1. Clinique Autisme et Asperger de Montreal
Healthy Sexuality for Individuals with Intellectual, Developmental Disability and other conditions
Isabelle Hénault, Ph.D.
sexologist & psychologist
Montreal, Canada
Clinique Autisme et Asperger de Montreal

2. Definition of sexuality
Few research & clinical attention
Normal part of development and life
Complexity of sexuality: more than behaviours!

3. Intellectual and Developmental Disability Profile
Social skills: free of social rules
Communication abilities: verbal and non verbal
Theory of Mind: different ways of thinking?
Emotions: detecting, reading, expressing
Sensory issues
Impulsive behaviours
Co-morbidity (other diagnosis)

7. Fears related to sexuality
Not being able to provide correct answer to a question
STDs & AIDS
Unwanted pregnancy
Unions, couples, marriage
Sexual exploitation
Judgment of others
Higher level of sexual interest

8. Issues of development
Sexual behaviours: self-stimulation, exploring sexuality
Frustrations and inappropriate behaviours
Gender identity & role definition:
flexibility, conflict, confusion
Social imitation: context, consent

9. Issues of development Interpretation of emotions: black & white!
Interpersonal relationships: couples, empathy, intimacy. Confusion & anxiety, disappointment
Sexual drive, desire, curiosity

10. Factors influencing social and sexual development (Griffiths, 1999)
Information
Basic knowledge
Experiences
Social support
Limitations of the environment
Gender segregation
Social network
Rules
Sex education

11. Factors influencing social and sexual development
Intimacy
Interests and limits
Private and public setting
Exploration
Medication
Secondary effects
Synergic effects
Infections
Monitored

12. Factors influencing social and sexual development
Rights and attitudes
Stereotypes
Permissive attitude or protective attitude?

13. Inappropriate behaviors
Selection of partner
Restricted choices
Natural choices
Expanding social circle
Sexual history
Sexual abuse: repetition, trauma
Lack of knowledge and experiences

14. Inappropriate behaviors
Sensory issues: hypersensitivity, hyposensitivity of tactile sense: vulvodynia, irritations, compulsivity
Social attention
Misunderstanding the environment
Deficit in expression (needs, verbal emotional)
Lack of stimulation or activities

15. Inappropriate behaviors
Overwhelming demands
Organic factors (25% serious health problems) no complains…
Psychologic/psychiatric condition: dual diagnosis
Depression, anxiety
ADHD
Phobia, OCD, etc.

16. Puberty Physiological changes Psychological changes
Hormones levels (testosterone, oestrogen)
Body changes: body hair, sexual function, reactions, periods, etc.
Psychological changes
Emotions (mood changes,stronger, cycle)
Independence
Curiosity
Interests

17. Puberty Friendship & social skills
Skills: communication: verbal & non verbal, social interactions, sharing
Intensity of relationship
Appropriate: finding a balance
Inappropriate
Love & friendship, intimacy

18. Puberty Recognition of abusive/unfriendly relationship
Dangerous relationship
Qualities of a healthy relationship
Sharing
Communication
Pleasure, interest
Respect, communication and much more…
Making Waves Program:

19. Puberty Self esteem: image Self confidence: positive experiences
Social network
Finding identity (group, norms, person, sexual)
Isolation
Depression, anxiety, (arrogance 15%)
Aggressive behaviors, self-abusing behaviors

20. Puberty Hygiene Positive & appropriate image Peer pressure & reactions
Desire to create relationships
Transition period, adjustments

21. Hygiene Body Face twice/day Deodorant Teeth Twice/day Clean clothing
Steps to Good Hygiene
Monday
AM. P.M.
Tuesday
A.M. P.M.
Wed.
A.M. P.M.
Thursday
Friday
Saturday
A.M. P.M.
Sunday
A.M P.M.
Body
Face
twice/day
Deodorant
Teeth
Twice/day
Clean clothing
Periods
(change sanitary pad every 2-4 hours)

22. Sex education Goals: Better knowledge Develop own limits and judgement
Decode situations: interpersonal & intimate contexts
Improve social and sexual skills: learn adaptive and positive behaviours

25. Sociosexual Skills Workshops
10-12 weeks, 90 minutes
10 themes
Small groups (4-12)
Adolescents & adults
Questionnaires, games, role-playing, software, videos, discussions, social stories, group project

26. Workshop Themes & Activities
Introduction
1. Love & friendship
2. Physiological changes
3. Sexual relationships
4. Emotions
5. Contraception and prevention of STD and AIDS

27. Workshop Themes & Activities
6. Sexual orientation
7. Alcohol, drugs and sexuality
8. Sexism and gender roles
9. Sexual abuse and problem behaviours
10. Theory of Mind, communication and intimacy

28. www.msss.gouv.qc.ca Free Program
Preventing AIDS and other STDS through sexuality education for students with intellectual impairments - Compendium of teaching and learning activities geared to adapted curricula

29. Government program-free
Gender differences, body parts
Age groups
Private-public
Sexual behaviours

30. " ..

