluded. Systematic reviews, monographs, meta-analyses, and scoping or comprehensive reviews were also excluded.

2.2.2. Process of Selecting Information Sources and Extracting Data

The inclusion criteria and the review’s objective were considered in the first stage of the selection process. If the title of an article did not entirely conform to the research objective, the abstract was reviewed for further clarification. If uncertainties persisted after reading the abstract, the article was forwarded for full-text analysis. The same procedure was applied to the references of the included articles, ensuring a more comprehensive analysis. Data respecting the study’s objective, method, sample characteristics (e.g., level of ID in subjects with IDD, age group), educational strategies, themes worked on, context, and the main results were extracted into an Excel worksheet.

2.3. Quality Appraisal

The quality of the studies was assessed through the Mixed Methods Appraisal Tool (MMAT)—Version 2018, which evaluates various aspects of research, including the appropriateness of the study aim, methodology, study design, participant recruitment, data collection, analysis, and presentation of findings. This tool is particularly useful for assessing qualitative, quantitative, and mixed-method studies, ensuring a standardized evaluation process. Factors like incomplete reporting, low response rates (<60%), trial contamination, and measurement errors can contribute to lower quality ratings. While the MMAT was used to assess the study quality, no studies were excluded based on its scores. The studies were graded on a scale where scores of ≤50% indicate low quality, 51–75% represent average quality, and 76–100% denote high quality.

3. Results

The final number of reviewed articles was 18. The PRISMA-ScR 2018 flowchart (Figure 1) summarizes the process.

3.1. Characteristics of the Studies

The 18 articles that met the review’s objective are shown in Table 1. Of the 18 studies, 2 are qualitative; 5 appear to be randomized controlled trials; 5 are non-randomized studies; 1 is quantitative descriptive, and 5 used mixed methods.

3.1.1. Population

Eleven studies involved participants with intellectual disabilities, while seven focused on interventions with parents (predominantly mothers) or caregivers. Of the articles on people with ID, only five specified the level of intellectual disability of the participants. Of these, three exclusively included individuals with mild ID, two others covered a wider range of severity from mild to severe ID, and one study included participants with mild to moderate ID. Noteworthily, the Frawley and O’Shea (2020) and Hemati Alamdarloo et al. (2023) studies did not specify the number of individuals with different levels of diagnosis or the age ranges of the participants, while Quesado et al. (2021) only mentioned that the majority had diagnoses between severe and profound. The studies focused only on adults and adolescents with ID.
The interventions mostly occurred in formal care institutions, special education schools, occupational activity centers, rehabilitation centers, and vocational training institutes.

3.1.2. Contents

The most recurrent theme in interventions was sexual abuse prevention, which was discussed in various studies. Some interventions focused on protection strategies, reporting abuse, and recognizing inappropriate touches. Other studies addressed types of violence, such as sexual assault, kidnapping, and mistreatment in relationships.
The topics of general relationships, marriage, and friendships were widely covered. Social skills development was also approached. Other major themes included safe sex practices, sexually transmitted infections (STIs), contraception, and pregnancy prevention, as well as physiology, hygiene, and menstruation.
Several studies highlighted sexual rights, particularly regarding family planning and marriage. Sexual development was also explored, focusing on puberty and menstruation. Other studies examined sexual experiences, including sexual attraction and desire. Sexual diversity and identity were also explored. Discussions on masturbation and inappropriate behavior control were present in several studies. Finally, studies involving parents related to parents’ knowledge about the sexual development and health of their children and how to reduce the risk of abuse.

3.1.3. Teaching Strategies

The programs usually adopted a multimodal approach, combining various didactic strategies such as visual/audiovisual support (e.g., videos, images, films, group discussions), experiential learning, role-playing, modeling, and direct practice with materials such as condoms and sanitary towels. Additional strategies included story readings, repeated exposure to content, educator Q&A sessions, experience sharing among people with ID and their parents, writing activities, quizzes and tasks, and gamification.

