Adolescence, Brain Injury, and Sexuality

Adolescence, Brain Injury, and Sexuality: Promoting Sexual Health

By Carolyn Rocchio

Puberty is the initiation of many hormonal and physical changes in the body – all of which frame a teenager’s identity, sense of self, independence and world view (Barton & Tepper).

The transition from childhood to adolescence is fraught with many physical and emotional changes. It can be a difficult time for the child and parents alike. Most families experience a period of major adjustment to the child’s changing mannerisms, quest for privacy and greater independence. When a child experiences a brain injury, either at a younger age or during this period of transition, it commonly creates many more problems than a child arriving at this age without a brain injury.

What does research tells us about adolescents and brain injury?

Research has been limited but a few studies have indicated that these youngsters:

•  have more than average difficulties in how they view themselves

•  often experience depression

•  function better when gender identity was well established before the injury.

•  will have difficulty with social behavior, such as, inappropriate touching, sexual aggression, and exhibitionism.

Rehabilitation professionals need to be knowledgeable about sexual development when treating these youngsters.  Sexual development includes physiological development, psychological development, social development and development of sexual knowledge (Barton & Tepper). Puberty is a time when adolescents can be highly emotional as they try to figure out issues relative to their development of self-esteem.  Changes in communication skills after a brain injury can make it even more difficult for adolescents to develop socially, understand relationships, identify gender roles, comprehend sex education, use contraception, and take responsibility for their actions.

Just as adults may experience hyposexuality and hypersexuality, so too do adolescents. When adolescents seem to have little or no interest or curiosity about sexuality, as most youngsters normally do at an age when hormones begin raging, they may be experiencing hyposexuality. The opposite effect of hypersexuality can become a very difficult behavior management issue. These adolescents often make crude remarks indiscriminately, masturbate or exhibit their genitals in public, tell off color jokes and display socially unacceptable behavior.

Congenital vs. Acquired Brain Injury

Adolescents normally experience a myriad of changes during adolescence.  Transitioning through this phase can be very emotional and puzzling at times as their bodies change along with their self perception. An injury at birth prepares a child very differently for the adolescent experience. Congenitally injured youngsters are often subjected to many tests and evaluations as they pass through their developmental years.  They may view their bodies as objects of evaluations. “Human touch has objectified the child’s body and it is not uncommon for children born with brain injuries to be unable to distinguish {good touch} from {bad touch.” (Barton and Tepper). They may experience a blurring of the line between what is right and what is wrong.

When the brain injury occurs after birth, yet during the developmental years, the adolescent period will still have the usual changes. However, the issues may be somewhat different depending on the level of learning, life experience and cognitive preservation. All adolescents experience some degree of cognitive change as a normal consequence of hormonal changes, such as:

•  poor problem solving and judgment

•  impaired reasoning skills 

•  memory and attention difficulties

•  mood swings

•  disinhibited thought and actions, an inability to judge what is private and what may be appropriate in public settings

•  inability to read social cues from others and poor ability to manage relationships

These common problems may be magnified as a result of brain injury, making management very difficult for parents as well as extended family, teachers and peers whom, for lack of understanding, often choose to distance themselves from the adolescent.

Promoting Healthy Sexual Attitudes

42-16795579Sex education is vital for developing wholesome attitudes about sex. All instruction should be clear and structured and leave the adolescent knowledgeable about body parts, sexual acts, safe sex and awareness that sexual health is not just intercourse. The goal is to help adolescents with brain injuries understand that although they may have some residual cognitive and physical deficits, they are still sexual beings. They must feel free to communicate with family, providers and others appropriately and comfortably about sexual issues and have opportunities to meet with and form relationships with others as appropriate. Families must be vigilant about monitoring abuse in all settings particularly when others besides the family are providing care. All adolescents with brain injury need help in realizing their dream to be like their peers.


Barton, B, Tepper, M. Adolescence, Brain Injury, and Sexuality: Promoting Sexual Health. Brain Injury/Professional. 7(1) 18-20, 2010.

Recommended reading:

This Fact Sheet is based on an article: Adolescence, Brain Injury, and Sexuality: Promoting Sexual Health. Brain Injury/Professional. 7(1) 18-20, 2010. Brain Injury/Professional is the largest professional circulation publication on the subject of brain injury and is the official publication of the North American Brain Injury Society (NABIS). Brain Injury Professional is published jointly by NABIS and HDI Publishers. Members of NABIS receive a subscription as a benefit of NABIS. Visit to order the entire issue or become a member.


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