Please no plagiarism and make sure you are able to access all resources on your own before you bid. Main references come from Murray, C., Pope, A., & Willis, B. (2017) and/or American Psychological Association (2014).  Assignments should adhere to graduate-level writing and be free from writing errors. Please follow the instructions to get full credit. I need this completed by 03/14/2020 at 4pm. 

Assignment 1 – Week 3

Research on Childhood and Adolescent Sexuality

What is considered to be “normal” sexual play for children? What level of sexual knowledge is appropriate for children of different ages? What do children and adolescents view as helpful in terms of how their parents and other adults teach them about sex? What is life like for teenagers who become pregnant? How are teenagers’ experiences of sexuality impacted by social media and “sexting”?

Each of the questions above has implications for counseling children and adolescents as well as for their parents. To learn more about these issues when they arise in counseling, counselors can turn to exist professional literature and empirical research. Empirical research can provide counselors with background information about clients’ experiences as well as interventions that research shows to be effective.

For this week’s Assignment, you explore a topic related to childhood/adolescent sexuality through a relevant empirical research article. To prepare, choose one topic related to childhood/adolescent sexuality. Search the Walden Library and select one empirical article related to this issue to use for this Discussion.

The Assignment (2- to 3-page paper):

Provide an analysis of the article you selected, including:

• A brief description of the article

• Possible implications of the findings for the practice of sexuality counseling

• Possible implications of the findings for parents and caregivers

Support your Assignment with specific references to all resources used in its preparation. You are to provide a reference list for all resources, including those in the Learning Resources for this course.

Required Resources

• Course Text: Murray, C., Pope, A., & Willis, B. (2017). Sexuality counseling: Theory, research, and practice. Thousand Oaks, CA: Sage

• Chapter 5, “Lifespan Development and Sexuality”

• Article: Bloom, Z. D., & Dillman Taylor, D. (2015). New Problems in Today’s Technological Era: An Adlerian Case Example. Journal of Individual Psychology, 71(2), 163–173. Retrieved from the Walden Library databases.

• Article: Dick, B., & Ferguson, B. J. (2015). Health for the world’s adolescents: a second chance in the second decade. The Journal Of Adolescent Health: Official Publication Of The Society For Adolescent Medicine, 56(1), 3–6. Retrieved from the Walden Library databases.

• Article: Kerr, B. A., & Multon, K. D. (2015). The development of gender identity, gender roles, and gender relations in gifted students. Journal of Counseling and Development, (2), 183. Retrieved from the Walden Library databases.

• Article: Morawska, A., Walsh, A., Grabski, M., & Fletcher, R. (2015). Parental confidence and preferences for communicating with their child about sexuality. Sex Education, 15(3), 235–248. Retrieved from the Walden Library databases.

• Article: Sujita Kumar Kar, Ananya Choudhury, & Abhishek Pratap Singh. (2015). Understanding normal development of adolescent sexuality: A bumpy ride. Journal of Human Reproductive Sciences, Vol 8, Iss 2, Pp 70-74 (2015), (2), 70. Retrieved from the Walden Library databases.

Media

• Animated Case Study: Laureate Education, Inc. (2011). Online snooping case study. Baltimore, MD: Author.

Note: The approximate length of this media piece is 5 minutes.

Accessible player  

COUN6361

Human Sexuality

Week 1 – Online Snooping Case

HELEN: Dear Diary– Oh, I can’t believe I just wrote that. It’s been years since I
kept a diary and I never thought I’d pick up the habit again. But a friend recently
reminded me how much writing about your problems can help you sort them out,
so, here I am.

Jim and I recently plunged headfirst into our forties, and every day we’re amazed
to look around the house to realize that our daughters are already 10, 12, and 14.
Seriously, where has the time gone? Things have been good, though. Jim
recently got another promotion, business is strong at the shop, and all the girls
are doing well in school. In fact, up until a few weeks ago, I would have been
hard pressed to come up with a complaint. One was bound to come eventually,
though. Juliet, our 14-year-old, has officially become sexually active.

It all started innocently enough about six months ago, when she told us she had
a boyfriend. His name is Scott. He’s 15, and very polite. And he’s always lived in
the neighborhood, so we knew him fairly well and expected nothing but an
innocent first relationship. I remember my seventh grade boyfriend. We held
hands for the first time and I panicked, thinking my father would catch me. I
guess I just assumed it would be the same for Juliet.

When she first told us about Scott, we set very strict rules for when and how they
could spend time together. An adult must be present if they were alone in either
our or Scott’s house, only group dates would be allowed, and she must always
be home by 9:00 PM. We naively thought that this would eliminate any chance
for sexual activity, and thought we had done our jobs as parents well.

In the last month or so, though, Jim and I both noticed Juliet becoming more and
more secretive about her plans and activities. She started rushing out after
school and on weekends with little more explanation than, “See you later.” We’d
ask her about it later and almost always just got the typical teenage response of,
“Nothing, or, just hanging out.” Jim said we owed her the benefit of the doubt, but
something inside me was screaming that something was wrong. And that brings
us to last week.

Juliet’s sneakiness continued to grow, and it finally just broke my ability to trust. I
went into her bedroom after she left one day and just started looking around. I
don’t really know what I was looking for, maybe drugs, maybe alcohol, birth
control, condoms. I came up empty-handed from my search, and was about to
leave her room when I noticed that her online profile was on the computer–

unlocked. I had always vowed to never undermine the girls’ privacy and spy on
them, but it was calling me to do so.

Against my better judgment, I sat down at her desk and clicked over to her
messages. Just as with any teenage girl, it was full of messages between friends
and, of course, puppy love notes from Scott. Most of it was typical junior high
gossip, but then, I found it. In one simple message, Juliet confessed to her best
friend that she and Scott were having sex.

I had always been concerned about the reliability of Scott’s parents to keep a
proper eye on what the kids were doing, and sure enough, their seeming
emotional distance and lack of rules left the door wide open for Juliet and Scott. It
was apparently as simple as the two of them locking the basement door and
having sex right there under his parents’ noses. I read more of the messages and
figured out the first encounter happened about a month and a half prior, with at
least four other incidents happening in the weeks that followed. I couldn’t tell if
she was enjoying it, or if they were even using contraceptives, but I was furious.

I told Jim what I found immediately after he got home that day expecting full
agreement and support, but instead, he criticized me for snooping. We both
obviously think that something has to be done to curb this sexual activity, but we
haven’t been able to agree on any course of action.

It’s been a rough and uncomfortable week with no clear road forward, so we
finally both agreed to see a counselor and hope that professional advice lights
the way a little bit. Our appointment is tomorrow, and I’m incredibly nervous
about it. Am I a bad mother for snooping? Or is it justified out of concern for my
daughter’s mental and physical health?

I’m going to try to get some sleep now, but with this on my mind and two other
girls about to enter their teenage years, too, I’m not sure if sleep will come until
the youngest one is married. Will update tomorrow. Helen.

© Laureate Education, Inc.

Parental confidence and preferences for communicating with their
child about sexuality

Alina Morawsk

a

a
*, Anthony Walsh

b
, Melanie Grabski

b
and Renee Fletcher

a

a
Parenting and Family Support Centre, School of Psychology, The University of Queensland,
Brisbane, Australia;

b
Family Planning Queensland, Brisbane, Australia

(Received 1 April 2014; accepted 4 December 2014)

Parents play an essential role in the development of children’s sexuality, yet often feel
uncomfortable and anxious about how best to communicate with their children about
sexual matters. This study had three main aims: (1) to examine parental views and
confidence in relation to communicating with their child about sexuality; (2) to explore
predictors of parental self-efficacy in communicating with their child about sexuality;
and (3) to assess parental preferences for programme content. Data were collected
across Australia by means of an online survey. Parents in the study felt relatively
knowledgeable and confident discussing sexuality topics with their child, although they
noted that there were topics they would not feel comfortable talking about. The extent
to which the parent felt knowledgeable and comfortable in educating their child about
sexuality and their use of effective parenting strategies were significantly related to
parental confidence. Finally, parents rated all potential parenting intervention topics as
being useful, but the most relevant topics were those related to prevention of child
sexual abuse and encouraging a positive sense of self and body image. The implications
of these findings for intervention design and development and further research are
discussed.

Keywords: parenting; discussing sexuality; communication; parenting confidence;
Australia

Introduction

Sexuality and sexual development in children are at the forefront of attention in Australia

and in many other countries. Sexual development is a normal part of personality

development, self-concept, and social skills (Bundy and White 1990), and children of all

ages display behaviours that adults would describe as sexual (de Graaf and Rademakers

2006; Friedrich et al. 2000). There are increasing concerns about the sexualisation of

children in the media and increasing exposure to sexuality-related messages (Walker and

Milton 2006). In general, children and adolescents have limited knowledge of sexuality

and sexual development (Brilleslijper-Kater and Baartman 2000). Young people in

Australia are tending to engage in sexual intercourse earlier, and to have more sexual

partners (Smith et al. 2009). While reports of the use of contraception are generally high,

rates for condom use are significantly lower, leading to concerns about sexually

transmitted diseases (Smith et al. 2009). Teenage pregnancy rates in Australia (,16/1000)
(ABS 2009) are lower than in countries such as the USA, but higher than in many

European countries. Furthermore, there are concerns about the rate of child sexual abuse:

while in 2008–2009, over 5500 Australian children (0–17 years) had experienced

q 2015 Taylor & Francis

*Corresponding author. Email: alina@psy.uq.edu.au

Sex Education, 2015

Vol. 15, No. 3, 235–248, http://dx.doi.org/10.1080/14681811.2014.996213

mailto:alina@psy.uq.edu.au

mailto:alina@psy.uq.edu.au

http://dx.doi.org/10.1080/14681811.2014.996213

substantiated sexual abuse (Bromfield and Horsfall 2010), estimates in the literature range

from 1.4% to 36% of children being affected by sexual abuse (AIFS 2013).

The role of parents in education about sexuality

The quality of parenting children receive is critical to children developing into self-

sufficient, resourceful adults, impacting on every aspect of their development (Vimpani,

Patton, and Hayes 2002), including sexual socialisation (Jaccard, Dodge, and Dittus 2002).

Children in the USA commonly ask parents questions about sexuality (Martin and Torres

2014), and the vast majority of Dutch two and three year olds have asked their parents

questions about genital differences, birth, and pregnancy (Brilleslijper-Kater and

Baartman 2000). While differences may exist between countries and cultures in both

children’s and parents’ views, cross-cultural comparisons are rarely conducted. While

parents acknowledge the importance of their role in educating their children about

sexuality, few parents actually discuss and communicate about sexuality with their

children (Canada: Byers, Sears, and Weaver 2008; Australia, Canada, Mexico, USA:

Dilorio, Pluhar, and Belcher 2003; Australia: Downie 1998; USA: Geasler, Dannison, and

Edlund 1995). There are a number of reasons for this including: parents not feeling

confident and lacking knowledge about sexuality; embarrassment about discussing

sexuality; fear of giving their child ideas and destroying their innocence; lack of effective

communication skills; and discomfort with their own sexuality (Australia: Berne et al.

2000; Dilorio, Pluhar, and Belcher 2003; Downie 1998; USA: Jerman and Constantine

2010; UK: Walker 2004; Australia: Walsh, Parker, and Cushing 1999).

Despite parental fears that early communication about sexuality may lead to

problematic sexual behaviour and damage children’s innocence, there is considerable

evidence that in fact the opposite is true. The relationship and communication between

parent and child, parental monitoring, and involvement have in fact been linked to

reductions in risky sexual behaviours in adolescence (Huebner and Howell 2003;

Hutchinson et al. 2003; Li, Stanton, and Feigelman 2000) and delays in initiation of sexual

intercourse (Lehr et al. 2000).

Existing approaches to education about sexuality

In general, there has been limited attention to effective interventions for education about

sexuality of children (Walker and Milton 2006). The majority of programmes have been

school based; however, these tend to have variable and often modest impact (Li, Stanton,

and Feigelman 2000; Stout and Rivara 1989) and the approach within the Australian

education system is ad hoc (Downie 1998; Hutchinson et al. 2003). In Australia, there are

few programmes designed and evaluated for parents, despite parents’ desire to be involved

in educating their child about sexuality. Efforts focusing on enhancing parent–teen

communication have had limited short-term results, but modest impact on adolescent

behaviour (Kirby and Miller 2002); however, there is some evidence that behavioural

interventions for parents can be effective with parents of young children (Wurtele et al.

1991, 1992).

The existing literature on programmes for parents has a number of limitations

including: (1) the use of non-randomised trials (Klein et al. 2005), with only qualitative

outcomes (Blakey and Frankland 1996; DiIorio et al. 2006), and small samples (Bundy

and White 1990; Caron et al. 1993); (2) an almost exclusive reliance on self-report

measures (Davis and Gidycz 2000; Kees Martin and Christopher 1987); (3) a focus on

236 A. Morawska et al.

parents of adolescents rather than younger children (Huston, Martin, and Foulds 1990;

Kirby and Miller 2002; Mannison 1988); (4) an emphasis on child abuse prevention (Davis

and Gidycz 2000; Wurtele et al. 1991); and (5) a variety of other methodological

limitations (Davis and Gidycz 2000).

In light of this, there is a clear need for evidence-based programmes to assist parents in

communicating with their children about sexuality. Such programmes should ideally be

grounded in theoretical and empirical literature around parent–child communication

(Byers, Sears, and Weaver 2008; Dilorio, Pluhar, and Belcher 2003; Jaccard, Dodge, and

Dittus 2002; Pluhar, DiIorio, and McCarty 2008), empirical evidence relating to evidence-

based programmes and interventions and should take into account the parent voice and

perspective (Sanders and Kirby 2012). In order to develop such programmes, information

is needed about parental views relating to children’s sexuality, predictors of parental

behaviours and confidence in educating their child about sexuality, and parents’

preferences for intervention.

The present study had three main aims: (1) to examine parental views and confidence

in relation to communicating with their child about sexuality; (2) to explore predictors of

parental self-efficacy in communicating with their child about sexuality; and (3) to assess

parental preferences for programme content. The term self-efficacy is defined as ‘the

conviction that one can successfully execute the behaviour required to produce the

outcomes’ (Bandura 1977, 193), and specifically pertains to an individual’s belief that they

can successfully perform a given activity, as well as to the strength of that belief (Bandura

1997). Thus, self-efficacy beliefs are attached to specific domains of functioning such as

parenting (Bandura 2000). We hypothesised that parental self-efficacy in communicating

with their child about sexuality, would be predicted by their knowledge, comfort, and use

of positive parenting strategies in educating their child about sexuality, over and above the

impact of demographic factors, parental adjustment, and general parenting self-efficacy.

Method

Participants

Participants were 557 parents who self-selected to participate via a wide recruitment

campaign, with a mean age of 38.4 (SD ¼ 6.72), of children between the ages of 3 and 10
years. If the parent had more than one child within this age range, they were instructed to

complete the survey based on the youngest child.

Measures

Due to the paucity of validated questionnaires which focus on parenting in the context of

child sexual development, a questionnaire was newly developed for the purpose of this

study. We sought to examine both parenting practices and parental self-efficacy in relation

to educating children about sexuality. We reviewed the existing literature and based the

development of the questionnaire on the largely qualitative work which has been done in

this area to date (e.g., Berne et al. 2000; Pluhar, Jennings, and DiIorio 2006). Questions

were created on the areas of child sexual development that were typically targeted in

available parenting intervention research (e.g., Byers, Sears, and Weaver 2008; Jerman

and Constantine 2010), and based on questions used in previous studies on parental

knowledge and comfort with sex education (e.g., Byers, Sears, and Weaver 2008; Jerman

and Constantine 2010). The questionnaire was reviewed by five Australian sex education

professionals and their comments and suggestions were incorporated into the final version.

