Dating and romantic relationships of adolescents with intellectual and developmental disabilities

Journal of Adolescence 79 (2020) 39–48

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Journal of Adolescence journal homepage: www.elsevier.com/locate/adolescence

Dating and romantic relationships of adolescents with intellectual and developmental disabilities

T

Marina Heifetza,∗, Johanna Lakea, Jonathan Weissa, Barry Isaacsb, Jennifer Connollya a b

York University, 4700, Keele Street, Toronto, Ontario, M3J 1P3, Canada Surrey Place Centre, 2 Surrey Pl, Toronto, Ontario, M5S 2C2, Canada

A R T IC LE I N F O

ABS TRA CT

Keywords: Developmental disabilities Intellectual disability Adolescence Romantic relationships Romantic conceptualizations Qualitative research

Introduction: Adolescents with intellectual and/or developmental disabilities (IDD) are at high risk for sexual exploitation, yet there is a paucity of research on their romantic relationships. The objectives of this study were to examine the romantic understanding and experiences of youth with IDD. Methods: Thirty-one adolescents (16–19 years; 21 males and 10 females) with IDD (12 participants with additional diagnosis of ASD) were recruited from a community health clinic. Individual interviews and questionnaires assessed cross-sectionally these youths’: (1) romantic conceptualizations; (2) romantic awareness (knowledge of: romantic relationships, sexual behaviours, initiating relationships); (3) involvement; (4) social competence; and (5) expectations for autonomy. Parent perspectives on these topics were also captured through questionnaires. Results: While 85% reported an immediate desire for a romantic relationship, only 35% were currently in a relationship. Qualitative findings indicated that 14% of youth were unable to differentiate between a romantic relationship and a friendship. Among those who could make this distinction, romantic relationships were conceptualized as serious, commitment for life, and primarily for companionship. Adolescents with ASD, compared to those without ASD, showed weaker social competence and lower romantic awareness. Parents were adolescents’ primary source of information about relationships. Finally, parents and adolescents differed in their perception of the age at which they were ready to date. Conclusions: This study contributes to our understanding of the romantic experiences of youth with IDD. Prevention efforts focused on education may be important to help ensure these youth develop safe and healthy relationships.

1. Introduction Research on romantic development of typically developing adolescents is an established and important area for socio-emotional development and mental health, but there remains a substantial gap in the field of romantic relationships among adolescents with intellectual and/or developmental disabilities (IDD). Adolescents with IDD demonstrate limited knowledge of sex and sexual risks (Baines, Emerson, Robertson, & Hatton, 2018; Brown-Lavoie, Viecili, & Weiss, 2014; Cheng & Udry, 2005; Hannah & Stagg, 2016), and those with an additional Autism Spectrum Disorder (ASD) diagnosis may also exhibit poor social competence (i.e., inferring social information; Solish, Perry, & Minnes, 2010), which may further impact their romantic development (Dewinter, Van Parys,

*

Corresponding author. Boomerang Health 9401 Jane Street, Suite 211, Vaughan, Ontario, L6A 4H7, Canada. E-mail address: [email protected] (M. Heifetz).

https://doi.org/10.1016/j.adolescence.2019.12.011 Received 2 May 2019; Received in revised form 11 November 2019; Accepted 19 December 2019 0140-1971/ © 2019 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

