How to Use Communication Supports in Sexuality Education for People With I/DD

Sexuality education depends on communication. People need a way to ask questions, say yes or no, share an experience, express discomfort, and change their minds.

When a person has limited or unreliable speech, those options can disappear from the lesson. Not because the person has nothing to say. Because we have not given them an accessible way to say it.

That is where communication boards and cards can help. They use words and images that a person can point to, gesture toward, or select with their eyes. In sexuality education, these supports give more people a way to participate, demonstrate their understanding, practice self-advocacy, and communicate about consent and relationships.

We created Elevatus Training’s Communication Supports: Boards & Cards to accompany our 22-lesson Sexuality Education for People with Developmental Disabilities curriculum. But here is the important part. The boards do not do the work by themselves. How you introduce and use them matters just as much.

In the workshop below, Molly K. Rearick, EdD, and Daniel Rosien walk through the essential practices. You can also download the Workshop Slides (PDF), Transcript (PDF), and Resources (PDF).

Why Communication Access Matters in Sexuality Education

Think about what we ask people to do in sexuality education. We ask them to talk about subjects that are personal, nuanced, and sometimes unfamiliar. A yes-or-no question is not always enough. A person may need to say:

• I have a question.
• I do not understand.
• I disagree.
• I am not comfortable with this.
• None of these choices fits.
• Tell me more.
• I changed my mind.
• I want to talk about something else.

Without access to language like this, how do we know what a person understands? How do we know what they want to ask, or whether they are participating by choice?

This matters especially when we teach consent. Consent cannot be reduced to selecting “yes” from two choices. A person must also be able to say no, reject all the available options, ask for more information, choose something that was not offered, and revoke consent after it has been given.

Good communication support does more than help you get through the lesson. It gives the person more control within the lesson.

Begin by Presuming Competence

Start here. Presuming competence means beginning with the assumption that a person can learn, wants opportunities to learn, and has thoughts worth communicating. This holds true even when their body or speech does not reliably show what they know.

In other words, do not confuse speech with intelligence. In the workshop, Dan describes what changed after he learned to type:

“Before that everyone thought I was stupid, and now at least some people believe I am smart.”

Dan’s experience is a powerful reminder. The absence of reliable speech is not evidence of an absence of understanding. Presuming competence does not mean assuming you know what a person thinks. It means giving them meaningful instruction, sufficient vocabulary, multiple ways to respond, and enough time to communicate for themselves.

The Communication Partner Matters

The board matters. You matter, too. A strong communication partner is calm, patient, flexible, trustworthy, and confident in the person. They stay steady when communication takes time or when a person’s movements are difficult to interpret.

In practice, this means:

• Be patient. Do not present the board, wait a few seconds, and conclude that it did not work.
• Be consistent. Use the support regularly enough for it to become familiar.
• Be persistent. If one approach is not working, pause, reset, and try another accessible approach.
• Be flexible. Positioning, motor access, regulation, and communication needs may change from one day to another.
• Be engaging. Give the person real, motivating reasons to communicate, not exercises that exist solely to practice pointing.
• Keep the support available. A communication tool should not be stored somewhere the person cannot independently reach when it is needed.
• Use the least support necessary. Give the person room to make an intentional selection without directing the answer.

This last point is critical. Do not use full physical prompting to produce a communication response. If you physically guide someone to an answer, it becomes impossible to know whose answer it is.

Model the Communication Support Before Expecting an Answer

Before asking a person to use a new board or set of cards, use it yourself. Show them how it works. And remember, the communication device or board belongs to the person. Begin by asking permission to touch it. If the person says no, respect the answer and find another way to demonstrate. If permission is given:

1. Position the board where the person can see and reach it.
2. Make sure they are attending in the way that is typical for them.
3. Explain what you are doing.
4. Point to an option yourself.
5. Talk through the process step by step.

For example: “I want to talk about being safe. I am going to point to the word safe on the board.”

Modeling makes the process visible. It also shows that the words on the board are real communication, not a test with a hidden correct answer.

How to Use Communication Boards and Cards in Seven Steps

Here is the seven-step process Molly teaches for introducing and using communication supports.

1. Determine How the Person Will Select

First, figure out how the person will make a selection. They may point with a finger, gesture toward an area, use another controlled movement, or select with their eyes.

If pointing is difficult, consider whether the person can hold a marker or another object to help stabilize the hand and isolate the pointing movement. Occupational therapists and speech-language pathologists may be able to help identify effective access strategies.

If the person uses eye gaze, learn what an intentional look looks like for them. Do not assume that every person can, or should, use a board placed directly in front of them.

2. Make Every Choice Physically and Visually Accessible

Positioning matters. A board may need to be moved left or right, tilted, raised, or lowered. A person who has difficulty crossing the midline may only be able to reach one side when the board is centered. Someone with a hunched posture may need the board positioned below eye level.

Do not center the board simply because it looks neat or feels convenient. Put it where the person can reliably see and reach every choice.

3. Check Identification Before Asking for a Choice

This distinction is easy to miss. Identifying a choice and making a choice are two different tasks. Before asking, “Which one do you want?” first establish that the person can locate the options. You might say:

• “Can you show me agree?”
• “Can you find not sure?”
• “Where is something else?”

You are not asking for an opinion yet. You are confirming that the person can see, distinguish, and reach the choices you plan to offer.

4. Ask the Question and Allow Time

Once you know the person can reach and identify the options, ask the real question in clear language. Then wait. Some people need much more processing and motor-planning time than a speaking participant. Do not repeat the question too quickly, answer for the person, or move the board while they are preparing a response.