3.1.4. Effects of Interventions

The studies generally found a significant increase in sexual knowledge among ID participants following intervention programs. However, some studies focused on program development rather than on the evaluation of the intervention.
Hemati Alamdarloo et al. (2023) reported significant improvements in knowledge regarding body parts, puberty, relationships, sexual boundaries, and safe sex practices. Quesado et al. (2021) found a decrease in “don’t know” or “no answer” responses, especially on complex topics like sexuality, menstruation, sexual interaction, contraception, pregnancy, STIs, masturbation, and homosexuality.
The SALUDIVERSEX program (Gil-Llario et al., 2023a, 2023b, 2023c) was analyzed in three studies: the first (Gil-Llario et al., 2023c) described its development, the second (Gil-Llario et al., 2023b) assessed its effectiveness based on participant characteristics, and the third (Gil-Llario et al., 2023a) compared a full 16-session version with a reduced 10-session version. The shortened version proved more effective, leading to greater improvements in sexual behavior, knowledge, and abuse prevention in less time.
Among the studies involving parents, the results showed increases in self-efficacy and awareness of their children’s sexuality. Kok and Akyuz (2015), for example, found that parents, despite prior knowledge, struggled to communicate effectively with their children. Goli et al. (2021) compared two intervention models, finding that group interventions were more effective than informational leaflets in improving awareness and attitudes. Still, Uçar et al. (2021) reported no positive impact on mothers’ attitudes toward their adult children’s sexuality, although the program provided emotional support and a space for shared experiences.
Finally, Chou et al. (2019) found a shift in attitudes toward sexual rights among parents and caregivers. Parents became more supportive of their children’s sexual needs, including relationships and masturbation. Caregivers transitioned from a problem-focused view to a rights-based perspective, leading to more affirmative behaviors, such as the use of direct terms when discussing sexual organs.

3.2. Quality Appraisal of Reviewed Studies

Eight out of eighteen studies met 100% of the quality criteria, six met 80%, and four met only 40% (Table 2). According to the criteria of the MMAT, 14 studies show high quality, and four show low quality.