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Vermeiren, & Van Nieuwenhuizen, 2017). Youth with IDD tend to be monitored more by parents and have fewer opportunities to engage with peers outside of school than their typically developing peers (Solish et al., 2010; Walker-Hirsch, 2007). These differences in day-to-day experiences may further influence the romantic knowledge and experiences of adolescents with IDD. 1.1. Definition of IDD IDD is estimated to have a 1% prevalence rate in the general population and is defined in the Diagnostic and Statistical Manual Fifth Edition (American Psychiatric Association, 2013) as having significantly sub-average general intellectual functioning, accompanied by significant limitations in adaptive functioning (American Psychiatric Association, 2013). Individuals with IDD are three to four times more likely to be diagnosed with an Autism Spectrum Disorder (ASD), compared to youth without IDD (Matson & Cervantes, 2013; Einfeld, Ellis, & Emerson, 2011). ASD symptoms include deficits in social communication and interactions. Since ASD frequently co-occurs in individuals with IDD (ranging from 28% to 40%; Bryson, Bradley, Thompson, & Wainwright, 2008), it is important to consider how this comorbidity may impact the romantic experiences of youth with IDD and ASD. 1.2. Romantic involvement and romantic conceptualizations Romantic involvement and romantic conceptualizations are important aspects of romantic relationships (Collins, 2003). Romantic involvement refers to adolescent dating experiences (i.e., going on a date) and is among the most frequently used indicators of romance during adolescence. For the purposes of this exploratory study, “going on a date” was defined as face-to-face outing. In early adolescence (i.e., ages 11–14 years), dating among typically developing adolescents tends to be characterized by affiliative activities, such as being together with partners in a group and holding hands, rather than sexual activities, which typically develop later in adolescence (Christopher, McKenney, & Poulsen, 2016). As such, the different types of dating stages are important to consider when studying adolescents’ romantic relationships. These dating stages include same sex friendships, cross-sex friendships, casual dating, and serious dating. Importantly, peers are thought to dictate romantic norms and facilitate opportunities for romantic interaction (Connolly & McIsaac, 2009). As adolescents increasingly join mixed-gender friendships (McDougall & Hymel, 2007), they become more interested in romantic relationships and there are more opportunities for romantic relationships to flourish through exposure to romantic partners and observation of peer models of romantic mixed-gender interactions (Christopher et al., 2016). In contrast, individuals with IDD may have limited social networks (van Asselt-Goverts, Embregts, Hendriks, Wegman, & Teunisse, 2015) and, thus, they may have less opportunities for developing romantic relationships, despite apparent desire for romantic experiences (Cheak-Zamora, Teti, Maurer-Batjer, O’Connor, & Randolph, 2019). Romantic conceptualizations are important because they reflect youths’ understanding of romantic relationships. Typically developing adolescents tend to describe the core features of romantic relationships as involving passion, affiliation, intimacy, and commitment (Connolly, Craig, Goldberg, & Pepler, 1999), and describe passion as the distinguishing factor between friendships and romantic relationships (Connolly et al., 1999). Adolescents with IDD, including those with autism, by contrast, are often perceived to have more limited romantic conceptualizations (e.g., Hancock, Stokes, & Mesibov, 2019; Isler, Tas, Beytut, & Conk, 2009; Cheng & Udry, 2005). Specifically, as reported through questionnaires and administrative health data, youth with IDD were found to have more limited knowledge about sex (Isler et al., 2009), fewer opportunities to meet partners, shorter relationships (Hancock et al., 2019), fewer sexual experiences, and greater risk for pregnancy and sexually transmitted diseases (STDs) (Cheng & Udry, 2005). 1.3. Parental autonomy granting Families often regulate the pace at which adolescents become involved in romantic relationships (Collins & Steinberg, 2006). Parents’ willingness to grant youth autonomy, as related to independent decision making, is particularly important during adolescence, as peer groups and dating present youth with situations where they often see themselves as the primary decision maker. During this time, it is also common for adolescents and parents to disagree on age-appropriate expectations for autonomous peer related behaviours, including dating (Daddis & Smetana, 2005). Parents of youth with IDD compared to parents of typically developing adolescents tend to be more overprotective and grant less autonomy to their child (Clark, Olympia, Jensen, Heathfield, & Jenson, 2004; Walker-Hirsch, 2007). In fact, a study by Evans (2002) found that as many as 83% of parents did not believe that their youth with IDD (ages 13-64 years-old), regardless of ability levels have the ability to make independent decisions in terms of relationships and sexuality. As such, parents may limit the social opportunities that youth engage in, such as going to the mall without parental supervision, social media use, and going to the movies (Walker-Hirsch, 2007). These limits may also constrain their awareness of romantic relationships, given that these features develop primarily through social experiences (Christopher et al., 2016). Research on both IDD and typically developing adolescents suggests that gender differences exist in parental autonomy granting. Within the typically developing adolescent population, early adolescent girls' dating activities, as compared to boys, are more intensely supervised by their parents (Kan, McHale, & Crouter, 2008; Renk, Liljequist, Simpson, & Phares, 2005). Consistent with these behaviours, some research also shows that parents' attitudes toward their adolescents’ dating is gender biased; parents indicate an earlier age for boys to start dating than for girls (Daddis & Smetana, 2005). Similarly, although parents of youth with IDD generally disapproved of their child having sex, relative to parents of typically developing youth, parents of males with IDD tended to be more 40