32. 3. Sexual relationships « My first relationship » video
« Fears » checklist
« Values » game
The Five Senses Activity:
A) Experience the senses?
B) Consequences in relationships?
C) Behaviours concerned?

33. Emotional sensitivity
“We don’t have emotional skin or protection. We are exposed, and that is why we hide”. Liliana

34. The Understanding and Expression of Affection
Ability to read the signals when
someone expects affection.
Ability to express the appropriate
level of affection.

35. The Understanding and Expression of Affection
Affection to repair someone’s feelings.
An immature expression of affection.
A limited vocabulary of expression that may not include subtle or age appropriate expressions.
Sometimes needing frequent expressions of affection for reassurance.

36. “We feel and show affection but not often enough, and at the wrong intensity”

37. Affection?
Why are typical people so obsessed with expressing reciprocal love and affection?
A hug can be an uncomfortable, constricting squeeze.
Don’t cry because someone will squeeze you.
Not comforted by affection to the degree that neurotypicals expect.

38. Different Perspective
Intense dislike of public praise that includes words and gestures of affection.
The capacity for affection, a cup versus a bucket.

39. Empathy Different type of empathy Practical-functional
Not in words or gestures
Compassion for animas
Actions

40. Empathy Affection to repair feelings Frequency of affection
Sensory sensitivity and affection

43. Aims of the Program Affection education to ‘de-mystify’ affection.
To understand why people need and enjoy affection.
Explain and encourage appropriate expressions of affection.
Explain to parents the perspective of the person with Asperger’s syndrome.

44. Objectives
Help each child-adolescent discover how expressing and experiencing affection can improve friendships and relationships.
Help each child-adolescent to identify not only his or her own comfort and enjoyment range for gestures, actions and words of affection, but also those of friends and family members.

45. 3. Improve for each child-adolescent the range of expressions for liking and loving someone, appropriate to each relationship and situation. 4. Explain to parents, friends and professionals the challenges faced by a person with an ASD in reading the signals that indicate when expressions of affection are needed and appreciated.

47. 4. Emotions and sexuality
Explore, identify and recognize a range of emotions
Pictures of human faces
Imitation
Mirror
Software-Gaining Face/Mind Reading
Emotions related to sexual realities: body language

48. Emotions Thermometer

50. 5. Contraception and prevention
Quizz
Importance of condom use
Demonstration on « penile model »

51. Condom use 10-steps on « penile model »
In fact, what ’s the first step?

52. 6. Sexual orientation List of myths Quizz: Am I homophobic? Video
Discussion

53. 7. Alcohol, drugs and sexuality
Group project: scenario
Positive approach (reinforcement) instead of reprehensive
Guide on the effects of alcohol and drugs on sexuality

54. 8. Sexism and gender roles
Privacy, boundaries, intimacy
Video: « machos »
Stereotyped relationships and roles
Scenarios and role-playing

55. 9. Sexual abuse and inadequate behaviours
Intimacy
Consent
Sexual assault
Sexuality and the law

56. 10. Mind-blindness, communication & intimacy
Social Stories integrating sexuality
Recognize other ’s emotions:
Mind Reading software (Baron-Cohen & coll., 2002)
Non verbal skills
Role-play: ToM activities

59. Relationships (What to expect in the couple?)
Respect
Accepting the partner ’s imperfections
Constructive criticism
Developing the potential of the couple
Blaming AS
Balance in the couple
Making time
Priority
Schedule management
Spending time together

60. Relationships Insecurity Dealing with conflict Taking responsibility
Making you feel good: comittment and trust
Dealing with conflict
Compromise
Dividing tasks
Using qualities of each partner

61. Relationships Expressing emotions Communication
Gestures, non verbal communication
Decoding the feelings of the partner
Intensity of emotions
Communication
Non verbal (? %)
Avoiding misinterpretations
Coherence
Priority

64. Video: www.ait.com 5 Safety rules: sexual abuse prevention
Basic rules, behaviours, young teenagers, low to middle functioning

65. Videos www.yai.org Relationship series-3 videos 1. Friendship
2. Boyfriend-girlfriend
3. Sexuality

66. Videos www. socialsignalsed.com Flirting or Stalking?
Making New Friends
Love or Abuse?
www. socialsignalsed.com

67. Results 1.Improvement of social and sexual skills Presentation
Conversation/reciprocity
Helping/empathy
Non verbal skills
General knowledge/judgement

68. Results 2. Reduction of problem behaviours
Isolation (contact, activities, conversation)
Impulsivity
Inapp. sexual behaviours (masturbation, touching)
3. Generalization (3 months measure)
Better knowledge
Interpersonal relationships, friendship
Positive attitude about sexuality

69. Discussion Interest and needs from individuals
Demand from parents and professionals
Interesting results
Service curriculum