4. Discussion

This wide-ranging review sought to map the literature on sex education for people with intellectual disabilities, identifying a total of 18 studies that address different aspects of content, teaching strategies, and the effects of interventions. The results indicate that although there is an effort to ensure that people with intellectual disabilities have access to sex education programs, interventions often address topics focused on prevention and containment, such as condom use, contraception, and STI prevention. Therefore, the programs’ scope might be limited and reflect fundamental defensive strategies rather than developmental strategies. This finding is not unexpected, even if programs should, desirably, adopt a more developmental perspective. Issues such as sexual abuse, pregnancy, or the public exhibition of sexualized behaviors are, and will certainly continue to be, a major concern for parents and educators, inducing protective or defensive behaviors. Pérez-Curiel et al. (2024), for example, refer to a focus on biological and anatomical contents and risks associated with sexuality and a de-emphasis on social or personal aspects.
Schaafsma et al. (2017) found that sex education aimed at people with intellectual disabilities tends to be restricted, and they usually address the same topics, such as safe sex and sexually transmitted diseases. According to the authors, this approach does not cover the full complexity of human sexuality. The motivation to protect this population seems to result in overly restrictive sex education that promotes overprotection rather than encouraging a safe experience (Deffew et al., 2021; Löfgren-Mårtenson, 2012). Once again, the intention to protect people with ID is understandable, but narrowing sex education to very limited topics might paradoxically increase their vulnerability to sexual crimes (Estruch-García et al., 2025; Gülay & Eratay, 2024; McDaniels & Fleming, 2016)
Despite the predominance of topics focused on prevention, most of the studies identified in this review (e.g., Frawley & O’Shea, 2020; Gil-Llario et al., 2023a, 2023b, 2023c; Gutiérrez-Bermejo et al., 2021; Quesado et al., 2021) also included topics such as sexual diversity, relationships, communication, pleasure, intimacy, self-efficacy, safety and consent. This change does not imply that issues related to prevention have been disregarded; on the contrary, many programs have presented the need for protection, recognizing the sexual rights and autonomy of people with ID. This balance is critical because while prevention of abuse and protection from risks remain central concerns, the inclusion of more holistic themes helps to promote a healthier and more conscious sexuality (Pérez-Curiel et al., 2024; Stoffers & Curtiss, 2024; Wellington et al., 2025).
Regarding interventions targeting parents of individuals with intellectual disabilities, programs emphasize communication with their children and the importance of sexuality education, offering guidelines on how to address the topic sensitively (Kok & Akyuz, 2015; Uçar et al., 2021). Stein et al. (2018) point out that parents’ attitudes influence their children’s sexual and emotional performance. The authors recognize that initiating dialogue about sexuality can be challenging, especially when there is parental resistance to recognizing their children as sexual individuals. Still, Tutar Güven and İşler (2015) defend that addressing sexuality is essential because parents are in a unique position to adapt sex education to the realities of their families through a personalized and effective approach.
Uçar et al. (2021) emphasize the value of families exchanging experiences and emotional support in difficult areas such as sex education and that for this exchange to be more effective, the support of specialized professionals is essential. Colarossi et al. (2023) also show that parents want more support from professionals, including advice from reliable sources of information.
Concerning teaching strategies, different approaches and pedagogical strategies were found. Multimodal approaches, such as didactic teaching, visual/audiovisual support, and activity-based learning, were widely used for people with ID, caregivers, and parents. These strategies, as highlighted by Schaafsma et al. (2015), align with the best practices in the field.
In addition to these strategies, some interventions included reading stories and reviewing content. According to Sala et al. (2019), these strategies are effective because they help to accommodate the conceptual limitations of people with ID, offering repetition and practical examples that favor knowledge retention and the internalization of abstract concepts, such as those related to sexuality and reproductive health.
