An article, in a parenting magazine about intimate or romantic relationships…groan…in this context, many parents would rather not talk about sex. But, open and honest conversations about sex, specifically when it comes to sexuality in neurodivergent individuals is a conversation that could keep your autistic adolescent safe—and make them feel seen.
Your neurodivergent child is growing up; you’ve put every effort into ensuring their transition to adolescence or adulthood is as smooth as it can be. You’ve spoken at length about physical and mental health, education, and job opportunities. These heavy topics seem tame however, at least in comparison to the things that need to be addressed in equal depth: sexual orientation, gender identity, sexual health, and sexual activity.
From bees, storks, and blushed avoidance we’ve all thought about not talking about topics that seem odd to discuss with our kids. When my son asked a detailed question about his birth during a car journey, I saw my husband’s eyes dart about wildly, in all likelihood he was contemplating the distracting power of a very light fender bender.
Dealing with kids’ questions is actually the easy part. Educating ourselves and learning to handle sensitive topics in a knowledgeable, judgment-free, honest, and open way may be even tricker, especially when talking to kids on the spectrum. Sexuality, particularly when it comes to neurodivergent youth, goes far beyond sexual education.
Parents have to be prepared (by talking to autistic adults, researching, and educating themselves) to listen and converse about sensitive topics like gender identity, sexual attitudes, sexual intercourse, and also the applicable legal rights protecting these. When children on the spectrum become teenagers they may want to talk to parents about sexual relationships, but, beyond typical questions, they may want information pertaining to the relation between specific autism characteristics and sexuality.
How do you address questions about physical contact when your child has an aversion to touch? How do you determine if the time is right to explain what a sexual relationship is when your nonspeaking child just does not seem interested in certain topics beyond their interests? Many parents feel—rightly so—that there are more questions than answers. Unfortunately, sexuality in autistic people is a topic which is still in its infancy when it comes to research and literature.
Sexual education for children with autism spectrum disorders
The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013) identifies and explains one of the core characteristics of autism: persistent challenges in social communication and interaction. Even as we salute advocates trying to change the deficit-model of autism, parents recognize that a differently wired brain may require a sex education that is tailored to the neurodivergent mind’s communication differences.
Many parents say their autistic kids do not receive sex education at school. Considering how diverse the autism spectrum is, educators may not be equipped to tailor a message about sensitive information—like sexual health and sexual orientation—appropriately to the varying needs of children with developmental disabilities. With more resources they could…realistically speaking however, the burden falls on parents and other caregivers to ensure sexual education is customized and appropriately delivered for their children with autism spectrum disorder (ASD).
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An article (Davies et al., 2021) offers recommendations to support more inclusive approaches to sex education, appreciating that a one-size-fits-all approach is not appropriate for children and adolescents with autism spectrum disorder. Acknowledging and supporting differences, rather than focusing on deficits, should be emphasized to help children feel comfortable and safe in their skins.
Before having conversations about sex with your young adult, child or adolescent, you should research and educate yourself about social and romantic functioning on the spectrum; autistic adults are often the best source of honest and accurate information. Without knowing more about sexuality on the spectrum, any conversation you have about intimacy may feel alienating to your child. Most of the information out there is tailored to the neurotypical, heterosexual experience; parents who want to converse openly and honestly with their kids may have to do their own research and reach out to other parents on support groups.
Autistic adults and romantic relationships
Answering your child’s questions about a sexual relationship wil be difficult if you’ve never considered intimacy from a neurodivergent perspective. When explaining the motivation behind flirting, with associated behaviors like extended eye contact and passionate kissing, a neurotypical child may be curious and grossed out in equal measure. For kids on the spectrum, with sensory issues, romantic relationships, and the accompanying intimacy could sound frightening or bizarre.