Sex Education 237

The first set of questions examined parents’ sex education knowledge and their own

sex education experiences. Four items rated the extent to which parents felt they had

sufficient knowledge: about child sexuality, to provide education about sexuality to their

children, and of the school curriculum and community resources. These questions had

adequate internal consistency (a ¼ 0.77). An additional two items examined parents’
comfort in discussing sexuality topics with their child and whether there were topics they

did not feel comfortable in discussing. We did not ask parents to specify what topics they

did not feel comfortable discussing. These six items were rated on a four-point Likert scale

ranging from 1 (not true of me at all) to 4 (true of me very much or most of the time).

Parents were also asked to list sources of information about sexuality, including where

they currently obtain information on child sexual development, and where parents

believed their child obtained such information.

The next set of questions looked at parenting strategies and information about child

sexual development, how parents typically communicate and teach their child about

sexuality, and how confident they felt engaging in these teaching techniques within the

past four weeks. Parents rated whether they engaged in 17 teaching strategies on a four-

point Likert scale ranging from 1 (not true of me at all) to 4 (true of me very much or most

of the time). They rated their self-efficacy in these teaching techniques on a scale of 1

(certain I can’t do it) to 10 (certain I can do it). Examples of questions in this section

included ‘listened to your child’s views on sexuality’ and ‘felt comfortable talking to your

child about sexuality’. These questions had a strong internal consistency for parenting

behaviour and self-efficacy (a ¼ 0.90 and 0.95, respectively). A mean score for all 17
items for parenting strategies was obtained. Parents also rated overall how confident,

comfortable, knowledgeable, and anxious they felt in responding to questions from their

child about sexuality using a five-point Likert scale ranging from 1 (not at all) to 5

(extremely). These questions had adequate internal consistency (a ¼ 0.78).
A final set of questions asked parents about their views on educating children about

sexuality and what they would like to see included in a possible intervention to help

parents teach their children about sexuality. Questions in this area included asking parents

about how important they were in educating their child about sexuality, how important

they felt their child’s school was, and how important the media was. Parents rated the

perceived level of importance on a five-point Likert scale ranging from 1 (not at all) to 5

(extremely). These questions had adequate internal consistency (a ¼ 0.65). Finally,
parents also rated the perceived usefulness of specific content to be included in a parenting

intervention to help parents in teaching their children about sexuality, on a five-point

Likert scale ranging from 1 (not at all useful) to 5 (extremely useful). These questions had

excellent internal consistency (a ¼ 0.94).
Parents also completed the Family Background Questionnaire (Sanders and Morawska

2010), assessing demographic information such as parental age, educational level, and

financial stress. In addition, parents were asked to rate their own adjustment and their

current relationship satisfaction. Questions from the Parenting Experience Survey (PES;

Turner, Sanders, and Markie-Dadds 2003) were used to measure parents’ experience in

their parenting role, how supported they feel by their partner, the level of parental

agreement over discipline, and parents’ level of happiness in their relationship with their

partner. The questions are rated on a five-point scale with varying anchors. The first five

questions assess participants’ parenting experience, in particular how stressful, rewarding,

demanding, fulfilling, and depressing parents found their parenting experience. Internal

consistency for these items in this study was adequate (a ¼ 0.73). Single parents were
only asked the first five questions, which were unrelated to having a partner. Three

238 A. Morawska et al.

questions addressed relationship support, conflict and satisfaction, and the internal

consistency for these items was high (a ¼ 0.86). Finally, parents were also asked about the
level of support as a parent in general, how confident they felt as a parent, and generally

how difficult the child’s behaviour had been during the past six weeks.

Procedure

Ethical clearance for the study was obtained in accordance with the ethical review

processes of the University of Queensland and the Australian National Health and Medical

Research Council guidelines. Parents were a self-selected group identified by emailing

information about the project to the majority of publicly listed schools, with an available

email address throughout Australia asking for an advertisement to be placed in the school

newsletter. Parents were also recruited via notices on parenting websites as well as through

family planning clinics. Parents could then choose to log on to the web address supplied or

contact the researchers if they had any questions or preferred a pen and paper version. The

web address and project information was also sent to a variety of national parenting

associations and online parenting forums. Parents accessed the survey on-line and were

presented with an information page about the study as well as a consent page. Questions

could be answered by clicking the appropriate button, selecting from a drop down menu,

or by typing words or numbers into an allocated box. Participants could exit the survey at

any time. Parents could also request pen and paper versions and a reply-paid envelope was

included, but almost all (99%) chose to do the survey online.

Results

Respondent characteristics

A total of 677 participants expressed interest in the survey by selecting the link and

opening the questionnaire. Thirty participants (4.43%) did not complete any questionnaire

items or provide demographic information, 12 participants (1.77%) completed fewer than

25% of the items, 48 (7.09%) participants did not provide any demographic data and so

were removed from the analysis, 22 participants (3.2%) did not indicate an age for their

child, and 8 participants (1.2%) indicated their child was more than 10 years old, resulting

in the final sample of 557. Missing data for most variables were below 5%; however,

possibly due to the layout of the questionnaire, the self-efficacy ratings items were missing

up to 17% of the data.

The majority of respondents were the child’s biological mother (N ¼ 514, 92.3%) with
a majority of the remaining respondents being the child’s biological father (N ¼ 28,
5.0%). The majority of respondents had a university degree (N ¼ 354, 63.9%), with 19.7%
(N ¼ 109) holding a trade or qualification or college certificate, and 16.43% (N ¼ 81)
having only high school or less education. The rate of university education in this sample

is much higher than in the Australian population more generally (i.e., 25%; ABS 2013).

Most (N ¼ 393, 71.4%) respondents reported working full- or part-time, and 87.5%
(N ¼ 461) reported their partner as working full- or part-time. Most respondents reported
being able to meet essential expenses in the past 12 months (N ¼ 437, 79.3%), but 17.1%
(N ¼ 94) of the sample reported not having enough money to purchase much of what they
wanted in the past 12 months. Most of the respondents were married or cohabiting

(N ¼ 465, 83.6%) and most children were living in an original family household
(N ¼ 425, 76.4%). The mean age of the target child was 7.33 years (SD ¼ 2.02), and there
were 315 girls (56.7%) and 241 (43.3%) boys. The majority of children were identified

Sex Education 239

with a white ethnic group (N ¼ 446, 89.6%), with the remainder primarily reporting as
being Asian (N ¼ 15, 3.0%) or Aboriginal Australian and Torres Strait Islander (N ¼ 8,
1.6%), which is consistent with the Australian population.

Overall, parents in this sample felt that parenting was a moderately to very positive

experience, M(SD) ¼ 3.51(0.61), and felt very confident as parents, M(SD) ¼ 4.16(0.72).
In general, parents felt supported in their role as parents, M(SD) ¼ 3.51(0.99) and
experienced only slight difficulties with their child’s behaviour, M(SD) ¼ 2.17(0.90).
Parents in a couple relationship felt very supported by their partner in parenting, M

(SD) ¼ 4.46(1.51), agreed on methods of discipline, M(SD) ¼ 4.35(1.43) and were very
happy in their couple relationship, M(SD) ¼ 7.79(3.04). For these items, scores
could range from 1 to 5, expect for the couple relationship item which was rated on a

scale of 1 to 10.

Knowledge and sources of information

Parents felt knowledgeable about educating their child about sexuality, M(SD) ¼ 2.38
(0.69). However, they also indicated that they wished their parents had talked to them

more about sexuality, M(SD) ¼ 2.48(1.04) and that there were topics about sexuality that
they would not be comfortable in discussing with their child, M(SD) ¼ 3.15(0.92). Scores
on these items ranged from 1 to 4.

As shown in Table 1, the main source of information about sexuality for parents when

they were children was friends, although nearly half also indicated that their parent was a

source of information. As adults, the main source of information about sexuality for

parents is the Internet as well as health professionals. Finally, parents felt that their child’s

main sources of information about sexuality were friends and parents. Parents could also

Table 1. Sources of information about

sexuality.

Source

When you were
a child, what was
your main source

of information about
sexuality?

N (%)

What is your
main source of

information about
sexuality now?

N (%)

Where do you
get information
about children’s

developing
sexuality

from? N (%)

Where do
your children
get information
about sexuality
from? N (%)

Friend/s 357 (64.1) 205 (37.1) 207 (37.6) 479 (86.0)
Parent/s

a
254 (45.8) NA NA 409 (73.4)

Media (e.g., radio,
TV, newspaper)

162 (29.2) 198 (35.9) 123 (22.4) 346 (62.1)

Teacher or
school staff

215 (38.8) 33 (6.0) 50 (9.1) 273 (49.0)

Internet 4 (0.7) 314 (56.9) 292 (53.1) 108 (19.4)
Other 113 (20.4) 120 (21.7) 161 (29.3) 53 (9.5)
Health professional
(e.g., GP, nurse)

33 (5.9) 257 (46.1) 243 (44.2) 51 (9.2)

Brochures 70 (12.6) 149 (26.8) 156 (28.4) 46 (8.3)
Partner

b
NA 175 (31.7) 70 (12.7) NA

Relative 48 (8.6) 38 (6.8) 38 (6.9) NA

Notes:
a
Given as an option for the questions ‘When you were a child, what was your main source of information

about sexuality?’ and ‘Where do your children get information about sexuality from?’
b
Given as an option for the questions ‘What is your main source of information about sexuality now?’ and

‘Where do you get information about children’s developing sexuality from?’

240 A. Morawska et al.

describe other sources of information. Of the 113 parents who identified another source of

information, the main additional sources identified were books, magazines and reference

materials.

Parenting

In terms of what parents reported doing, they were most likely to avoid teasing their child

about sexuality, to monitor their child’s Internet and television use and to stay calm when

their child asked a question about sexuality (Table 2). Parents were least likely to give their

child brochures or other materials, access community resources and interestingly to read

books with their child. In terms of confidence, parents were also most confident in

avoiding teasing their child about sexuality, monitoring Internet and television use, and

using correct terminology, and least confident in starting up a conversation about sexuality

with their child, accessing resources, and giving their child resources. Overall, parents felt

very knowledgeable, confident, and comfortable, and slightly anxious in responding to

questions about sexuality posed by their child, M(SD) ¼ 3.80(0.79), 3.77(0.81), 3.73
(0.90), and 1.91(0.86) respectively. Questions were rated on a scale of 1 to 5.

Predictors of parenting self-efficacy

Parenting self-efficacy was based on parents’ response to the question, ‘Overall, how

confident do you feel in explaining answers to questions that are asked of you by your

child in regard to sexuality?’ We did not use the mean score of 17 items relating to self-

Table 2. Rank-ordered parenting strategies from most to least frequent.

Behaviour

Frequency
M(SD)

Range 1–4

Confidence
M(SD)

Range 1–10

Avoided teasing my child about sexuality 3.68 (0.79) 9.33 (1.40)
Monitored my child’s Internet and television use 3.62 (0.74) 8.89 (1.72)
Stayed calm when my child asked a question about sexuality 3.33 (0.94) 8.07 (2.07)
Used correct terminology for genitalia 3.18 (1.06) 8.46 (2.20)
Modelled a positive body image 3.14 (0.88) 7.79 (2.14)
Felt comfortable in talking to my child about sexuality 3.10 (0.99) 7.76 (2.40)
Responded to a question about a sexuality topic 3.05 (1.05) 7.67 (2.24)
Listened to my child’s views on sexuality 3.05 (1.11) 8.29 (2.08)
Expressed comfort with my own sexuality 2.85 (1.12) 7.66 (2.53)
Encouraged my child to share their thoughts and feelings
about sexuality

2.62 (1.15) 7.62 (2.45)

Encouraged my child to ask questions about sexuality 2.52 (1.13) 7.24 (2.53)
Discussed sexuality education for my child with my partner
or another caregiver

2.51 (1.21) 8.02 (2.42)

Used a current event or media story to start a conversation
with my child about sexuality

2.15 (1.17) 7.28 (2.61)

Started up a conversation about sexuality with my child 1.95 (1.01) 6.68 (2.76)
Read books with my child about sexuality 1.85 (1.14) 7.17 (2.88)
Accessed community resources to help me learn about
child sexuality

1.79 (1.09) 6.97 (2.92)

Gave brochures or other materials to my child to help
them learn about their sexuality

1.67 (1.07) 6.96 (2.92)

Sex Education 241

efficacy for specific parenting strategies, due to the larger proportion of missing data for

these items (ranging from 8.1% to 17.2% compared to 1.8% for the single-item confidence

measure). In addition, the correlation between the single item and the mean of the 17 items

was high (r ¼ 0.69, p , 0.001), suggesting that responses to these were highly related.
Hierarchical multiple regression was used to examine the relationship between

parental self-efficacy in addressing sexuality issues, and sexuality-specific parenting

(knowledge (single item); discomfort (single item); anxiety (single item); parenting

practices (mean of 17 strategies)), taking into account demographic variables (parent age,

child age, parent education, and finances), general adjustment (parent adjustment (mean of

5 items), parent support (1 item), and relationship satisfaction (1 item)), and general

parenting confidence (single item). Demographic characteristics (parent age, child age,

parent education, and finances) were entered at step 1, general parent adjustment and

general parenting confidence at step 2, and measures assessing sexuality-specific parenting

were entered at step 3. There was no significant relationship between parental self-efficacy

and the demographic variables entered at step 1 (R ¼ 0.121; F(4,474) ¼ 1.77, p ¼ .133).
Table 3 provides the standardised regression coefficients (b), as well as their 95%

Table 3. Results of the hierarchical multiple regression predicting parent self-efficacy.

95% confidence interval for b

b Lower bound Upper bound t r sr2

Step 1
Parent age 0.05 20.05 0.15 1.00 0.07 ,0.01
Child age 20.02 20.11 0.08 20.30 20.01 ,0.01
Parent education 0.05 20.04 0.14 1.08 0.07 ,0.01
Able to pay essential expenses 20.08 20.17 0.01 21.67 20.10 0.01
Step 2
Parent age 0.04 20.06 0.13 0.80 0.07 ,0.01
Child age 20.01 20.11 0.08 20.30 20.01 ,0.01
Parent education 0.07 20.03 0.16 1.42 0.07 ,0.01
Able to pay essential expenses 20.04 20.14 0.05 20.89 20.10 ,0.01
Parent adjustment 0.02 0.08 0.12 0.40 0.15 ,0.01
Parent support 0.02 20.09 0.13 0.39 0.12 ,0.01
Relationship happiness 20.03 20.01 0.07 20.65 0.04 ,0.01
Parenting confidence 0.22 0.11 0.33 4.06** 0.24 0.03
Step 3
Parent age 0.03 20.02 0.08 1.20 0.07 ,0.01
Child age 20.03 20.08 0.03 20.97 20.01 ,0.01
Parent education 20.02 20.07 0.03 20.90 0.07 ,0.01
Able to pay essential expenses 0.01 20.06 0.05 20.18 20.10 ,0.01
Parent adjustment 0.02 20.04 0.08 0.71 0.15 ,0.01
Parent support 20.02 20.08 0.04 20.57 0.12 ,0.01
Relationship happiness 20.03 20.09 0.02 21.16 0.04 ,0.01
Parenting confidence 0.04 20.02 0.10 1.20 0.24 ,0.01
Knowledgeable

a
0.45 0.39 0.51 15.77** 0.71 0.14

Comfortable
a

0.49 0.42 0.55 14.85** 0.75 0.13
Anxious

a
0.03 20.03 0.08 0.97 0.34 ,0.01

Parenting
b

0.07 0.02 0.13 2.54* 0.44 ,0.01

Notes: *p , 0.05; **p , 0.001.
a
‘Overall, how do you feel in explaining answers to questions that are asked of you by your child in regard to
sexuality?’
b
Mean of 17 items where parents rated how they typically communicate and teach their child about sexuality.

