Sex and relationship education for young people with PMLD

Sex and relationship education (SRE) should support a child or young person in lifelong learning about sex, sexuality, relationships and sexual health.

An appropriate SRE curriculum can help pupils develop self-awareness and awareness of appropriate sexual behaviour, from their own and another person's point of view. With an effective SRE curriculum, the pupil will also be supported in developing protective behaviours, focused on keeping the child or young person safe (such as having the understanding and self-esteem to know what is appropriate and what is not, and the ability and confidence to communicate this).

Our bodies are a source of a variety of sensations and experiences, some pleasant and some unpleasant. Children and young people with profound and multiple learning disabilities (PMLD) may not be able to differentiate between sensations and experiences as either sexual or non-sexual, or even as coming from within their body or from the external environment. It can be difficult to assess the level of response from a child or young person with PMLD, and so we cannot be sure how physical experiences are being perceived by them.

These experiences may be complicated by the difference between the child's cognitive, social development and their physical development. For most children and young people with PMLD, their assessed cognitive development will be up to the chronological age of a child of 24 months, yet as they get older they will have physically developed bodies which can experience sexual arousal, including orgasm. In some children there may be precocious sexual development, for example entering puberty at age seven or eight. Further complications arise for many children and young people with PMLD who respond in a negative way to physical contact, or their physical problems can lead to discomfort and pain.

Before developing an appropriate starting point for a sex and relationship education curriculum for a particular child or young person, consider their cognitive awareness, their response to physical contact and their relevant life experiences: it may be that past experiences lead them to feel unsafe in personal care situations, or that physical contact is unpleasant owing to a sensory processing disorder or discomfort.

• You can use this chart to assess the progress of pupils on individualised sex and relationship programmes.
• Diagram showing the developmental stages in sex and relationship education.
• Sexual development of people with a developmental level of 0 to 24 months.

We welcome any comments, examples of excellent practice or suggested amendments/additions.