Written by Laura Orchard, member of the 2025 CanFASD Trainee Program.

When working with individuals who have Fetal Alcohol Spectrum Disorder (FASD) and intellectual disabilities (ID), supporting socio-sexual development is crucial. Many people with FASD and ID experience gaps in their understanding of relationships, personal boundaries, and sexual health. As a result, these gaps can leave people vulnerable to exploitation and harm.

When we talk about FASD and healthy relationships, there is a lot to consider. It’s not just about physical health, it’s about emotional well-being, relationships, and, in many cases, understanding boundaries and appropriate behaviour. This is where assessment tools like the SSKAAT-3 (Socio-Sexual Knowledge and Attitudes Assessment Tool) become invaluable. While the SSKAAT-3 has been validated for use with people with intellectual disabilities, it has not yet been formally validated for people with FASD. However, it may offer promising insights for supporting socio-sexual education in this population. In this post, we will explore how this tool could help identify learning needs and support safer, more informed decision-making in relationships and sexual health.

The need for socio-sexual education

People with FASD and intellectual disabilities have the same capacity for connection and intimacy as anyone else. But for many, learning how to build healthy relationships or set personal boundaries may not be so straightforward. Social skills like reading body language, knowing when and how to say no, or recognizing risky situations don’t always come naturally to people with neurodevelopmental differences, leaving gaps in understanding. Without support, these gaps can make everyday interactions more difficult or even unsafe.

There are many reasons these gaps exist. For instance, some individuals may not have had access to clear or consistent sexual education. Others may have missed out on informal learning opportunities such as spending time with classmates outside of school or going on dates, simply because of social exclusion. Additionally, outdated beliefs about the sexuality of people with disabilities have often led to this area of learning being overlooked.

These missing pieces can make it more difficult for people with FASD or ID to advocate for themselves or recognize when something doesn’t feel right. That is why education in this area needs to be intentional and personalized. To truly support someone’s learning, we first need to understand where they’re starting from. By identifying areas where each person may need more guidance, we can create more meaningful education plans. This is exactly where the SSKAAT-3 can make a difference.

What is the SSKAAT-3?

The SSKAAT-3 is an online and in-person assessment tool, recently revised by Dr. Shelley Watson, and is currently validated for use with persons with intellectual disabilities. This updated version reflects a stronger focus on inclusion, cultural responsiveness, and real-world relevance.

Here’s what it includes:

• Visual Assessments: The tool uses pictures and drawings to depict social situations, making it accessible to individuals who may have limited language or reading skills.
• Knowledge and Attitude Questions: The tool covers topics such as sexual health, relationships, and consent, while also exploring how individuals feel about these subjects.
• Situational Problem-Solving: The SSKAAT-3 asks what someone would do in different real-world scenarios. This helps caregivers and educators understand how individuals think through challenges and whether they can apply their knowledge.
• Updated Content: The newest version of this tool includes discussions about internet safety, different contraception options, and more inclusive representations of gender, culture, and sexuality.

Exploring the SSKAAT-3’s potential for FASD

While the SSKAAT-3 has not been formally validated for individuals with FASD, it may offer a helpful starting point for assessing socio-sexual knowledge and attitudes in this community. Its visual, situational, and conversational design may align well with the learning needs and cognitive profiles often associated with FASD.

1. Identifying Knowledge Gaps and Addressing Specific Needs. The SSKAAT-3 can help families, educators, and clinicians design education that is personalized, based on an individual’s current level of understanding.
2. Promoting Healthy Attitudes Toward Relationships, The way people think about relationships matters. The SSKAAT-3 helps open conversations about respect, boundaries, and consent, which are key to fostering safe, positive connections with others.
3. Enhancing Social Problem-Solving Skills. Real-life situations aren’t always black and white. That’s why the SSKAAT-3 includes scenarios like, “If someone asks for a hug, what should you do?”. These prompts help assess whether a person can respond thoughtfully and safely in different social situations.
4. Increasing Self-Advocacy and Confidence. Knowledge builds confidence. When people understand their rights and know how to set boundaries, they are more likely to advocate for themselves in relationships, friendships, and everyday life.

Using the SSKAAT-3 in practice

Though more research is needed to validate the SSKAAT-3 for FASD populations, its structure and approach may still offer value in exploratory contexts. Here’s how it will be used in broader settings, and how it might be adapted:

• Creating Tailored Educational Plans: The results can guide the development of specific lessons or conversations about hygiene, relationships, or safety, depending on the individual’s needs.
• Ongoing Monitoring and Support: People grow and change over time. Re-administering the assessment can help track progress and keep the learning relevant.
• Engaging Families and Caregivers: Families play a central role in helping individuals apply what they learn. The SSKAAT-3 can help open up communication and guide caregivers in offering consistent, supportive guidance at home.

A tool for empowerment

The SSKAAT-3 is more than an assessment tool. It’s a starting point for meaningful conversations and impactful sexual education. Although the SSKAAT-3 is not yet validated for use with individuals with FASD, it presents a promising opportunity to better understand and support learning in socio-sexual development. For people with FASD and IDs, it can create a pathway to safer relationships, stronger boundaries, and greater independence. By using this tool, we can ensure that people are not left out of important conversations about sexuality and safety. With the right support, they can feel confident, respected, and empowered to make informed decisions about their bodies and their relationships.

See this information letter to learn more. If you or someone you support would like to participate in the development of the SSKAAT-3, I would love to hear from you. Please feel free to reach out to me directly at lorchard1@laurentian.ca. Thank you for helping us make this tool more inclusive, supportive, and empowering for everyone who uses it.

Laura Orchard is a Master’s student in Interdisciplinary Health at Laurentian University. She is dedicated to improving health equity and well-being in northern and rural communities and is committed to supporting individuals with FASD, their families, and those who support them.