If eye contact is impossible and kissing is a nightmarish sensory experience, how will sexual interest be shown? Parents should be prepared to answer questions like these, not only about the possible interaction between autistic individuals and a neurotypical romantic partner, but also how an intimate relationship between two adults on the spectrum. Interestingly it seems many individuals on the spectrum may prefer a partner who is also on the spectrum (Nordsletten et al., 2016).
Sensory stimuli and sensory sensitivities
Sexual expression involves so much more than just sexual behavior, it’s how we express our sexual selves. In literature and academic articles, sexual expression includes all sexual acitivity with and without a sexual partner. Sexual activity is difficult to seperate from sensuality and sensory processing.
Research tells us an estimated 90% of individuals with autism have atypical sensory experiences (Marco et al., 2011). Talking to autistic youth about romantic relationships while ignoring the different ways they may experience intimacy will set parents up for failure.
For autistic individuals, sensory features impact sexual and relationship experiences in potentially negative and positive ways (Grey et al., 2021). Hypersensitivity may mean any sensory input such as tactile stimulation, smells, even the feel of someone’s breath may be too much. Hyposensitive individuals (those who seek or crave additional sensory input) on the other hand, may be under-responsive to touch. Sensory-seekers may need additional sensory input, or sensory integration therapy.
For those with sensory issues (which includes most individuals on the spectrum) physical contact and sexual activity may be uncomfortable. Societal expectations and neurodivergent sexual expresion do not always align; autistic people should feel acceptance when it comes to their approach to social and romantic functioning.
Parents play a major part in raising confident children. If your child feels uncomfortable with touch, or if they handle emotional intimacy in a unique way, be encouraging and help them realize that it is not necessary for them to conform to the sexual expression of neurotypical people.
Helping your child with self-acceptance means they will be more accepting of others. Accepting and respecting the choices and boundaries of others may also contribute to your child’s understanding of consent.
Consent and legal rights
Sexual practices, consent and legal rights are interconnected; every parent should educate their child and have conversations about these important topics when the child is ready. It is a strange myth that all adults with asperger syndrome (which is no longer a diagnosis but many people still use the term) are either hypersexual or asexual and nothing in between.
Research does indicate that individuals with autism spectrum disorder (ASD) may be more likely than those without ASD to self-identify as asexual (Bush et al., 2021). Studies also suggest males on the spectrum may have more hypersexual fantasies and behaviors (Schöttle et al., 2021).
Just like neurotypical people, autistic individuals could fall anywhere on the sexual spectrum. But, because communication deficits often render them vulnerable to abuse, it is especially important to ensure the safety of children and adolescents on the spectrum.
Research tells us that children with intellectual disability are particularly vulnerable to abuse. For autistic women, sexual exploitation is a worrying reality. Girls on the spectrum may be oblivious to danger and eager to fit in which makes them an easy target for predators.
Studies show that in females ASD was linked to an estimated threefold increase in risk of coercive sexualized victimization, while attention deficit hyperactivity disorder (ADHD) was associated with a doubled risk (Ohlsson Gotby et al., 2018). The authors’ speculations go as far as suggesting sexual predators may actively target individuals with neurodevelopmental disorders.
As a parent, you know your autistic child best, and it goes without saying that possible asexuality, hypersexuality, hypersensitivity, and hyposensitivity are factors demanding a customized sexual education. Consent should also form part of the majority of conversations relating to sexual activity. Neglecting to converse about consent leaves your child open to abuse, but it also means your child may unknowingly act in ways which could compromise the safety of others.
Sex education is no longer only about warning teens against sexually transmitted infections and unwanted pregnancies. When our kids are ready they need all relevant information to ensure they stay safe, physically and emotionally. This means beyond sexual education and sexual health talks, sensitive topics like sexual orientation and gender identities should be discussed when your child is ready.
Gender dysphoria and autism
According to the DSM–5, gender dysphoria could be defined as a “marked incongruence between their experienced or expressed gender and the one they were assigned at birth”. Previously known as “gender identity disorder” there is an increasing amount of research pointing to a link between autism and gender dysphoria.