In the case of the “Girls’ Talk+” program (van den Toren et al., 2022), teaching strategies were selected systematically using the “Intervention Mapping Protocol” by Bartholomew Eldredge et al. (2016). This protocol guided the choice of methodologies, such as modeling, discussions, and active learning, based on behavioral theories. Similarly, the SALUDIVERSEX study (Gil-Llario et al., 2023a, 2023b, 2023c) used modeling, role-playing, and skills practice to promote the sexual health of people with mild intellectual disabilities.
Although these strategies are theoretically supported, many studies fail to describe the practical implementation of the methodologies in detail. In the “Girls’ Talk+” program, for example, there is little information on how the strategies were applied in daily sessions and adjusted to the audience’s needs. Similarly, the SALUDIVERSEX study does not clearly describe how the practices were operationalized, making replicating the interventions in other contexts difficult.
This gap in the description of methods is a recurring limitation among the analyzed studies. Although the choice of methodologies is based on theories and evidence, the articles often do not specify how these methods were applied in practice, nor do they provide clear parameters for their correct use (Saini et al., 2021). Schaafsma et al. (2015) noted that this lack of clarity in the implementation process raises doubts about the suitability of the methodologies to achieve the best possible results, even if the effects obtained have been positive.
Stoffers and Curtiss (2024) addressed the difficulties that sex educators face when trying to evaluate the effectiveness of their instruction. Many reported a lack of appropriate tools and methods to measure students’ learning and development concerning sexuality, making it difficult to improve teaching practices continuously. In this sense, it remains uncertain whether the teaching strategies of the interventions analyzed were used optimally to achieve the best possible results. Our findings suggest the importance of selecting pedagogical strategies based on robust theories and providing detailed descriptions of how these strategies are operationalized in the practical context of the interventions.
Even with some drawbacks, the effects of the interventions seem generically positive (comparing baseline and post-intervention), despite variations in the content and strategies of sex education. This finding suggests that certain common factors might be crucial to the success of interventions. For example, the combination of multimodal pedagogical methods, such as visual aids and the promotion of active learning, proved effective, as did the balance between preventive and holistic themes on sexuality. The involvement of parents and caregivers as mediators in the educational process also plays an important role. These elements, when present, seem to contribute to the positive results of the interventions, regardless of the differences in the methods applied. Therefore, the correct selection of the methods used, the materials, the type of activities, and the duration seem fundamental for the success of interventions (Schaafsma et al., 2015; Schwartz & Robertson, 2019).
Another central issue lies in the individual differences of people with IDD and the effect these have on the results of the intervention. The articles by Gil-Llario et al. (2023a, 2023b) illustrate the importance of identifying specific variables such as age, marital status, and time to optimize the results and to ensure that the different needs of the participants are effectively addressed. On the other hand, no studies have evaluated the long-term effects of the interventions or presented data on the maintenance of gains over time. Another relevant aspect, which was not properly specified in the studies, is the level of intellectual disability (ID) of the participants and the educational adaptations required to meet their needs. The absence of this information compromises an in-depth understanding of which types of interventions are most effective for different degrees of disability.
Through the research, only one study was conducted in a general public school (Warraitch et al., 2021), although others were conducted in special education schools (e.g., Hemati Alamdarloo et al., 2023; Kok & Akyuz, 2015; van den Toren et al., 2022). Considering that educational inclusion policies lead to an increasing number of students with ID in schools and that sexuality issues are particularly pressing from adolescence onwards, the lack of studies in the school context is surprising. There may be multiple unreported, unpublished, or unpublicized programs in schools. The problem is that these programs will likely have greater limitations or gaps than the intervention programs found in the specialized literature.

