For Teachers & Professionals

Autism and Sexuality

Autism, or autism spectrum disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviours, speech and nonverbal communication. We know that there is not one autism but many subtypes, most influenced by a combination of genetic and environmental factors. Because autism is a spectrum disorder, each person with autism has a distinct set of strengths and challenges. Some people with ASD may require significant support in their daily lives, while others may need less support and, in some cases, live entirely independently. Signs of autism usually appear by age 2 or 3 (like avoiding eye contact, delayed language acquisition, repetitive behaviours...).

Individuals with neurodevelopmental disorders, including Autism (ASD), often have the same desires as typically developing people to express their sexuality and form intimate relationships. The discrepancy between their physical development and their socio-emotional development may increasingly lead to difficulties as individuals with ASD mature. They might also have an increased risk of sexual exploitation and abuse. They thus have the right and need for appropriate sexuality and relationship education. Furthermore, the impairments in social skills and communication central to ASD potentially impact an autistic individual’s expression and experience of sexuality by affecting their abilities to understand and interpret the social cues, emotions, and nonverbal behaviours of others

Appropriate and inappropriate sexual behaviour

Although most individuals with ASD engage in masturbation, fewer report sexual behaviours with a partner. Individuals with autism present with less lifetime sexual experience than the general population and the first sexual intercourse happens around 4 years later. This has been attributed to a delay in the development of skills required to initiate sexual interactions and a history of unsuccessful attempts at developing sexual relationships. However one must remember that high-functioning individuals with ASD are comparable to the general population for what concerns the frequency of sexual interactions.

Because individuals with ASD also experience difficulties discriminating between the behaviours that are considered appropriate across different settings, they may naively engage in inappropriate behaviours as a means of seeking contact or initiating relationships with others. The risk of pursuing potential partners in ways construed as threatening (eg, engaging in inappropriate touching, stalking) is thus higher. The difficulty in reading facial expressions and impairments in Theory of Mind can also lead to misinterpreting signals from others. Restricted and repetitive behaviours and stereotyped interests can manifest as a preoccupation with specific sexualized behaviours. Sensory sensitivities can also impact sexual experiences, with some hypersensitive individuals experiencing soft physical touches as unpleasant.

Sexual victimization

Significantly higher rates of sexual abuse and coercive sexual victimization have been observed among youth with ASD than among the broader population. An additional concern is that the communication impairments prevalent in ASD make individuals less likely to identify and report these experiences as forms of sexual victimization. Some documented cases include naive engagement in promiscuity as a means of initiating desired relationships and poor choices of abusive romantic partners. Others have cited an increased susceptibility to sexual exploitation because of being overly trusting, and more likely to misinterpret the sexual intentions of others. Finally, the social and emotional challenges related to ASD may increase the vulnerability of individuals to be viewed as easy targets of sexual abuse by opportunistic offenders.

Sexual identity: sexual orientation and gender identity

Sexual orientation is a multidimensional construct comprising the domains of sexual identity, sexual interests, sexual attraction, and sexual contact. Each influences an individual’s underlying sexual preference toward others. There seems to be also a higher prevalence of nonheterosexual orientations in ASD than in the general population: females with ASD are between three and four times more likely to identify as bisexual than females without ASD.

There is evidence that individuals with ASD present with more diverse gender identities than the broader population. There seems to be also a higher gender variance, an individual’s variation in gender roles and typical behaviours, which deviate from culturally specific gender norms. adults with ASD than census-based prevalence estimates in the broader population. Females with ASD are also more likely to identify as transgender, or with a more fluid gender identity than individuals without ASD assigned female at birth. Similarly, females with ASD are also more likely to report masculinized gender behaviours in childhood, and a more masculinized gender identity than same-sex control subjects.

The identified challenges experienced by individuals with ASD reflect the inherent need for developmentally appropriate sexual education with an emphasis on the underlying social competencies required for developing healthy intimate relationships tailored to the unique needs of each patient. Clinicians may consider evidence-based relationship education, such as that offered by the PEERS for young adults, Sexuality Education for Youth on the Autism Spectrum, or Tackling Teenage programs.

Professionals should likewise be attuned to recognizing the risk factors, warning signs, and symptoms of potential sexual offending and sexual victimization, and previous unwanted sexual experiences among clients with ASD. Clinicians who work in gender clinics may want to screen for autism, and those working in autism clinics may want to discuss gender identity and sexual health, researchers say. Sex-education materials should also be LGBTQIA+ inclusive.

REFERENCES

• What Is Autism? (n.d.). Autism Speaks. Retrieved August 31, 2022, from https://www.autismspeaks.org/what-autism

• Pecora, Laura A.; Hooley, Merrilyn; Sperry, Laurie; Mesibov, Gary B.; Stokes, Mark A. (2020). Sexuality and Gender Issues in Individuals with Autism Spectrum Disorder. Child and Adolescent Psychiatric Clinics of North America, 29(3), 543–556. doi:10.1016/j.chc.2020.02.007

• Dattaro, L. (2020, September 18). Gender and sexuality in autism, explained. Spectrum | Autism Research News. Retrieved August 31, 2022, from https://www.spectrumnews.org/news/gender-and-sexuality-in-autism-explained/