Sexuality and the Autism Spectrum

1. Sexuality and the Autism Spectrum Ted Hoch, Ed.D., B.C.B.A. Jennie Kampf, M.Ed. (Almost!) August 15, 2009

2. Agenda • Safety for your child • Safety for others • Socially-sexually appropriate behaviors • Sexuality and individuals with autism • Relationships and individuals with autism

3. Safety for your child • There is evidence that individuals with disabilities experience sexual assault or abuse at rates higher than individuals without disabilities, and that victims who have some level of intellectual impairment are at the highest risk of sexual violence (Sobsey et. al, 1995). Because individuals with autism spectrum disorders (ASD) are generally taught compliance from a very young age, have difficulty picking up social cues, and may also have intellectual disabilities, they can be easy targets for criminals (Autism Society of America, downloaded on 14 August 2009) • http://www.autism-society.org/site/DocServer/domestic-abuse-lwa.pdf?docID=9722

4. Safety for your child • According to research, most people with disabilities will experience some form of sexual assault or abuse during their lifetime (Marge, 2003). • In the case of women and men with autism and other developmental disabilities, an “intimate partner” must also be defined as a caregiver, attendant, or personal assistant. Sobsey reported that the four most common categories of offenders against individuals with developmental disabilities are disability service providers, acquaintances and neighbors (including dating partners), family members, and peers with disabilities (Sobsey, 1994). Margolin (1992) reported that, controlling for relative caregiving time, male caregivers abuse those in their care more than 6.5 times as often as their female counterparts. • http://www.autism-society.org/site/DocServer/domestic-abuse-lwa.pdf?docID=9722

5. Teach independence as early as possible Ask yourself . . . “If I do it for him or her, what would others have to do for him or her?”

6. Independence • Toilet training • Dressing and undressing • Appropriate dress and appearance • Bathing

7. Independence • Menstrual care • Tending to own rashes, wounds, etc. • Brushing teeth and other hygiene

8. Independence • Locker rooms • Public restrooms • Changing rooms / fitting rooms

9. Independence • Compliance • Cooperation • Assertiveness

10. Age Appropriate Friends • Friends v. other companions • Leisure activities – solitary and social • Supervision – appropriate to age and functioning and circumstance

11. Differing levels of intimacy • Spouse or lover • Parent • Sibling • Cousin • Aunt or uncle • Teacher • Physician or nurse • Bus driver or babysitter

12. Interacting with “well meaning strangers” • Strangers who want to hug • Strangers who want to give your child “freebies” he or she has not earned or does not deserve

13. Public vs. private • Closing the bathroom door • Coming out of the bathroom or bedroom undressed • Doing “private” things in private

14. Language • Naming all body parts correctly • Language to describe and explain various sexual activities • Language pertinent to different types of relationships

15. Know the slang!!! • When my child says that, does he or she mean what the other kids are saying or is he or she just saying that? • What to do if your child says “the wrong thing”? • Know when to react and when not to react

16. Safety for Others / Social Responsibility With rights come responsibilities!

17. Age Appropriate Friends • Friends and other companions • Leisure activities • Supervision – remember that more eyes are sometimes on our kids!

18. Friendships • Friendship behaviors vs. aggressive / coercive behaviors • Friendship behaviors vs. sexually seductive / explicit behavior • Friends v. boyfriends / girlfriends • Crushes!

19. Friendships • Greetings and “okay touch” • Personal Space • Public vs. Private

20. Socially-sexually appropriate behavior Part I

21. Masturbation • Give language to this • Allow reasonable time for masturbation – if your son or daughter is interested

22. Masturbation • What to do, if it happens at school? • Interrupt! • Redirect! • Not allow! • Functional assessment, develop and implement BIP as is appropriate, get data, make data based decisions

23. Masturbation • In a “public area” of your home, what should you do? • Interrupt! • Redirect! • Not allow! • Functional assessment, develop and implement BIP as is appropriate, get data, make data based decisions

