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Isabelle Hénault M.A., Ph.D. Montreal, Canada. Definition of sexuality Few research & clinical attention Normal part of development and life Complexity.

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Presentation on theme: "Isabelle Hénault M.A., Ph.D. Montreal, Canada. Definition of sexuality Few research & clinical attention Normal part of development and life Complexity."— Presentation transcript:

1 Isabelle Hénault M.A., Ph.D. Montreal, Canada

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

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4 ASD & Asperger’s 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

5 ASD & Asperger’s profile Sexual behaviours: self-stimulation, exploring sexuality, lack of experience Frustrations and inappropriate behaviours: paedophilia, preferences, fetishism, compulsions Gender identity & role definition: « My way » flexibility, conflict, confusion cross-dressing, transsexualism Social imitation: context, consent

6 ASD & Asperger’s profile Interpretation of emotions: black & white! Interpersonal relationships: couples, empathy, intimacy. Confusion & anxiety, resentement Sexual drive, desire, curiosity Accepting the diagnosis

7 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

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

9 HFA- Asperger’s Syndrome and Sexuality Research Do individuals diagnosed with HFA-AS have a sexual profile dinstinct from their peers?

10 Actual literature Lack of research, data Sexual development and interest Communication and social skills difficulties Depression, anxiety and other psychiatric disorders Sexual development Inappropriate behaviours

11 Experimentation Derogatis Sexual Functioning Inventory (DSFI, 1982) Self-report questionnaire, confidential 11 aspects of sexuality measured Scores compared to norm of general population AQ Test (Baron Cohen et al., 2002)

12 Experimentation Subjects N: 131 adults 88 men and 43 women (3 transgendered male to female) Age: M: 38 Range 18 to 68 years Diagnosis: 126 AS 5 High Functioning Autism

13 Experimentation Nationality 22 Canada6 France28 Denmark 61 Australia3 Belgium 7 USA4 UK Status 60 single 71 relationship

14 Subscales Results 1-Information (M= 43 SD= 13) 2-Experience (M= 42 SD= 13) 3-Drive (M= 44.5 SD= 10.4) 4-Attitude (M= 46.5 SD= 12.6) 5-Symptoms (M= 35.7 SD= 9.4) 6-Affects (M= 37 SD= 11.4) 7-Role Definition (M= 48 SD= 13.4) 8-Fantasy (M= 51 SD= 14.5) 9-Body Image (M= 35.5 SD= 12.7) 10-Satisfaction (M= 41 SD= 11.3) 11-GSS (M= 47 SD= 12.1)

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16 Low Scores Body Image: 35.5 Negative self-image Unhappy about genitals, physical appearance Unattractive: decrease of sexual activity Sensitivity about self-image Symptoms: 35.7 Pain in the body, insomnia, digestive problems Agitation, loneliness Guilt, anxiety and depression in 65% AS(Attwood,CBT, 2002) Comorbidity

17 Low Scores Affects: 37 Sadness, tense and bitter Depression and anxiety Low self-esteem Sexual satisfaction: 41 Activities, partner, variety, interest “There is not enough variety in my sex life” “Often, I worry about my sexual performance”

18 Mean scores Experience: 42 Age sexual interest: 14 years First experience: 21 years 26 virgins subjects (18 to 40 years) Lack of experience Information: 43 Mediocre general knowledge: superficial-practical Curiosity Sexual experience

19 Mean scores Sexual drive: 44.5 Frequency of behaviours (actual and desired) Sexual fantasy Despite limited experience, sexual desire

20 High scores Positive attitude: 46.5 Moral judgement and social conventions Liberal values Open-minded General Sexual Satisfaction: 47 All subscales Importance of sexuality in one ’s life Improvement, experiences, knowledge

21 Highest scores Role Definition: 48 Gender issues according to their personality Gender flexibility/social rules Fantasy Life: 51 Rich and diverse Stimulations, positions, homosexual, erotic material Variety larger than list!

22 Discussion Sexual desire, rich fantasies, sexual roles Positive attitude Incidence of homosexuality Role definition and Gender Identity Disorder Comorbidity of AS & GID? Flexibility in sexual orientation

23 Sexual and social behaviours No distinction between men and women, cultural: Negative body image Limited knowledge Symptoms of depression and anxiety and other psychiatric disorders Restrictive environment Confusion in socio-sexual situations and need for sex education Higher risk of sexual abuse in ASD

24 Support and strategies Goals Improve self-esteem and interpersonal exchanges Decrease isolation and depression Establish friendships and intimacy Provide knowledge and positive experiences Consultations: individual couples & groups Healthy sexuality = Quality of life

25 Outcomes Dinstinct sexual profile of ASD & Asperger ’s adults Need for ongoing research Development of sex education and counseling programs

26 Typical History of Relationships. Late developer in social/emotional maturity. Not sexist, ageist or culturally biased in choice of friends and partner. Wanting to be a friend and lover but with little intuitive knowledge and experience of how to do either.

27 What Attracted You to Your Partner? The silent handsome stranger. Admiration of intellect or abilities. Compassion for his/her limited social skills. Belief his or her character was due to childhood circumstances and the person will change in a new relationship.

28 What Attracted You to Your Partner? Shared interests (hobbies, animals). The degree of adulation. Fidelity in relationships.

29 What Attracted You to Your Partner? ‘Pillar’ of the community. Child like quality, a ‘Peter Pan’. Creative in his/her work and good career prospects. Similar characteristics to a parent (learned the language and culture in childhood).

30 What Attracted You to Your Partner? A challenge to get to know. I was his first serious relationship. Not ‘macho’.

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32 Choice of Partner Women with AS may prefer a relationship with a man with As. Extreme neurotypicals more likely to fall in love with an Aspie. Adults with High Functioning Autism less likely to seek a partner.

