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Clinique Autisme et Asperger de Montreal

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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 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

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: 5 Safety rules: sexual abuse prevention
Basic rules, behaviours, young teenagers, low to middle functioning

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

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

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

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