242 A. Morawska et al.

confidence intervals and tests of significance, zero-order and squared semi-partial

correlations for steps 1–3. Addition of general parent adjustment and confidence at step 2

significantly contributed to prediction, Fchange(4,470) ¼ 6.72, p , 0.001. Taken together,
all of the variables accounted for 6.8% of the variance (Radj

2 ¼ 0.052) in parental self-
efficacy, F(8,478) ¼ 4.29, p , 0.001. The only variable significantly related to parental
self-efficacy in addressing sexuality issues was general parenting confidence, as indicated

by a significant t-value and confidence intervals which do not span zero. Addition of

sexuality-specific parenting variables at step 4 significantly contributed to prediction,

Fchange(4,466) ¼ 285.24, p , 0.001. Taken together, all of the variables accounted for
73.0% of the variance (Radj

2 ¼ 0.052) in parental self-efficacy, F(12,478) ¼ 104.86,
p , 0.001. The variables significantly related to parental self-efficacy were the extent to
which the parent felt knowledgeable and comfortable in educating their child about

sexuality and their use of effective parenting strategies, as indicated by significant t-values

and confidence intervals which do not span zero. Interestingly, parental anxiety about sex

education was not found to be negatively associated with parental self-efficacy.

Sex education

Overall, parents believed that they had an extremely important role in the education of

their child about sexuality, M(SD) ¼ 4.60(0.59), while schools and the media played a
moderate role, M(SD) ¼ 3.47(0.97) and 2.99(1.27), respectively, with items scored on a
1–5 scale. In terms of topics parents thought it important to cover in an intervention, the

topics rated as most relevant were those related to prevention of child sexual abuse and

encouraging a positive sense of self and body image. However, as shown in Table 4,

Table 4. Rank-ordered usefulness of topics in a parenting programme.

Topic
M(SD)

Range 1–5

Protecting children from sexual abuse 4.84 (0.53)
Encouraging child self-acceptance and self-esteem 4.79 (0.57)
Encouraging a positive body image 4.79 (0.55)
What to do about and how to react to signs of sexual abuse 4.73 (0.59)
Communicating effectively with children about sexuality 4.71 (0.55)
Helping children to express emotions and feelings 4.69 (0.62)
How to identify sexual abuse in a child 4.67 (0.69)
Obtaining accurate information about child sexuality and education 4.67 (0.63)
Discussing puberty with children 4.61 (0.66)
Understanding parents’ roles as sexuality educators 4.56 (0.72)
Learning about sexual development and behaviour across childhood 4.53 (0.73)
Exploring barriers to communicating effectively with children about sexuality 4.52 (0.76)
Learning about the influence of the media and the Internet on children’s sexuality 4.47 (0.82)
Discussing parental standards for children’s sexual behaviour 4.47 (0.78)
Understanding the human body, reproduction, pregnancy, and birth 4.42 (0.83)
Talking about sexuality, sexual expression, sexual relationships 4.39 (0.85)
Using appropriate terminology with children 4.36 (0.91)
Parent’s attitudes and values about sexuality 4.35 (0.86)
Responding to child sexual play 4.30 (0.91)
Exploring gender roles and gender identity 4.21 (0.97)
Responding to child masturbation 4.19 (1.00)
Responding to child nudity 3.97 (1.10)

Sex Education 243

parents rated all topics highly, with only one item, ‘responding to child nudity’, rated as

less than four on the five-point scale.

Discussion

In this study, parents reported generally feeling knowledgeable about educating their child

about sexuality; however, they also indicated that they wished their own parents had talked

to them more about sexuality and that there were topics about sexuality that they would not

be comfortable in discussing with their child. This finding is interesting in the context of

studies showing that children actively engage their parents in conversation about sexuality

(e.g., Martin and Torres 2014), and consistent with Australian literature showing that

parents often do not communicate with their children about sexuality (Berne et al. 2000;

Dilorio, Pluhar, and Belcher 2003; Downie 1998; Walsh, Parker, and Cushing 1999).

Parents thought that as parents they were their children’s main source of information

about sexuality (along with peers), and their role was very important. It is interesting to

note that parents indicated that they were a more important source to their child, than their

own parents were to them about sex education. This may represent a shift in how parents

and children relate to children across generations, or may perhaps reflect wishful thinking

on the part of the parent (Beckett et al. 2010; Miller et al. 1998). Parents also reported that

their children were more likely to use the media and Internet than they were as children to

get sexuality information, reflecting a change in access to media and technology, and/or

the increased availability of sexuality information in the media. While confident in certain

areas of parenting, such as avoiding teasing their child about sexuality, and monitoring

their child’s Internet and television use, parents were least confident in starting up a

conversation about sexuality with their child, accessing resources, and giving their child

resources. Interestingly, they were less likely to read books with their child about sexuality

despite identifying this as an important way of accessing information. Consistent with our

hypothesis, the best predictors of parental self-efficacy in addressing sexuality issues were

(1) the extent to which the parent felt knowledgeable and comfortable in educating their

child about sexuality and (2) use of effective parenting strategies. Significantly, in this

study, parental demographics and broader measures of parenting and the family

environment did not contribute to prediction of parents’ self-efficacy. This finding is

important as it suggests that in helping parents to feel more confident in discussing

sexuality with their children, addressing parent knowledge as well as specific parenting

behaviours and skills may be important intervention components. While parent knowledge

and comfort have been previously identified as important in communication about

sexuality between parents and their children (e.g., Byers, Sears, and Weaver 2008; Jerman

and Constantine 2010), studies have neither examined this in child–parent communication

nor looked at the role of specific parenting behaviours in educating children about

sexuality.

Parents thought that all of the topics listed would be important to cover in an

intervention, and the most highly rated ones were those related to prevention of child

sexual abuse and encouraging a positive sense of self and body image. It is clearly

important to ensure that parenting interventions focus on topics that are salient and

relevant to parents, and intervention design should be informed by parents’ perspectives

(Sanders and Kirby 2012).

This study had a number of limitations, which need to be considered. First, while the

sample size was relatively large, parents were comparatively well educated and adjusted,

meaning that generalisation to other groups is limited. However, the data did not show any

244 A. Morawska et al.

effect of parent demographic characteristics on self-efficacy with education about

sexuality, suggesting that parenting interventions should be available to all parents

regardless of background. Similarly, while we made the questionnaire available in a pen

and paper version, most parents accessed the survey online. Australian data show that

households with children are very likely to have Internet access (Ewing and Thomas

2010); nevertheless, this did limit the potential reach of this survey to those who had

Internet access and were comfortable in using the Internet.

A further limitation relates to our reliance on self-report, and particularly the use of a

purpose-built questionnaire. While the measures we used appeared to demonstrate good

internal consistency, the results need to be interpreted with caution, particularly given the

potentially sensitive nature of the questions being asked. In particular, the design and

layout as well as the instructions for the self-efficacy items need to be considered given the

relatively large amount of missing data on these questions. This limitation reflects a

broader gap in this area in terms of measurement of parent skill, self-efficacy and

behaviour. While self-report measures need to be developed and refined, further research

should also investigate options for direct or analogue assessment of parent–child

communication and parenting skill in this area. The development of such assessment tools

is an essential element in evaluating programmes that aim to enhance parents’ skills and

confidence.

Findings from this study point to the importance of incorporating specific parenting

skills in addition to enhancing parental knowledge about children’s sexuality in

developing programmes for parents. While parents felt confident in responding to

initiations from the child, they felt less confident initiating and were not likely to initiate

conversations with the child. Thus programmes should include skills about the initiation of

conversations about sexuality, and address parental barriers and beliefs which may impede

their ability to initiate such conversations. This could include information about age-

appropriate topics, how to use both available resources, such as books and materials

available on the Internet, and daily events to engage children in education about sexuality,

and practice of specific communication skills. Importantly such programmes should focus

on ways to integrate education about sexuality into daily life rather than waiting to have a

big talk once children are older. Furthermore, programmes need to include elements on

keeping children safe and more general body image and self-esteem concerns to ensure

that the needs of parents for information about these issues are met.

Parents in our survey said that they thought it was important to educate their children

about sexuality and indicated that they felt confident in this area, yet did not seem to

initiate conversations with their child about sexuality. In addition, most parents indicated

that there were sexuality topics that they would not be comfortable in discussing with their

child. Unfortunately we did not ask parents about what those topics might be. This is an

area which should be explored in more depth, particularly using more qualitative

approaches to better understand parents’ difficulties. Parents may have lacked skills and

confidence relating to specific topics or issues. It is also possible that they felt some topics,

correctly or incorrectly, were not age-appropriate for their child and hence their

discomfort with certain issues. More in-depth understanding of parental barriers will

enable the development of specific strategies to assist parents in overcoming such

difficulties.

One additional area worth exploring in further research relates to the findings about

where parents and children get their information from. Parents told us that health

professionals are a key source of information for them as parents. Given this role, it would

be important to explore to what extent these professionals are adequately resourced and

Sex Education 245

supported in terms of providing this information and in what ways they would prefer to

access information and skills training in this area. Parents also told us that one of

children’s main sources of information was the media. However, US teenagers themselves

indicate that they use but do not necessarily trust the information received from the

Internet (Jones and Biddlecom 2011). While we can speculate that much of the

information from the media and the Internet is accessed by children and teenagers

incidentally rather than intentionally, it would be interesting for research to explore ways

of using the media as a tool to communicate such information to children effectively.

Conflict of interest

The Triple P – Positive Parenting Programme is owned by The University of Queensland.

The University through its main technology transfer company, UniQuest Pty Ltd, has

licensed Triple P International Pty Ltd to publish and disseminate the programme

worldwide. Royalties stemming from published Triple P resources are distributed in

accordance with the University’s intellectual property policy and flow to the Parenting and

Family Support Centre in the School of Psychology, Faculty of Health and Behavioural

Sciences, and contributory authors. No author has any share or ownership in Triple P

International Pty Ltd. Alina Morawska is however an author of various Triple P resources.

Funding

This project was supported by funding from Family Planning Queensland.

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248 A. Morawska et al.

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• Abstract

Introduction
The role of parents in education about sexuality
Existing approaches to education about sexuality
Method
Participants
Measures
Procedure
Results
Respondent characteristics
Knowledge and sources of information
Parenting
Predictors of parenting self-efficacy
Sex education
Discussion
Conflict of interest
Funding
References

Journal of Adolescent Health 56 (2015) 3e6

www.jahonline.org

Review article

Health for the World’s Adolescents: A Second Chance in the
Second Decade

Bruce Dick, M.B. a,*, and B. Jane Ferguson, M.Sc. b
a Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
b World Health Organization, Geneva, Switzerland

Keywords: Adolescent health; Mortality; Disability-adjusted life years; Health-related behaviors; Determinants; Policies; Universal
health coverage; Indicators; Intersectoral collaboration; Program guidance

A B S T R A C T

TheWorldHealthOrganizationhasproducedamultimedia,interactiveonlinereportentitledHealthfortheWorld’s
Adolescents: A Second Chance in the Second Decade. The report provides an overview of global and regional esti-
mates of adolescent mortalityand disability-adjusted lifeyears,disaggregated byage, sex, and cause, and country-
level dataon health-related behaviors and conditions among adolescents. Itoutlines the reasons whyadolescence
is a unique period in the life course requiring special attention and synthesizes current thinking about the
determinants that underlie the differences inhealth statusbetween adolescents. Forthe firsttime, thisnew report
pulls together recommendations and guidance from across the World Health Organization relating to
interventions directed to a range of priority health problems, including use of alcohol and other psychoactive
substances, AIDS, injuries, mental health, nutrition, sexual and reproductive health, tobacco use, and violence,
focusing on four core functions of the health sector: supportive policies, service provision, strategic information,
and working with other sectors. The report concludes with 10 key actions that would strengthen national
responses to adolescent health, and outlines the approaches that are needed to overcome the obstacles to
accelerating evidence-informed actions to improve the health of adolescents worldwidedwith all the benefits
that this will have for public health in the present and across the life course, for this generation and the next.

� 2015 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine.

* Address correspondence to: Bruce Dick, M.B., Chemin des Noyers 5bis, 1295
Tannay, Switzerland.

E-mail address: bgadick@gmail.com (B. Dick).

1054-139X/� 2015 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine.
http://dx.doi.org/10.1016/j.jadohealth.2014.10.260

Much has been written over the past 25 years about the need to
direct more attention and resources tothehealthand development
of adolescents. During this time, we have seen progress on many
fronts: a better understanding of the health status of adolescents;
growing clarity about the determinants underlying death, disease,
and health-related behaviors during adolescence; a stronger
evidence base for interventions; and increased commitment and
action from national governments and nongovernmental organi-
zations. This journal exemplifies the growing body of research
focusing on adolescent health, although evidence from the low-
and middle-income countries where the vast most of the world’s
adolescents live is still relatively limited.

A number of recent publications have advocated on behalf of
adolescents from a range of perspectives, including public health,
human rights, and socioeconomic development [1e10]. However,
although highlighting the progress that has been made, these re-
ports also stress that much more needs to be done if we are to take
advantage of this period of the life course to improve the present
and the future for individuals, families,communities, and

countries.

The World Health Organization’s Health for the World’s
Adolescents:a second chance in the seconddecade (H4WA) willboth
contribute to the groundswell of attention being directed toward
adolescents and support accelerated action, including follow-up
to the 2011 World Health Assembly Resolution on Youth and
Health Risks.

H4WA is a multimedia, interactive online, fully referenced
report that can be found at http://www.who.int/adolescent/
second-decade. Readers can download and print a summary

Delta:1_given name

Delta:1_surname

http://www.who.int/adolescent/second-decade

http://www.who.int/adolescent/second-decade

mailto:bgadick@gmail.com

http://crossmark.crossref.org/dialog/?doi=10.1016/j.jadohealth.2014.10.260&domain=pdf

http://www.jahonline.org

http://dx.doi.org/10.1016/j.jadohealth.2014.10.260

B. Dick and B.J. Ferguson / Journal of Adolescent Health 56 (2015) 3e64

that is available in all official UN languages, but the report itself is
only Web based, which allows the inclusion of videos, interactive
graphics, and direct links to documents that are mentioned in the
report.

H4WA focuses primarily on the health of adolescents
(10e19 years) and the role of the health sector in improving and
maintaining adolescent health. It is directed at senior-level and
mid-level staff in ministries of health, and partners in the health
sector who are providing technical, financial, and implementa-
tion support for interventions that contribute to adolescent
health and development. However, it should also appeal to many
other audiences: advocates, service providers, educators, and
even young people themselves.

H4WA has received input from across the World Health
Organization (WHO) and from experts in the field of adolescent
health. In addition, WHO organized two online consultations,
one with primary care providers and the other with adolescents.

The consultation with primary care providers covered a range
of issues relating to the provision of health services to adoles-
cents. It was conducted via an open-access online survey in
English, and 735 primary care providers from 81 countries
participated, most from high- and middle-income countries.