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lenient in those beliefs compared to parents of females (Cheng & Udry, 2005). 1.4. Relationship education For youth with IDD, access to appropriate relationship education has been linked to better awareness of romantic relationships and sexuality (Cheng & Udry, 2005). At the same time, parents of youth with IDD report discomfort discussing relationship information and express concerns that discussion could lead to romantic involvement, including unplanned pregnancy or sexually transmitted diseases (STDs). They also fear that their child would be unable to comprehend relationship information, or that they would fixate on it (Ballan, 2012; Grant & Fletcher-Brown, 2004; Walker-Hirsch, 2007), and that they are less interested in romantic relationships than typically developing youth (Pownall, Jahoda, & Hasting, 2012). Not surprisingly, studies have found that almost half of adolescents with IDD had never talked about sex with their parents (Isler et al., 2009), and utilize fewer sources of sexual information (e.g., family, friends, doctor) while demonstrating lower sexual knowledge about such topics as puberty, contraception, STDs than their adolescent peers without IDD (Cheak-Zamora, 2019; Jahoda & Pownall, 2014). Due to underdeveloped abilities in judgment and evaluation, these youth are also more vulnerable to sexual coercion and assault, as well as risky relationship behaviour, such as engaging in unsafe sex practices (Baines et al., 2018; Basile, Breiding, & Smith, 2016; Isler et al., 2009; Khemka, Hickson, Casella, Accetturi, & Rooney, 2009). 1.5. Current study The purpose of this study was to examine the following within a clinical sample of adolescents with IDD: a) romantic conceptualizations, as referred to the basic understanding of what is a romantic partner and what is the difference between a romantic partner and a friend; b) awareness of romantic relationships, as related to knowledge of sexually related behaviours and how to initiate relationships; c) romantic dating stage, as understood through same-sex, opposite-sex, casual, and serious dating; d) parental autonomy granting; and e) relationship education, specifically related to learning sources for initiating relationships. Qualitative methods were used to assess romantic conceptualizations, while quantitative questionnaires were administered to explore all other variables. It was hypothesized that these youths’ romantic experiences are more likely to be within the cross-sex affiliative stage rather than casual or serious dating. As well, parents were predicted to endorse a later age than their adolescents in terms of readiness for dating, and to endorse a later age for girls than for boys in dating readiness. We expect that greater parental autonomy granting will be associated with a more advanced dating stage, and greater romantic awareness. Relationship education was predicted to be associated with higher dating stage and greater romantic awareness. Finally, we hypothesized that adolescents with IDD would demonstrate better social competence, higher dating stage, and better romantic awareness than their ASD counterparts. 2. Methods 2.1. Sample Thirty-one (21 males, 10 females) adolescents between the ages of 16–19 years (M = 17.5; SD = 1.39) diagnosed with Mild IDD residing within the Greater Toronto Area participated in the study. Twelve of these participants were reported by parents to have a formal diagnosis of ASD (8 males, 4 females). Participants were recruited from an interdisciplinary community-based agency providing clinical services and programs to children, adolescents and adults with IDD. Study inclusion criteria were as follows: (a) sufficient cognitive skills to participate (i.e. mild IDD), and (b) sufficient verbal skills to answer interview questions (determined informally). Participants ranged in their IQ between 55 and 70 (M = 66; SD = 8.36). The participating adolescents self-identified as predominantly heterosexual (77.4%), with some identifying as bisexual (9.7%) and others as questioning their sexual identity (12.9%). For further demographic information, please see Table 1. ASD diagnosis did not make a significant difference in adolescents’: IQ, t (29) = .66, p = .52; age, t (29) = -0.68, p = .50; or gender, t (29) = .10, p = .92. 2.2. Measures Romantic Conceptualizations (Youths' Perspective). To understand how adolescents conceptualize romantic relationships and how they distinguish between a romantic partner and a friend, participants were asked to respond to the following: “What is a boyfriend/girlfriend?” and “What do you think is the difference between a male/female friend and a boy/girlfriend?” Thematic analysis methodology was used to analyze responses (Dixon-Woods, Agarwal, Jones, Young, & Sutton, 2005). All responses were transcribed and then the first author organized and coded the raw data. A trained research assistant independently coded all responses, yielding high levels of agreement between the primary researcher and the research assistant (average kappa was .88). The coding framework was based on the themes identified by Connolly and colleagues’ (1999) in their study of romantic conceptualizations of typically developing youth. The codes for both questions are identified in Table 2. Assessment of IQ (Youth). The Wechsler Abbreviated Scale of Intelligence (WASI; Wechsler, 1999) was utilized to assess intellectual functioning for each adolescent. The WASI is a reliable and quick measure of intelligence, which assessed whether participants fell in the “mild” IDD range. Seven adolescents were excluded from the study as their IQ fell outside the mild IDD range specified. 41

