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1 When is it too young to talk about Sex? Lawrence Sutton, Ph.D. and Claire Maher Choutka, M.Ed., BCBA.

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Presentation on theme: "1 When is it too young to talk about Sex? Lawrence Sutton, Ph.D. and Claire Maher Choutka, M.Ed., BCBA."— Presentation transcript:

1 1 When is it too young to talk about Sex? Lawrence Sutton, Ph.D. and Claire Maher Choutka, M.Ed., BCBA

2 2 Advanced organizer Objectives Objectives Typical development Typical development Specifics for ASD Specifics for ASD Issues when sexual development is not addressed Issues when sexual development is not addressed Case studies Case studies Psychosexual development Psychosexual development Teaching resources/programs Teaching resources/programs Questions? Questions?

3 3 School’s finally good

4 4 Stimming is down; your child is even speaking more

5 5 Now he or she is making friends are they the right friends? Friends are nice Friends are nice You have to do what I say!

6 6 You’re tired, he’s doing pretty well and the sex talk can wait until he’s older, right?

7 7 When do you begin talking about sexuality? Typical children learn good touch/bad touch in Kindergarten. Typical children learn good touch/bad touch in Kindergarten. They are taught no one but mom, dad, doctor, or nurse touches you where your swimsuit covers. They are taught no one but mom, dad, doctor, or nurse touches you where your swimsuit covers. You don’t touch others in those places. You don’t touch others in those places. If a touch feels funny, strange, or uncomfortable, tell someone in charge. If a touch feels funny, strange, or uncomfortable, tell someone in charge.

8 8 For children with ASD Often praise statements are accompanied by tickles, hugs, big squeezes, etc. Often praise statements are accompanied by tickles, hugs, big squeezes, etc. By school age these are inappropriate in a school setting. By school age these are inappropriate in a school setting. Typical peers are not being tickled by staff-- it sets the child up for a problem—allows more people to put hands on him/her, and potentially starts “feelings”. Typical peers are not being tickled by staff-- it sets the child up for a problem—allows more people to put hands on him/her, and potentially starts “feelings”. How will they know who is allowed to tickle them and who not? They should not be asking adults for hugs, squeezes, tickles; it’s a slippery slope. How will they know who is allowed to tickle them and who not? They should not be asking adults for hugs, squeezes, tickles; it’s a slippery slope.

9 9 For children with ASD We are thrilled when they spontaneously show affection. We are thrilled when they spontaneously show affection. We rejoice that they understand others exist in their world. We rejoice that they understand others exist in their world. We need to teach our children how to read the signs others give, that a hug to staff would be better as a hand shake or smile. We need to teach our children how to read the signs others give, that a hug to staff would be better as a hand shake or smile. That you ask a girl, “May I kiss you?, touch you?”, etc. That you ask a girl, “May I kiss you?, touch you?”, etc.

10 10 Jimmy’s story Starts with “playing doctor” with little sister. Starts with “playing doctor” with little sister. On vacation in the south friends set Jimmy up with a date. They tell him what girls “expect.” Girl and parents freak out and do not press charges. His parents seek a “sex therapist” to help. On vacation in the south friends set Jimmy up with a date. They tell him what girls “expect.” Girl and parents freak out and do not press charges. His parents seek a “sex therapist” to help. At home local girl who once had crush on him becomes object of his fascination—includes stalking, following, staring, and she cries rape. At home local girl who once had crush on him becomes object of his fascination—includes stalking, following, staring, and she cries rape.

11 11 Jimmy continued She later recants & both families agreed Jimmy disregarded conventional social boundaries, She later recants & both families agreed Jimmy disregarded conventional social boundaries, But never involved in anything overtly sexual with Jen; no intercourse, exposure, or touches. But never involved in anything overtly sexual with Jen; no intercourse, exposure, or touches. Jimmy was then home schooled full time. Jimmy was then home schooled full time. Next summer in the South- met a 17 yr old who shows him lots of video porn and porn mags. Next summer in the South- met a 17 yr old who shows him lots of video porn and porn mags. Jimmy told me, “Now I know what sex is”, now “I know what to expect” from a girl. Jimmy told me, “Now I know what sex is”, now “I know what to expect” from a girl.