The adolescent consultation was open to all adolescents aged
between 12 and 19 years and was conducted via an open-access
online survey that was available in Arabic, Chinese, English,
French, Russian, and Spanish. A total of 1,143 adolescents from
104 countries participated in the consultation, most from low-
and middle-income countries.

WHO additionally organized a global photo competition for
adolescents aged 14e19 years. All the photos included in H4WA
were taken by the 10 winners of the competition.

A Picture of Adolescent Health

H4WA provides new estimates of mortality and disability-
adjusted life years (DALYs) lost during adolescence, based on
the 2012 WHO global health estimates. Data from the 2000 es-
timates are provided for comparison. The estimates are available
by cause, sex, age (10e14, 15e19, and 10e19 years), and WHO
regions. There are also country-level data on health-related
behaviorsdincluding trendsdfrom the health behavior in
school-age children surveys and the global school-based student
health surveys.

The leading causes of death among adolescents globally in
2012 were road injury, AIDS, suicide, lower respiratory
infections, and interpersonal violence. The most important dif-
ference from the 2000 mortality data is that human immuno-
deficiency virus (HIV) is now estimated to be the number 2 cause
of mortality among adolescents; in 2000, HIV was not among the
top 10 causes of death.

The increase in adolescent HIV mortality is likely the result of
more children living to adolescence through improved pediatric
HIV treatment and care. It may also reflect the limitations in
our current knowledge and estimation of survival times for
HIV-positive children. At the same time, there is good evidence
on the poor quality of, and retention in, services for adolescents
living with HIV, indicating the need for improved service de-
livery for this group.

Between 2000 and 2012, there were significant declines in
mortality among adolescents because of maternal causes and
measles, which demonstrates what is possible with concerted
efforts.

Regional mortality highlights include

(1) One of every three deaths among adolescent males in the
low- and middle-income countries in the Americas Region is
due to interpersonal violence.

(2) One of every five deaths among adolescents in high-income
countries is due to road traffic injuries.

(3) One of every five deaths among adolescent males in the low-
and middle-income countries of the Eastern Mediterranean
region is due to war and conflict.

(4) One of every six deaths among adolescent females in the
south-east Asia region is due to suicide.

(5) One of every six deaths among adolescents in the African
region is due to HIV.

DALYs declined between 2000 and 2012 for all adolescents
except 15- to 19-year-old males in the Eastern Mediterranean
region and the Americas Region. DALYs for all adolescents declined
most in the south-east Asia region (21%) and the Western Pacific
and European regions (16% and 17%, respectively). The smallest
declines took place in the Eastern Mediterranean region (4%).

The major causes of DALYs changed little between 2000 and
2012. In 2012, depression, road injuries, iron-deficiency anemia,
HIV, and intentional self-harm were the top five global causes of
DALYs for adolescents. The one notable change from 2000 was
the high ranking of HIV.

The DALYs highlight not only the epidemiologic transition
that takes place during adolescence but also a number of gender
differences (e.g., more interpersonal violence and war-related
deaths among male adolescents and maternal problems
affecting females).

In terms of health-related behaviors, the report shows that
fewer than one in four adolescents meets recommended guide-
lines for physical activity; in some countries, as many as one in
every three is obese. And in most countries in every region, at
least half of younger adolescent boys report serious injuries in
the preceding year.

Fortunately, there is also some positive news concerning
adolescent behavior. In most countries, half or more of 15-year-
olds who are sexually active report using condoms the last time
that they had sex, and cigarette smoking is decreasing among
younger adolescents in many high-income countries.

In addition to these data, the report has a section outlining the
availability and important gaps in strategic information, particu-
larly program input and output data A clear message from the
report is that the data available to inform policy-making and pro-
gramdesignandmonitoringare farlessadequatethanthedatathat
are available for other age groups. This requires urgent attention.

Support for Action in Countries

For the first time, H4WA collates all WHO recommendations
and guidance from across the organization relating to adolescent
health, including use of alcohol and other psychoactive sub-
stances, HIV, injuries, mental health, nutrition, sexual and
reproductive health, tobacco use, and violence.

Health services

A number of specific analyses were carried out for H4WA to
place the provision of health services for adolescents within the
context of universal health coverage. In terms of needed health

B. Dick and B.J. Ferguson / Journal of Adolescent Health 56 (2015) 3e6 5

services, the report compiles all the health services and
interventions addressed in WHO Guidelines, including HIV,
immunization, the integrated management of common condi-
tions, mental health, nutrition, physical activity, sexual and
reproductive health and maternal health, substance use, tobacco
control, violence, and injuries. Concerning sufficient quality, a
new synthesis of standards for the provision of health services to
adolescents has identified eight standards on the basis of the
national standards from 25 countries, existing WHO guidance,
and a literature review. Finally, in response to the need to ensure
that services do not expose the user to financial hardship, obstacles
and solutions of particular importance to adolescents were
identified to maximize the range of services and the number of
adolescents covered by effective prepaid pooling arrangements,
and to reduce out-of-pocket payments at the point of use.

Strategic information

H4WA includes 32 proposed core adolescent health indicators,
on the basis of the WHO/International Health Partnership
measurement framework, for use in countries. Thirteen of the
indicators measure impact, eleven measure outcome/coverage,
five measure inputs/outputs, and three measure determinants.
Seventeen of the 32 indicators have already been reviewed in
terms of their quality and availability, an additional eight are
included in existing nationally representative multicountry
surveys, and five others are collected in WHO-supported surveys.

Supportive policies

H4WA includes a new analysis of 109 national health policy
documents. Eighty-four percent of the policies included some
attention to adolescents, with three-quarters of them focusing
on sexual and reproductive health, including HIV/AIDS; approxi-
mately one-third address tobacco and alcohol use among
adolescents and one-quarter address mental health. Specific
consideration of other important issues, such as injuries, nutrition
or physical activity among adolescents, is infrequent in national
policies. Fifty-two of the countries specify goals related to adoles-
cents, but only 32 of the countries spell out measureable targets in
their policy documents, and these mostly address changing the
prevalence of a specific health condition or increasing coverage or
access to health services for adolescents. H4WA also includes a
specific review of mental health policies from 30 countries.

Strengthening other sectors

Responding to the major causes of mortality and lost DALYs
during the adolescent years will require engaging a range of
sectors beyond just the health sector. Section 9 of the report
focuses on interventions with parents, the creation of safe and
supportive communities, education and the school environment,
social protection, and preparing for and obtaining decent work. It
highlights success stories and lessons learned about overcoming
the challenges to convergence between sectors.

Ten Key Actions to Strengthen National Responses

H4WA proposes the following:

(1) Understand that adolescent health is essential for public
health.

(2) Strengthen advocacy for adolescent health.
(3) Incorporate a focus on adolescents into all health policies,

strategies, and programs.
(4) Use the response to adolescent health as an indicator of

equity.
(5) Involve adolescents and maintain a positive perspective

toward them.
(6) Support interventions that go beyond the individual

adolescent.
(7) Improve the collection, analysis, and use of data.
(8) Focus on universal health coverage for the second decade.
(9) Work with other sectors to improve the health of

adolescents.
(10) Define and fund research priorities.

Although many of these recommendations would be appli-
cable to all population groups, they are of particular importance
to the second decade because this period of the life course has
been so neglected.

There are many reasons why adolescent health has been
neglected in comparison with other age groups:

(1) Data are not disaggregated by age; what we fail to measure
we fail to act on.

(2) Consensus around global indicators to monitor adolescent
health is lacking.

(3) Interventions are often more complex than those for child
health.

(4) Action is required from a range of sectors.
(5) Many of the issues are culturally and politically sensitive.
(6) Research is limited, particularly in low- and middle-income

countries.

H4WA highlights a number of ways in which these obstacles
can be overcome.

(1) Move beyond the myths. There are still many myths about
adolescents that obstruct accelerated action: that they are
healthy and therefore do not need much attention; that
the only real problems that they face are related to sexual
and reproductive health; and that the evidence base is
weak and we do not really know what to do. None of these
are true.

(2) Define priorities beyond mortality. Deaths in adolescence are
important, and no adolescent should die from a cause that is
preventable or treatable. But for public health more gener-
ally, more attention needs to go toward preventing the
health-compromising behaviors and conditions that arise
during adolescence and have a long-term impact on health
across the life course.

(3) Focusbeyondtheindividual.Althoughprovidinghealthservices
and improving adolescents’ own knowledge and skills are
important, these alone will not be enough to improve adoles-
cent health. Structural, environmental, and social changes will
also be essential, including more support for parents and
schools, and policies that protect and promote adolescents’
health.

(4) Act beyond single-problem thinking. Many of the behaviors
and conditions that undermine the health of adolescents
have common determinants and are linked. We must focus
on interventions that more effectively address the common
determinants of multiple risk behaviors.

B. Dick and B.J. Ferguson / Journal of Adolescent Health 56 (2015) 3e66

(5) Develop programs that are beyond “business as usual.”
As countries move toward universal health coverage,
ensuring that adolescents receive adequate consideration is
essential. There are many untapped resources to improve
and maintain the health of adolescents, including adoles-
cents themselves and interactive media and technologies.

(6) Be challenged beyond aspirations. A human rightsebased
approach stresses the obligations of governments. Setting
clear goals and targets and monitoring progress give focus to
these obligations. Consensus is needed on a set of measur-
able and achievable goals and targets, which countries can
select and adapt as necessary.

In the second decade of the millennium, we have many op-
portunities to improve health in the second decade of life. H4WA
aims to support countries, and partners accelerate action and
increase accountability for adolescent health. It was launched at
the 2014 World Health Assembly, and there have been proposals
for adolescent health to be taken up in subsequent sessions of
WHO’s Governing Bodies.

References

[1] Lloyd CB. Growing up global: The changing transitions to adulthood in
developing countries. Washington, D.C: The National Academies Press; 2005.

[2] Jimenez EY, Fares J, Gauri V, et al. World development report 2007:
Development and the next generation. Washington, D.C: The World Bank;
2006.

[3] The state of the world’s children 2011. Adolescence: An age of opportunity.
New York: United Nations Children’s Fund; 2011.

[4] Progress for children: A report card on adolescents, number 10. New York:
United Nations Children’s Fund; 2012.

[5] Moving young. New York: United Nations Population Fund; 2006.
[6] Generation of change: Young people and culture. New York: United

Nations Population Fund; 2008.
[7] The Lancet series on adolescent health, 2012. London: The Lancet, 2012.

Available at: http://www.thelancet.com/series/adolescent-health-2012.
Accessed February 13, 2014.

[8] The Lancet series on adolescent health, 2007. London: The Lancet, 2007.
Available at: http://www.thelancet.com/series/adolescent-health. Accessed
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[9] Emerging issues in adolescent health. J Adolesc Health 2013;52-
(Supplement 2):S1e45. Available at: http://www.jahonline.org/issues?
issue_key¼S1054-139X%2812%29X0007-7. Accessed February 6, 2014.

[10] Supplement on multiple risk behaviour in adolescence. J Public Health
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• Health for the World’s Adolescents: A Second Chance in the Second Decade

A Picture of Adolescent Health
Support for Action in Countries
Health services
Strategic information
Supportive policies
Strengthening other sectors
Ten Key Actions to Strengthen National Responses
References

Journal of Counseling & Development ■ April 2015 ■ Volume 93 183
© 2015 by the American Counseling Association. All rights reserved.

Received 08/29/13
Revised 04/15/14

Accepted 05/30/14
DOI: 10.1002/j.1556-6676.2015.00194.x

Counselors can help gifted students more effectively when
they understand the interaction of giftedness, gender identity,
and gender role and the ways in which many gifted educa-
tional practices are gendered. A model for the development of
talent in the context of gender must also include the interac-
tions of gender with privilege. Counselors can reduce inequi-
ties for gifted students at all levels of education by confronting
gendered practices in education—all those practices that are
based on gender role expectations rather than on what is best
for the individual student.

In this article, giftedness is defined as one’s potential for
exceptional achievement or eminence in a domain, similar to
the definition offered by Subotnik, Olszewski-Kubilius, and
Worrell (2011). Gender identity is the subjective sense of
one’s maleness or femaleness (Johnson & Wassersug, 2010).
Sexual orientation refers to the direction of one’s sexual at-
traction, generally categorized as lesbian, gay, or bisexual.
Gender role is defined as the expectations of a society about
the proper behaviors for males or females (Eagly, 2013).
Gender relations are the attitudes and behaviors of males
and females in relationships with one another and the ways
in which gender roles shape social relations (Ridgeway,
2009). Each of these has an impact on how giftedness is
perceived and developed. Finally, distance from privilege is
defined as the distance that an individual must travel to reach
the center of power in any domain, in terms of overcoming
barriers such as gender, race, class, age, and citizenship.
This concept, in addition to gender concepts, expands the
Model of Talent Development given by Subotnik et al. so
that a road map is provided for nurturing both gifted male
and female individuals.

barbara a. Kerr and Karen D. Multon, Department of Psychology and Research in Education, University of Kansas. Correspondence
concerning this article should be addressed to Barbara A. Kerr, Department of Psychology and Research in Education, University
of Kansas, 1122 West Campus Drive, 130 Q JRP, Lawrence, KS 66025 (e-mail: bkerr@ku.edu).

The Development of Gender Identity,
Gender Roles, and Gender Relations
in Gifted Students
Barbara A. Kerr and Karen D. Multon

This article describes the interaction of giftedness with gender identity, gender role, and gender relations. The authors
explored ways in which many gifted educational practices are gendered, a model for the development of talent in the
context of gender and gender relations, and ways of reducing gender inequities in the realization of potential for both
male and female students. Issues that are unique to gifted individuals are aligned with suggestions for counseling
interventions.

Keywords: gifted, gender identity, gender role, gender relations

Gender identity is considered to be a spectrum of beliefs
and emotions rather than the traditional sense of a dichotomy
of male and female (Eagly, 2013). Gender identity has devel-
opmental stages paralleling cognitive development. Toddlers
(ages 1–4) have a very fluid gender identity; being a boy or
girl does not matter much to toddlers. This indifference gives
way to gender rigidity in early childhood (about ages 4–7),
when both boys and girls strictly enforce gender rules. What
may be puzzling to many parents is the tendency of little
children to think that it is their clothing or toys that make
them boy or girl. In later childhood, the mature identity can
form as children begin to understand that their biological sex
is stable (Signorella, 2012).

Gifted students’ behavior and preferences often differ from
those of their same-sex peers (Kerr, 1997; Terman & Oden,
1935); gifted girls are more like gifted boys than like other
girls. As a result, gender identity formation may be more
complicated. Gifted girls not only are likely to enjoy boys’
activities but also may have an early awareness of sexism
and reject the second-class status of the female gender role
(Kerr, 1997; Kerr & McKay, 2014). Although gifted girls
are more like gifted boys in their interests and aspirations,
they experience the same socialization as average girls; that
is why gifted girls’ gender identity can be conflicted (Miller,
Falk, & Huang, 2009).