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Table 1 Number and percentage of demographic characteristics in each category. Characteristics

Males (N = 21)

Ethnicity European-Canadian Asian-Canadian African/Caribbean-Canadian Other Living Arrangements Both natural parents Mother and step-father Mother only Both natural parents, joint custody Other School Type Not in school Public school (boys and girls) Independent/private school (boys and girls) Special Education school for youth with ID (same-sex) Other

Females (N = 10)

Total (N = 31)

N

%

N

%

N

%

11 2 3 4

55 10 15 20

6 3 0 1

60 30 0 10

17 5 3 5

56.7 16.7 10 16.7

11 1 5 1 3

52.4 4.8 23.8 4.8 14.3

6 1 2 1 0

60 10 20 10 0

17 2 7 2 3

54.8 6.5 22.6 6.5 9.7

2 15 1 0 2

10 75 5 0 10

0 3 0 7 0

0 30 0 70 0

2 18 1 7 2

6.7 60 3.3 23.3 6.7

Table 2 Romantic conceptualizations codes. Code Passion: Intense emotions Physical contact Affiliation: Companionship Dating Intimacy Commitment Other

Description

Feelings of love, crush, really liking someone, or caring a lot for someone Kissing, hugging, or sexual activity Hanging out or references to being friends Activities specific to dating, such as going out on dates Trust, self-disclosure, closeness, or support Long-term alliance or exclusivity When responses did not fit into the above categories

Romantic Desire (Youths’ Perspective). Adolescents were asked whether or not they would like to have a romantic relationship “at this time” in a categorical format (“yes” or “no”). Dating Stage (Youths' Perspective). The Dating Questionnaire (DQ; Connolly, Craig, Goldberg, & Pepler, 2004) was used to assess adolescents' participation in activities underlying romantic stages. The DQ consists of eight items that assess experience with friendships and dating. Four dating stages were developed based on the DQ: (1) same-sex affiliations for adolescents who endorsed same-sex friendships only and did not endorse any mixed-gender or dating items; (2) cross-sex affiliations for adolescents who responded positively to at least one of the mixed-sex items but did not endorse any dating activities; (3) dating for adolescents who reported at least one dating item but did not have a romantic relationship; and (4) dyadic romantic relationships for adolescents who reported having a romantic relationship. This categorization provides stable groups with stage-like characteristics and acceptable reliability (Connolly et al., 2004). The internal consistency for this scale in the present study was satisfactory, with Cronbach's alpha of .63. The questionnaire also asks youth if they have a current boyfriend or girlfriend and to indicate how often they see him/her. In addition, youth were asked whether they were interested in having a romantic relationship as well as their sexual orientation interests. Visual aids were provided here to show opposite-sex, same-sex, or bisexual couples, as well as questioning (a question mark next to a person to indicate reflection and questioning). Romantic Awareness (Parents' Perspective). The Courting Behaviour Scale (CBS; Stokes, Newton, & Kaur, 2007) was adapted to examine parents' perceptions of adolescents' romantic knowledge and behaviours, including awareness of different types of romantic relationships, knowledge of sexually related behaviours, and knowledge of how to initiate relationships. The CBS (composed of nine items) has been found to have good reliability (Stokes et al., 2007). The present study showed good reliability for this scale with Cronbach's alpha of .71. Relationship Education (Parents’ Perspective). Parents were asked to check off all that applied to the question “How did your child learn to initiate relationships?” The options were: parents/caregivers, peers and friends, social observation, siblings, formal sex education, media, and other. Dating Autonomy Granting (Youths' and Parents' Perspective). The Teen Timetable (Feldman & Quatman, 1988) was used to obtain both parents' and adolescents' expectations for dating autonomy. The Dating subscale (comprised of five items) yielded Cronbach's alpha of .44 and .58 (for parents' and adolescents' report, respectively). 42