12 12 Not a one time story Sadly, this story is not that unusual. Sadly, this story is not that unusual. Every week we get calls about young men masturbating in school, in the boys room with female aides trying to straighten out the situation. Every week we get calls about young men masturbating in school, in the boys room with female aides trying to straighten out the situation. When the exposure occurs in front of other students, now it’s really problematic and police are often called. When the exposure occurs in front of other students, now it’s really problematic and police are often called. This gets a young man a ticket to the YDC. This gets a young man a ticket to the YDC.

13 13 Reality is even with a developmental delay the biology moves onward. As the child grows… Bodies change. Bodies change. Adolescence begins at 8 for girls 10 for boys. Adolescence begins at 8 for girls 10 for boys. Medications may increase or decrease sexual urges. Medications may increase or decrease sexual urges. Regardless, the children need to be taught what to do. Regardless, the children need to be taught what to do. Bodies react; biology marches on in spite of cognitive delays or social skills issues. Bodies react; biology marches on in spite of cognitive delays or social skills issues.

14 14 Break down what the child needs to know They need to know who to hug, kiss, approach about dating They need to know who to hug, kiss, approach about dating They need to know when to do this. They need to know when to do this. They need to know how to ask for a date, a kiss, more… They need to know how to ask for a date, a kiss, more… What rules does the family have for their neuro-typical children? What rules does the family have for their neuro-typical children? Who will do the coaching? Who will do the coaching? How do you address problems? Think Cyrano de Bergerac How do you address problems? Think Cyrano de Bergerac

15 15 Progression of skills needed From friendship to dating, to relationship, to sex? From friendship to dating, to relationship, to sex? What are the boundaries? How do you teach that? What are the boundaries? How do you teach that? How do you keep your child safe from predators and from him/herself? How do you keep your child safe from predators and from him/herself? Remember, with frustration comes increased possibility of aggression. Remember, with frustration comes increased possibility of aggression.

16 16 What’s the problem? Is SEX a Four letter Word? Does it need to be? Is SEX a Four letter Word? Does it need to be? Supposed to be an expression of love and deep regard between two people? Supposed to be an expression of love and deep regard between two people? Even adolescents and young adults with ASD that can discuss their feelings have discussions of sex accompanied by fear and anxiety, surprises, and sometimes ugliness? Even adolescents and young adults with ASD that can discuss their feelings have discussions of sex accompanied by fear and anxiety, surprises, and sometimes ugliness?

17 17 Don’t know good idea/bad idea Adolescents with ASD are sometimes convinced or coerced/duped by peers to commit criminal offenses and then are left to face the consequences of the “criminal act” by themselves. Teach this young. Use sample worksheets, role plays. “Teach Me Language” by Freeman, has a format.

18 18 Background data In data from treatment facilities for sexually related crimes, children and adolescents with ASD may have been the victim of a sexual assault and may be re-enacting a sexual act on someone else the way they were “taught”.

19 19 Think about the thinking process To learn need to see appropriate models of behavior To learn need to see appropriate models of behavior Typical situations and peers to practice skills in vivo in order to change what may be really, downright challenging behavior. Typical situations and peers to practice skills in vivo in order to change what may be really, downright challenging behavior.

20 20 Problem Often individuals now in “difficulty” learned about sex by being sexually assaulted as children. Often individuals now in “difficulty” learned about sex by being sexually assaulted as children. Often by loved ones or by important authority figures in their lives. Often by loved ones or by important authority figures in their lives. Despite the fact that the sex may have hurt they perceive the acts in a concrete and matter-of- fact way—as in this is what a person does to someone else—very matter of factly, to meet sexual needs. Despite the fact that the sex may have hurt they perceive the acts in a concrete and matter-of- fact way—as in this is what a person does to someone else—very matter of factly, to meet sexual needs.

21 21 Case studies from the sex offender unit Learning a treatment program “inside” does not mean that the skills will generalize and transfer. “Tom” has said “I don’t know that I will not go out and sexually offend.” if placed in a situation where he is attracted to someone and denied access.