5. Conclusions

The publications reviewed in this study highlight the need to enhance sexual knowledge, prevent abuse, and promote sexual autonomy for people with ID through sex education programs. Interventions are still limited in scope, often focusing on specific topics such as safe sex and abuse prevention without covering the complexity of human sexuality. The lack of long-term studies and of research in school contexts have been identified as important gaps in the field.
For future studies, researchers must consider the immediate and long-term impact of interventions, as well as look at how sex education can be implemented in environments that promote the interaction between individuals with ID and the general population. Schools are the obvious candidates. However, programs designed for schools must consider who will implement the programs, how they will be implemented, the contents, whether parents will be involved, and the periodicity and format. It will be a demanding task but invaluable for people with ID, their families, and society.

Author Contributions

Conceptualization, C.O., S.O. and J.L.; Formal analysis, C.O. and J.L.; Investigation, S.O.; Methodology, C.O., V.G., S.A. and J.L.; Software, V.G. and S.A.; Writing—review & editing, C.O. and J.L. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Conflicts of Interest

The authors declare no conflicts of interest.

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Education 15 00685 g001
Figure 1. PRISMA flowchart.
Figure 1. PRISMA flowchart.
Education 15 00685 g001
Table 1. Descriptive data from the analyzed studies (n = 18).
Table 1. Descriptive data from the analyzed studies (n = 18).
Author(s) (Year)Study ObjectivePopulationDesignContextEducational StrategiesContentKey FindingsLimitations
Bornman and Rathbone (2016)To develop four social stories for a sexuality and relationship training program for women with ID.Ten caregivers (ages 23–55) of women with ID (phase 3). Disability level unspecified.Three-phase design: (1) literature review, (2) focus groups, and (3) training development.South Africa, targeting women with ID in residential care.Interactive readings: Social stories are read aloud with visual aids, followed by role-play and discussions to enhance understanding. Topics cover relationships, boundaries, behavior, affection, safety, emotions, and personal rights.The program enhanced understanding, raised caregiver awareness, and highlighted the need for ongoing education.Challenges: Recruitment, stakeholder focus, context relevance, and ethical concerns on consent due to sex education misconceptions.
Chou et al. (2019)To assess RSHP’s impact on parents’ and service workers’ attitudes toward the sexual rights of adults with ID. 57 parents and 164 service workers. Comparison group: 21 parents and 37 service workers.Quasi-experimental design.In service centers and group homes for adults with ID in Taiwan (ID).1. Value clarification.
2. Reciprocal interaction model.
3. Film viewings.
4. Small group discussions.
5. Feedback and reflection.		Sexual health rights, sexual identity, and culture; focus on rights and sexuality, parenting, and societal attitudes toward sexuality and social stigma.The RSHP fostered a rights-based perspective, improving understanding, trust, and inclusivity while highlighting the need for ongoing support.Limitations include limited generalizability, comparison group issues, social desirability bias, follow-up needs, and a small qualitative sample.
Chou et al. (2020)To evaluate a two-year sexual health intervention’s impact on the knowledge, attitudes, and quality of life in adults with ID.87 adults (19–43 years; mild to profound ID); 51 participated in both years and 36 in the second year.Non-equivalent multiple-groups-with-replications design.Taiwan: non-profit day-care centers.PowerPoint presentations;
videos; hands-on activities; group discussions;
peer facilitators; user-inclusion strategy; custom adaptations.		Sexual health, intimate relationships, and being a parent as a rights issues.Program revisions improved knowledge and attitudes, empowering adults with ID and fostering caregiver support.Limitations included disability level oversight, study design flaws, dropouts, weak outcomes, caregiver gender imbalance, and unreliable questionnaires.
Frawley and O’Shea (2020)To develop and analyze the SL&RR program (Sexual Lives and Respectful Relationships) for individuals with ID.The study targets Australians with ID, focusing on those developing and leading sex education as peer educators.The SL&RR study uses a participatory, theme-focused, qualitative approach to assess peer-led sex education experiences.Delivered by eight networks in Australia, the study uses a peer-led approach to advocate for sexual rights, empowerment, and inclusivity.Peer education, storytelling, and discussions on relationships, rights, and identity, with activities reinforcing safe sex, decision-making, and privacy.The SL&RR program addresses sexuality, relationships, and rights, focusing on safe sex, self-acceptance, orientation, consent, privacy, and autonomy.SL&RR empowers individuals with ID through rights-based sex education.Further research is needed; limitations include the theoretical framework, context specificity, disability diversity, feedback bias, implementation variability, and sustainability.