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Social Competence (Parents' Perspective). The Children's Social Behaviour Questionnaire (CSBQ; Luteijn, Jackson, Volkmar, & Minderaa, 1998) assessed adolescents' social competence. This measure has been normed among youth with various developmental disabilities, and aims to assess subtle social skills. The psychometric qualities of CSBQ in youth with IDD have previously been found to be good (Luteijn et al., 1998). Two of the six scales were used in this study: “Tendency to withdraw,” which examines the adolescent's tendency to withdraw in social situations and to show little need for contact; and “Not understanding,” which examines difficulties in understanding social information. These subscales were chosen based on their relational focus compared to other subscales that were more specifically related to ASD characteristics, such as stereotyped behaviours and orientation problems. These subscales are reverse coded, such that a lower score indicates greater social competence. The present study showed a good internal consistency for these scales, with Cronbach's alpha score of 0.73. 2.3. Procedure Following the consent process (obtained by means of written parent consent and adolescent assent), adolescents participated in a brief cognitive assessment to ensure they met IQ inclusion criteria for the study. Upon meeting eligibility requirements, adolescents participated in a face-to-face interview with the first author, during which the conceptualization questions and questionnaires were read to youth. To facilitate understanding specifically for sexual orientation questions, all participants were presented with visual cues, created for the purposes of this study (e.g., drawings of an opposite-sex, same-sex, or bisexual couple on a date, as well as questioning). Finally, because acquiescence may be an important threat to the validity of research in this population, a “don't know” option was made available for each question. To thank participants for their involvement in the study, they were each provided with a gift card to a local coffee shop. Each participating adolescent's parent was also asked to complete questionnaires about their autonomy granting. 3. Results 3.1. Descriptive statistics Of the 31 participants interviewed, 48.4% (N = 15) reported having a previous girlfriend/boyfriend, and 34.5% (N = 10) reported a current girlfriend/boyfriend. Adolescents were interested in dating regardless of their romantic relationship status, with 85% reporting that they want a romantic relationship “right now.” 3.2. Romantic relationships conceptualization As seen in Table 3, more than half of participants (58.1%; N = 18) reported that companionship was the defining feature of a boyfriend/girlfriend (sample responses included “Like a best friend, someone you know”). Over one quarter (38.7%) of participants described intense emotions as a key characteristic of romantic relationships (e.g., “When you really really love very much”), followed by dating (25.8%; e.g., “Go on a date”), physical contact (16.1%; e.g., “Girlfriend is when you get to … touch them and stuff. When you hug them”), and commitment (16.1%; e.g., “A girlfriend marries a guy”). Only four (12.9%) participants noted intimacy as a key feature (e.g., “Somebody who you're close to … you can share your emotions with, your hopes and dreams, and you can share your love for them … and how you feel about them”), and six (19.4%) reported their descriptions (e.g., “like a partner”, “a gentleman”, “when someone is shy”) which could not be coded into the expected categories. More than half of adolescent participants (58.1%; N = 18) provided responses that fell into more than one category. For example, participant responses included “Who you love to spend time with. You like to kiss them.” No significant gender differences were found in terms of how adolescents described romantic partners for any of the coding categories. The majority of youth (85.7%) were able to provide specific examples of how a romantic partner and a friend differ, such as “Kissing is only with girlfriend, not friend,” however; a small group of adolescents (14.3%) demonstrated some confusion in this regard. This subgroup indicated being “unsure” of this distinction or reported that a friend and a romantic partner were the “same.” Table 3 Percent of youth responses within coding categories for definition of a boyfriend/girlfriend. Category

Passion Intense Emotions Physical Contact Affiliation Companionship Dating Intimacy Commitment Other

Males (N = 21)

Females (N = 10)

Total (N = 31)

N

%

N

%

10 5

47.6 23.8

2 0

20 0

12 5

38.7 16.1

14 6 2 2 2

66.7 28.6 9.5 9.5 9.5

4 2 2 3 4

40 20 20 30 40

18 8 4 5 6

58.1 25.8 12.9 16.1 19.4

43

N

%

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Table 4 Sample responses for Each Theme in Response to “What is a boy/girlfriend?”. Organizing Theme

Sample Response

Passion

A girl who you love … hugging, kissing You like to kiss them When you really really really love very much

Affiliation

Like a best friend, someone you know A girl who you love and like to spend time with Someone you can date with either of the same sex or opposite

Intimacy

Someone you enjoy conversations with You can turn to him if have problems Somebody who you're close to, you can share your emotions with, your hopes and dreams, and you can share your love for them … and how you feel about them.

