Good Practice Symposium Understanding sexually inappropriate behaviours in Autism as a means to consider risk

Sexual Maturation and Health Key developmental task marking the transition from childhood to adulthood. Sexual health arises out of positive sexual development. It is important to the wellbeing of an individual and that of others (WHO 2006) Add additional rules on flipchart

Issues of sexuality and ASD Viewed as a problem because it is not an issue Is an issue because it is a problem Referral to our service because services are challenged and or because of perceived risk

3 Domains in Normative Sexual Development Sexual Behaviour Sexual Socialisation Sexual Selfhood Sexual behaviour – things that people do. Sexual socialisation- the contexts in which people learn about and experience sexuality. Sexual selfhood- sexual identity , notions of one oneself as a sexual being and incorporates attitudes and values

Sexual Development Biological development in ASD =NT Social and Emotional development more prolonged /delayed? All individuals appear to show an interest in sexuality and relationships.

Sexually Inappropriate Behaviours in ASD Masturbation Stalking Accessing inappropriate images ( e.g. child sexual abuse) Sexual assault Counterfeit deviance

Sexual Socialisation in ASD Different for NT and ASD Links between poor sexual knowledge and unsafe sexual practices and sexual victimisation in NT is well established. Social difficulties + Poor sexual knowledge in ASD= increased potential for difficulties.

Possible Reasons? Co-occurring mental health issues? Impaired Theory of Mind? Poor coping strategies? Limited opportunities for appropriate sexual expression? Intense interests? Lack of social skills? Lack of common knowledge? Research is not robust, some of the figures quoted are skewed due to the areas in which the research was conducted e.g. Mental health facilities, forensic populations. Sexual offences are lower than in that of other offenders.

Intervention Treat co-occurring mental health concerns Talking therapies e.g. CBT Early intervention (late diagnosis) Sex education incorporating social skills training – limited evidence of effectiveness Sex education for adults – virtually non existent and usually reactive

Shifting Perspectives NT research indicates that adult sexual outcomes are rooted in adolescence. Shift from the notion that sexuality is dangerous and pathological to a recognition that it is integral to identity formation. Developmental lag in relation to ASD. Paternalistic, risk aversive attitudes persist alongside low aspirations.

Shifting Perspectives Improved aspirations Sexual development and education in ASD should not be considered a one off event. It needs to be an ongoing process. Education and support needs to be both formal and informal to ensure positive sexual development and wellbeing . Need to find ways for adolescents with ASD to have access to the same learning networks of their peers.