7 Oct 2026
**Puberty, Boundaries & Inclusion: Supporting People with Down Syndrome with Cat Cunningham, LCSW**
Content Note: This episode includes discussion of puberty, sex education, sexuality, consent, relationships, body boundaries, and private/public behaviors. The conversation is educational and focuses on supporting people with Down syndrome with safety, dignity, informed decision-making, and independence.
The advice most parents get about puberty, boundaries, and sexuality is often too late, too vague, and too shaming.
In this episode of Where the Ramp Ends, Cat Cunningham, LCSW, from the Mass General Hospital Down Syndrome Program, breaks down the conversations families need to start early, keep going, and adapt as their child grows.
What makes this episode so valuable is how practical it gets. Cat explains why a child’s developmental age and biological age can be wildly different—and why that matters when we talk about relationships, sexuality, privacy, and independence. She also shares how to teach body safety without creating fear or shame and offers practical tools that can make these conversations easier, including anatomical language, visual teaching strategies, and the “circles” framework.
In this episode, you’ll discover:
Why puberty education should be “early and often” instead of one awkward talk
How to talk about private vs. public behavior without shame
The “circles” framework for teaching boundaries, consent, and safe relationships
How to help a child who is naturally affectionate learn social limits
Why modeling respectful greetings can be more effective than correcting in the moment
How to approach relationships and sexuality in ways that support safety, dignity, and independence
Cat also recommends trusted resources for parents and professionals, including Teaching Children with Down syndrome about their bodies, boundaries, and sexuality, along with companion guides for girls, boys, and dating. These resources can help turn overwhelming conversations into practical, teachable moments.
If you’re a parent, caregiver, educator, or clinician supporting someone with Down syndrome, this episode offers a clearer, kinder roadmap for navigating puberty, privacy, relationships, sexuality, and independence.
It’s especially valuable for families who want to prepare their child for adulthood while supporting both safety and self-determination.
This is a thoughtful, practical conversation for anyone who wants to do this well—with less fear, more confidence, and better outcomes for the people they love.
If this episode helps you, please subscribe to Where the Ramp Ends, share it with another parent, caregiver, educator, or professional who could benefit, and leave us a review. Sharing these conversations helps us reach more families and make sure people have access to information that supports inclusion, dignity, and independence.
Music: “Fields of Light” via Soundstripe.Resouces mentioned in this podcast are:
"Teaching Children with Down Syndrome about Their Bodies, Boundaries, and Sexuality" by Terri Couwenhoven
The Boys' Guide to Growing Up by Terri Couwenhoven
The Girls' Guide to Growing Up by Terri Couwenhoven
Boyfriends + Girlfriends by Terri Couwenhoven
The Facts of Life-- and More: Sexuality and Intimacy for People with Intellectual Disabilities edited by Leslie Walker-Hirsch (https://www.google.com/goto?url=CAESXAHrOzAVUMsF9F7xIqL0pTAyHfaq3hzhW3p2TfxXm-HIY_4jYz_LIdypiZ5HE3J1wM9BClE2gMJGHZibCm7YLfllz6NVmpI9AQm9nO3EFwxwwOL71PUhtn3tLgpu)
Planet Puberty: https://www.planetpuberty.org.au/ (https://www.planetpuberty.org.au/)
Puberty Relationships, and Sexuality for Teenagers with Down Syndrome (a blog post) written by the Down Syndrome Resource Federation in Canada
Circles Curriculum: https://stanfield.com/circles?srsltid=AU7gw4UhhcO0CaBG5D1Obc6OnK06xtcTXkf1Q3vDYsWMTGd1qUqpDiSq (https://stanfield.com/circles?srsltid=AU7gw4UhhcO0CaBG5D1Obc6OnK06xtcTXkf1Q3vDYsWMTGd1qUqpDiSq)
Supporting Positive Behavior in Children and Teens with Down Syndrome
by Dr. David Stein
Behavior and Down Syndrome: A Practical Guide for Parents
(companion guide also written by Dr. David Stein):
https://dsagsl.org/wp-content/uploads/2014/04/Behavior-Guide-for-Down-Syndrome.pdf (https://dsagsl.org/wp-content/uploads/2014/04/Behavior-Guide-for-Down-Syndrome.pdf)
Off to a Good Start: A Behaviorally Based Model for Teaching Children with Down Syndrome (a two-book set), by Dr. Kathleen Feeley and Emily A. Jones