Associations among stress perception, clinical symptoms, and hippocampal subfield volumes in first-episode patients with schizophrenia.

Individuals with intellectual and developmental disabilities (IDD) who identify as lesbian, gay, bisexual, transgender, or queer+ (LGBTQ+) experience compounded discrimination resulting from the intersection of disability and sexual or gender minority identities (–). Diagnosed before the age of 22, IDD are characterized by limitations in intellectual functioning and adaptive behavior that affect every day social and practical skills (). Harmful misconceptions about the sexuality of individuals with IDD include being perceived as either asexual or hypersexual—a false and harmful dichotomy that negatively affects autonomy and leads to increased social exclusion (–). For LGBTQ+ individuals with IDD, these ableist assumptions intersect with heteronormativity and cisnormativity, contributing to marginalization and limiting access to affirming services and supports, placing them at a higher risk of sexual victimization and adverse health outcomes (, , –). Direct support and service-providing professionals (DSPs) hold a critical role in shaping the quality, inclusivity, and responsiveness of services for individuals with IDD. Providing inclusive services, resources, and support across service settings has the potential to enhance well-being and foster more fulfilling lives for LGBTQ+ individuals with IDD. Through everyday interactions, policy implementation, and advocacy, DSPs influence whether LGBTQ+ identities are affirmed or further marginalized within service-providing settings. However, research indicates that although some professionals consider sexual health as part of their professional practice (–), many report feeling underprepared, uncomfortable, or lacking confidence when addressing sexuality topics with individuals with IDD (–). These challenges stress the need for structured, identity-affirming professional development that prepares DSPs to provide equitable and culturally-responsive services and care. The experiences of LGBTQ+ individuals with IDD are best understood through an intersectional framework. Intersectionality, introduced by Kimberlé Crenshaw (), posits that social identities such as disability, sexual orientation, gender identity, race, and class do not operate independently but interact within broader systems of power. Rather than representing additive forms of disadvantage, these identities intersect within structures shaped by ableism, heteronormativity, and cisnormativity, producing unique patterns of marginalization and access to resources. Intersectionality has been widely applied across public health and social sciences (–) to examine how structural inequities shape lived experience and well-being among multiply marginalized populations. Applying this lens to LGBTQ+ individuals with IDD highlights the need for service models that explicitly address intersecting identities rather than relying on disability or LGBTQ+ frameworks alone.