Ungdomar med
autismspektrumtillstånd
p
och sexualitet
Peter Vermeulen, PhD
Autisme Centraal
Belgium
peter_autisme
Take away messages
• Young people with ASD need MORE sex education, not less
• Autistic thinking also plays a role in sexuality, i i hi ki
l
l
l i
li
so look beyond the behaviour you see and avoid neurotypical projections
Fire brigade approach
sexuality only gets attention in a crisis situation or when there are problems
www.autisme.be
1
Consequences of autism on sexual development
autistic biology
autistic psychology:
perception thinking
desires
emotions
beliefs
values
behaviours and development
Autistic thinking
• Difficulties imagining things
• Literal understanding
• Rule
Rule‐based
based reasoning and concepts
reasoning and concepts
• Focusing on details
• Difficulties with the abstract
Autism as context blindness
Reduced ability to use the context spontaneously
when giving meaning to g g
g
(especially vague, ambiguous and abstract)
stimuli. www.autisme.be
2
Living in a relative world
Nothing
has an
absolute
meaning!!
stimulus
context
meaning 1
meaning 2
meaning 3
Context blindness
Without autism
With autism
stimulus
stimulus
context
meaning1
meaning2
meaning3
meaning
Consequences of autism on sexual development
Internal stimuli
External stimuli
Context blindness
Different understanding - misunderstandings
Different behaviours
www.autisme.be
3
Understanding bodily changes
•
•
•
•
•
Growth
Pubic hair
Different face
Acne
Different voice
• And all the differences
Understanding new feelings
• Falling in love
• “Love sickness”
• Sexual thoughts and phantasies
d h
i
Understanding new behavioural rules
•
•
•
•
•
•
Kissing
Hugging
Being naked
Talking about sex
Touching yourself / other people
Use of toilets
Context has changed!
Difference between knowledge and application in daily life
www.autisme.be
4
Understanding sexual information
• Understanding of sexual information in its context is difficult
Imagination problems
• Understanding sexuality on a presentational level, not representational level
• “Seeing” things behind the information given
• Difficulties to see dynamic in static material
• Filling in the gaps
Sexuality problems often seen in ASD
• Lack of “shame”
• “Offending” behaviours, e.g. stalking, public nudity, masturbating in public, asking offending questions
• Talking about sex too overtly
Talking about sex too overtly
• Sexual routines
• Obsessive behaviours and / or preoccupations with sex
• Obsessive questioning
www.autisme.be
5
Additional problems
• People with ASD have a sexual desire, but many of them an inability to develop a sexually satisfying life
• Living conditions of people with a disability
• U
Understanding information in a different way often d t di i f
ti i diff
t
ft
leads to fears and anxiety
• Negative feedback on their sexual behaviours
Sex education in autism
• Who needs what kind of information, when?
Level 1. Discrimination skills Level 2. Intimate hygiene
Level 3. Parts of the body and their functions
Level 4. Masturbation
Level 5. Sex education in traditional sense Level 6. Emotional guidance
Level 7. To build up an intimate relationship
1. Discrimination skills
• How to dress in different situations?
• Where can I be naked? In my underwear?
• What words can I use when?
Wh
d
I
h ?
• Asking questions? When? To whom?
• Touching, kissing: Who? Where? When?
• Use of (public) toilets (recognizing picto’s) www.autisme.be
6
2. Personal hygiene
• Taking a bath / shower
• Clean underwear
• Use of toilet paper
f il
• Menstrual hygiene
3. Body parts and their function
• Naming /pointing to the different body parts
• Recognizing the differences between boys and girls / men and women
• Bodily changes
Bodily changes
4. Masturbation
Revaluation of masturbation:
• “having sex with yourself”
• Is “real” sex!
• Everyone does it
• Many advantages
www.autisme.be
7
5. Sex education in traditional sense
information on sex organs, sexual orientation, sexual behaviours, conception, contraceptives, pregnancy, birth, STD
5. Sex education in autism
People with autism need not less information about sex, but more!!
Not only knowledge of facts...
• ... also language
• ... also social aspects
Æ concrete rules!
5. Sex education in autism
People with autism need not less information about sex, but more!!
Not only knowledge of facts...
• ... also language
• ... also social aspects
• ... also practical skills (putting on a condom, taking a shower, ...)
www.autisme.be
8
Autism friendly education
• An autism friendly program for sex education
– Part 1: sexuality
(Hellemans, Vermeulen, Conix, & D l
Delameillieure, 2006)
illi
2006)
– Part 2: relationships
(Vermeulen, Carette, a.o., to be published in 2011)
[email protected]: content
1. Parts of the body : man/woman
2. Changes in the body, puberty: man/woman
3. Sexual feelings and masturbation: feelings of love, sexual orientation, sexual feelings, masturbation man/woman
4. Making love, having sex, procreation
5. Pregnancy and giving birth
6. Contraceptives
7. Homo‐ and bisexuality
8. Sexually Transmitted Diseases
Autism friendly sex education
• A rational, neutral and factual approach: put aside your emotions
• No information overload
• Make everything explicit: don’t leave anything to their imagination
www.autisme.be
9
Use of explicit visual materials
• VISUALISATION: explicit slides
• Make everything explicit: leave as less as p
possible to their imagination
g
• photos, slides, video….take into account their autistic thinking all the time !
• first : let them name what they see
6. Emotional support / counselling
• Help them to cope with their diagnosis
• Offer alternatives for an intimate sexual relationship
• Support them so they can enjoy sex:
Support them so they can enjoy sex:
– Upgrade masturbation!!
– Use of materials to increase the pleasure: magazines, video’s
– Paid sexual services?
7. Intimate relationships
• An autism friendly program for education
– Part 1: sexuality
(Hellemans, Vermeulen, Conix, & D l
Delameillieure, 2006)
illi
2006)
– Part 2: relationships
(Vermeulen, Carette, a.o., to be published in 2011)
www.autisme.be
10
Autism friendly education
1. Relations in general: different kinds, process, feelings, skills, influence of autism
2. Professional relations (co‐students, colleagues, teachers, employer…) 3. Family relations
4. Friendship
5. Love relationship
6. Self‐protection
Sexual problems
In case of sexual problems:
• Try to understand the problems from within (autistic thinking!)
Good assessment before you start any action plan:
assessment before you start any action plan:
• Good
be careful when interpreting sexual problems
• Do not punish or break habits, but teach!
(educational approach instead of restrictive approach)
• Think about the needs for “intimacy” behind the (sexual) problems
What do they want?
•
•
•
•
•
•
•
•
•
Social contact outside the family
Social contact outside the service
Sex
A ‘status’‐girlfriend
A status girlfriend / boyfriend
/ boyfriend
Comfort
Physical contact: a hug
Holding hands
A buddy
…
www.autisme.be
11
Intimacy
• Tension between teaching and protecting
• Look for alternatives:
–
–
–
–
–
–
Animal / blanket to hug – “snoezelen”
Relaxation
Electronic dating
Buddies to go out with
Social status through a job
Sexual services
Conclusion
• Sex education:
– More than informing them about the facts and the mechanics (more, not less!)
– More than sex!
More than sex!
– Make sex education autism friendly!
– An important topic on the IEP or personal future plan
THANK YOU FOR YOUR ATTENTION!
peter_autisme
www.autisme.be
12