In fact, exclusive data from Autism Parenting Magazine showed (in the sample surveyed) close to 6% of autistic children have some form of gender dysphoria. In comparison to DSM–5 data stating gender dysphoria is present in 0.005–0.014% of biological males and 0.002–0.003% of biological females globally, it would seem gender dysphoria is higher in the autistic community in comparison to the general population.
According to a large study (Warrier et al., 2020) examining the connection between autism and gender diversity, transgender and gender-diverse individuals have higher rates of autism in comparison to cisgender individuals. In research and literature, we often find the term gender-diverse which is a broad term inclusive of individuals who are nonbinary, transgender, and gender-queer.
Mental health support for gender-diverse individuals on the spectrum
Results from a study (George & Stokes, 2018) suggest that autism introduces a unique experience to the development and consolidation of gender identity. Furthermore, results showed that for some autistic individuals, their sexual orientation is linked to their gender experience. Most importantly, the authors encourage awareness of gender-diversity for clinicians working with ASD, to ensure the necessary support (for healthy socio-functioning and mental health) is offered.
If your autistic teen is struggling with gender identity, you should ensure they have access to appropriate specialized mental health care. While parents know their kids best, the combination of autism and gender dysphoria may present unique challenges, especially for parents who are still learning about gender diversity. Finding someone with no agenda, except the well-being of your child may be a challenge. But considering the risk of depression in autistic individuals with gender dysphoria, it may be crucial to have mental health support available if your child is struggling.
A study (van der Miesen et al., 2018) reported individuals with autism who endorsed the response: “I wish to be of the opposite sex,” reported higer levels of anxiety and depression. Trying to fit into a world created for neurotypical individuals while dealing with gender dysphoria could increase anxiety; anxiety which is already present in more than 40% of the pediatric autistic population (Matilla et al., 2010).
An autistic child simultaneously struggling with gender identity and neurotypical social norms and expectations—with possible impairments in expressing and communicating such emotions—deserves appropriate medical intervention.
Less talk
When researching sexuality in neurodivergent individuals, I found most studies and literature referring to high-functioning adolescents or high-functioning adults on the spectrum. Besides the fact that the autism community is advocating for the term “high functioning” to be abandoned; I found a shocking lack of information about sexual health and sexual education in the nonspeaking autistic pediatric population.
Many studies are survey based, meaning autistic individuals with advanced verbal skills may facilitate the interview or survey process. But where does this trend of focusing on a single side of the spectrum leave parents of nonspeaking autistic kids? Where do they seek advice about sensitive conversations? Considering that nonspeaking children with autism may be especially vulnerable in sexual contexts; their parents need support to address sensitive topics in a way that makes sense for kids who communicate differently.
A literature review (Solomon et al., 2019) deduced that providers should use the specific characteristics of autism when developing sexual education curricular. The authors highlight the social communication and sensory profile of autistic individuals—as these appear to relate specifically to the way in which information is accessed, the “motivation to engage in healthy sexual activities, and the development of skills needed to engage in healthy sexual behavior.”
This review (Solomon et al., 2019) and the conclusions reached may highlight the way in which parents should approach conversations about sexuality with their neurodivergent kids—wherever they fall on the spectrum. By taking their specific needs and characteristics into consideration, important information can be shared in a way that makes sense. If your child does not speak but uses technology or visual aids to communicate you could follow their cue and use these methods to educate them and learn about their needs. Social stories may be used to present crucial information to assist autistic individuals and their parents or caregivers in preparing for safe, healthy, and satisfying sexual future (Tarnai & Wolf, 2008).
It seems the best way to talk to and educate autistic children about sexuality in neurodivergent individuals includes: finding appropriate information from autism research and the experience of autistic adults; paying specific attention to their autism characteristics and using this information to customize our conversations about sexuality; but, most importantly, finding a way to help them communicate their questions, needs, and emotions in a way that makes them feel safe…and seen.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.