Commitment

He is always with me Don't do anything wrong [with boyfriend], like cheating. Someone you marry, have children [with]

Participants most commonly (N = 12; 42.9%) indicated commitment as the key differentiating feature between a friend and a romantic partner. Participants noted “A girlfriend you marry her, take her out for dinner … don't do with a friend” and “Girlfriend like a wife, when you're married … husband and wife, friend see each other at school.” Twenty-one percent of participants noted physical contact as the main difference between a romantic partner and a friend (e.g., “Girlfriend you can kiss them, friend can talk to them but can't kiss or touch them”), followed by dating (17.9%; e.g., “You can go on dates with your girlfriend [not friend]”), intimacy (17.9%; e.g., “That's very simple … female friend … you can't be intimate with them, well usually can't … with a girlfriend you can. And … with female friend you are not able to always express yourself emotionally. And with a girlfriend you can without always having fear of being judged or looked down on”), passion (14.3%; “Friend can just talk about anything, girlfriend you do touching, kissing, go to movies, sex … don't do that just with friend”), and companionship (7.1%; e.g., “Friend hangs out with you just for a day, a boyfriend hangs out with you all the time - every day - and stays with you every night, watches TV with you”). Further examples of responses for these themes are provided in Tables 4 and 5. A 2 × 2 chi-square analysis did not yield any significant gender differences in any of the coding categories. 3.3. Dating stage As assessed by the DQ, there was a significant difference in the percentages of youth endorsing each of the dating stages, χ2 (1, N = 31) = 27.19, p = .03. Significantly more youth indicated having predominantly Cross-Sex Affiliation rather than Dating, χ2 (1, N = 31) = 6.53, p = .01, or Dyadic Romantic Relationships, χ2 (1, N = 31) = 14.14, p < .01. Ordinal chi-square analysis did not yield significant gender differences. 3.4. Dating autonomy granting Paired t-tests showed that the Dating subscale significantly differed between parents and youth t (28) = 3.72, p < .001. Overall, parents rated their adolescent's readiness to engage in dating activities to be significantly older than adolescents: 32% (N = 10) of Table 5 Sample Responses to Themes in Response to “What is the difference between a female/male friend and a girl/boyfriend?”. Organizing Theme

Sample Response

Passion

Kissing is only with girlfriend, not friend With a girlfriend you have sex, [not with a friend] Friend is just a friend, hanging out, not holding hands. Boyfriend is someone you hold hands with, cuddle …

Affiliation

one of them like a classmate (friend) and one of them like a fiance (girlfriend) Can go to a park with friends, boyfriend go out for dinner, see a movie. … You can go on dates with your girlfriend

Intimacy

Female friend … you can't be intimate with them, well usually can't … with a girlfriend you can. And … with female friend you are not able to always express yourself emotionally. And with a girlfriend you can without always having fear of being judged or looked down on Boyfriend helps you and understands more [than a friend]

Commitment

A girlfriend you marry her, take her out for dinner … don't do with a friend (marriage) girlfriend like a wife, when you're married … husband and wife, friend see each other at school