33 The development of the relationship An initial extremely deep love for the partner with ASD- AS. In the early years of the relationship, not expecting the partner with ASD-AS to know what the person is thinking or needs. The extreme neurotypical can imagine the ASD-AS perspective but the partner with ASD-AS can have great difficulty imagining the NT perspective.

34 What signs indicated he/she was different? Indifference e.g. Early attentions in courtship stage vanished Dominance of hobbies in time Resist being changed Reduction in social life Emergence of obsessive compulsive routines Less need for social relationship with partner

35 Problem processing what you say and cannot change mind with more information Paranoia- e.g. you did something deliberately to annoy them All your fault Phenomenal memory of what you have said and repeating it Unaware of how to handle people close to you

36 Difficulty resolving conflict Unable to discuss issues Wanting to be mothered but fighting and resisting that No concept of time

37 Individual Activity: List the characteristics of love

38 Love is: Tolerance, non-judgemental, supportive. Love is: A complex of beliefs that tap into our childhood languages and experiences; it is inspired when you meet someone that has a quality that maybe you admire, or do not have (admiration and respect) – or that they (someone you admire) reflects back to your ideal self – which is what you want to be or see yourself as.

39 Love is: Passion, acceptance, affection, reassurance, mutual enjoyment. Love is: What I feel for myself when I am with another person.

40 Emotional bonding Sharing and support Balance of independence and dependence and being comfortable with that person Long term commitment

41 ASD-AS Partner Definitions

42 ASD-AS definitions Love is: Helping and doing things for your lover. Love is: An attempt to connect to the other person’s feelings and emotions. Love is: Companionship, someone to depend on to help you in the right direction. Love is: I have no idea what is involved. Love is: Tolerance, loyal, allows ‘space’.

43 Four aspects of love: everybody, friends, family, erotica. Love cannot be observed. Love is yet to be felt and experienced by myself. What is Love? I don’t know the correct answer.

44 Euphoric feeling without logic A good roast meal Understands needs and how you feel Looks after the kids so I can pursue my special interest Someone that will try to understand the Aspie way and still be there in the morning.

45 Partners Two magnets - that either attract or repel each other. Adored or despised. Attract : Seek affection and approval. Seek a partner with a similar profile of abilities.

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48 Understanding Relationships Issues of relationships: two individuals or an entity? Sexuality and intimacy as a whole: much more than intercourse! Communication, emotions, comittment Personal history, experiences, sexuality & values, education, etc. Development and interest Isolation Conflicts

49 Addiction (Carnes, 2007) Obsession-Compulsions Pornography Continuation despite consequences Unsuccessful efforts to control Irritability, escape Lying, illegal acts Jeopardizing relationship-employment Financial consequences

50 Inappropriate Behaviors Organic factors (25% serious health problems) no complains… Psychologic/psychiatric condition: dual diagnosis Depression, anxiety PTSD-ADHD Addictions Phobia, OCD, etc.

51 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

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

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

54 Intimate communication Unresolved issues from the past Structure and focus: pedantic (always, each time..) Emotionnal: loosing track, overwhealming Delay in answer Not understood: agressive or withdrawn

55 Intimate communication Logical, goal Asking a direct question Respecting different opinions Diffusing the tension Assertive Letting go

56 Rules of Communication 1. Make eye contact or physical 2. Be in same room 3. Make sure you are available for a reasonable period of time 4. If inconvenient say “I need more time, I need to think about it, can we make a time to talk” 5. Make time each week for a discussion

57 Rules of communication 6. I express myself: positive way: I statement, neutral 7. I listen: paying attention & I am open to compromise. I consider the other person 8. I verify: avoid misunderstandings, ask questions 9. Does it worth an argument, is this about us or something external, trivia 10. Write, draw, sing, etc.

58 Strategies to improve intimacy and sexual skills Friendship & social skills Sex education & counselling The first date: Where & what to do Conversation Flirting Safety Maintening the relationship

59 Strategies to improve intimacy and sexual skills Emotions Reading facial emotions, Mind-Reading Expressing emotions Emotion management (intensity, anger, rigidity, empathy) CBT

60 Strategies Social behaviors Support groups Different activities, interests « Neuro-typical » friends, group, family

61 Strategies Couples therapy Enhancing intimacy & sexuality program from Lonnie Barbach List of pleasures-Quality time Sharing & compromise Reflexion questions & practicle exercices Weekly/monthly sessions

62 Pleasure List Activity Quality time: for myself & as a couple Relaxing activities: reading, cooking, shopping Physical activities: walking, swimming, gym Social activities: coffee with a friend, support group, phone, meeting family On a weekly schedule: make it happen!

63 Pleasure List Activity Time Energy Freedom Respect Positive feedback from the partner, childrens

64 CBT Mind over Mood: How to change your mood by changing your thoughts. Anxiety, depression, anger Describe situations, mood, intensity: 1-10 Thought, situation, emotion Questions: does some of your activities have an impact on your mood, do you see a pattern in your emotions, etc.

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66 Couple Homework Week: ____________ 1. Provide an example of good, positive communication. ___________________________________________________________________ 2. What intimate moments took place over the past week (activity, sexuality, sharing, etc.)? ___________________________________________________________________ 3. Describe a misunderstanding that you discussed and solved amongst yourselves. ___________________________________________________________________ 4. Rate each of the following on a scale of 1 to 10: Communication: 4.2 Intimacy: 4.3 Sexuality: 4.4 Daily activities:

67 Relationships ingredients…. Sharing Caring Support Communication Love/Affection Quality time

68 Compromise & Balance my contribution

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72 Outcomes…. Better communication Quality time Intimacy (rich, diverse, needs) Improving sexuality Positive emotions


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