Gifted boys also struggle with gender identity issues when
they prefer creative activities to activities prescribed for males,
such as sports and an interest in video games. They often fear
that loving art, music, and drama may mean that they are
not masculine enough (Kerr & Cohn, 2001). There is some
evidence that the millennial generation of adolescents and

Journal of Counseling & Development ■ April 2015 ■ Volume 93184

Kerr & Multon

young adults regards gender identity and sexual orientation
as much more fluid and changeable compared with previous
generations (Galinsky, Aumann, & Bond, 2012). This may
mean less pressure on creative boys to prove their masculin-
ity by the avoidance of creative activities. One of the most
striking differences in millennials is their tolerance for, and
performance of, a wide variety of gender identity and sexual
orientation combinations (B. E Wells & Twenge, 2005). For
example, Weston (pseudonym), a 20-year-old student at an art
institute, is biologically male, has a gender identity as a female
(asks to be addressed as “she”), and has a bisexual orientation.
Parents model egalitarian or nonegalitarian values. Parents
who are homophobic or anxious about gender identity may
discourage androgynous or opposite-sex interests (Kerr &
Cohn, 2001). On the whole, however, most of the American
public is moving in the direction of greater tolerance for di-
verse sexual orientations and gender identity (Hans, Kersey,
& Kimberly, 2012).

Gender role is the set of characteristics prescribed by a
culture and communicated through direct communication
and through media (Wood, 2012). Despite more openness
and tolerance toward diversity, the ways in which gender
roles are communicated by the media to boys and girls con-
tinue to favor rigid, stereotypic images, as Orenstein (2011)
documented. There is an increasing trend for sex-segregated
clothing, toys, and media, although gifted girls and boys have
more challenging toys and media available than before. Girls
have early exposure to what Orenstein referred to in her book
as the “princess industrial complex” (p. 10); they learn that
the color pink, sparkly clothing, and pretty toys are critical to
being a girl. Boys have early exposure to masculine models
of violence and dominance, learning that monsters, weapons,
and machines are the province of boys. Older gifted boys and
girls usually take their cues from same-age peers (Shepard,
Nicpon, Haley, Lind, & Liu, 2011).

Giftedness and Gendered Practices
Gifted Girls

Most girls who are identified as gifted are early readers
(Halsted, 2009). Many precocious readers are simply decod-
ing or memorizing; however, the probability is much higher
that girls are actually reading with comprehension and need
to be allowed greater challenge (Halsted, 2009). Thus, early
reading with comprehension is problematic when the child
starts kindergarten late (i.e., when the child’s birthday falls
shortly after the cutoff date and must wait another year) and
opportunities for advancement are lacking in school. Kin-
dergarten admission policies vary depending on the school,
the district, and the state. Early admission to kindergarten is
one of the best methods of acceleration for gifted girls, but
it is often denied because of concerns for the child’s social
and emotional maturity, which may be unfounded in the case
of gifted girls, who tend to adjust quickly to kindergarten

(Colangelo, Assouline, & Gross, 2004). Because gifted girls
on the average read earlier than gifted boys, both admissions
policies and gifted identification policies that do not take into
account these differences in development can be considered
gendered practices. Counselors need to be advocates for
policies that acknowledge and allow for the encouragement
of early reading in girls. Counselors need to educate school
administrators about the importance of early reading in girls
as a sign of giftedness and encourage early admission and
acceleration in reading for these girls.

Gifted girls tend to have interests more like those of gifted
boys than those of average girls, but they may be rejected by
boy groups. Older friends are desirable to gifted children,
but grade schools tend to discourage formation of cross-age
friendships for gifted children (Gross, 2002, 2009). Coun-
selors can help gifted girls form positive relationships with
older girls and encourage parents to allow gifted girls to play
with gifted boys through formal and informal means. When
gifted girls have access only to average girls, they may be
rejected despite good social skills. Because bright girls long
for friends who do not reject them for their greater vocabulary
or general knowledge, they need help finding a “sure shelter”
(Gross, 2009, p. 347), a friend who is advanced intellectu-
ally as well as who is at the same social development level.
Counselors need to carefully assess situations of rejection
and to intervene only when the gifted girl herself perceives
her peer relationships to be a problem.

In U.S. society, being “bad at math” seems to be a key
aspect of the female gender role. Despite decades of research
(Else-Quest, Hyde, & Linn, 2010) showing no sex differ-
ences in math ability, the popular perception is still biased
against girls. This may have a strong impact on gifted girls’
development; some may continue from that point to believe
that they are less able in science, technology, engineering, and
mathematics (STEM; Dai, 2002). The math gap has closed
and has shrunk even at the highest levels of mathematics
ability, where the discrepancy in boys’ and girls’ scores was
once extreme. Girls who hold stereotypic beliefs or who are
reminded of stereotypes of girls’ inferiority in math may
underachieve in math and science objective tests. Davies and
Spencer (2005) demonstrated experimentally the nature of
stereotype threat. In addition, parents who subscribe to the
stereotypic beliefs can have a negative effect on gifted girls’
mathematics achievement (Jacobs & Eccles, 1992). Also,
the more distant girls believe that they are from privilege
(e.g., seeing themselves as less valued because of their race,
socioeconomic status [SES], sexual orientation), the greater
the stereotype threat (Kerr et al., 2012). Therefore, without
intervention to change beliefs about math for mathematically
gifted girls, the gap between potential for their achievement in
childhood and actual achievement in adulthood may be great.

As advocates for gifted girls, counselors play an important
role in helping teachers develop math and science education
instruction that uses the best practices for overcoming nega-

Journal of Counseling & Development ■ April 2015 ■ Volume 93 185

Gender Identity, Gender Roles, and Gender Relations in Gifted Students

tive beliefs about math and science, increasing self-efficacy,
and reducing stereotype threat (Baker, 2013; McNees,
2003). Counselors can provide professional development for
teachers to help them to understand the importance of early
intervention, can educate parents of gifted girls about ways
of encouraging girls in math and science, and can challenge
gifted girls’ stereotypes about math and science careers.

Gifted girls, because of their multiple talents, are often
pulled in too many directions, with too many academic and
social activities (Kerr, 1997). Most counselors have been
taught to encourage high school students to have as many
activities as possible to make their college applications more
attractive to selective schools. For gifted girls, it is better to
counsel moderation in the number of choices of activities and
focus on the goals of those options. That is, counselors need
to help these gifted girls limit their activities to just a few
extracurricular organizations and to prioritize those activi-
ties that most closely match their interests and values. This
generation of gifted girls also has much more responsibility
for siblings, particularly in low-SES families. Counselors
who see the signs of overextension—fatigue, sleepiness in
class, stress, and nervousness—should examine these girls’
schedules and help them to get control of both their time and
their health.

Among millennials, depression, anxiety, and eating dis-
orders are more prevalent than in previous generations (B.
E. Wells & Twenge, 2005). Too often, educators assume that
gifted girls have it all—that is, not only do they have good
grades and leadership, but they are unlikely to have any
psychological disorders. Although it is true that, in general,
gifted girls are better adjusted than average girls, they may
have hidden disorders. Gifted girls are at risk when they
are perfectionistic and skilled in camouflage. There is some
evidence that gifted girls who have perfectionism related
to high personal standards and concern for evaluation are
particularly at risk. High intelligence allows girls the ability
to gather and synthesize knowledge about nutrition to use for
the purpose of restricting calories (Boone, Soenens, Braet,
& Goossens, 2010). Gifted girls may be more capable than
other girls at masking depression and anxiety, so counselors
need to watch carefully for the signs in these girls. Webb
(2009) described how gifted students carefully hide their
difficulties with depression, anxiety, and eating disorders
and showed how counselors can identify and guide their
gifted clients toward health.

The combination of earlier puberty than in previous gen-
erations and the media’s sexualization of adolescent girls
means that gifted girls are at risk for compromising their
dreams and goals for the sake of romance and intimacy. Stud-
ies of eminent women suggest that the earlier gifted girls begin
intimate relationships, the less they will achieve. Although all
gifted adolescents benefit from delay, girls seem to be more
negatively affected than boys by early sexual involvement
(Csikszentmihalyi,1996). In both high school and college,

peer groups value and reward girls’ relationships more than
girls’ accomplishments (Holland & Eisenhart, 1990). Even
though gender relations (i.e., the nature of women’s relation-
ships with their partners) have been found to be the major de-
terminant of women’s achievement in academe, industry, and
leadership, little is done on the high school level to educate
girls about the direct link between egalitarian relationships
and accomplishment of their goals (Xie & Shauman, 2003).

Finally, counselors need to be aware that many gifted girls’
intellectual abilities are more developed than their social
maturity in adolescence, a common aspect of gifted students’
asynchrony (Lee, Olszewski-Kubilius, & Thomson, 2012).
As a result, they may have difficulty making independent
decisions for early investments in their future and may need
help making college choices that provide the most challenging
and focused education. Gifted girls may be less likely than
gifted boys to take advantage of highly challenging academic
opportunities; girls tend to be less risk taking in general than
boys, and this may account for their failure to take the most
rigorous pathway (Byrnes, Miller, & Schafer, 1999). The
single most important thing that counselors can do for gifted
girls is to insist on their choosing the most rigorous courses,
to challenge them to engage in activities that will hone their
skills, and to aspire to the highest and best college education
they can find.

Gifted Boys

Many educators assume that gifted boys, especially those
from privileged families (i.e., those with access to resources
and other forms of power), will find their way to elite colleges
and high-status careers. Although most gifted boys do grow
up to be accomplished and achieving men (Lubinski & Ben-
bow, 2006), there are those who are lost along the way (Kerr
& Cohn, 2001). A nationwide study of gifted underachiev-
ers—boys who were at the 95th percentile on ACT scores but
failing in school—found that the largest group was made up
of White, high-SES boys from large suburban high schools
(Colangelo, Kerr, Christensen, & Maxey, 1993). Hartley and
Sutton (2013) examined the underachievement of relatively
privileged boys and found that many gifted boys who do not
achieve their potential are blocked by gendered practices in
education and society, some of which are described below.

Kindergarten redshirting, the practice of holding a child
back an extra year before starting kindergarten, continues
to be on the rise despite little evidence of its benefits (Frey,
2005). Parents believe that they are giving their child the gift
of time for physical and social development, and educators
encourage it for boys, thinking it will help boys catch up with
girls’ social development. For gifted boys, being held back an
additional year puts them 2 years behind where they could
be, which can lead to these boys being out of step and bored
throughout school (Kerr & Cohn, 2001). There are few good
reasons for holding gifted boys back; in fact, the only valid
reasons are learning disabilities and clear social and emotional

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Kerr & Multon

delays or disorders (Colangelo et al., 2004). Counselors need
to provide the community, parents, and school staff with in-
formation about the negative consequences of kindergarten
redshirting, particularly for gifted boys. Boys who show signs
of giftedness, such as early reading or early mathematical
skills, or boys who are able to perform at first- or second-grade
level on out-of-level standardized achievement tests should
be allowed to enter kindergarten.

A surprising finding is that gifted boys may underachieve
as a way of establishing masculinity with their peer group
(Kerr & Cohn, 2001). Failing to turn in homework and
low participation in class can also be a way of expressing
boredom for gifted boys. Gifted girls are less likely to be
underachieving when they are bored compared with gifted
boys; in fact, across research studies of gifted underachievers,
boys outnumber girls by a factor of two to three (Matthews &
McBee, 2007). In general, teachers tend to be female and to
favor girls’ ways of interacting in the classroom, and they also
tend to give boys an increase in grades, especially White boys
who act most like girls in their compliance with assignments,
participation in class, and interaction (Cornwell, Mustard, &
Van Parys, 2013).

A special problem for gifted boys who are highly gifted in
spatial reasoning occurs when their abilities in this area result
in them being placed in gifted education programs that em-
phasize verbal and mathematical curricula (Kell & Lubinski,
2013). Their low performance in these classes may not be true
underachievement but rather a case in which the education
they are receiving does not tap their spatial abilities. Counsel-
ors need to be aware of the critical periods when gifted boys
are most likely to begin to underachieve—preadolescence and
late high school—and engage in preventive and supportive
counseling. This includes careful assessment of gifted boys’
abilities and achievement, discussions with gifted boys about
conflicts between “acting like boys” and being achievement
oriented, and encouragement to pursue interests that are
nontraditional for boys through career education.

Gifted boys who act out their boredom are at risk for
misdiagnosis with attention-deficit/hyperactivity disorder
(ADHD), bipolar disorder, and conduct disorder (Webb,
2009). Counselors need to consult with parents and medical
professionals, advocating for the child and helping to avoid
misdiagnoses. Before gifted boys are diagnosed with ADHD,
counselors should advocate for acceleration options, such as
in-class differentiation, grade skipping, and out-of-school
opportunities for advanced work (Colangelo et al., 2004).

In high school, boys who identify strongly with masculine
models may avoid girl-led or girl-dominated activities, such
as show choir, yearbook, or student theater (Kerr & Cohn,
2001). Because of the surge of girls in formerly male courses
and activities, such as Advanced Placement math and science
fairs, some gifted boys may disengage as a way of maintaining
their status. The other side of the coin is boys’ greater tendency
toward risk taking, which can result in activities such as sub-

stance abuse. Counselors need to question boys who are drop-
ping out of after-school activities to ascertain if it is because of
economic need or negative stereotypes about “girl activities.”
Although gifted boys may seem disengaged in school, it is likely
that they are very engaged in an out-of-school activity that fits
their creative interests; counselors need to question gifted boys
closely about their interests that may not fit into typical school
activities, such as robotics, a rock band, animation, or creating
apps (Kerr & McKay, 2013). Many creative boys have hidden
projects that they do not realize should be a serious part of their
portfolio of accomplishments.

One aspect of gendered education is the failure to provide
boys with the same opportunities to discuss relationships that
girls have with peers and adult confidants (Kerr & Cohn, 2001).
Gifted boys may confuse relationships with achievements, for
example, choosing a relationship based on what is considered
an “A” girlfriend. As with gifted girls, gifted boys need educa-
tion in gender relations, because their intellectual ability will
continue to have an impact on their relationships. Most gifted
boys will eventually be members of dual-career couples (Xie
& Shauman, 2003). Helping boys to understand what the future
might hold for them in a relationship in which both partners are
employed, or where the female partner is the breadwinner, will
be more in keeping with predictions of marriage and careers in
the next decades (Wang, Parker, & Taylor, 2013).

Finally, many of the careers for which gifted boys and
gifted girls will qualify require early planning and investment.
Gifted boys, particularly African American and Hispanic boys,
may be less engaged in career planning than gifted girls. R.
S. Wells, Seifert, Padgett, Park, and Umbach (2011) found
striking differences between boys and girls in the amount of
discussion of college and career with parents, the amount of
investment parents put into planning, and the amount of talk
with peers. That is, it is less likely for low-SES and minority
boys than girls to seek or receive the social capital that leads
to college attendance, no matter what their ability level might
be. Gifted boys who do not discuss college and career with
parents and peers in positive ways or who procrastinate on
planning may miss important qualifying exams and scholar-
ship opportunities. Counselors will find that not only low-SES
gifted boys may not know how to plan for their future, but also
some high-SES gifted boys who have been “coasting” along
without challenge are missing important opportunities. Gifted
boys need deadlines and active encouragement by counselors
to engage in career assessment and academic planning.

Giftedness and Lesbian, Gay, Bisexual,
and Transgender Students

Gifted lesbian, gay, bisexual, and transgender (LGBT) stu-
dents meet federal, professional, and cultural definitions of
giftedness at approximately the same frequency as non-LGBT
students (Fredericks, 2009). The exact prevalence of this
group in the United States is related to the definitions of both

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Gender Identity, Gender Roles, and Gender Relations in Gifted Students

LGBT and giftedness. According to the most clear-cut general
definition (i.e., gifted students are those in gifted programs
and LGBT youth are those who self-identify as sexual mi-
nority members), it is estimated that there are 260,000 gifted
LGBT students in the United States (Fredericks, 2009). How-
ever, this estimate is very conservative because it is limited
to those youth enrolled in elementary and high school who
are open about their sexual minority status.