Gil-Llario et al. (2023c)SALUDIVERSEX develops and evaluates sexual health and quality of life intervention for adults with mild ID.Adults aged 18 to 65 who have a diagnosis of mild intellectual disability.Randomized controlled, pre- and post-experimental design.Two specific support service networks in Spain.Role-playing, games, quizzes, discussions, visual aids, and summary posters for reinforcement.Topics: Sexuality, intimacy, relationships, self-awareness, self-care, integration, and reflection.n.d.Limitations: Non-systematic review, small sample, methodological flaws, assessment issues, educator dependence, setting variability, and participant bias.
Gil-Llario et al. (2023b)The study assesses SALUDIVERSEX’s effectiveness in affective–sexual education, focusing on gender, age, relationships, and autonomy254 adults with mild intellectual disability, aged 19 to 67 years.Quasi-experimental with a pre-test–post-test design.Daytime support services in Spain. Sessions begin with pre-questions and include story-based activities, role-playing, and summary sheets for reinforcement.Topics: Sexuality, body image, communication, hygiene, self-care, sexual practices, diversity, dating, intimacy, assertiveness, and health.Improved sexual knowledge and reduced concerns, especially in autonomous, younger, and partnered participants, with tailored education.Focused on participant variables, lacked implementation analysis, had limited generalizability, and showed non-significant differences in some areas.
Gil-Llario et al. (2023a)The study analyzed the SALUDIVERSEX program (16 vs. 10 sessions) for affective–sexual education in 208 adults with ID (19–67 years)208 participants with mild ID. Ages range from 19 to 67 years.The study utilized a quasi-experimental design.Occupational centers where individuals with ID are supported in their daily activities in Spain. Pre-questions, story-based activities, role-playing, and summary sheets.Sexuality, body image, sexual communication, hygiene, self-care, sexual practices, diversity, dating, intimacy, sexual assertiveness, and sexual health.The reduced version showed greater improvements in sexual behaviors, safer practices, and abuse prevention, with similar knowledge gains. Sample bias, self-reporting, lack of long-term follow-up, and limited randomization.
Goli et al. (2021)To compare the effects of group training vs. booklet training on sexual health awareness, attitudes, and self-efficacy.Mothers (n = 81) (aged 25–55) of intellectually disabled adolescent girls (11 to 20 years old). The study employed a cluster randomized control trial design.Training centers in Isfahan, Iran.The training group had lectures and discussions, while the booklet group used tailored resources for their daughter’s sexual health.Puberty, menstruation, sexual health, body rights, harassment prevention, and communication skills.Improved mothers’ awareness, attitudes, and self-efficacy. The control group showed no progress.The sample did not account for sensitivity, cultural norms, learning differences, and clustering.
Gutiérrez-Bermejo et al. (2021)To promote responsible sexuality, rights, health, and self-determination.44 adults with mild to severe ID, aged between 22 and 67 years.Pre-experimental intervention design with a one-group pre-test–post-test format. Occupational center in the region of Castilla y León, Spain.Discussions, readings, tasks, and questionnaires to assess knowledge, attitudes, and misinformation.Body, genitalia, intimacy, gender, desire, relationships, abuse prevention, internet safety, prostitution.The program enhanced responsible relationships, privacy, safety, and empowerment knowledge.A small sample, pre-experimental design, attitude measurement only, no longitudinal data, and a homogeneous sample.
Hemati Alamdarloo et al. (2023)To evaluate SEI effectiveness on sexual knowledge in female adolescents with intellectual disabilities (ID).Thirty female adolescents with ID, aged 13 to 18 years.Randomized controlled trial design. Special education organization in Shiraz, Iran.Pre- and post-tests, discussions, role-playing, Q&A, visual aids, demonstrations, self-care, and reviews.Body awareness, self-care, puberty, sexual health, reproduction, sexual desires, and sex laws for individuals with ID.The program improved sexual knowledge and confidence in girls, especially in safe sex and puberty, but masturbation was harder to address.Cultural constraints, taboos on masturbation and sexuality, and a limited sample of female adolescents with ID.
Kim (2016)To evaluate the effectiveness of a sexual abuse prevention program for children with ID.Three elementary-aged girls with mild ID, aged between 11 to 13 years.Concurrent multiple-probes-across-participants design.Local community centers in South Korea.Story cards, coloring books, posters, role-playing, visual aids, modeling, discussions, and feedback.Body ownership, body parts, appropriate vs. inappropriate, refusal skills, secrets, bribes, threats.The program improved recognition, refusal, and reporting skills in children with ID, with lasting effects and positive parental feedback.No baseline measures, small sample size, scenarios used in assessments, the influence of known individuals, and social validity data.