22 22 Scary statistic Children with autism are now entering the criminal justice system in surprising and yet unknown numbers. In an unpublished account at the New Castle Youth Development Center in May, 2005 it was estimated that 40% of the adolescents in the sexual offenders unit had an autism spectrum disorder. Children with autism are now entering the criminal justice system in surprising and yet unknown numbers. In an unpublished account at the New Castle Youth Development Center in May, 2005 it was estimated that 40% of the adolescents in the sexual offenders unit had an autism spectrum disorder.

23 23 When it’s too easy Child with ASD will meet “new friends” who explain that it is ok to do something to a girl or another boy. Child with ASD will meet “new friends” who explain that it is ok to do something to a girl or another boy. Or meet a peer who may site a popular television program as an authority –Rick meets Courtney at the start of a 30 minute sitcom and by the end of the program, they are lovers in bed together. Or meet a peer who may site a popular television program as an authority –Rick meets Courtney at the start of a 30 minute sitcom and by the end of the program, they are lovers in bed together.

24 24 Unconditional trust in authorities Black and white thinking –also concrete thinking in the way they interpret things. If for example one is told that if they have a problem it is important to go to a person in authority to get help with the problem. Black and white thinking –also concrete thinking in the way they interpret things. If for example one is told that if they have a problem it is important to go to a person in authority to get help with the problem. What happens if the authority does not help? What happens if the authority does not help? What might happen to that child/adolescent? What might happen to that child/adolescent?

25 25 At adolesence… Combine significant deficits in social skills Combine significant deficits in social skills Rage over bullying, inability to understand or control many things Rage over bullying, inability to understand or control many things Inappropriate information about sex/boy-girl relationships Inappropriate information about sex/boy-girl relationships No peer group to use to find out information No peer group to use to find out information They go on incorrect/ half-correct info They go on incorrect/ half-correct info No sleepovers a friends home to gain info, no sleepover camp, sometimes no bus ride which is where many learn about sex. No sleepovers a friends home to gain info, no sleepover camp, sometimes no bus ride which is where many learn about sex.

26 26 Misunderstood by those in authority Bobby was being bullied by peers. Bobby was being bullied by peers. Brought a knife to school to “show he was not to be messed with” that day. Brought a knife to school to “show he was not to be messed with” that day. Rethought it and went immediately to the guidance counselor to tell her of his troubles. Rethought it and went immediately to the guidance counselor to tell her of his troubles. Counselor then called the principal and the police—zero tolerance rules—or does it? Counselor then called the principal and the police—zero tolerance rules—or does it?

27 27 The rules are the rules An additional problem exists with scripted and canned programs when attempting to rehabilitate adolescent sexual offenders is that many of these individuals are concrete thinkers. Once taught that what they did was something they should not have done (not necessarily wrong), then in some cases it is “all or none”. Robbie is a young man who “learned that sexual thoughts, interest or even attraction to someone in a sexual way is wrong.

28 28 Children at the YDC David – Lacks the Social Sense to LIE David – Lacks the Social Sense to LIE Rocky – Institutional Stress and Biting (self and others) Rocky – Institutional Stress and Biting (self and others) Robbie - concrete understanding leads to concrete thinking and self-mutilation Robbie - concrete understanding leads to concrete thinking and self-mutilation Bobby – The Thought Police – Coping with Bullying and Sexual fantasies Bobby – The Thought Police – Coping with Bullying and Sexual fantasies Jimmy – you can see the problem coming, but can’t stop it (sexual urges leading to sexual abuse) Jimmy – you can see the problem coming, but can’t stop it (sexual urges leading to sexual abuse)

29 29 David Asperger’s Syndrome – senior project Asperger’s Syndrome – senior project Understand his touching, exposing and attack of mother Understand his touching, exposing and attack of mother Concrete thinking which requires real-life modeling to develop new methods to courtship Concrete thinking which requires real-life modeling to develop new methods to courtship ACT 21 ACT 21

