Sexuality – Considerations and Practical Teaching
Common issues around inappropriate sexual behavior are: inappropriate touching of others, excessive masturbation, masturbasting in public, dangerous forms of masturbation, masturbation that doesn’t result in climax increasing frustration, public nudity, discussion of inappropriate topics at inappropriate times, and a lack of knowledge on how to navigate sexual feelings and urges.
For children that are concrete thinkers, teach rules and skills. Many individuals with ASD follow rules well and understand those types of boundaries. Make sure everyone who works with that child knows the established rules as well. You can teach the “why” behind the rule if the child is at a higher social-cognitive level. Keep in mind the cognitive level when teaching concepts. Does the person understand abstract concepts? Can they apply what they’ve learned in books to real life? Think about how the person learns best: using computers, through visuals, reading, video modelling etc.
Let’s talk about masturbation, one of the freuqent concerns surrounding sexuality. Be specific about when and where masturbation can happen. If you say it’s OK in the bathroom, the person with autism may take that to mean any bathroom (school, mall, grandma’s house). Say which bathroom is fine and which ones are off limits. Same goes for bedrooms – which ones, with the door closed, and shades drawn if the window faces the street. When can masturbation take place? What materials can be involved (i.e. lubricant, ejaculating into a towel).
Do some detective work on when masturbation is a problem. If it’s attemped at school or work, is it to avoid a task or seek attention? Recognize when it happens and see if it occurs within the context of another activity. Teach the rules around masturbation and reinforce behavior that you want instead of masturbation when it isn’t appropriate. Consider clothing modifications like belting pants, no sweat pants, and check for medical problems if masturbation is occurring frequently.
For young people that are sexually frustrated, provide assistance in the form of instructional how to videos, lubricants, or appropriate sex toys. Provide alternative sensory input such as deep pressure or a tactile activity like a stress ball. Use a “how to” visual task breakdown of masturbation with pic symbols showing the steps involved. An OT should be able to provide some ideas.
Establish a safe person for the individual with ASD to talk to like a sibling, friend or other family member. Talking to parents can be hard no matter who you are. Monitor also what the person is watching. Are they learning inappropriate sexual behavior from TV, movies, or music videos?
To address the inappropriate touching of others, teach the Circle of Friends. Do not classify aides or support workers as friends in the circle. Categorize who gets hugs and kisses and who gets a Hi-5. Make others around that individual aware of what you’ve taught regarding Circle of Friends. Don’t assume that all touching is sexual in nature; it can be a need for sensory input. This is also true of nudity. Disrobing may be a need to get out of restrictive clothing or bothersome fabrics or clothing tags.
Start teaching sexuality early. Also “think it forward”. What I mean by this is it can be cute to let a preschooler run around naked when at home, but what happens when this becomes a habit that is hard to break as the child ages? I know someone who made this mistake with her son, allowing him to be in underwear and a T-shirt when he was at home. Now the rule is pants are on until it’s time for bed. There was too much self-touching with just underwear on.
Look for teachable moments rather than sitting down and having “the sex talk”. Use correct terminology and forgo the cutest words like willy and wee-wee. The initial reaction you have to questions and statements from the individual is critical in creating an open dialogue. Try to remain non-judgemental. Communicate with the team around the person with ASD, letting them know family values, religious beliefs, and rules. There is a misconception that talking about sexual feelings will create them; this is untrue. Sexuality is a normal part of being human, disabled or not.
Special thanks to Treena Gower of the Society for Treatment of Autism for this presentation. The information I outlined here was given in her helpful and informative talk.
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