Slides - Conference.ie

Relationships and Sexuality Education and
Autism
13 January 2012
Suzanne Mc Canney
Learning Support Manager
Middletown Centre for Autism

Middletown Centre for Autism
An Overview

Middletown Centre for Autism
To promote excellence throughout Northern Ireland
and Ireland in the education of children and
young people with Autism Spectrum Disorders in
partnership with families and existing services

Centre Services
‣ Middletown Centre for Autism is a cross border facility funded by
the Department of Education, Northern Ireland and the
Department of Education and Skills Republic of Ireland.
‣ The Centre currently has three operational services, these are:
‣ Advice and Guidance
‣ Training
‣ Research and Information

Introduction
Adolescence is one of the most important developmental stages, with significant
changes occurring in the social, physical and emotional aspects of a person’s
life.
• Individuals with autism spectrum disorders (ASD) mature physically and
sexually according to normal developmental stages; however a young person
with an ASD can develop normally in some areas of social and emotional
understanding and have difficulties in others.
• Families and schools are often concerned about the growing sexual behaviour
in young people with ASD because it is generally not accompanied by a
corresponding growth in the field of social know-how which often leads to
socially embarrassing behaviour.
• People often falsely believe that people with ASD are sexually immature or do
not experience sexual attraction (Konstantareas & Lunsky, 1997), are unaware of
their sexuality and are uninterested in intimacy (Sullivan & Caterino, 2008).

Introduction
Sexuality education is usually taught when inappropriate behaviours are first
seen (e.g. public masturbation) and when the intervention leads to a
behaviour change considered meaningful to others (e.g. menstrual hygiene)
(Ruble &Dalrymple, 2003).
Adolescents with ASD have the same sexual desires and fantasies as
people who do not have ASD (Stokes, Newton & Kaur, 2007), and the
success or failure encountered by young people during their sexual
development impacts upon their ability to effectively transition into adulthood.

How the core features of autism impact on
expression and understanding of sexuality
and relationships.
Communication
Interaction
Flexibility of Thought
Sensory

Special Issues for Young People with
Asperger’s Syndrome
• Mood swings-young people will need help diffusing
anger, sadness and anxiety.
• Changes to bodies, emotions and friendships happen
rapidly and can be especially bewildering.
• Strong sexual feelings may result in inappropriate
sexual behaviour unless the young person is very
clear about boundaries.
• The young person’s naiveté can lead to teasing or
becoming the target of sexual predators (including on
the internet).

Problems with Typical RSE
Some books neglect the detail that may be
appreciated by a fact loving person with autism.
Typical resources do not take into account the
social and emotional difficulties that characterize
autism and assume that the young person is
socially competent.
RSE is a value laden subject and as such
requires a theory of mind to understand other
people’s opinion.

How to teach RSE to children
with ASD
• Use the same visual strategies that used to
teach other skills (schedules, work systems etc)
• Use a consistent approach at home and school
• Put your own judgements, prejudices or issues
aside- these may be meaningless to the
adolescent with autism
• Before teaching social/sexual skills, the
person’s individual preferences, strengths and
communication skills should be assessed.
• It is recommended that a thorough functional
behavioural assessment (FBA) is undertaken
(Lee, 2004; Sterling-Turner & Jordan, 2007) as
part of this individualised approach.

How to teach RSE to children
with ASD
Be clear:
• What you are trying to teach
• That what you are doing is pitched at
the right level and is meaningful for the
individual
• Teaching should be less about “what
erections are and why they occur” and
more about what to do when they have
one.
• Focus on independence – they’ll soon
be an adult

Key Issues in Communicating About
RSE
• Reduce social demands by reducing eye
contact.
• Take opportunities to talk about feelings as
well as facts.
• Help young people understand that crushes
are normal, temporary and okay so long as
they are not pursued to the point of
harassment or stalking.
• Do not rely on euphemisms, use correct
terminology.
• Remember your sense of humour!

Key Issues in Communicating
About RSE
Use both proactive and reactive strategies.
• Proactive strategies educate young people
about sex and relationships and
• Reactive strategies support them during
instances of sexually inappropriate
behaviour.

What about sexual behaviour?

Sexual Behaviours
Sexual behaviour includes self-image, emotions, values, attitudes, beliefs,
behaviours and relationships. To parents and carers, it is the observable
behaviours that are the most obvious of these, for example masturbation.
• Approximately 75% of people with ASD display some kind of sexual
behaviour and most masturbate (Sullivan & Caterino, 2008).
• It is normal to express sexuality within the confines of one’s social networks
(Koller, 2000).
• It is important to note that up to 30% of young people with ASD experience
an increase in behaviours of concern during adolescence (Eaves & Ho, 1996).
• The transition from childhood to adolescence may also coincide with
emerging social interest of some degree for individuals with ASD (McGovern &
Sigman, 2004)

Sexual behaviours of concern
in people with ASD
• Touching private body parts
• Removing clothes in public
• Masturbating in public areas
• Touching others inappropriately
• Discussing inappropriate sexual subjects
• Looking up shorts, skirts, dresses or down shirts
• Obscene gestures
• Non-consensual hugging
• Inappropriate remarks and suggestions that have
sexual connotations
• Echolalic repetition of sexual terms
• Perseveration on sexual topics
(Adapted from Lawrie & Jillings, 2004 and Ray, Marks &
Bray‐Garretson, 2004).

Sexual behaviours of concern
in people with ASD
There are a number of explanations for why sexual
behaviours of concern may occur:
• Inappropriate sexual conduct becomes the only
alternative to seeking relationships
• A young person tries to copy an observed adult sexual
behaviour
• Attempts to make connections with peers using sexual
information and behaviours
• Experiences of sexual abuse
• Some medications can affect libido, sexual interest or
drive. Others can make arousal and ejaculation
difficult which may increase tendency towards
compulsive masturbation and other sexual behaviours

Masturbation Issues
The most common concerns associated with masturbation
include:
1. The person is considered to be unable to masturbate properly
2. The person does not know how to masturbate
3. The person is masturbating for long periods
4. The person is masturbating inappropriately (such as in public
areas)
5 The person is using inappropriate objects or means to help
them masturbate
6. The person becomes frustrated or aggressive during or after
masturbating
7. The person masturbates to the point of self injury (Cambridge,
Carnaby & McCarthy, 2003; Walsh, 2000).

Masturbation
With regard to more concrete learners this
generally concerns teaching:
• Where and when to masturbate
• Where and when not to masturbate
• What to call masturbation

Inappropriate Masturbation
• Interrupt the behaviour.
• Remind the person of the appropriate time and place
for masturbating.
• Redirect the person to an activity that involves high
concentration, lots of physical activity or the use of
both hands.
• Provide reinforcement for staying on the assigned
task.
• Redirect the person to a more appropriate location.
• Provide visual schedule which includes private time
breaks so that the person can anticipate and plan for
personal needs.

• Approach teaching these skills as you
would any other.
• Leave your embarrassment and personal
judgements at the door.
• Teach as a rule.

• Don’t assume the young person will
generalise the skill to different environments.
• Young people may need to be taught an
appropriate place for ‘private time’ at Nan’s
too.
• Don’t expect or assume the young person will
be able to internalise the skill.
• It’s OK and normal if they always need the
visual supports.

Key Issues
• Stress the issues being dealt with are
typical and normal.
• Presentation style-matter of fact, no
embarrassment or shirking issues.
• Do not discuss own personal judgements
and values.
• Careful use of humour- enough to relieve
tension, but focus on teaching.

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