44

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parents indicated 15–17 years old, 55% (N = 17) noted 18 or older, and some (13%; N = 4) felt their youth would “never” be ready to date. In contrast, 10% (N = 3) of adolescents noted being ready to date before 12 years-old, another 10% (N = 3) felt ready between 12 and 14 years-old, 45% (N = 13) of youth reported being ready between 15 and 17 years old, 31% (N = 9) rated being ready at 18 or older, and 3% (N = 1) indicated “never” being ready to date. Dating autonomy was significantly linked with romantic awareness, r (29) = .50, p = .01, but not with dating stage or with gender. Relationship Education. Paired t-tests of the relationship education sources consistently revealed that parents were adolescents’ primary source of relationship education compared to all other sources (e.g., social observation, formal relationship, peers/friends, media, siblings, other). The association between relationship education source and romantic awareness revealed that learning about relationships from social observation, t (28) = −2.55, p = .02, and from the media, t (28) = −2.01, p = .05, was associated with significantly better romantic awareness. Adolescents reported increased knowledge about how to initiate relationships when they learned about relationship education through social observation (M = 3.40, SD = 1.06), t (28) = 2.21, p = .04, or from peers/friends (M = 3.50, SD = 1.10), t (28) = 3.71, p < .001. Dating stage did not differ significantly among the various education sources. IDD and ASD: Social Competence, Dating Stage and Romantic Awareness. Consistent with our hypothesis, youth with additional ASD diagnosis (M = 17.33, SD = 8.51) were less socially competent (based on CSBQ measure) than youth with IDD only (M = 12.11, SD = 5.77) only, t (29) = 2.04, p < .05. Closer examination revealed that adolescents with ASD demonstrated a more limited understanding of social cues than their IDD counterparts (IDD: M = 1.40, SD = .48; IDD/ASD: M = 0.89, SD = .51), t (29) = 2.84, p < .01, but the tendency to withdraw from social situations did not significantly differ across groups (IDD: M = 0.78, SD = .40; IDD/ASD: M = 0.51, SD = .34), t (28) = 1.98, p = .06. Youth without ASD diagnosis demonstrated better overall romantic awareness (IDD: M = 1.06, SD = .17; ASD: M = 1.39, SD = .31) t (28) = 3.77, p < .001, awareness of different types of romantic relationships, χ2 (1, N = 30) = 12.80, p < .001, and significantly more knowledge of how to initiate relationships (IDD: M = 3.33, SD = 1.08; ASD: M = 2.33, SD = 1.23), t (28) = −2.35, p = .03, than youth with ASD diagnosis. There were no significant differences between these youth in knowledge of sexual behaviour or in their dating stage. 4. Discussion The present study makes an important contribution to our understanding about romantic experiences and romantic conceptualizations among youth with IDD. Results revealed that social competence and comorbid ASD play a significant role in adolescents’ understanding of romantic relationships. Findings also demonstrate that the majority of adolescents with IDD currently desire a romantic relationship and almost half have had some previous romantic experiences. 4.1. Romantic conceptualization Youth varied in their understanding of romantic relationships. Among adolescents who were able to make this distinction, romantic relationships were conceptualized as serious, stable, committed for life, and offering primarily companionship. These responses are in contrast to literature in the typically developing adolescent population, who tend to characterize romantic relationships primarily by passion (Connolly et al., 1999; 2014). These qualitative differences may reflect differences in general relationship attitudes among youth with IDD; for example, a study on friendships of adults with IDD identified that individuals tended to engage in friendship maintenance behaviours (i.e., telephoning, extending dinner invitations, praying for one another, asking assistance, remembering important occasions, offering support) more often than their typically developing peers (Pottie & Sumarah, 2004). Findings from this study suggest a need to educate youth with IDD about the difference between romantic relationships and friendships, including their role and functions. 4.2. Dating Stage Similar to typically developing adolescents (Connolly et al., 2004), youth with IDD reported engaging in dyadic dating experiences, as well as cross-sex affiliations. These findings contrast the notion that individuals with IDD are socially isolated and tend engage in more solitary activities (Solish et al., 2010). Since research shows that mixed-gender groups increase romantic interest as well as romantic involvement (Connolly et al., 2004), it is possible that these cross-sex experiences contribute to the process of romantic development. In comparison to the literature on typically developing adolescents, youth with IDD appeared to be delayed in their dating stage. In the typically developing population, results of several large US time-lag surveys of 8-12th graders suggest that approximately 43% of 8th graders, 57% of 10th graders and 63% of 12th graders, report ever going on a date (Twenge & Park, 2019). Similarly, 69% of 8th graders, 73% of 10th graders and 85% of 12th graders, report going out without their parents at least once a week (Twenge & Park, 2019). In another study of typically developing youth, 50% of 15-year-olds report having a previous or current romantic relationship, and this number increases to 70% by age 18 (Carver, Joyner, & Udry, 2003, Dixon-Woods, Agarwal, Jones, Young, & Sutton, 2005). This is in contrast to only 48.4% of older adolescents with IDD in our study. In fact, adolescents with IDD in our study were more similar in their dating stage to typically developing young adolescents (i.e. 9–14 years) than their same age peers. For example, Connolly et al. (2004) found that 82% of typically developing early adolescents engaged in mixed-sex friendships, 24–31% casual dating in groups, and 26% dyadic dating. 45

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Although we do not know whether their dating trajectory is the same as on-time daters, studies have not found any association between delayed dating stage and later maladjustment (Connolly et al., 2013). Longitudinal studies examining dating development among typically developing youth and those with IDD are necessary to understand how adolescents progress through dating stages and whether these experiences differ.

4.3. Parental autonomy granting Since adolescents with IDD are more sheltered by parents (Clark et al., 2004; Saaltink, MacKinnon, Owen & Tarfif-Williams, 2012; Walker-Hirsch, 2007), which has been linked to fewer social opportunities to interact with peers (Walker-Hirsch, 2007), it was surprising that our study found parental autonomy was not associated with dating stage or romantic awareness. Adolescents indicated significant disagreement with their parents in regard to dating autonomy. This is consistent with more general research on parental autonomy granting among youth with IDD (e.g., Bigby, Whiteside, & Douglas, 2017; Saaltink, MacKinnon, Owen & TarfifWilliams, 2012), however, this is the first study to demonstrate how much parents' and adolescents' attitudes differ in terms of dating behaviours. Since dating autonomy clearly plays an important role in adolescents and parents dating expectations, as well as in adolescents’ romantic awareness, it is important to explore this concept further in future studies.

