Brianda Hickey
Autism spectrum disorder is a neurodevelopmental condition involving persistent challenges in social communication, as well as restricted, repetitive patterns of behavior (American Psychiatric Association, 2013). As ASD is a spectrum, individuals diagnosed may experience a wide range of symptoms, and are characterized as “requiring support,” “requiring substantial support,” or “requiring very substantial support,” based on the severity of symptoms (American Psychiatric Association, 2013). Since individuals with ASD often have difficulty with interpersonal skills and communication, they are regularly mischaracterized as having a lowered libido, a disinterest in intimate relationships, or being incapable of forming romantic relationships (Byers, Nichols, & Voyer, 2013; Rosqvist, 2014). Yet, research has shown that individuals with ASD develop the same levels of sexual interest as their typically developing (TD) peers (i.e., those without developmental disabilities; Dewinter, Vermeiren, Vanwesenbeeck, & Van Nieuwenhuizen, 2016; May, Pang, Williams, 2017; Pecora, Mesibov, & Stokes, 2016). Nevertheless, the experience of sexuality (i.e., sexual identity, courting, and sexual interactions) greatly differs for a person with ASD (Barnett & Maticka-Tyndale, 2015; Pecora et al., 2016).
These discrepancies in experience are informed in part by the symptoms associated with their ASD diagnosis, the high prevalence of non-heterosexual identities within this community, as well as the sex education that individuals with ASD receive (Gilmour, Schalomon, & Smith, 2012; Holmes et al., 2014; Rosqvist, 2014). Understanding how individuals with ASD engage in sexual interactions and the factors influencing their sexual engagement is important, since research indicates that participating in intimate relationships is a strong predictor for developing feelings of independence and empowerment, as well as social skills, for individuals with ASD in particular (Byers, Nichols, & Voyer, 2013; Pearlman-Avnion, Cohen, & Eldan, 2017). Given the broad spectrum of ASD, this review focused primarily on individuals with ASD who “require support” (i.e., those needing minimal assistance with social interactions and daily behaviors; Barnett & Maticka-Tyndale, 2015; Mintah & Parlow, 2018). Thus, this review focused primarily on individuals with autism who “require support”, and sought to answer the research question: How do individuals with autism spectrum disorder experience sexuality?
Sexual Experiences
Individuals with ASD often cite social cues, sensory dysregulation, and restricted, repetitive behaviors as significantly affecting their sexual experiences (Aston, 2012; Byers et al., 2013; Rosqvist, 2014). These factors not only influence the interactions involved in a sexual experience, but can vary depending on the preferences and challenges of the specific individual, since even within the ASD community, individuals experience a range of different symptoms at varying degrees (Barnett & Maticka-Tyndale, 2015; Hannah & Stagg, 2016; Rosqvist, 2014). Social communication, a key component of ASD, may complicate the interactions involved with flirting, which is one of the key components in expressing sexual interest (Barnett & Maticka-Tyndale, 2015). Flirting is a social process rife with nonverbal and purposefully indirect (e.g., euphemism- or innuendo-based) methods of communication, and it requires the understanding of both verbal and non-verbal social cues, such as pitch, tone, and facial expression (Moore, 1985; Wade & Feldman, 2016). As such, difficulty ascertaining these social cues can result in an increased misunderstanding of the nature of flirtatious advances (Barnett & Maticka-Tyndale, 2015; Mintah & Parlow, 2018).
Individuals with ASD have reported misinterpreting flirtatious interactions as strictly friendly, as well as misperceiving nonverbal social cues of disinterest as flirtatious (Barnett & Maticka-Tyndale, 2015; Mintah & Parlow, 2018). Consequently, individuals with autism may also have difficulty recognizing subtle cues that indicate if a person is taking advantage of them, as well as whether or not the person has ill intentions (Rosqvist, 2014). Research further indicates that an impairment in interpreting non-verbal cues in ASD may also hinder some individuals’ ability to communicate or interpret feelings, intentions, and agreements in sexual interactions (Holmes et al., 2014). This impairment, in turn, may lead to situations where individuals with ASD are unable to communicate or revoke consent, which may place them at risk for sexual abuse (Hannah & Stagg, 2016).