Kok and Akyuz (2015)To evaluate a health education program for parents on adolescents’ sexual development with ID.38 mothers and 24 fathers of 144 children (ages 10–19) with ID.Quasi-experimental with a pre-test and post-test design. Two Special Education and Rehabilitation Centers in Turkey.Contents are presented in simple, concise language, discussion-based exercises, and explicit skills training. Educational modules on hygiene, sexual behavior control, abuse prevention, and communication strategies.Improved parental knowledge; mothers prioritized self-care, and fathers focused on behavior.Sample size and scope, participation criteria, timing and scheduling challenges, and potential for response bias.
Neherta et al. (2019)To improve mothers’ knowledge and attitudes to reduce
the risk of sexual abuse on children with mental retardation.		45 mothers with mentally disabled children.Quasi-experimental.Child Care Foundation Payakumbuh, Indonesia.Powerpoints, discussions, short video films, and control sheets.Sexual abuse prevention.Mothers’ improved knowledge and a more positive attitude after receiving health education on the primary prevention of child sexual abuse.n.d.
Quesado et al. (2021)To assess the effects of a sexual education program on a sample of people with ID. Probabilistic sample: 1st cycle (58), 2nd cycle (62), 3rd/4th cycle (16). Group A: 9 (age 21–44). Group B: 7 (age 17–42).The study utilized an action-research (AR) design method.Institution in the central region of Portugal.Health education sessions, storytelling, gamification, and interactions. Younger students: sexual education,
sexuality, and hygiene.
Older students: education for affections and sexuality. 		The program improved knowledge and engagement in individuals with ID, reducing uncertainty in key areas.Limited transferability (single institution), variability in severity and capacities, program adaptation, and the need for specialized professional training.
Uçar et al. (2021)To examine the effect of the Sex Education Program for Families of Adults with ID (ZACEP). Nine mothers of adults with ID between 21 and 35 years old.Quasi-experimental with a pre-test and post-test design. İbrahim Ethem Kesikbaş Handicapped Assembly Workshop of Eskişehir Tepebaşı Municipality, in Turkey.Group meetings, presentations, discussions, and interactive sessions aimed at engaging families and enabling them to share experiences.Sexuality and sexual development in adulthood, sex education, child neglect and sexual abuse, and teaching security skills.ZACEP had mixed results: no attitude change and limited knowledge gains. Still, families valued the support and shared experiences.Small sample, short duration, no social validity data, low education, and overlapping programs.
van den Toren et al. (2022)To evaluate the effect and process of the Girls’ Talk+ program, a sexual education program for mild ID in the Netherlands.249 girls (12–20 years; mild ID) in vocational education: 18 intervention groups (Girls’ Talk+) and 12 controls.A mixed-methods approach with a concurrent design combining qualitative and quantitative methodologies.Special schools for vocational training across various regions in the Netherlands.Active learning, modeling, discussions, consciousness-raising, coping strategies, repetition, and exercises (e.g., negotiation, risk mapping).Sexual health education, promoting equality, informed choices, self-worth, and social network involvement.Girls’ Talk+ improved knowledge, confidence, and attitudes but had minimal impact on self-esteem and social networks.Validity of measurements, potential positive reporting, inadequate examination of social networks, non-random allocation and social desirability bias.
Warraitch et al. (2021)To evaluate the preliminary effect, acceptability, and feasibility of a sexual abuse prevention program Fifteen female children with mild ID, aged between 10 to 15 years.The study employed a non-randomized pre-post evaluation design.Public school in Rawalpindi District, Pakistan.Role-playing, PowerPoint presentations, story cards, digital posters, coloring books, interactive discussions, and short focused sessions.Body ownership, private parts, appropriate vs. inappropriate behavior, refusal, and reporting.The program improved knowledge, skills, and feasibility, with the potential for wider use in Pakistani schools.Small sample, gender bias, limited ID scope, cultural stigma, unexamined familiar offenders, no long-term follow-up, no side-effects assessment.
Yıldız and Cavkaytar (2017)The study examined SEPID’s impact on mothers’ attitudes toward sexuality education and their perceptions of social support.44 mothers of individuals with ID: 22 in the experimental group (mean age 53) and 22 in the control group (mean age 54).Empirical research methods: pre-test, post-test control-group design.Tepebasi Municipality and ISKUR (for the employment of young adults with ID in Eskisehir, Turkey.Needs-assessment activities and content delivery with visuals and materials.