For gifted LGBT youth, being twice different can lead to
depression and isolation (Levy & Plucker, 2003). As gifted
students, they must deal with their intellectual deviance from
the mainstream; as LGBT students, they must deal with their
stigmatized sexual orientation. They are often confused, clos-
eted, and frightened for the same reasons nongifted LGBT
youth are—fear of parental rejection, fear of bullying, and the
desire to be similar to others in their peer groups. Finding a
supportive community is paramount for these students. Gifted
programs can be safe, nurturing spaces.

For LGBT gifted boys and girls, one advantage is the
ability to read at a high level and use books and online learn-
ing to learn more about what it means to be LGBT. Thus,
counselors can make very good use of bibliotherapy to help
LGBT gifted youth feel less isolated. Gay–straight alliances
fit students with similar strengths to foster talents (e.g., cre-
ative writing, artistic abilities, leadership skills) and can also
broaden awareness of LGBT identities and lessen any feelings
of loneliness. Counselors can also encourage LGBT youth to
seek community experiences for their talent (e.g., community
theater) and to connect with community mentorships (e.g.,
study under professional writer).

In the area of career counseling for LGBT gifted youth,
concerns about physical and emotional safety will have a sig-
nificant impact on career decision making (Peterson & Rischar,
2000). LGBT gifted students may avoid taking certain courses
or programs of study in high school or college despite interests
because of those same concerns. They are more likely to choose
“safe” careers rather than pursue areas that are a better fit for
their interests and abilities. Counselors need to work with
LGBT gifted youth to thoroughly examine the extent of these
safety concerns and how they affect career choice.

Gender, Gender Relations,
and Distance From Privilege

The new megamodel of talent development proposed by
Subotnik et al. (2011) has been helpful in showing how gift-
edness progresses throughout development toward eminence
and achievement in a domain. Unfortunately, the concepts of
gender and distance from privilege are lost in the model—
despite ample evidence that gender relations and distance
from privilege (particularly race and SES) are major defining
and delimiting factors in achievement (National Science
Foundation [NSF], 2003). Noble, Subotnik, and Arnold’s
(1999) Model of Talent Development was the only model

created to specifically address gender and giftedness and
distance from power or privilege. Kerr and McKay (2014)
updated the model to include the newest research findings.
Counselors can benefit from a detailed understanding of
this model and the ways in which it has been validated by
previous research. The model includes talent, achievement,
and distance from privilege as individual variables and con-
text, filters, and opportunities as environmental variables in
predicting both public and personal achievement. In an NSF
project, Multon, Kerr, Robinson-Kurpius, and Hammond
(2009) investigated major predictors of college women’s
persistence in the STEM fields using Noble et al.’s model
as a theoretical foundation. Given that gender relations is
the most important variable determining women’s entry into
the top positions in STEM fields, and given that distance
from privilege moderates all forms of opportunities, it is
important that these variables be operationalized and studied
in various contexts.

Distance from privilege is how the gifted person perceives
fitting in the mainstream of the dominant culture’s traditions,
values, and practices (Kerr et al., 2012). As Noble et al.’s
(1999) model indicates, the context of a gifted person’s life has
a major impact on career choice and persistence. The model
posits that predictions of potential based on ability should
include the capacity to overcome certain barriers created by a
person’s distance from the center of privilege and power. Thus,
it would predict that a poor, rural African American girl with
above-average math achievement scores who has managed
to graduate high school and enters a prestigious college may
have as much potential for persistence and achievement in
STEM majors as a wealthy European American boy with very
high math achievement scores at that same college.

Two scales were developed to measure distance from
privilege (Kerr et al., 2012). The first scale, Access to Re-
sources, has two measures corresponding to social capital
and economic resources. An economic resource (i.e., having
money through funds from family, scholarships, etc.) is not
the same as having the social connections (i.e., social capital)
to encourage and support persistence in college and, more
specifically, in STEM fields. The second scale, Distance
From Privilege Status, provides a measure of the person’s
own perceptions of privileged status in society. As predicted
by theory and research on privilege, this scale effectively dif-
ferentiated perceptions of privilege between the following:
males and females, racial minorities and nonracial minori-
ties, heterosexuals and nonheterosexuals, levels of economic
status, and types of geographic status (e.g., city, rural). That
is, males, nonracial minorities, heterosexuals, high-SES in-
dividuals, and city residents were perceived to have greater
privilege. These findings support the idea that college students
internalize societal values of gender, sexual orientation, and
other personal identity variables (e.g., SES, religion).

The second major construct derived from Noble et al.
(1999) is a barrier to opportunities due to gender relations.

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Kerr & Multon

Gender relations (Multon, Kerr, Fry, & Syme, 2007) refers
to the impact a romantic partner has on an individual’s career
ambitions and development. In a classic study of the “culture
of romance,” Holland and Eisenhart (1990) found that 80% of
college women’s conversations outside of the classroom were
devoted to relationships with men. College women were also
found to spend inordinate amounts of time helping boyfriends
with their homework and housework and taking responsibility
for family-related tasks that are virtually absent from the lives
of college men (Sax et al., 2003). For women who do persist
in STEM careers, an NSF (2003) report found that gender
relations, particularly characteristics of marriage and family,
distinguished female academic scientists who succeeded in
achieving tenure-track positions, tenure, and/or rank. That is,
of the academic scientists and engineers, married women and
women with children were likely to be less successful than
men who were married with children as well as women who
were not married and did not have children.

To address this important issue of the impact of gender rela-
tions on persistence in STEM, Multon et al. (2007) developed
a measure of gender relations (the Gender Relations Inventory)
and provided evidence of reliability and validity. Although few
studies have examined the impact of romantic relationships on
career persistence, the NSF (2003) report on academic scientists
and engineers indicated that this variable was important enough
to be examined and was part of the context variables related to
achievement as theorized in the Model of Talent Development
(Noble et al., 1999). For talented college women, partner sup-
port, beliefs about societal roles, and family needs seem to have
a more prominent influence on career decisions than their own
career ambitions.

The primary outcome of the NSF study (Multon et al., 2009)
was that talent, achievement, and social capital (i.e., distance
from privilege) combined with equitable gender relations pre-
dicted persistence in STEM in a large, diverse sample of college
women. Thus, the Model of Talent Development (Noble et al.,
1999) received its first empirical support. Interview data also
indicated that, although the college women were aware of the
tendency of female scientists to not have the same success as
male scientists, the college women tended to have naive beliefs
about gender relations. That is, they assumed that the difficul-
ties encountered by other women in STEM would not happen
to them. College women did not seem to make the connection
between their present assumptions of inequitable roles in their
romantic relationships and future compromises of their career
goals. Less privileged young women, however, appeared to be
more resistant to stereotypes and to inequitable relationships
and less naive about the barriers ahead of them compared with
more privileged women.

What does the Model of Talent Development mean for
gifted boys? Although gifted adolescent boys are less deterred
by gender relations than gifted adolescent girls, the boys are
entering a world that has been transformed by new gender
roles. It is important to assess these boys’ attitudes toward

their future gender relations to help them to project into the
future in a more holistic way, taking into account that they
are likely to be both earners and partners. All of the other
variables in the model have been shown by the literature
reviewed here to have importance to the engagement and
persistence of male students toward their goals. The level of
talent, as shown by Lubinski and Benbow (2006), is directly
related to the kind of college and career to which both male
and female students can aspire. The variable of achievement
must be assessed by counselors not merely in terms of the
gifted student’s performance in school relative to all students,
but also in terms of the student’s performance in school rela-
tive to his or her potential. Male underachievement must be
taken seriously, and when a student’s grades do not match his
or her objectively assessed achievement scores, intervention
is necessary. Distance from privilege is certainly relevant to
gifted boys; assessing distance from privilege is a powerful
way of discovering how gifted boys, despite their status as
the dominant gender, may feel otherwise limited. Certainly,
minority gay gifted boys do not feel as if they benefit simply
from being male in a society where racism and heterosexism
can prevent the fulfillment of intellectual potential.

Using the Model of Talent Development
in Counseling

The Model of Talent Development (Noble et al., 1999) can
provide a set of guidelines for the provision of gender-fair
counseling to gifted girls and boys. Among the conclusions
that one can draw from this model are the following.

1. For gifted students, academic and career development
cannot be treated separately from gender identity, gender role,
and gender relations. At each point in the education of gifted
students, there are milestones and danger zones related to
gender. Counselors who are alert to the dangers of ignoring
girls’ early signs of giftedness and kindergarten redshirting
for boys can promote greater achievement and engagement
in young gifted children. Counselors who help parents to deal
with rigid gender role socialization for both boys and girls
open up more possibilities for children to develop their own
unique identity. Counselors who always engage in holistic life
planning rather than narrow career development can ensure
that gifted boys and girls are prepared for a life of career and
relationship satisfaction.

2. Gender interacts with a wide variety of variables to
predict achievement and life satisfaction. Assuming that
gifted boys and girls will succeed merely because of their
objectively assessed abilities and aptitudes is clearly a false
assumption. Along the pathway toward their goals, other
individual variables and contextual variables will affect their
progress. For gifted girls, the resistance to stereotype threat
and early sexualization is critical; for gifted boys, the refusal
to underachieve as a response to boredom and the openness
to equitable gender relations are critical to well-being.

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Gender Identity, Gender Roles, and Gender Relations in Gifted Students

3. Gifted students who diverge from the heterosexual or
gender role norms—as well as intellectual norms (e.g., the
gifted gay boy who hates sports)—face difficulties with peers
that may require counselor interventions to prevent bullying
and to promote self-esteem.

4. Giftedness has implications for health, particularly
with regard to eating disorders, where unhealthy perfec-
tionism can interact with fears of evaluation, particularly
for gifted girls. For gifted boys, the pressure to be athletic
can lead to health problems when they try to prove them-
selves through sports. The stress resulting from gifted
students’ perceived needs to overperform may compromise
their health. Counselors can build awareness of health is-
sues for gifted students and teach both students and teach-
ers the warning signs of perfectionism and stress-related
health problems.

5. Understanding the complex interactions of gender, talent,
achievement, distance from privilege, academic challenge,
access to social capital, and economic resources leads to the
conclusion that there are many pathways to success and life
satisfaction. Where a student may be lacking in one area, a
strength in another area can propel the student forward. It is
the counselor’s role to observe and carefully build the profile
of success for each gifted student based on the avoidance of
danger zones and achievement of milestones in his or her
academic and career development.

Conclusion
Gender and giftedness interact to create challenges for gifted
girls and boys throughout the school years. Counselors can
promote awareness of gendered educational practices; can
provide same-sex groups for counseling about gender rela-
tions, academic planning, and career development; and can
support gifted students, their parents, and teachers with
consulting and counseling.

Counselors-in-training need to be aware of the issues at
the intersection of gender and giftedness; of assessments
useful to academic and career planning; and of useful
information, resources, and interventions. It is essential to
consult with parents and teachers of gifted students because
they often do not have access to literature that dispels the
myths about sex differences in achievement and career
development.

The Model of Talent Development (Noble et al., 1999)
needs further refinement and expansion. For example, it does
not include personality and self-regulation variables, both of
which have been linked to achievement and life satisfaction.
In addition, outcome and longitudinal studies need to be per-
formed on gender equity strategies and single-sex career and
life planning strategies. By considering talent in this holistic
way, counselors can help gifted individuals to achieve the
milestones and avoid the danger zones on the many pathways
to the realization of potential.

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70 Journal of Human Reproductive Sciences / Volume 8 / Issue 2 / Apr – Jun 2015

development takes place; adolescents
develop abstract thinking and reasoning.
Emotionally, they develop a sense of identity
during late adolescence; social involvement,
peer interaction, as well as sexual interest,
develop in this phase. Different behavioral
experimentation is seen in early adolescence,
risk taking in middle adolescence, and later
adolescents learns to assess their own risk
taking.[3]

As per the 2014 data, published by U.S
Census Bureau, adolescents (10–19 years
of age) count approximately 1.2 billion
across the globe.[4] Nearly, 70% of total
adolescent (10–19 years of age) population
o f t h e w o r l d r e s i d e s i n d e v e l o p i n g
countries.[5,6] Developing countries in recent
decades are going through a rapid change
due to – urbanization, migration, education,
and mixing of cultures, which are having
a definite impact on the attitude toward
sexuality in adolescents.

In developing countries like India, the
adolescents are also subjected to early
marriage, which results in teenage pregnancy
and adolescent fatherhood. In most cases,
females in comparison to males are subjected
to early marriage. Early exposure to sexual
relationship also increases the risk of
sexually transmitted diseases. As the culture

I N T R O D U C T I O N

Growth and development are continuous
processes, which bring a change in an
individual, every moment. Development
of sexuality starts as early as in intrauterine
life following conception and continues
through infancy, childhood, adolescence,
adulthood till death.[1] During infancy,
there is no awareness of gender. The child
acknowledges its gender in early childhood
as early as by 3 years. Self-awareness about
sexuality (gender role, gender identity)
evolves during the childhood.[2] Biological
research evidences are suggestive of the
definite role of androgens in deciding the
gender sensitive roles and gender-specific
behaviors.[2] Adolescence is a phase of
transition during which major developments
of sexuality takes place. Puberty is reached
during adolescence, which is a major
landmark in the development of sexuality.
The hypothalamo-pituitary-gonadal axis
function is highly essential for the sexual
development during puberty.

Adolescence can be broadly divided into
three stages: Early (10–13 years), middle
(14–16 years), and late (17–19 years). Physical
changes start in early adolescence, where
they are very concerned about their body
image. During adolescence cognitive

ABSTRACT

Adolescence, derived from the Latin word “adolescere” meaning “to grow up” is a critical
developmental period. During adolescence, major biological as well as psychological
developments take place. Development of sexuality is an important bio‑psycho‑social
development, which takes an adult shape during this period. During adolescence, an
individual’s thought, perception as well as response gets colored sexually. Puberty is an
important landmark of sexuality development that occurs in the adolescence. The myriad
of changes that occurs in adolescents puts them under enormous stress, which may
have adverse physical, as well as psychological consequences. Understanding adolescent
sexuality has important clinical, legal, social, cultural, as well as educational implications.

KEY WORDS: Adolescence, development, puberty, sexuality

Review Article

Understanding normal development of adolescent
sexuality: A bumpy ride

Sujita Kumar Kar,
Ananya Choudhury1,
Abhishek Pratap Singh1
Department of Psychiatry,
King George’s Medical
University, Lucknow,
Uttar Pradesh, 1Department of
Psychiatry, Institute of Human
Behavior and Allied Sciences,
New Delhi, India

Address for correspondence:
Dr. Sujita Kumar Kar,
Department of Psychiatry,
King George’s Medical
University, Lucknow,
Uttar Pradesh, India.
E‑mail: drsujita@gmail.com

Received: 18.04.2015
Review completed: 01.05.2015
Accepted: 04.05.2015

Access this article online
Quick Response Code:

Website:
www.jhrsonline.org

DOI:
10.4103/0974-1208.158594

Kar, et al.: Adolescent sexuality: A bumpy ride

71Journal of Human Reproductive Sciences / Volume 8 / Issue 2 / Apr – Jun 2015

of the developing country facilitates early marriage, as well
as early pregnancy and adolescent fatherhood, the family
and the society usually prepare the adolescents for the same
which colors the adolescents attitude toward sexuality.
In some reserved cultures, sexuality is discussed little so
there is little scope to explore sexuality, and it still remains
as a myth or enigma for the adolescent, which affects their
perception of sexuality.