In addition to a decreased ability to interpret nonverbal social cues, individuals with ASD often have difficulty with sensory dysregulation (i.e., an increased or decreased sensitivity to outside stimuli) when engaging in sexual activity (Rogers & Ozonoff, 2005; Rosqvist, 2014). For some individuals, this can lead to extreme pain, while for others it may present itself as an absence of sensation (Aston, 2012; Barnett & Maticka-Tyndale, 2015). Both of these experiences can consequently prevent a person with autism from engaging in or enjoying sexual acts either with or without a partner (Aston, 2012; Barnett & Maticka-Tyndale, 2015).
Nevertheless, research has shown that individuals with autism can use physical and verbal strategies to combat sensory dysregulation (Aston, 2012; Barnett & Maticka-Tyndale, 2015). Painful sensory dysregulation may be regulated by using blankets or latex gloves as physical barriers to avoid skin contact (Barnett & Maticka-Tyndale, 2015). Individuals with ASD may also manage their level of over stimulation by directing their attention to the sensations they are experiencing (e.g., focusing on where their partners are touching them and the amount of pressure applied by their partners; Barnett & Maticka-Tyndale, 2015). Additionally, in place of non-verbal forms of communication, many individuals with ASD choose to utilize a literal declaration (i.e., explicitly stating their sensations) to indicate to their partner when they are experiencing pain or discomfort (Barnett & Maticka-Tyndale, 2015). Conversely, an absence, or decrease, in sensation to physical contact can make reaching an orgasmic state challenging for individuals with ASD (Aston, 2012). Thus, to achieve this important part of a sexual experience, individuals with ASD may communicate their need for increased pressure to their partners (Aston, 2012; Brody & Weiss, 2011).
While communicating these needs explicitly can help mitigate some of the obstacles that individuals with ASD face, their restrictive and repetitive patterns of behavior may still present a challenge for their engagement in a positive sex life with their partners (Aston, 2012). Research suggests that the rigidity associated with the restricted behaviors of individuals with ASD may adversely affect sexual interactions by decreasing their partner’s sexual satisfaction (Byers & Nichols, 2014). However, for some people with autism, restricted, repetitive behavior can promote regular sexual contact with their partner (Aston, 2012), such as helping them and their partner form a sexual routine (e.g., time of day, sexual position, activities before and after) which helps regulates their sensory dysregulation (Barnett & Maticka-Tyndale, 2015; Urbano, Hartmann, Deutsch, Polychronopoulos, & Dorbin, 2013).
Thus, as existing research shows, while some individuals with ASD may experience a host of challenges in their unique sexual experiences, there are also individualized techniques they can employ to engage in safe and enjoyable sexual experiences.
Factors Influencing Sexual Experiences
In addition to their unique sexual experiences, there are also several factors that may influence the sexual experiences of individuals with ASD. The sexual identity one holds can dramatically shift an individual’s sexual experience, since identifying as non-heterosexual influences not only sexual interactions, but also access to education and availability and safety of partner-seeking environments (George & Stokes, 2018; Tullis & Zangrillo, 2013). Within the ASD community, there is a higher prevalence of individuals who identify as non-heterosexual than in the TD community (George & Stokes, 2018; Gilmour et al., 2012; Rosqvist, 2014). In fact, individuals with ASD are more likely to report that they do not identify
with terms such as heterosexual, homosexual, or bisexual, and instead identify with minority sexual identities (e.g., bicurious, sapiosexual, asexual) and minority relationship styles (e.g., pansexual, polyamorous, heteroromantic; Barnett & Maticka-Tyndale, 2015; Rudolph, Lundin, Åhs, Dalman, & Kosidou, 2018). The combination of both a non-heterosexual identity and an autism diagnosis can result in increased difficulty for individuals to find communities and resources that are accepting of their intersectional identity (Urbano et al., 2013). As such, individuals with ASD often report feeling isolated both in their non-heterosexual identity and their ASD identity (Urbano et al., 2013).
