‘Issues within Puberty & Sexuality in people with Autism Spectrum Disorders’

1. ‘Issues within Puberty & Sexuality in people with Autism Spectrum Disorders’ Lynne MoxonESPA, Northumbria University

2. Building social relationships by making friends and establishing intimate partners is a key developmental life stage for young adults

3. “ Before I turned sixteen years old I became sexually active. Had anyone asked me if I were, I probably would have said no, only because I did not comprehend what “sexually active” meant. I can now comprehend the term, but not always the degree of “activity” that accurately defines “sexually active””. (Snyder 2006 p.121)

4. Young people are increasingly bombarded by sexual images and there is an increase in casual sex • 60% of children,12 to 15 have seen porn online • Boys may be pressurised into having sex • Girls as young as 12 feel they should be shaving their pubic hair • There is a dangerous lack of knowledge about STIs

5. However, individual interest in sex or in developing an intimate sexual relationship with another person varies widely across individuals at all ability levels • As such, there is a significant need for group and individualised effective instruction for people with ASD across the ability spectrum (Henault and Attwood Hellemans et al 2007)

6. Sexuality is a part of life and is as developmentally appropriate for people with autism as anyone else Hellemans 2001 Heterosexuality 50% Homosexuality 4% Bisexuality 13% Asexuality or undetermined 25% 8% heterosexual paedophile

7. Sexuality education should be proactive • Griffiths, (1999) notes that most learners with a developmental disability receive sexuality education only after having engaged in sexual behavior that is considered inappropriate, offensive or potentially dangerous..

8. Social competence • Levels of perception, cognition and connected communication are fundamental in determining whether a relationship progresses into friendship, along with shared interests, fantasy, humour and self-disclosure (Dodge, Pettit & McClaskey, 1986, Dunn, 1993)

9. Mere exposure to appropriate, social situations does not help a child with ASD improve their social skills, or there would not be a problem in the first place (Jordan & Jones, 1999) rather specific interventions which aim to remediate the core deficit in social functioning are necessary (White, 2002; Jordan & Jones, 1999; Aarons & Gittens, 1998; Donnellan & Kilman, 1986)

10. People with ASD desire intimate relationships, yet they lack the appropriate skills and knowledge to initiate such relationships successfully (Henault & Attwood, 2002; Stokes & Kaur, 2005) • Due to their social ineptness, some people with ASD may naively engage in inappropriate or intrusive courtship behaviours, including stalking, in their attempts to initiate a relationship (Stokes, Newton & Kaur 2007)

11. Sexual expression in individuals with autism may easily be mistaken as deviant… Difficulty in learning adaptive social behaviours in an unstructured fashion, recognising subtle affective cues, communicating accurately and competently with others, taking the perspectives of other individuals and considering their own and others’ viewpoints may confound sexual development and contribute to inappropriate sexual behaviours Realmuto and Ruble 1999

12. “ Chatting someone up is not that different to an interview. Don’t forget to look at their face more than two thirds of the time whilst listening or speaking and smile a bit. If they are doing the same, it means they like you.” (Segar 1996) • “ I don’t like to masturbate because I think of all of those thousands of children who will never be born.” (Harocopus 1996)

13. “An autistic teenager, 18, who groped two care workers has been sent to a mental health hospital indefinitely.” (2005) • Solicitor with AS aged 35, given a three-year sentence for the attempted rape of a woman solicitor after a ball. He told police: “I spent £200 on her. Why can’t I do what I did to her?”

14. Goals of a comprehensive sex education programme • Provide accurate information • Develop personal values • Develop the necessary social competence • Use ‘scripts’ to give an approximate idea of rules and expectations, what to do in different situations

15. What should be included in a sex education programme? • BODIES- women’s and men’s bodies, naming of private parts, the • Differences and similarities • Growing up and puberty • Menstruation and menopause • Hygiene • Body parts and functions

16. What do you see?

17. Sex - physical and practical aspects • Masturbation • Same sex activity - including consequences. Sexual health information • Heterosexual activity - including consequences. Information on pregnancy • Contraception, - sexual health information • Different kinds of sex

18. Relationships • Family relationships • Friendships • Boyfriends/girlfriends • Relationships with staff • Internet sex • The needs of individuals will vary according to ability and experience

19. How to get a second date

20. Sex - social aspects • What does sex mean? • Why do people do it? • How do we learn about sex? • Who can/can’t we have sex with and why? • Consent • Right times and places – public and private • Keeping safe, socio-sexual rules, norms and values, • Discrimination skills (which behaviour is appropriate in which situation, place, and time?)

21. Will I get into trouble?

22. Sex - keeping safe • Good and bad touching • Pressures to have sex • Who makes decisions about sex • Reasons for saying no, role-play saying no • What to do to try to prevent abuse • What to do if it happens

23. Personal space

24. ASD Specific Areas • Emotional guidance and support (explaining autism, acceptance of the sexual and relational limitations related to ASD, searching for alternative ways of satisfying sexual expression); counselling in dating skills and development of an intimate relationship (emotional reciprocity, perspective-taking, setting and accepting limits, responsibility, norms and values)

25. The Private Parts Rules • If it has to do with PRIVATE PARTS, then • It is to be done at a PRIVATE TIME, and • In a PRIVATE PLACE and • If it involves someone else I need his/her PERMISSION OR CONSENT

26. Use visuals and explicit pictures

27. Social Story It is OK to have an erection or hard-on while at school. When this happens I will ask the teacher to be excused to go to the bathroom. I will not talk to others about my erection. I know that this is a private thing and it is natural. Erections happen to all boys at some time. Social Stories for Sexuality Education for Persons with Autism/Pervasive Developmental Disorders - Balazs Tarnai & Pamela S. Wolfe Sexuality & Disability (2008) 26:29-36

28. Koller (2000) gave a short overview of teaching methods and sexuality curricula for people with autism. She concluded that the question is not if sexuality education can or should be provided for individuals with autism, but how it will be offered

29. Aston, M. (2003) Aspergers In Love. Jessica Kingsley Press • Attwood S. and Powell J. (2008) Making sense of Sex, Jessica Kingsley • Henault, I (2003) in Asperger Syndrome and Adolescence Ed. Liane Holliday Willey. Jessica Kingsley • Henault I (2006) Aspergers Syndrome and Sexuality, Jessica Kingsley • Kerr Edwards, l. and Scott, L. (2003) Talking together about sex and relationships, fpa • Kerr Edwards, l. and Scott, L. (2005) Talking together about contraception. Fpa and Teenage Pregnancy Unit • Newport, J. and Newport, M. (2002) Autism-Asperger’s and Sexuality: Puberty and Beyond. Future Horizons Inc. • Schwier, K.M. and Hingsburger, D. (2000) Sexuality: Your sons and daughters with intellectual disabilities. Paul H. Brookes • Slater-Walker, G. and Slater-Walker, C. (2002) An Asperger Marriage. Jessica Kingsley Publishers. • Wrobel, M. (2003) Taking Care of Myself. Future Horizons inc.