30 30 David’s Story Eventual Arrest Eventual Arrest Treatment Treatment Now Now Fear of not “testing” prior to potential Discharge Fear of not “testing” prior to potential Discharge Lack of the “Social Sense” to Lie Lack of the “Social Sense” to Lie

31 31 Rocky Regression and Biting History of institutionalization History of institutionalization ASD issues with rigidity, black and white thinking, social skills problems ASD issues with rigidity, black and white thinking, social skills problems Experienced stress and perception of attack Experienced stress and perception of attack Lacks the language to communicate issues Lacks the language to communicate issues Biting- self & others leading to more charges and more time, and more biting and the Chewing Gum Solution used at YDS Biting- self & others leading to more charges and more time, and more biting and the Chewing Gum Solution used at YDS

32 32 What are the “early” problems Staring Staring Touching others Touching others Smelling someone Smelling someone Looking different (stimming) Looking different (stimming) Missing social cues Missing social cues Misinterpreting social cues Misinterpreting social cues Becoming seduced by the dark side (designing other’s) Becoming seduced by the dark side (designing other’s)

33 33 Psycho-sexual skill development and problematic Sexual Behaviors Courtship Courtship Touching Touching Staring Staring Obsessing- blind infatuations Obsessing- blind infatuations Wishful thinking Wishful thinking Understanding wants and needs Understanding wants and needs Love and Friendship Love and Friendship Sexual emotions and adolescence Sexual emotions and adolescence Communication and Sexuality Communication and Sexuality

34 34 Psycho-sexual skill development and problematic Sexual Behaviors Love and Friendship Love and Friendship What is a friend? Not just someone in your class. What is a friend? Not just someone in your class. What is a close friend? To whom do you tell your secrets? What is a close friend? To whom do you tell your secrets? How does friendship turn into love? How does friendship turn into love? Are the rules different for being a friend than for being in love? Are the rules different for being a friend than for being in love? These are taught in Circles Curriculum These are taught in Circles Curriculum

35 35 Psycho-sexual skill development and problematic Sexual Behaviors Sexual Emotions and Adolescence Sexual Emotions and Adolescence Sexual Emotions and Hormones Sexual Emotions and Hormones Sexual needs and desires Sexual needs and desires Labiality of sexual emotions Labiality of sexual emotions Sexual Response Cycle-- Henault book Sexual Response Cycle-- Henault book Healthy sexual encounters; what do they look like? Healthy sexual encounters; what do they look like?

36 36 Psycho-sexual skill development and problematic Sexual Behaviors Communication and Sexuality? Communication and Sexuality? Communication and Honesty between partners Communication and Honesty between partners What does “no” really mean? What does “no” really mean? Between friends Between friends When in courtship When in courtship When married When married Saying what it is you want to say Saying what it is you want to say Saying what you really mean without offending Saying what you really mean without offending

37 37 What is being Done Models for intervention, education and treatment Models for intervention, education and treatment It’s Perfectly Normal It’s Perfectly Normal Taking Care of Myself Taking Care of Myself Circles Curriculum Circles Curriculum Asperger’s Syndrome and Sexuality Asperger’s Syndrome and Sexuality Positive Approaches Positive Approaches

38 38 Good Resources ASD and Sexual Education ASD and Sexual Education Educational-based Educational-based Parental-based Parental-based Video-based Video-based Should be: Should be: Peer referenced Peer referenced Systematic Systematic Need comprehension checks Need comprehension checks Practiced skills Practiced skills

39 39 Biological Sexual Education It’s Perfectly Normal, Robbie Harris Sexual Education Sexual Education A. Sex – defined A. Sex – defined B. Our Bodies B. Our Bodies C. Puberty- puberty problems --masturbation C. Puberty- puberty problems --masturbation D. Relationships D. Relationships E.- SEX E.- SEX How babies are made How babies are made Feelings and Love Feelings and Love

40 40 Caring for myself Taking Care of Myself, Mary Wrobel Self Care – Taking care of myself Self Care – Taking care of myself A. Hygiene A. Hygiene B. Living Healthy B. Living Healthy C. Modesty C. Modesty D. Touching D. Touching E. Masturbation E. Masturbation