Additionally, while many individuals within the ASD community identify as non-heterosexual, there is a persistent lack of inclusive sexual education specific to non-heterosexual identities, as well as for individuals with ASD (Barnett & Maticka-Tyndale, 2015; Byers et al., 2013; Rosqvist, 2014). This is of particular importance when considering that a well-informed sexual education can potentially reduce feelings of isolation and common challenges that individuals with ASD may experience when engaging in sexual interactions or experiences (Hannah & Stagg, 2016). Yet, individuals with ASD have fewer opportunities to receive sexual education than their TD peers (Holmes et al., 2014; Gougeon, 2009).
When individuals with ASD do receive sexual education (i.e., through parent interventions, school curriculums, or pediatric provider visits; Holmes et al., 2014), however, they typically receive sex education focusing on the biological aspect of sexual intercourse (i.e., the function of sexual organs) and pregnancy (Barnett & Maticka-Tyndale, 2015). This type of sex education makes no mention of sexual interactions that do not serve a reproductive purpose, and thus may also exclude many sexual experiences, especially for those who identify as non-heterosexual (Barnett & Maticka-Tyndale, 2015; Rosqvist, 2014). Additionally, the use of metaphors (e.g., “birds and bees”) or euphemisms for sexual organs (e.g., “privates”) is common in sex education, and these teaching techniques can be confusing for individuals with ASD, as they may have difficulty understanding these metaphors and euphemisms (Barnett & Maticka-Tyndale, 2015; Roqvist, 2014). Furthermore, research has also shown that TD individuals regularly form in peer groups to discuss the topics learned in sex education to assist in the application of knowledge; individuals with ASD, however, are often excluded from these groups (Hannah & Stagg, 2016). As a result, individuals with ASD receiving sexual education do not always know how to apply what they learn in their sexual encounters (Hannah & Stagg, 2016).
For these reasons, individuals with ASD often report a lack of knowledge surrounding their sexual identities, identifying healthy and unhealthy relationships, nonverbal social interactions, sensory needs, as well as how to manage their restricted, repetitive behaviors during sexual activities (Ballan & Freyer, 2017; Barnett & Maticka-Tyndale, 2015; Hannah & Stagg, 2016). As there is a lack of sexual education that accommodates the specific needs of individuals with ASD (Rosqvist, 2014), this gap in knowledge negatively influences a person with autism’s sexual experience and engagement in sexual activities (e.g., unnecessary physical pain in sexual interactions; Aston, 2012; Tullis & Zangrillo, 2013; Urbano et al., 2013).
Conclusion
The sexual experiences of individuals with ASD are often guided by mischaracterizations of what sexual activity looks like for someone with autism (Barnett & Maticka-Tyndale, 2015). When engaging in sexual behaviors and activities, people with autism often experience sensory dysregulation and difficulty interpreting social cues, which may negatively influence their sexual experiences (Byers et al., 2013; Rosqvist, 2014). Additionally, an individual with autism’s engagement in sexual activities is influenced by their sexual identity and the sex education received (Ballan & Freyer, 2017). The unique qualities and challenges of an individual with autism warrants a sex education that targets the specific educational needs of ASD individuals (May et al., 2017). The current research on the sexual experiences and sex education of individuals with ASD is limited and has been primarily conducted on people with ASD who require limited support, and excludes those who require very substantial support. Therefore, future research should include individuals with autism who require substantial, or very substantial support and explore how individuals with both an ASD diagnosis and a non-heterosexual identity engages in sexual experiences. With more research on this topic, comprehensive sexual education programs can be developed for people on the spectrum, in turn promoting a safer and higher quality of life for individuals with ASD.
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