Bringing the Birds and Bees Down to Earth: Social Skills, Sexuality, and Autism Spectrum Disorders | Organization for Autism Research

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Over the past 10 years, much has been written about facilitating social skill development in persons with Autism Spectrum Disorders (ASD). Intensive efforts to teach social skills from very young ages have made the newest generation of young people with ASD more socially aware and skilled than the previous generation. However, the onset of adolescence and the transition into young adulthood bring new challenges, making many young people on the spectrum who adapted relatively well in social settings flounder. Parents and professionals often are at a loss with how to best support their young people through this turbulent period in their lives.

 

Tips and Interventions

Most individuals with ASD can benefit from some form of socio-sexual education. Such education is best if personalized to the individual’s age and level of functioning. Efforts should be made to make training visual, concrete and repetitive, but also engaging. Interventions may include: social stories and comic strip conversations (Gray, 2000 and 1994); pictorial mix-and-match activity books or boards (Wrobel, 2005); role-plays; anatomically correct dolls (Teach-A-Bodies); body charts; graphic organizers; lists; scripts; schedules; instructional cards; visual checklists; and video self-monitoring (Dowrick, 1999).

 
Key Concepts

Preparation for Puberty: Education about puberty and body changes is best done prior to changes occurring. While some adolescents on the spectrum have difficulty with their ever-changing bodies, with advance preparation, most accept the changes in a matter-of-fact manner. Looking up-to-date and clean is important if one wants to be socially successful. Young people with ASD may need to be taught to pay greater attention to their personal hygiene and appearance. The necessity for more frequent bathing can sometimes be met with resistance. Should this occur, additional bathing days can be gradually added to the young person’s schedule. Girls with ASD may benefit from practice with sanitary products prior to their first menstrual period.

Abuse Prevention: The social naivety of persons with ASD can leave them vulnerable to exploitation. Basic abuse prevention education may include: differentiating types of touches (e.g. good, bad, and sexual touches); rules for sexual touching; and what to do in abusive situations (e.g. No, Go, Tell; Krents and Atkins, 1991). Older or higher functioning individuals may benefit from being told that sex is not necessary to get others to like them, nor should it be used as a means to compensate for social skill deficits. Teaching the following may also be helpful: ways to turn down unwelcome advances; identifying exits when entering new locations; and looking for cues for predatory behavior (e.g. people who do not take “no” for an answer, are overly controlling, denigrate, or attempt to isolate the individual).

Interpersonal Skill Training: Most individuals with ASD acquire interpersonal skills gradually and not by intuition, but by intellect and repetitive training. Basic skills needed for social success are maintaining eye contact, listening, taking turns, identifying appropriate topics of conversation, greetings, and conversing through one or two exchanges. Eventually, more advanced skills can be added to training. Such skills include: differentiating between public and private (body parts, locations, behavior, and subject matter); perspective taking; inside and outside thoughts (inside thoughts stay unsaid in the head, outside thoughts are verbalized); dealing with rejection; conflict resolution; and reading body language.

The concept of adjusting one’s social behavior to the level of familiarity with others can be made more concrete by creating a personalized Circles chart (Champagne and Walker-Hirsch, 1993). Using this bull’s-eye-like chart, pictures of the young person, family, friends, community helpers, and strangers, along with appropriate behaviors to use with each category are placed in ever-widening circles of color. Rules for healthy relationships should be provided (e.g. they are mutual, non-abusive, and fun (Melberg-Schwier and Hingsburger, 2000). Reciprocity can be made understandable by explaining that healthy relationships are like two-way streets. Caregivers can use small cars on a diagram of a two-way street to demonstrate the back-and-forth or give-and-take in positive relationships. Staircases and thermometers offer visual illustrations for issues that exist upon a continuum, such as of the gradual progression of intimacy in relationships, self-rating scales for feelings, rating perceived levels of attraction or interest, and even safe and unsafe sexual behaviors.