41 41 Caring for myself Taking Care of Myself, Mary Wrobel Basics of self-care Basics of self-care Erections- how to deal with these (before and after puberty)? Erections- how to deal with these (before and after puberty)? Masturbation- where? Only in person’s own bedroom or bathroom Masturbation- where? Only in person’s own bedroom or bathroom Touching myself- only in private Touching myself- only in private Male and female masturbation- in private Male and female masturbation- in private Appliances Appliances Human rights issues- cannot deny a person sexual expression or tell them “first work; then sex” Human rights issues- cannot deny a person sexual expression or tell them “first work; then sex” Clean-up Clean-up

42 42 Practical Teaching Hand Made Love: A Guide For Teaching About Male Masturbation By Dave Hingsburger Hand Made Love: A Guide For Teaching About Male Masturbation By Dave Hingsburger Book and video set discusses privacy, pleasure and the realities of sharing living spaces with others. Book and video set discusses privacy, pleasure and the realities of sharing living spaces with others. The narrator of the video talks about myths and suggests that masturbation can be a way of learning about sex, while the book discusses masturbation from the point of view of both health and pleasure. The narrator of the video talks about myths and suggests that masturbation can be a way of learning about sex, while the book discusses masturbation from the point of view of both health and pleasure.

43 43 For females… Finger Tips: A guide for teaching about female masturbation By Dave Hingsburger and Sandra Haar Book and video set is aimed at teaching women with developmental disabilities about masturbation. Confronts typical myths about female sexuality. A gentle, positive film that is clear, graphic and dignified. The book includes a step by step photographic essay about masturbation, and the joy of private time.

44 44 Circles- James Stanfield Publishers Not autism specific but very visual. Videos show dating situations and work through teaching skills Part I: Social Distance- 11 video programs students "see" social and sexual distance. It explains the levels of intimacy & TOUCH, TALK to and TRUST. Teaches "relationship boundaries" and relationship specific behaviors, i.e., it's okay to hug your mother, it's not okay to hug the mailman, or a stranger at the mall.

45 45 More “Circles” Part 2: Relationship Building, six video programs demonstrate how intimacy levels change as relationships change. The role of mutual choice among individuals is emphasized, a critical concept for protecting students from exploitation. Part 2: Relationship Building, six video programs demonstrate how intimacy levels change as relationships change. The role of mutual choice among individuals is emphasized, a critical concept for protecting students from exploitation. Authors- Leslie Walker-Hirsch, MED Marklyn P. Champagne, RN MSW Authors- Leslie Walker-Hirsch, MED Marklyn P. Champagne, RN MSW

46 46 Summary We need to break down the steps to appropriate sexual behavior and think about it from the moment the child enters Kindergarten. We need to break down the steps to appropriate sexual behavior and think about it from the moment the child enters Kindergarten. If you would not allow the behavior in a typical child do not allow it in a child with ASD. If you would not allow the behavior in a typical child do not allow it in a child with ASD. Be careful of “inappropriate” touching/behaviors. Teach another way to get the need met, high five, praise, teach the sexual bits early. Be careful of “inappropriate” touching/behaviors. Teach another way to get the need met, high five, praise, teach the sexual bits early.

47 47 Finally Erections – be prepared to respond to children who have discovered/experienced erections for the first time at home, in school, in public places and have a plan on how to respond before and after puberty. Erections – be prepared to respond to children who have discovered/experienced erections for the first time at home, in school, in public places and have a plan on how to respond before and after puberty. Masturbation in school will get you arrested. Make it more difficult for the person- use pants with a belt; teach where it’s allowed- not the bathroom—the bathroom in their home. Masturbation in school will get you arrested. Make it more difficult for the person- use pants with a belt; teach where it’s allowed- not the bathroom—the bathroom in their home. Inappropriate comments to another will get you a harassment charge- teach what to say and what to keep in your head. Inappropriate comments to another will get you a harassment charge- teach what to say and what to keep in your head. Teach and prepare for relationships. As with everything else with our children it won’t happen quickly. Teach and prepare for relationships. As with everything else with our children it won’t happen quickly.


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