4.4. relationship education The present study found that the majority of youth with IDD learn about romantic relationships through their parents. This is consistent with the literature in this area which suggests that children and youth with IDD spend more time with their parents (e.g., Walker-Hirsch, 2007) and that young adults with IDD rely more on parents for relationship education (Bucknall, 2005; Grant & Fletcher-Brown, 2004). However, it is concerning that parents of youth with IDD may be hesitant to discuss romantic issues with their child for fear of encouraging sexual activity (Ballan, 2012; Grant & Fletcher-Brown, 2004; Walker-Hirsch, 2007), or because they feel unprepared to address the content or questions that may arise (Allen & Seery, 2006; Isler et al., 2009). Contrary to these concerns, our study found that discussing romantic relationships with parents did not necessarily lead to higher dating stages. In fact, the majority of adolescents held very serious attitudes about romantic relationships, which they conceptualized as characterized by companionship and commitment. Results also showed that formal sex education was not predictive of adolescents' romantic awareness, a finding which may suggest that existing relationship education programs are not consistently effective in addressing at least some topics related to romantic relationships. Results also identified that social observation, peers/friends, and the media played a significant role in adolescents’ knowledge about how to initiate relationships. These findings are important in that they highlight the need to provide youth with IDD with social opportunities and appropriate media access.

4.5. Youth with IDD compared to youth with ASD Youth with IDD demonstrated better social competence and awareness of different types of romantic relationships, as well as greater knowledge about how to initiate relationships, compared to youth with ASD. Importantly, the majority of adolescents in this study expressed a desired to have a romantic relationship “at this time,” yet social skills and social awareness play an important role in developing relationships (e.g., Stokes et al., 2007). Youth who do not have the skills or experience to form more complex romantic relationships often demonstrate a developmental lag, whereby they may gain higher levels of social and romantic functioning with age, but this process occurs at a slower rate than among their typically developing peers (Stokes et al., 2007).

4.6. Limitations There are a number of limitations of this study that must be acknowledged. One of our limitations is that with 21 males and 10 females in our sample, we have low power. Our results, although relevant given the paucity of similar studies in this population, are best considered exploratory and strong evidence must be declared only upon replication of the findings. Non-significant results can only be interpreted as evidence in favor of the lack of large effects, and are best interpreted as non-conclusive. Additionally, the crosssectional design of this study limits some of our conclusions, such as understanding how youth with IDD progress through dating stages over time. As well, although some of the instruments used in this study have been standardized with the IDD population, others were modified for the purpose of the study, such as adding visual aids to questions. Nevertheless, efforts were made to maintain good reliability and validity, and all qualitative measures demonstrated good internal consistency and inter-rater reliability. Third, while our study asked participants about their sexuality, further exploration of this topic needs to be conducted; evidence suggests that lesbian, gay, bisexual, transgender and queer (LGBTQ) youth with disabilities may have unique romantic experiences compared to their heterosexual counterparts (Duke, 2011; Hillier et al., 2019). Finally, the results of this study are limited to youth with mild IDD. Adolescents with moderate or severe IDD may display different behaviours and desires for romantic relationships. Indeed, research shows that individuals with mild IDD tend to have more friendships (Stokes et al., 2007) and sexual experiences (Cheng & Udry, 2005) than youth with moderate or severe levels of IDD. 46

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5. Conclusions This is the first study of its kind to specifically address the romantic conceptualization, awareness, and dating stage of youth with IDD. Results identified that romantic relationships are an important and salient part of these adolescents’ lives, dispelling the myth that individuals with IDD are hypersexualized or tend not to form or desire these kinds of relationships. Unfortunately, beliefs like this continue to influence how some people treat individuals with IDD, thus it remains an important issue to address to enhance quality of life for this population. Adolescents varied in their understanding of romantic relationships, highlighting a need for open dialogue and education on this topic among parents, educators, and clinicians. Declaration of competing interest None. References Allen, M., & Seery, D. (2006). The current status of sex education practice for people with an intellectual disability in Ireland. 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