Bush, H. H., Williams, L. W., & Mendes, E. (2021). Brief Report: Asexuality and Young Women on the Autism Spectrum. Journal of autism and developmental disorders, 51(2), 725–733. https://doi.org/10.1007/s10803-020-04565-6.
Davies, A. W. J., Balter, A.-S., van Rhijn, T., Spracklin, J., Maich, K., & Soud, R. (2021). Sexuality Education for Children and Youth With Autism Spectrum Disorder in Canada. Intervention in School and Clinic. https://doi.org/10.1177/10534512211051068.
George, R., & Stokes, M. A. (2018). Gender identity and sexual orientation in autism spectrum disorder. Autism : the international journal of research and practice, 22(8), 970–982. https://doi.org/10.1177/1362361317714587.
Sarah Gray, Anne V. Kirby, and Laura Graham Holmes. Autism in Adulthood.Sep 2021.238-246. http://doi.org/10.1089/aut.2020.0049.
Marco, E. J., Hinkley, L. B., Hill, S. S., & Nagarajan, S. S. (2011). Sensory processing in autism: a review of neurophysiologic findings. Pediatric research, 69(5 Pt 2), 48R–54R. https://doi.org/10.1203/PDR.0b013e3182130c54.
Mattila, M. L., Hurtig, T., Haapsamo, H., Jussila, K., Kuusikko-Gauffin, S., Kielinen, M., Linna, S. L., Ebeling, H., Bloigu, R., Joskitt, L., Pauls, D. L., & Moilanen, I. (2010). Comorbid psychiatric disorders associated with Asperger syndrome/high-functioning autism: a community- and clinic-based study. Journal of autism and developmental disorders, 40(9), 1080–1093. https://doi.org/10.1007/s10803-010-0958-2.
Nordsletten, A. E., Larsson, H., Crowley, J. J., Almqvist, C., Lichtenstein, P., & Mataix-Cols, D. (2016). Patterns of Nonrandom Mating Within and Across 11 Major Psychiatric Disorders. JAMA psychiatry, 73(4), 354–361. https://doi.org/10.1001/jamapsychiatry.2015.3192.
Ohlsson Gotby, V., Lichtenstein, P., Långström, N., & Pettersson, E. (2018). Childhood neurodevelopmental disorders and risk of coercive sexual victimization in childhood and adolescence – a population-based prospective twin study. Journal of child psychology and psychiatry, and allied disciplines, 59(9), 957–965. https://doi.org/10.1111/jcpp.12884.
Schöttle, D., Briken, P., Tüscher, O., & Turner, D. (2017). Sexuality in autism: hypersexual and paraphilic behavior in women and men with high-functioning autism spectrum disorder. Dialogues in clinical neuroscience, 19(4), 381–393. https://doi.org/10.31887/DCNS.2017.19.4/dschoettle.
Solomon, D., Pantalone, D. W., & Faja, S. (2019). Autism and Adult Sex Education: A Literature Review using the Information-Motivation-Behavioral Skills Framework. Sexuality and disability, 37(3), 339–351. https://doi.org/10.1007/s11195-019-09591-6.
Tarnai, B., & Wolfe, P. S. (2008). Social stories for sexuality education for persons with autism/pervasive developmental disorder. Sexuality and Disability, 26(1), 29–36. https://doi.org/10.1007/s11195-007-9067-3
van der Miesen, A., Hurley, H., Bal, A. M., & de Vries, A. (2018). Prevalence of the Wish to be of the Opposite Gender in Adolescents and Adults with Autism Spectrum Disorder. Archives of sexual behavior, 47(8), 2307–2317. https://doi.org/10.1007/s10508-018-1218-3.
Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M. C., Allison, C., & Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature communications, 11(1), 3959. https://doi.org/10.1038/s41467-020-17794-1.
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