D E V E L O P M E N T O F S E X U A L I T Y I N A N
A D O L E S C E N T

During adolescence, the physical growth, psychological as
well as cognitive development reaches its peak. Adolescent
sexuality development can be better explained with the
bio-psycho-social model.[7] Biological factors, psychological
factors, as well as social factors have equal importance in
determining, the development of sexuality in adolescents.

Biological factors are the genetic factors and neuro-endocrinal
factors, which determine the biological sex and also having
an influence on the psychological sex. During adolescence
the gonadal hormones, cortisol, and many other hormones
play a role in causing the onset of puberty.[8] The secondary
sexual characters are expressed due to this neuro-endocrinal
influence.

In both males and females-pubic hairs, axillary hairs
develop which take a gender specific growth pattern. In
males, there occurs enlargement of genitals, appearance
of beard and mustache, and the physique takes a typical
masculine shape. In females, there occurs development
of breast; menstruation starts, genitalia takes an adult
shape, and the physique changes to a feminine type.
An adolescent’s interest in a sexual relationship is also
influenced by the hormones.

Individual’s personality or temperament is an important
psychological factor that also decides the attitude
toward sexuality. Introvert adolescents face difficulty in
approaching and responding sexually.

Social factors or environmental factors also play a significant
role in the development of adolescent sexuality. The attitude
of the parents toward sexuality, parenting style, peer
relationship, cultural influences are the important social
factors which facilitates the sexual learning and decides the
sexual attitude of the adolescent.

Other than the biological, psychological, and social factors,
many more factors such as political, legal, philosophical,
spiritual, ethical, and moral values significantly influence
the sexuality development.[9] Media also influences the
sexuality in adolescents.[10] In the recent decades, there is

an exponential growth in the media coverage worldwide.
Adolescents’ access literature related to sexuality, sexual
crimes, and violence through media which affects the
adolescent’s perception and attitude toward sexuality.[10]
Similarly television, internet also exposes the adolescents
to literature and movies with sexuality content, influencing
their perception about sexuality.[11]

Sigmund Freud had proposed his theory of psychosexual
development, where he described about – oral phase, anal
phase, phallic phase, latency phase, and genital phase as the
landmark steps of psycho-sexual development.[12] During
these phases, different body parts behave as most erotogenic
and the individual attempts to explore or stimulate these
erotogenic zones in order to get gratification.[12] The
table 1 below mentions about the onset of the phases
of psychosexual development across life time.[12]

Table 1: Phases of psycho-sexual development
Phase of psychosexual development Lifetime
Oral phase Birth to 18 months
Anal phase 18 months-3 years
Phallic (oedipal) phase 3-5 years
Latency phase 5 years to puberty
Genital phase Puberty to till end of life

During early adolescence, an individual enters the genital
phase from latency phase and throughout the adolescence
the genital phase is maintained. The sexuality, which
remains quiescent during the latency phase, becomes active
during the genital phase.

During adolescence, an individual’s need for intimacy and
love making with opposite gender increases. Adolescents
explore about different appropriate ways to express the
love and intimacy.[13]

The development of an adolescent occurs not in isolation,
rather in the background of the family, society in a defined
culture, which significantly influences the adolescent
sexuality.[13] Society’s attitude and cultural perception of
sexuality largely have an influence on the families in which
an adolescent nurtures and his or her sexuality cherishes.

G E N D E R A N D A D O L E S C E N C E

Puberty changes differ in both the sexes. On an average
females experience these changes 12–18 months earlier
than males. Furthermore, the time of attaining maturity can
impact the adolescent development differently.[14]

Early maturing boys having good body image are more
confident, secure, and independent as compared to
late maturing boys. However, they may have increased

Kar, et al.: Adolescent sexuality: A bumpy ride

72 Journal of Human Reproductive Sciences / Volume 8 / Issue 2 / Apr – Jun 2015

aggressiveness due to a surge of hormones.[15,16] They are
more likely to be sexually active and participate in risky
behavior.[15,16]

Early maturing girls on the other hand, are very
self-conscious, insecure, and more likely to develop eating
disorders.[17] They are more likely to face sexual advances
from older boys, more chances of unwanted pregnancies
and more likely to be exposed to alcohol and drug abuse.

As per a research in the United States, during childhood-boys
as compared to girls are more likely to face negative health
outcomes like aggressive behavior and depression.[18] On
the other hand, during adolescence, the girls are more
likely to face the higher risk of negative health outcomes.[18]
The effect of discrimination, gender, poverty, and abuse
make the adolescent girls more vulnerable to the adverse
outcomes.[19]

In areas of conflict (war prone zones, countries with political
instability, and religious conflicts), young girls are at higher
risk of sexual abuse and trafficking and young boys are
more likely to be recruited as child soldiers.[20] The culture
influences the roles and expectations from girls and thus
has an impact on their access of information, education,
and opportunity.

A D O L E S C E N T S E X U A L B E H AV I O R

Adolescence is the period during which an individual’s
thought perception, as well as response gets colored
sexually. Adolescence is the age to explore and understand
sexuality. Sexual curiosity in the adolescence led to exposure
to pornography, indulgence in sexual activities, and also
increases the vulnerability for sexual abuse.

Halpern et al., studied on western population regarding
sexual behavior patterns of adolescents and explored the
possible factors attributing to the sexual behaviors.[21] In
this study, they studied over 11,000 adolescents between 18
and 27 years of age and found that more than 90% lose their
virginity before marriage.[21] The virgin population is found
to be younger in age, have the poor physical maturity, higher
body mass index, more religious inclination, and often
had perceived disapproval for sex during adolescence by
parents.[21] By the late teenage and early 20’s, most individuals
experience oral or vaginal sex irrespective of marital status
as found in different studies from US.[22,23] It was seen that
early exposure to vaginal sex during adolescence increased
the risk of sexual transmitted disease, however, the risk
gradually declines with age.[24-26] It was also reported that,
those who were exposed early to vaginal sex found to have
more number of sexual partners which might have a link
with the increased risk of sexually transmitted diseases.[26,27]

In recent years, internet has brought a revolution
i n a d o l e s c e n t ’ s a t t i t u d e a n d p e r c e p t i o n t o wa r d
sexuality.[11] Adolescents acquire extensive information
related to sexuality, which may be misguiding and can have
a significant negative impact on the sexual behaviors.[11]
Sexuality is a complex human behavior, which is largely
influenced by factors such as physical appearance,
psychological factors, social factors, cultural norms, and
past experiences.[2]

Most of the studies focus on vaginal sex on the sexual
behavior in adolescence and hardly few studies discuss
the non-vaginal sexual behavior.[26] There is a need to
explore the non-vaginal sexual behaviors (oral sex, anal sex)
which may be potential routes of transmission of sexually
transmitted diseases including HIV infection/AIDS as
adequate protections like use of condom is taken in these
methods like vaginal sex.[26,28-32]

C H A L L E N G E S FA C E D

Adolescents face a great challenge in their early adolescence.
Many critical biological, as well as psychological changes,
occur during this phase for which many adolescents are not
prepared enough to cope with, which often puts them under
stress. Onset of menstruation, change in voice (puberphonia)
in boys, development of secondary sexual characteristics,
and psychological changes often perceived as challenges.
Family and society’s attitude, as well as a cultural influence
on these changes, during puberty, plays a major role in
deciding the adolescent’s sexual behavior after puberty.

Sexual exposure during adolescence is a matter of serious
concern due to the risk of transmission of sexually
transmitted infections including HIV infection/AIDS,
teenage pregnancy, and adolescent fatherhood.[13,33] In many
developing countries, as well as underdeveloped countries,
early sexual exposure leading to HIV infection is a matter
of great concern.[34,35] Early marriage leading to early sexual
exposure, and pregnancy also has adverse consequences on
the reproductive health.[5,36]

I n m a n y d e ve l o p i n g c o u n t r i e s a n d m o s t o f t h e
underdeveloped countries, formal sex education in school
mostly does not exist; if it exists, then mostly found to
be inadequate. Lack of proper sex education often leads
to unprotected sex, unintended pregnancy, and sexually
transmitted diseases.

Due to multiple reasons adolescents are exposed to
unprotected sex. Lack of awareness and improper sex
education is an important reason of unprotected sex in
adolescents.[5] In developing and underdeveloped countries,
the parent – child communication related to sexuality and

Kar, et al.: Adolescent sexuality: A bumpy ride

73Journal of Human Reproductive Sciences / Volume 8 / Issue 2 / Apr – Jun 2015

sexually transmitted diseases is poor.[5] Adolescents get little
opportunity to discuss about their sexuality related issues,
which likely to hamper the healthy sexual development.[7]

Difficulties associated with the sexual approaches and
encounters are not the only challenge in adolescence.
Interpersonal violence is one of the notable concerns in
adolescents.[13] It may result in physical, as well as sexual
abuse. Most of the interpersonal violence is related to
sexuality. Usually, the adolescents are not trained enough
in the parenting skills due to, which teenage pregnancy
and adolescent fatherhood becomes a challenge.[13] Clinical
and educational interventions on adolescent sexuality focus
mostly on coital sexual activities of adolescents. However,
there are plenty of evidence regarding adolescent’s
involvement in non-coital activities, which are potential
routes of transmission of sexually transmitted diseases
including HIV infection.[5,26,28-32,37] There is a need to focus
on non-coital sexual activities during clinical assessment
and health education.

C O N C L U S I O N

Understanding the sexuality development of adolescent is of
utmost importance. Without this understanding, one cannot
move forward for clinical or educational intervention.
Understanding the factors influencing sexuality is also
useful for intervention. At the same time, understanding
adolescent sexuality, will also help parents to understand
the difficulties of their children better and will help them
to guide their children in the crossroads of adolescence.

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21. Halpern CT, Waller MW, Spriggs A, Hallfors DD. Adolescent predictors
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22. Fortenberry JD, Schick V, Herbenick D, Sanders SA, Dodge B, Reece M.
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24. Upchurch DM, Mason WM, Kusunoki Y, Kriechbaum MJ. Social and
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25. Kaestle CE, Halpern CT, Miller WC, Ford CA. Young age at first sexual
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26. Haydon AA, Herring AH, Halpern CT. Associations between patterns
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How to cite this article: Kar SK, Choudhury A, Singh AP. Understanding
normal development of adolescent sexuality: A bumpy ride. J Hum Reprod

Sci 2015;8:70-4.
Source of Support: Nil, Conflict of Interest: None declared.

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New Problems in Today’s Technological Era:
An Adlerian Case Example

Zachary D. Bloom and Dalena Dillman Taylor

Abstract

Adolescents’ Internet use, when done properly, can be viewed as a healthy, appro­
priate way to facilitate social interest. However, without guidance, the Internet can
create a variety of problems for adolescents and their families. The authors of this
article contend that extreme stances regarding adolescent Internet use can negatively
affect adolescent development. The authors present a case study in which Adlerian
therapy was used to facilitate developmentally appropriate Internet use in a family
that originally banned adolescents from using the Internet at home.

Keywords: Individual Psychology, Adler, adolescents, technology, Internet,
pornography

Alfred Adler first presented Individual Psychology after the turn of the
20th century. Nearly a century later, one development that Adler could
not imagine was the vast expansion of technology in the daily lives of in­
dividuals. In 2008, according to the National Campaign to Prevent Teen
and Unplanned Pregnancy (NCPTU, 2008), 87% of adolescents had a cell
phone, 79% of adolescents had a computer, and 33% had a web cam. The
Internet’s wealth of information, media, and social networking opportuni­
ties are available at the click of a button or the swipe of a finger. If Adler
were still alive today, how would he address the technological advances
in our society and their impact on human nature? We attempt to answer
this question in the context of adolescent development through the use of a
case study.

Adolescents on the Internet

In today’s world, the coming-of-age experience for adolescents is dif­
ferent from that of past generations. It is estimated that 89% of adolescents
have a profile on a social networking website (e.g., Facebook), and in 2008
between 78% and 80% of adolescents posted, sent, and received pictures
and video on the Internet (NCPTU, 2008). Although many adolescents pri­
marily use this technology to benignly connect socially with others (Reich,

The Journal o f Individual Psychology, Vol. 71, No. 2, Summer 2015
©2015 by the University of Texas Press

Editorial office located in the College of Education at Georgia State University.
Published for the North American Society of Adlerian Psychology.

164 Zachary D. Bloom and Dalena Dillman Taylor

Subrahmanyam, & Espinoza, 2012), Internet use has been associated with
various problems, including addiction, gambling, bullying, and stealing
(Mitchell, Becker-Blease, & Finkelhor, 2005). In addition, perhaps because
adolescence is a normative time for curiosity about sex (American Academy
of Pediatrics, 2013; Berk, 2008), 18%-22% of male and female adolescents
have used the Internet to share sexually provocative images of themselves,
and 39% have used technology to send sexually provocative messages
(NCPTU, 2008). Research has identified that these behaviors are correlated
with multiple issues of concern to counselors, including impulsivity and
substance abuse (Temple et al., 2014), legal problems (Mitchell, Finkelhor,
Jones, & Wolak, 2012), and risky sexual practices (Rice et al., 2012).

With increased access to the Internet in affordable and anonymous ways
(Cooper, 1998), adolescents are increasingly exposed to sexually explicit
materials online, whether they pursue them purposely or encounter them
accidentally (Weber, Quiring, & Daschmann, 2012). Despite some research
that has failed to identify negative impacts on adults who use sexually explicit
material (Poulsen, Busby, & Galovan, 2013), a variety of negative conse­
quences have been established for adolescents who use such material. The
identified consequences include social isolation, symptoms of depression,
conduct problems (Owens, Behun, Manning, & Reid, 2012), and risky sexual
practices (Wright & Randall, 2012). Consequently, there is a call for thera­
pists to address the adverse effects related to adolescents’ pornography use
(Bloom & Hagedorn, 2015; Peter & Valkenburg, 2010; Weber et al., 2012).

With more than 1 billion active Facebook users who each month spend
more than 640 million minutes online (Statistic Brain, 2014), Adler’s social
interest is actively demonstrated on a worldwide level in a drastically dif­
ferent realm from when the concept was first developed. Even though the
world today is indeed different from the one Adler knew, Adlerian therapy
is suited for it (Carlson, Watts, & Maniacci, 2006). A compelling compo­
nent of Adlerian theory is Adler’s continual striving to perfect his theory,
as evidenced through the maturity of the theory over time (Ansbacher &
Ansbacher, 1956). In Adler’s absence, practicing Adlerian therapists are
compelled to adapt his theory to fit the evolving technological world.

Adolescent Development

Although some researchers believe that contemporary adolescence
has extended into the mid-20s (Gallo & Gallo, 2011; National Institute
of Mental Health, 2011), for the purpose of this discussion, we focus pri­
marily on early adolescence (11-13 years), the crux of the transition from

N ew Problems in Today’s Technological Era 165

childhood to adulthood. During this crucial milestone between childhood
and adulthood, adolescents enter a period of change that affects all lines of
development: physical, sexual, social, emotional, and cognitive.

During early adolescence, beyond changes in physical maturity, in­
dividuals also begin to develop interest in sexual experiences and more
intimate or romantic relationships with their peers (American Academy of
Pediatrics, 2013). Although they develop strong relationships with both
sexes during this time, adolescents often struggle with perceptions of body
image and feelings of self-esteem because they are questioning their own
development in comparison to their peers (Berk, 2008; Centers for Disease
Control and Prevention, 2014). Adolescents tend to seek out independence
from their parents while simultaneously spending significantly more time
with peers, in an evolving effort to find their identity (American Academy of
Pediatrics, 2013).

