Love Sex and ASD June 07


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Love, Sex ‘n’ ASD: 

Love, Sex ‘n’ ASD Extreme Sexual Behaviours In Autistic Spectrum Disorder Jenny Cutler Consultant Chartered Forensic Psychologist Head of Therapies Brookdale Care 27th June 2007


Aim To explore the difficulties in relationships experienced by people with ASD To identify the aetiology of extreme sexual behaviours in people with ASD Recommendations for treatment and risk management

Looking at: 

Looking at Sexuality Gender Identity Inappropriate sexual behaviour Deviancy Obsessional Harassment The Normal Need for Intimacy Aids for supporting individuals

Rights of Individuals with ASD: 

Rights of Individuals with ASD UN Statement of Rights (1971) '…(they) have the same rights as other people of the same age who are living in that country'

British Law: 

British Law Age of consent for heterosexuals and homosexuals is 16 years Group gay sex was legalised in 2003 Gay sex in public is a criminal offence Lesbian sex has been recognised by law since 2003 It is an offence for male/ female to expose their genitals in public if they intend another person to see them and become distressed.

Unhelpful Myths: 

Unhelpful Myths Some common misconceptions about people with ASD: They are innocent and remain like children forever. Therefore sexual expression is not seen to be appropriate at any age They have strong sexual desires and poor self-control. This means the individual is a danger to themselves and others.

Brookdale’s Policy : 

Brookdale’s Policy Clients should be free to develop and maintain intimate personal relationships with consenting people of their choice Information and specialist guidance should be provided to help the client make decisions and keep safe. Clients have the right to choose consenting partners of any gender and engage in sexual behaviour if they so wish. Client’s dignity, privacy and freedom should be respected at all times Clients are encouraged to be responsible in their sexual behaviour and be considerate to other patients, relatives and visitors.


Impairment of Social Communication: 

Impairment of Social Communication Difficulties in initiating, maintaining, understanding social relationships. Coping with or accepting the decline of a relationship Difficulties meeting, or identifying appropriate partners. Difficulty in expressing their own feelings in a way which others can understand or accept.

Impairment in Social Relationships / Interaction: 

Impairment in Social Relationships / Interaction References to special interests Lack of interest in others Routines and rituals Lack of empathic responses Misunderstanding of personal space A desire to comply with what they believe to be ‘normal’ Deficits within the Triad leading to vulnerability

Impairment in Imagination: 

Impairment in Imagination Difficulties in perspective taking can cause relationship problems Difficulties generalising or learning from mistakes Difficulties with imagination – i.e. imagining the consequences of their actions Can become impulsive, or rigidly formulaic, as they struggle to reduce their social anxiety. Can lead to misunderstanding/vulnerability

Normal Sexual Development: 

Normal Sexual Development Physical Cognitive Social ASD can affect any of the domains of normal development


Sexuality Sexual behaviour a common occurrence in people with ASD Sexual behaviour can be expressed in an inappropriate way Sexual behaviour can sometimes be expressed in a deviant/bizarre way by people with ASD Behavioural problems can occur in connection with unresolved, sexual problems People with ASD can often be unable to establish sexual relationships, despite a desire to have them

Gender Identity: 

Gender Identity A male wearing a dress A young female who shaves her head and wears boys clothing How may this behaviour be a reflection of ASD? What is the individual expressing? What are the person’s rights? Is the person at risk? Are other people at risk? How can we support the ASD individual?



Deviancy An ASD man tells you that he would like to have sex with a 6 year old A 40 year old male in school uniform and short trousers How may these behaviours be a reflection of ASD? What is the man expressing? What are the man’s rights? Is the man at risk? Are other people at risk? How can we support this individual?

Obsessional Harassment Behaviours: 

Obsessional Harassment Behaviours A young man has expressed an interest in a girl who works in a local pub, visiting her 2-3 times a day. This makes her feel uncomfortable. A young woman runs up a £2000 debt on 8 mobile phone contracts to ring a young man hundreds of times a day. A young woman goes to prison for breaching an injunction. How are these behaviours a reflection of ASD? What is being expressed? What are their rights? Is the individual at risk? Are other people at risk? How can we support the individual?


Interventions Kar2ouche

Inappropriate to ExtremeSexual Behaviour: 

Inappropriate to Extreme Sexual Behaviour An intelligent young man asks a stranger ‘What does a vagina feel like on your penis?’ Your 24 year old son is masturbating in the living room. The search for a wife leads to imprisonment. An obsession with defecation leads to conviction and a Hospital Detention Order A young woman sets fire to the home of a teacher with whom she was obsessed Overwhelming anxiety in a moment of intimacy leads to a brutal homicide An inability to manage a relationship’s growing intensity ends in a tragic death Allegations of rape stemming from misunderstandings


Normal Need for Intimacy: 

Normal Need for Intimacy Your ASD young adult daughter has a boyfriend, she tells you they want to start a sexual relationship How is her behaviour a reflection of ASD? What is she expressing? What are her rights? Is she at risk? Are other people at risk? How can we support their relationship?

Talking Mats: 

Talking Mats Not sure/Never tried

Duty of Care andRoles within Professional Boundaries: 

Duty of Care and Roles within Professional Boundaries Do Respect the right to express sexuality. Provide appropriate guidance or seek assistance from other agencies. Model and reinforce appropriate social skills. This needs to begin in childhood Provide safe opportunities for ASD individuals to conduct relationships with peers, which may or may not be sexual.


DO Be aware of the signs of abuse and report concerns immediately. Maintain professional boundaries around touch. Maintain client dignity in personal care routines. Be aware that ASD people may not understand the rules governing social behaviour.


DON’T Don’t ignore or disconfirm the needs of an individual with ASD. Don’t ignore rights or ethical considerations. Don’t let ignorance or embarrassment prevent you from assisting with guidance or protection. Don’t impose your own beliefs or preferences onto the ASD individual


Recommendations Ensure that people with ASD understand the difference between public and private Ensure that people with ASD can recognise age and understand age appropriateness Ensure that people with ASD have capacity to consent Ensure that sex education is an integral part of an ASD specific Relationship Treatment programme Use correct terminology in sex ed.


Recommendations Anticipate, plan and provide for relationship difficulties Be guided by the Law and not our own beliefs Seek ASD specialist treatment for sexual problems Seek ASD specialist treatment for sexual offenders Early modelling of appropriate behaviour and education is key to the prevention of a problem

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