Discussion reflection and practical applications. 		Child neglect and sexual abuse, sexuality and development, masturbation, menstruation, intercourse, and sexuality education for special young adults.SEPID improved mothers’ attitudes, social support, and confidence in sex education, with high satisfaction and increased knowledge.Limited and self-selected sample; cultural and privacy-related barriers; educational delivery methods.
Table 2. Evaluation of the methodological quality of the studies through the Mixed Methods Appraisal Tool (MMAT)—Version 2018.
Table 2. Evaluation of the methodological quality of the studies through the Mixed Methods Appraisal Tool (MMAT)—Version 2018.
Screening Questions1. Qualitative Studies2. Randomized Controlled Trials3. Non-Randomized Studies4. Quantitative Descriptive Studies5. Mixed Methods StudiesQuality Index
Author(s)Type of StudyS1S2Q1Q2Q3Q4Q5Q1Q2Q3Q4Q5Q1Q2Q3Q4Q5Q1Q2Q3Q4Q5Q1Q2Q3Q4Q5
Bornman and Rathbone (2016)Qualitative YesYesYesYesYesYesYes *****
Chou et al. (2019)Mixed YesYes YesYesYesYesYes*****
Chou et al. (2020)Mixed YesYes YesYesYesYesYes*****
Frawley and O’Shea (2020)Qualitative YesYesYesYesYesYesYes *****
Gil-Llario et al. (2023c)QuantitativeYesYes YesYesYesCan’t tellYes ****
Gil-Llario et al. (2023b)QuantitativeYesYes YesYesYesYesYes *****
Gil-Llario et al. (2023a)QuantitativeYesYes Can’t tellYesYesYesYes ****
Goli et al. (2021)QuantitativeYesYes YesYesYesNoYes ****
Gutiérrez-Bermejo et al. (2021)QuantitativeYesYes YesYesYesCan’t tellYes ****
Hemati Alamdarloo et al. (2023)QuantitativeYesYes YesYesYesCan’t tellYes ****
Kim (2016)QuantitativeYesYes NoNoYesYesCan’t tell **
Kok and Akyuz (2015)Mixed YesYes YesYesYesYesYes*****
Neherta et al. (2019)QuantitativeYesYes Can’t tellCan’t tellYesCan’t tellYes **
Quesado et al. (2021)Mixed YesYes YesYesYesYesYes*****
Uçar et al. (2021)QuantitativeYesYes NoYesCan’t tellNoCan’t tell **
van den Toren et al. (2022)Mixed YesYes YesYesYesYesYes*****
Warraitch et al. (2021)QuantitativeYesYes NoYesCan’t tellCan’t tellYes **
Yıldız and Cavkaytar (2017)QuantitativeYesYes YesYesYesCan’t tellYes ****
Note: Screening questions: S1. Are there clear research questions? S2. Does the collected data allow us to address the research questions? Qualitative studies: Q1. Is the qualitative approach appropriate for answering the research question? Q2. Are the qualitative data collection methods adequate to address the research question? Q3. Are the findings adequately derived from the data? Q4. Do the data sufficiently substantiate the interpretation of results? Q5. Are the qualitative data sources, collection, analysis, and interpretation coherent? Randomized controlled trials: Q1. Is the randomization appropriately performed? Q2 Are the groups comparable at baseline? Q3. Are there complete outcome data? Q4. Are outcome assessors blinded to the intervention provided? Q5 Did the participants adhere to the assigned intervention? Non-randomized studies: Q1. Are the participants representative of the target population? Q2. Are measurements appropriate regarding both the outcome and intervention (or exposure)? Q3. Are there complete outcome data? Q4. Are the confounders accounted for in the design and analysis? Q5. During the study period, was the intervention administered (or did exposure occur) as intended? Quantitative descriptive studies: Q1. Is the sampling strategy relevant in addressing the research question? Q2. Is the sample representative of the target population? Q3. Are the measurements appropriate? Q4. Is the risk of nonresponse bias low? Q5. Is the statistical analysis appropriate for answering the research question? Mixed methods studies: Q1. Is there an adequate rationale for using a mixed-methods design to address the research question? Q2. Are the different components of the study effectively integrated to answer the research question? Q3. Are the outputs of the integration of qualitative and quantitative components adequately interpreted? Q4. Are divergences and inconsistencies between the quantitative and qualitative results adequately addressed? Q5. Do the different components of the study adhere to the quality criteria of each tradition of the methods involved? Quality Index: * = 20% of quality criteria met; ** = 40% of quality criteria met; *** = 60% of quality criteria met; **** = 80% of quality criteria met; ***** = 100% of quality criteria met.
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MDPI and ACS Style

Oliveira, C.; Ozorio, S.; Gomes, V.; Araújo, S.; Lopes, J. Sex Education for Individuals with Intellectual Development Disorder (IDD): A Scoping Review. Educ. Sci. 2025, 15, 685. https://doi.org/10.3390/educsci15060685

AMA Style

Oliveira C, Ozorio S, Gomes V, Araújo S, Lopes J. Sex Education for Individuals with Intellectual Development Disorder (IDD): A Scoping Review. Education Sciences. 2025; 15(6):685. https://doi.org/10.3390/educsci15060685

Chicago/Turabian Style

Oliveira, Célia, Sarah Ozorio, Verónica Gomes, Soraia Araújo, and João Lopes. 2025. "Sex Education for Individuals with Intellectual Development Disorder (IDD): A Scoping Review" Education Sciences 15, no. 6: 685. https://doi.org/10.3390/educsci15060685

APA Style

Oliveira, C., Ozorio, S., Gomes, V., Araújo, S., & Lopes, J. (2025). Sex Education for Individuals with Intellectual Development Disorder (IDD): A Scoping Review. Education Sciences, 15(6), 685. https://doi.org/10.3390/educsci15060685

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