24. Masturbation • During a therapy, what should you or the therapist do? • Interrupt! • Redirect! • Not allow! • Functional assessment, develop and implement BIP as is appropriate, get data, make data based decisions

25. Masturbation • In the yard, what should you do? • Interrupt! • Redirect! • Not allow! • Functional assessment, develop and implement BIP as is appropriate, get data, make data based decisions

26. Masturbation • At the MCI center, what should you do? • Interrupt! • Redirect! • Not allow! • Functional assessment, develop and implement BIP as is appropriate, get data, make data based decisions

27. Masturbation • In a restaurant or at the supermarket, what should you do? • Interrupt! • Redirect! • Not allow! • Functional assessment, develop and implement BIP as is appropriate, get data, make data based decisions

28. One interesting program … • Baseline masturbation rate ~ 12 times / day • Masturbation occurring in private (bedroom), but also in public, and sometimes in front of others • Masturbation given a name • Teen given 12 opportunities to masturbate per day. • Masturbating in public interrupted, one opportunity lost. • With continued success, number of opportunities consolidated to fewer, longer opportunities.

29. Socially-sexually appropriate behavior Part II

30. Social Skills • Hidden curriculum • What do typically developing kids do that keeps them out of trouble? • What are the rules for relationships, dating, what to say around whom, how to say it, etc? • What are the rules for dressing, grooming, being “suave,” etc.?

31. Appropriate behavior • Provocative Behavior • Intentional • Unintentional • Inferred by others (e.g., every problem is a sex problem to some people!)

32. Appropriate behavior • Appropriate dress • Age appropriate • Circumstance appropriate • Well fitting and in good repair • Appropriately stylish

33. Appropriate behavior • Teaching your child what is okay and what is not okay • Around authority figures • Around other adults • In public • In private • Around similar age peers • Around younger kids • In general, and in keeping with your family’s moral code

34. Appropriate behavior • What is legal, and what isn’t? • Where is it okay to masturbate? • Is it true that if you say “yes” once, you can’t say “no” later? • What do you call a guy who pulls down his pants in Target? • What do you call a woman who masturbates at Wal Mart?

35. Sexuality and people with autism

36. A multifaceted problem • Same Parts • Same physiological and anatomical development

37. A multifaceted problem • Differing levels of supervision • More eyes • Typically very concerned eyes • Welfare or person supervised, liability, reputation, etc. • Differing levels of assistance

38. A multifaceted problem • Differing ranges of leisure repertoires • Differing formal and informal education regarding sex and relationships from that received by typically developing peers

39. A multifaceted problem • The assumption that individuals with autism are not “interested in relationships”

40. Multifaceted Solution • Acknowledge, understand, and work around difficulties imposed on the individual • Supervision • Assistance • Limitations in leisure repertoire

41. Multifaceted Solution • Teach independent self-care • The more intimate, the more important to become independent or less reliant on others! • Increase repertoire of leisure and expressive behaviors • Solitary leisure • Group leisure

42. Multifaceted Solution • Teach assertiveness (to replace compliance) • Teach age appropriate sexually related terminology

43. Multifaceted Solution • Teach “how”, “where”, “when”, etc. as appropriate • Teach what is okay for others to do and what is not • Teach what to do when others do what is not okay

44. Multifaceted Solution • Teach about menstruation and menstrual care before it happens • Reproduction and contraception • Hiding that erection

45. Multifaceted Solution • What about intercourse, oral sex, etc.? • Private vs. Public

46. Relationships and individuals with autism

47. What types of relationships are possible? • Strangers • Acquaintance • Friend • Intimate Friend • What types of relationships might interest your child?

48. Dating • Safe Dating Rules • General dating rules • How to date • What to do on a date

49. Marriage and committed relationships • Safe and unsafe • Healthy and unhealthy • Be a good role model • Draw attention to good role models

50. What to do with your child? • What hidden curriculum issues are there? • What supports need to turn into self-supports?