For the most part, individuals with ASD have similar levels of social interest and sexual feelings as their neurotypical peers (Henault and Attwood, 2002). Caregivers can best support young people by helping them to find adaptive ways to channel sexual thoughts, feelings, and impulses. Loved ones can offer this type of support by: validating the desire to masturbate and providing opportunities for such “private time;” role-playing ways to converse with prospective friends or romantic interests (both face-to-to face and on the phone); assisting in writing socially appropriate letters or e-mails; or going on mock dates with the young person in preparation for an upcoming outing with a peer (Newport and Newport, 2000).

Teenagers and young adults may need guidance in how to maintain a healthy balance between new relationships and older interests or responsibilities such as those to family, work, social activities, and preexisting friends. While empathy, perspective taking and reciprocity may not come automatically to many persons with spectrum disorders, they can be taught how to care, show concern, and give comfort if made aware that is what is required of them in relationships (Ashton, 2001). Emotional and physical intimacy may initially seem daunting to individuals with ASD. However, if taught to seek intimacy through a series of small steps, they can be rewarded with satisfying relationships within their comfort zone (Bee, 2003).

Adolescence and young adulthood are difficult times for anyone, particularly so if the young person has an ASD. While there is no definite socio-sexual roadmap available for young people on the spectrum, information can still be accurately relayed and valuable skills can be taught. Through initiative, time, patience, and a bit of creativity, caregivers can help to make abstract concepts such as growing up, staying safe, interpersonal skills, reciprocity, and relationships more tangible or down to earth for their loved ones with ASD.

 

References

Ashton, M. (2001). The Other Half of Asperger Syndrome. The National Autistic Society.

Bee, M. (1/17/03) Ask the Expert at the Sexual Health Network: www.sexualhealth.com/questions/read.cfm?ID=2296

Champagne, M. and Walker-Hirsch, L. (Rev. ed., 1993). Circles I: Intimacy and Relationships. Santa Barbara, CA: James Stanfield Publishing.

Dowrick, P.W. (1999). A Review of Self Modeling and Related Interventions. Applied and Preventive Psychology, 8, 23-39.

Gray, C. (2000). The New Social Story Book: Illustrated Edition. Future Horizons.

Gray, C. (1994). Comic Strip Conversations. Future Horizons.

Henault, I. and Attwood, T. (2002). “The Sexual Profile of Adults with Asperger’s Syndrome: The Need for Understanding, Support and Sex Education.” Inaugural World Autism Congress, Melbourne Australia, 10-14.

Krents, E. and Atkins, D. (1991) No-Go-Tell: Protection Curriculum for Young Children with Special Needs. Santa Barbara, CA: James Stanfield Co.

Melberg-Schweir, K. and Hingsburger, D. (2000). Sexuality: Your Sons and Daughters with Intellectual Disabilities. Baltimore, MD: Paul H. Brookes Publishing Co.

Teach-A-Bodies. P.O. Box 416, Grapevine, TX, 76099-0416; 888-228-1314 or 817-416-9138; www.teach-a-bodies.com

Wrobel, M. (2005). Taking Care of Myself: A Hygiene, Puberty, and Personal Curriculum for Young People with Autism. Future Horizons.


Lisa Mitchell is licensed clinical social worker and has worked with individuals with developmental disabilities for 15 years. Her specialties in the field include psychotherapy, social skills training, and human sexuality education and training. She is currently the coordinator of the Sexuality Education and Reproductive Health Program at The Cody Center for Autism and Developmental Disabilities in Port Jefferson Station, New York. Over the past three years, Mitchell has provided numerous seminars on human sexuality and developmental disabilities, which have been offered to parents, care providers, school and agency administrators, educational staff, clinicians, and persons with developmental disabilities. She has also published articles on sexuality and developmental disabilities in the Cody Center for Autism and Developmental Disabilities Newsletter, Long Island Parents and Children, and Social Work Today magazine.


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