The transition from childhood into early adolescence shows changes
in an individual’s cognitive development. Children tend to be concrete in
their thinking, often dichotomizing subjects into black or white categories
while also beginning to develop an increased capacity for abstract thought
(Berk, 2008; Centers for Disease Control and Prevention, 2014). Despite
these changes in cognitive development, early adolescents focus more on
the present because they struggle with an inability to consider the long­
term consequences of their actions (National Institute of Mental Health,
2011). Perhaps it is for this reason that between one and two of every five
male and female adolescents have used technology to experiment sexually
(NCPTU, 2008), without recognizing some of the consequences of their ac­
tions (Mitchell et al., 2012; Owens et al., 2012).

Developmental Implications

In our society, the Internet can play a supportive role in adolescents’
pursuits of identity formation and social interest, if it is used in constructive
and appropriate ways— yet it is crucial for parents to monitor adolescents’
Internet activities to ensure their appropriate use (Wang, Bianchi, & Raley,
2005). Extreme stances toward Internet use (e.g., completely unrestricted
access, absolutely restricted access) could impede an adolescent’s develop­
ment of social interest in today’s society (Wang et al., 2005). The following
case study demonstrates the consequences of an extreme stance taken
against Internet use.

The case example should illustrate the counseling process through an
Adlerian lens, with a focus on developmental concerns in relation to today’s
technological world. The case example describes a typical clinical scenario
and does not represent any real single case.

166 Zachary D. Bloom and Dalena Dillm an Taylor

Case: Identifying Features and Presenting Concerns

The client, David, a 13-year-old only child and Caucasian male, was
brought to his initial intake session by his father, Mr. Smith. David reported
on his experiences of sadness and isolation, particularly in response to be­
ing homeschooled and not having access to the Internet. David stated that
his parents’ ban on Internet use made it difficult to complete his homework
and created a barrier between him and his peers at church, who were more
involved with one another through their use of e-mail and social media.
Further, David reported that his peers discussed mainstream media that
David had never seen, which added to his feelings of isolation.

By the conclusion of the intake session, David reported that the “real
reason” he was being “punished with counseling” was because he sneaked
onto his father’s computer to access pornography. Consequently, David
reported that his father “screamed at him and grounded him indefinitely.”
David’s father confirmed the story and added that he had forbidden David
from masturbating— he viewed masturbating as a “sin”— and had hoped
that not having any discussion about sexuality whatsoever would “preserve
David’s innocence.”

Like many peers of his age, David appeared to struggle with body im­
age and self-esteem because of his lack of friendships and the tension in his
relationship with his father. David’s cognitive level— his focus on the present
as opposed to future consequences of his actions— was also similar to that
of his peers of his age. However, his emotional development appeared to
be lagging behind, as evidenced by a lack of solid peer relationships and
expressed role confusion.

Treatment Plan and Treatment

Adlerian theory emphasizes optimism, free w ill, and the subjective na­
ture of human beings (Ansbacher & Ansbacher, 1956). Because Adlerian
theory is a wellness-oriented model, Adler proposed that all individuals
are born with an innate ability to develop social interest. Adler also be­
lieved in the goodness of individuals, indicating that all people are socially
embedded, holistic, creative, purposeful, goal oriented, unique, and sub­
jective (Ansbacher & Ansbacher, 1956; Dinkmeyer, Dinkmeyer, & Sperry,
1987). David’s family was also approached as a whole, with an emphasis on
finding significance and belonging in the family system and in society. The
process of family counseling proceeded through the four phases of Adlerian
theory: (a) establishing an egalitarian relationship, (b) investigating the life­
style, (c) gaining insight, and (d) reeducating and reorienting.

N ew Problems in Today’s Technological Era 167

After the intake, it became apparent to the counselor that David’s par­
ents were hesitant to get involved in therapy and that they viewed David as
the “identified patient.” A decision was made to see David in weekly indi­
vidual sessions and to conduct biweekly parent consultations to decrease
the protective barrier and/or resistance between the parents and counselor.

Phase 1: Establishing an Egalitarian Relationship

In Phase 1 the counselor focuses on establishing a strong therapeutic
alliance in which the counselor conveys and the client experiences trust,
care, and acceptance (Kottman, 2003). The counselor creates an atmo­
sphere of warmth and trust by providing the client opportunities to share
experience of self, others (e.g., parents), and the world by encouraging the
client to present his or her needs, desires for the session, and thoughts re­
garding potential goals for therapy. The counselor, in turn, uses reflections
on feeling and content and encouraging statements to communicate to the
client that he or she is heard, understood, and considered an expert on
his or her own experiences. By understanding the client’s perceptions of
the presenting issue and early life experiences, the counselor can begin to
formulate hypotheses regarding the client’s mistaken beliefs and lifestyle
(Ansbacher & Ansbacher, 1956; Kottman, 2003). However, most of this in­
vestigation takes place in Phase 2, and thus is described in more depth in
the following section.

Initially, David presented as discouraged by the pressure imposed on
him by his father and his own limited capabilities, and as socially isolated,
given that he was homeschooled and had minimal interactions with others
outside his family. Because peers are crucial to adolescents’ overall social
and emotional development, David’s feelings of isolation and loneliness
were pronounced.

During initial parent consultations, the counselor provided the choice
for David to participate in the conversation and encouraged him to volun­
teer information if his father or mother stated any events that he perceived
as untrue. For the first two consultations, David, his mother, and his father
were present. In these meetings, the father presented as loud, domineering,
and distracted by his phone only when David would speak. During the con­
sultations, David’s mother appeared to stay in the shadow of her husband.
She spoke only when the counselor posted a question directly to her.

At the end of the first two parent consultations, the counselor encour­
aged the father to explore his own self-defeating beliefs, concluding that he
might be more capable of accepting his son as he is and more open to al­
lowing his son more freedom to use the Internet in an appropriate way. The
counselor feared that the father’s ban on Internet use impaired David’s ability
to socially connect with others, particularly because of his already-isolated

168 Zachary D. Bloom and Dalena Dillman Taylor

environment. The counselor noted this hypothesis and decided to evaluate
its validity when collecting evidence concerning David’s, his mother’s, and
his father’s lifestyles during the next phase of counseling.

Phase 2: Investigating the Lifestyle
According to Dinkmeyer and Sperry (2000), counselors exhibit the tru­

est form of empathy when they fully understand the client’s lifestyle. This
allows the counselor to help clients modify their beliefs and adopt a more
socially interested outlook on life. In this case, the counselor chose to con­
duct a genogram with the family to gain both a visual and verbal perspective
on David’s lifestyle and his parents’ lifestyles. A brief synopsis for each
member is presented in the following sections.

Father. Based on early life experiences, Mr. Smith found significance in
controlling himself, others, and situations in order to feel safe in the world.
Later in life, he stated that he found God and became a born-again Christian,
which he reported as shifting his view on life. Yet it became apparent that his
need to control is still present in his life, as evidenced by statements made
in the intake session of verbal and emotional abuse toward his wife. His life­
style convictions indicated the following: “I must be in charge to feel safe,”
“I must protect my son from making my mistakes,” “It’s hopeless for me to
change, but I can control my son’s actions.”

Mother. Mrs. Smith presented as stuck in life. She expressed a desire
to divorce her husband because of his emotional abuse; however, she ap­
peared dependent on him financially and emotionally, and so she expressed
feeling uncertain about leaving. Mrs. Smith found significance and belong­
ing in her family and the world by pleasing others. She identified her goals
in consultations as wanting what is best for David. Her lifestyle convictions
indicated “I am worthless and deserve to be hurt,” and “If I please others,
they won’t hurt me; therefore, I must always please everyone.”

David. At age 13, David presented as striving toward superiority. He
needs to have control over his situation, and this is clear from power strug­
gles with his father. He exhibited symptoms of depression, as evidenced by
sulking during family sessions and sharing feelings of isolation, helpless­
ness, and hopelessness. David’s Internet activity could be a transgression
against his father, and he was shamed for his curiosity. His lifestyle convic­
tions indicated “I am bad, others must punish me, the world is unsafe,” and
“M y needs are shameful, punishable, others correct me, tell me what to
think and feel; therefore, I lack ability to control myself and my actions, and
others must do it for me.”

N ew Problems in Today’s Technological Era 169

The lifestyle investigation revealed that each member contributed to the
underlying issues, but David’s parents refused to participate in family inter­
ventions, and so David would be the only one returning for treatment.

Phase 3: Gaining Insight

In Phase 3, the counselor balances a nondirective and a directive role
with adolescents to create an atmosphere of sharing power and to enable
the client to gain awareness of the purposefulness of his or her responses to
specific life situations (Dinkmeyer et al., 1987; Kottman, 2003). The focus in
this phase was on understanding the client’s current beliefs and goals that
formulate one’s private logic (Dinkmeyer et al., 1987), on sharing hypoth­
eses about the goals of the client’s lifestyle, and on modeling social interest
for the client. During Phase 3 with David, the counselor followed the family
activity with processing and debriefing. In the family sessions, the coun­
selor had realized the lack of power David had in his family, his discomfort
in vocalizing his thoughts and feelings in his family, and the overall sense
of insecurity he felt when around his parents. The counselor focused on
establishing a sense of safety in the counseling relationship by modeling a
trusting relationship. David began to voice that he wanted his future family
to be different than his current one. He set goals of owning a farm and hav­
ing his own family. Although David appeared motivated and was striving
for superiority in most of his actions and behaviors, he was unaware of how
these current goals fit into his current lifestyle.

In parent consultations, it was critical for Mr. Smith to gain insight into
his views about self, others, and the world and the impact those views were
having on his parenting and on David’s view of self. Over the course of parent
consultations, Mr. Smith began to make some progress in allowing himself
to see the potential impact of his private logic on his own and his family life.

Mrs. Smith was present during these sessions as well. She appeared
encouraged that Mr. Smith was gaining awareness about his actions and
seemed as hopeful about his possible changes. The counselor also meta-
communicated that her lack of involvement in the family was a clear
message to David that Mr. Smith held all the power; therefore, Mrs. Smith
was not a secure person to confide in for David. She appeared receptive to
these hypotheses and eager to implement her insights to improve her ability
to connect with and support David.

Phase 4: Reeducation and Reorientation

In the reorientation phase, the counselor helps clients implement so­
cially interested goals and behaviors (Dinkmeyer et al., 1987) in order
to shift clients’ private logic to a view of the world that encompasses a
greater level of social interest. The counselor’s role is as an active teacher

170 Zachary D. Bloom and Dalena Dillman Taylor

and encourager (Kottman, 2003), which helps clients establish realistic
goals, develop problem-solving and decision-making skills, and find func­
tional alternatives.

During this phase, the counselor and David worked on establishing real­
istic goals and problem solving situations so as to meet his emotional needs.
The counselor and David identified goals and various ways to socialize for
David (i.e., he was allowed access to the library). In addition, incorporating
more peers into his life helped David with his feelings of isolation.

The counselor also explored David’s goals for his future family and real­
istically discussed his ability to achieve those goals while also encouraging
his ability to note the differences between what he wants and does not want,
and then implementing his view of self, others, and the world to create an
optimal life for himself. Additionally, the counselor offered David psycho­
education about sex in individual sessions. The counselor normalized David’s
curiosity and worked with David to process some of the things he saw in por­
nography while using appropriate, professional (or educational) language.

Although most of this sex education and deconstruction of pornography
occurred in individual sessions with David, a portion of it was conducted in
the parent consultations with Mr. and Mrs. Smith—despite their hesitance to
participate in therapy. By this time, having participated in Phase 3, Mr. Smith
had already gained some awareness of the thoughts and behaviors that af­
fected his family and, therefore, was open to discussing his son’s sexual
curiosity in parent consultations, especially once he had come to view his
son’s sexuality as a normal and healthy part of adolescent development.
The counselor worked with Mr. Smith to set realistic goals for his son, and
the counselor encouraged Mr. Smith to see the intention in his son’s use of
pornography before shaming him first. The counselor held two family ses­
sions toward the end of treatment to achieve attainable goals for both David
and his parents.

David and his parents worked to find common ground in discussing
issues related to sexuality, and David gained valuable information about
himself and his family that he could use to make more informed deci­
sions regarding his behaviors as he thought about his future. David’s shift
in present thinking to considering long-term consequences indicated that
he increased his overall cognitive development so that it came to match
age-related developmental expectations. The counselor mediated discus­
sions regarding healthy Internet use, limitations on computer use, parental
involvement in sex education, and discussing appropriate social activities
or hobbies (i.e., volunteering at church)— all the things that David could
do to increase healthy peer relationships. Both David’s self-confidence and
his parents’ ability to hear David and appropriately respond to his wants
increased. David’s overall increase in healthy peer relationships and his in­
creased self-confidence gave a boost to his emotional maturity.

N ew Problems in Today’s Technological Era 171

Conclusion

Use of the Internet enables billions of people to access information, view
media, and connect with others in previously unfathomable ways. As such,
the contemporary world is different from the world in which Adler lived and
developed his theory and practice. However, the major tenets that drove
Adlerian therapy in the past are still viable for today’s counseling clientele
(Carlson et al., 2006). During the transition from childhood to adolescence,
it becomes especially important for individuals to strive toward significance
and belonging. The Internet (and social media especially) offers the tools
to foster those developmental needs in adolescents. However, Internet use
has been linked to various interpersonal problems for some of its users. If
Adler were alive today, he would have embraced technological advances,
but he would have been most concerned about the widespread availabil­
ity and ease of access to pornographic materials for adolescents (see Adler,
1931). Adler believed that parents should create space for and respond to
an adolescent’s questions about sex rather than preemptively shunning an
adolescent’s sexual curiosity. Adler would have promoted and encouraged
parents and other adults to have open conversations with their adolescents
about sexuality. He would have also encouraged parents to collaborate with
their adolescents in finding a balance of Internet use as one means of striv­
ing for significance and belonging during this developmental stage.

While establishing fair and appropriate boundaries around adolescent
Internet use might be an intimidating subject for parents, engaged parental
involvement with adolescents about their online activities can foster trust and
communication in the family system, thus potentially eliminating the condi­
tions that contribute to extreme parental stances on adolescent Internet use
and the resultant negative emotional and behavioral consequences. With
open dialogue and involved parenting, parents and guardians put themselves
in an empowered position to assist their children’s continuous development
of social interest as they move from childhood into adolescence.

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Zachary D. Bloom (zbloom@knights.ucf.edu), MA, RMHCI, RMFTI, is a doc­
toral student in the Counselor Education Program at the University of Central
Florida. W hile com pleting his doctoral degree, Bloom has been working
w ith individuals, couples, and families at the university’s Comm unity Coun­
seling and Research Center. His primary research interests include trauma,
human sexuality, and the impact of technology on individuals and families.

Dalena Dillman Taylor (dalena.taylor@ucf.edu), PhD, LPC, RPT, is assistant
professor at the University of Central Florida, past president of the North
Texas Association for Play Therapy (2013-2014), and the play therapy
certificate coordinator at UCF. D illm an Taylor is a trained Adlerian play ther­
apist and focuses her research on the effectiveness of Adlerian play therapy
w ith children and adolescents who demonstrate disruptive behaviors or aca­
demic difficulties in the classroom and at home.

http://www

mailto:zbloom@knights.ucf.edu

mailto:dalena.taylor@ucf.edu

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