Brain injury and youth sexuality: Q&A with Caron Gan

Along with colleagues from Holland Bloorview Kids Rehabilitation Hospital in Toronto, Caron Gan, a registered marriage and family therapist, will host a workshop — Sexuality, Safety & Smarts on Feb. 21. The workshop will touch on topics such as meeting people, dating and healthy relationships, effects of brain injury on sexuality, safer sex and Internet and social media safety.

Gan spoke to BIST about some of those issues.

Caron Gan/Submitted

BIST: Have you run this type of event before? What is the usual turnout? Do people get embarrassed talking about the topic?

Gan: We offer this workshop every two years. This is the fourth time we have offered it. We usually get 30 – 40 participants.

This topic tends not to be embarrassing for the youth and young adults as discussions around friendships, dating, and relationships are typically of interest with this population. It tends to be more embarrassing for the parents than the youth.

BIST: For children and youth with an ABI, what are some of the common challenges and issues they face with sexuality?

Gan: Early sexual development or late sexual development can occur after an ABI. For example, an eight-year-old girl starting menstruation versus age 12 or 13. Their body may have developed prematurely — young gals getting breasts and menstruating much earlier — and emotionally they may not have caught up with way they feel physically. That can be quite distressing.

Sometimes there’s the other end as well, where 17 or 18-year-olds have very few of the characteristics, like body hair for example. That can be very embarrassing if they are in gym class.

A young person might have limited or incorrect knowledge around common physical and emotional changes that accompany puberty and adolescence. They may have missed out on sexual health education, or may not have fully grasped the material due to learning challenges. They may have trouble having friends and fitting in with peers. There may be issues with their body image, self esteem and peer acceptance. They may be vulnerable due to an ABI’s impact on social judgment and impulsivity. Their social and dating skills may not be well developed due to the ABI. They may be socially isolated. They may want to date but have limited life and sexual experience. They may have trouble explaining their ABI to others.

Their ability to control impulses may be more affected, so we may see more anger issues or people blurting things out when they shouldn’t be blurting them out. They may not recognize social boundaries and not know they are in somebody’s face, talking too close or touching people inappropriately. Their social skills may be a little bit off. They might say things that are kind of rude or offensive and make off-colour jokes.

To listen to a CBC radio piece on teens and sexuality, featuring Caron Gan, click here and then click each link to download the segment. You may need to convert the file to an Mp3 if you are using an Apple computer.

BIST: What do the friends of a person with an ABI need to know to help them help their friend?

Gan: I think it’s good to involve the friends in the education process early on so they do understand what’s going on and the changes in their friend and how best to support them. When they don’t understand that’s when there can be all kinds of judgments and misinterpretations.

It requires a lot of self-acceptance on the teen’s part as well, to be able to open up that conversation with their friends.

BIST: For parents of a young person with ABI, is it even more important to talk with their child about healthy sex ?

Gan: Absolutely. Talking about it helps to instill values and promote a positive attitude around healthy sexuality. Their kids are sexual beings regardless of age and they are continually surrounded by sexual messages. Not talking about healthy sexuality can lead to difficulties down the road. The young person may not know about what is appropriate and what isn’t, which can get them into trouble. For example, inappropriate touching can lead to difficulties with the law.

BIST: Is there an ideal way to approach such a conversation?

Gan: First, it’s important to create a comfort zone to talk about healthy sexuality. Many people may have been raised in households where sexuality simply is not talked about, so it’s important for parents to find a way to be comfortable. One way to do this is to develop a broader definition of healthy sexuality. It’s not just about having sex. It’s about how you feel about yourself, it’s about the physical and emotional changes that occur during adolescence, it’s about relationships, it’s about making safe choices. The most important thing is to listen, to understand where the teen is at, and to use teachable moments to broach the topic, such as during a TV program. Talk about it in a general way first so everyone can be eased into more of a comfort zone. In the workshop, we also offer a handout for parents on how to talk to their kids about healthy sexuality.

BIST: You have called for sexuality programs in pediatric brain injury rehab. Have there been any developments on that front?

Gan: At Holland Bloorview, we are incorporating this topic on a regular basis into our support groups. We also offer this workshop to the larger community every two years. I have also consulted with the Brain Tumour Foundation of Canada to develop resource materials for pediatric survivors of brain tumours. A group in B.C. is looking into developing a sexuality program for youth. Someone in Australia is also working on some resource materials for teens with ABI.

BIST: Are people with an ABI more likely to stay involved in an unhealthy relationship or is that an unfounded concern of parents?

It is a valid concern as the young person may not be able to fully discriminate unsafe relationships or individuals who may potentially exploit them. Because of the social isolation, young people can be desperate to develop friendships, and sometimes their choices are not so healthy. Poor social judgment and poor impulse control can also put them at risk.

BIST: Are there tips or reminders you teach to youth with ABI to remind them to use protection when they engage in sexual activity?

Gan: It’s not just safety around sexual activity, it’s also safety around the choice of friends, knowing how to say no, knowing when you’re in an unhealthy relationship and how to get out of one, knowing how to keep oneself safe during a date, learning social boundaries, discriminating safe versus unsafe activities, cyber safety, disclosure of personal information. When a teen is ready to consider sexual activity, we try to ensure they are linked to appropriate resources to support decision-making around birth control, such as the House through Planned Parenthood, Teen Sexual Health Info line and other web resources.

Sexuality, Safety & Smarts is a workshop for youth 8-25 with brain injuries and/or their parents. Contact Caron Gan — 416-425-6220, ext. 3514 for more info.

Matthew Chung, BIST member and Editor of Toronto brain injury blog

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