5. Watch for Intentionality and Patterns

Learn what an intentional response looks like for the individual. Some people have motor patterns that can appear to be a deliberate answer. A hand may repeatedly move toward the upper-left corner. A person may touch every option before settling on one. Someone else may point out before you have even asked the question.

That does not mean the person cannot use the board. It means you need to slow down, observe, and learn the difference between a motor pattern and an intentional selection.

6. Troubleshoot Without Taking Over

If the same location is selected repeatedly, try moving the board, changing its angle, leaving that location blank, or temporarily covering choices that are not relevant.

If there are too many options, reduce the visual field without reducing the person’s ability to reject the offered choices or ask for something else.

The goal is better access, not steering the person toward the answer you expect.

7. Expand the Choices Over Time

Communication should grow over time. Add vocabulary that is relevant to the person, the lesson, and the situations they want to discuss. Use the blank cards to add names, places, questions, concepts, or personal language that is missing from the standard set.

No preprinted board can anticipate everything a person may want to say. That is why “something else,” “none of these,” and “tell me more” are essential options, not extras.

Real Choices Support Real Consent

Here is a simple test. A choice is only meaningful when the person is allowed to reject it. Before using a communication support, ask whether the person can do each of the following:

• Say no.
• Select none of the options.
• Ask for something different.
• Request more information.
• Take more time.
• Change their mind later.

If the answer to these questions is no, the interaction may appear to be choice-making. But it is not a real choice. This applies to the lesson itself, too. A person may begin class ready to participate and later become uncomfortable or need a break. The communication support should give them a way to say, “I changed my mind,” “I am not ready,” or “I need time.”

Use Specific, Adult, and Relevant Vocabulary

If you are teaching sexuality, the communication support needs the language of sexuality. That sounds obvious. But people with I/DD are too often given simplified language that leaves out the very subjects we are trying to teach.

People need accurate anatomical terms, relationship language, consent, sexual acts, feelings, boundaries, privacy, respect, and other lesson-specific concepts. A board limited to generic words such as yes, no, and happy does not give someone enough vocabulary to participate fully.

The images should respect the person’s age, too. Adults deserve materials that do not look childish or institutional. Pairing written words with clear graphics can support non-readers while also providing exposure to written language.

Some concepts are hard to represent with one picture. Trust, respect, responsibility, and confidentiality are good examples. In those cases, it is better to use the written word and teach the concept than to add an image that may be confusing or misleading.

Communication Supports Are Not Only for Nonspeaking People

One more important point. Communication boards are not only for people who do not speak. They may also be useful for people who:

• Have limited or unreliable speech
• Use an AAC device, but benefit from lesson-specific vocabulary
• Communicate more reliably by pointing or eye gaze
• Experience anxiety that makes speaking difficult
• Have a trauma history or selective mutism
• Need visual choices to process a question
• Are non-readers or benefit from words paired with graphics
• Find it easier to discuss sensitive topics without speaking aloud

If the person already uses an AAC system, keep it available. Lesson-specific boards and cards can supplement that system. They should not replace a more robust communication method or limit the person to the instructor’s chosen vocabulary.

Using Communication Supports in a Group

Communication takes time. That time is part of the communication, not a disruption or dead space the instructor needs to fill. At the beginning of class, make agreements with the group. If one person needs time to type or point, ask whether they are comfortable with the conversation continuing while they prepare their response. Make sure the group knows that the person has something to add. And make sure they are given the space to add it.

If several people use the boards:

• Provide more than one set when possible.
• Use the lesson cards and boards at the same time.
• Rotate who selects first.
• Allow enough time for every person to participate.
• Never announce a selected response without permission.

If a person points to something private, do not read it aloud simply because the class is waiting. Ask, “May I share this?”

The same rule applies when others cannot hear a voice-output device clearly. Get permission. Then repeat the person’s words without adding your interpretation.

Frequently Asked Questions

Do communication boards replace a person’s AAC device?

No. Keep the person’s established AAC device or communication system available. Lesson-specific boards and cards can provide immediate access to sexuality vocabulary, but they should not narrow or replace a more complete communication system.

Does a person have to be able to read?

No. The boards pair graphics with written words and can be used with non-readers. You should still teach the location and meaning of each option rather than assuming the images explain themselves.

How do I know whether a selection was intentional?

First, make sure the person can see, identify, and physically reach the choices. Learn their typical movement patterns and allow enough time for a response. An intentional selection may include looking toward the choice before pointing, pausing on the choice, or repeating the selection when asked to confirm.

What if the person always points to the same location?

The person may be caught in a motor pattern rather than repeatedly making the same choice. Reposition the board, cover irrelevant options, leave the favored location blank, reduce visual complexity, and try again. Do not physically guide the response.

Can I move the person’s hand toward an answer?

No. Do not physically guide someone to a communication response. Use the least intrusive support possible. You can adjust the board, model how it works, give a verbal or gestural prompt, or simply allow more time.

Can the boards be customized?

Yes. The set includes blank cards, and instructors can add relevant people, places, vocabulary, and choices. Always preserve options such as “something else” and “none of these” so customization does not become another way of limiting the person’s response.

Give Every Person a Way to Participate

Making sexuality education accessible is not simply about making the information easier. It is about expanding the ways a person can question, respond, disagree, consent, and advocate for themselves.

When we introduce communication supports with patience, respect, and a presumption of competence, people gain more than a way to respond to the instructor. They gain a stronger way to participate in conversations about their own bodies, relationships, boundaries, and lives.

Learn more about Communication Supports: Boards & Cards