Autism Spectrum Disorder

Autism Spectrum Disorder and Sexuality:

Due to the nature of ASD in that it manifests on a spectrum of functional abilities, addressing sexuality with those with ASD must be approached with the client's specific functional abilities in mind.

Sensory modulation is an important consideration for this population and will impact the manifestation of their behaviors through the lifespan, including during puberty.

Due to inability to understand social cues, those with ASD learn about courtship through any means of observation. With this in mind, it was found that what they learned from sources outside of their peers (parents, social media, siblings, sex education, and observation) negatively impacted their behaviors in romantic relationships. (Pritchard, Kordes, & Hoffman, 2012, p. 244)

Despite difficulties in social participation, some individuals with ASD want the things that they see others have, including dating, intimacy, and marriage.

Barriers:

  • ASD at any point on the spectrum is characterized by difficulty with social participation, with avoidance of eye contact, social interaction, and interest in objects rather than people.
    • Those who are "high-functioning" may want to interact with peers, but will have extreme special interests and difficulty navigating or understanding social situations.
    • Most are unable to read social cues and will be unable to differentiate social relationships, understand body language, paralanguage, and other external cues.
      • Would also likely be unable to understand who might be a "dangerous" person or someone who they cannot trust.
      • Social skills impact their ability to form intimate relationships due to their social behaviors and tendency to be rigid.
  • Limitations in communication abilities, possibly non-verbal.
  • Unless taught, those with ASD are unaware of privacy rules or what constitutes inappropriate or sexual behavior (Pritchard, Kordes, & Hoffman, 2012, p. 243).
  • Those with ASD do not understand how their behaviors are received by others and can lead to stalking behaviors when attempting to pursue a romantic relationship with someone who is neurotypical (Pritchard, Kordes, & Hoffman, 2012, p. 244).
  • Rigid adherence to routines and predictability can be impacted by new experiences, including puberty.
  • People with autism have lower knowledge regarding sexual activity and report less access to sexual health education than typical peers (cite)

Specific Suggestions:

  • Utilize sensory modulation techniques prior to engaging your child in learning about sexuality at their individual level so that they can attend to the information that you are providing them.
  • Early on, utilize techniques such as social stories to teach what behaviors are expected or unexpected (or inappropriate) in social situations.
  • If the child receives ABA therapy as an adjunct service, you can recommend that sexuality be incorporated into their program if ABA is something that has been successful for them in the past.
  • If the child uses alternative forms of communication, possibly even through behavior, provide them with the ability to communicate with you while learning about sexuality or appropriate behaviors. Avoid using language that is not explicit or may have alternative meanings or be unclear to an individual with ASD.
  • Even if a child does not communicate, it does not mean that they do not understand and they still need to be taught about human sexuality.
  • Teach explicitly what behaviors are or are not private or inappropriate, how to withhold consent from sexual acts, and what constitutes a sexual act. If children with ASD do not understand the difference they are at a higher risk for sexual abuse. (Sexuality Resource Center for Parents, n.d.)
  • Teach the child to be open and report to the parent or another adult when they believe that something "bad" or inappropriate has occurred. (Sexuality Resource Center for Parents, n.d.)
  • It is important to teach your pre-teen about puberty before their body starts developing. Otherwise, a girl may think she is bleeding to death when she has her first period. (Sexuality Resource Center for Parents, n.d.)
  • Usually, teens with ASDs are emotionally less mature than their peers without autism. They may not be ready for some information about intimacy and sexuality, but they will need to have some sexuality education to reduce the risk of behaving inappropriately or being sexually abused. (Sexuality Resource Center for Parents, n.d.)
  • Sexuality talks with pre-teens and teens who have problems with eye contact may work better if you are not sitting face-to-face. Try talking while you walk side-by-side or work on a parallel task together. (Sexuality Resource Center for Parents, n.d.)
  • Use multiple sensory input in order to better establish learning. (Sexuality Resource Center for Parents, n.d.)
  • Be patient in teaching sexuality to someone with ASD, as it will take more time to have a full understanding.
  • Utilize social scripts to provide the child with a memorized list of phrases that are appropriate for them to use. This will provide them with the words to say when they are unsure. You can provide role-play scenarios to allow them to practice these skills. (Sexuality Resource Center for Parents, n.d.)
  • Make rules. Many children with ASD are driven my rules. So, you can make explicit rules about behaviors and work on establishing those in their daily routines. (Sexuality Resource Center for Parents, n.d.)
  • Practice "what if?" scenarios to prepare the child for any situation that you deme necessary for them to feel prepared to face. Examples: "what if you start your period at school". (Sexuality Resource Center for Parents, n.d.)
  • Sexuality education for people with autism should include the following sections:
    • Personal hygiene skills, including managing menstruation
    • Types of contraception and proper use
    • When and where sexual behavior is appropriate
    • Social skills training for dating behaviors
    • Safety regarding internet dating
  • Resource for dealing with masturbation behaviors. (Sexuality Resource Center for Parents, n.d.)
  • Resource for teaching privacy circles for prevention of sexual abuse. (Sexuality Resource Center for Parents, n.d.)
  • Resource for teaching dating and relationship skills. (Sexuality Resource Center for Parents, n.d.)

Sample Social Story: (Sexuality Resource Center for Parents, n.d.)

    • My name is Jason. I am a student at Rosa Parks Middle School.
    • I like several girls in my class. I like to go up and touch them. Although I like to touch them, the girls don’t like it at all. They often yell at me or tell the teacher.
    • I get to decide who touches my body. Now I must learn that the girls also get to decide if they want to be touched. It’s okay for me to ask the girls if I can touch them, but if they say “no,” then I must not touch them.

Social Mapping Example: (Sexuality Resource Center for Parents, n.d.)

References

Pecora, L. A., Mesibov, G. B., & Stokes, M. A. (2016). Sexuality in high-functioning autism: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders, 46, 3519-3556. doi: 10.1007/s10803-016-2892-4

Pritchard, V., Kordes, T. L., & Hofmann, A. (2012). Spinal cord injury and sexuality. In C. Linkie & B. Hattjar (Ed.), Sexuality and occupational therapy. Bethesda, MA: American Occupational Therapy Association.

Sexuality Resource Center for Parents. (n.d.) Autism spectrum disorder and sexuality. Retrieved from http://www.srcp.org/for_some_parents/developmental_disabilities/activities_to_use_with_your_child/autismDD.html

Tullis, C. A., & Zangrillo, A. N. (2013). Sexuality education for adolescents and adults with autism spectrum disorders. Psychology in the Schools, 50(9), 866-875. doi: 10.1002/pits.21713