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

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

School’s finally good

Stimming is down; your child is even speaking more

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

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

When do you begin talking about sexuality? 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. You don’t touch others in those places. If a touch feels funny, strange, or uncomfortable, tell someone in charge.

For children with ASD Often praise statements are accompanied by tickles, hugs, big squeezes, etc. 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”. 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.

For children with ASD We are thrilled when they spontaneously show affection. 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. That you ask a girl, “May I kiss you?, touch you?”, etc.

Jimmy’s story 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. At home local girl who once had crush on him becomes object of his fascination—includes stalking, following, staring, and she cries rape. Larry’s slides next 2. The “friends” tell him that Southern girls engage in oral sex and so he “goes for it” on a “date” and exposes himself expecting to be reinforced for the behavior.

Jimmy continued 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. 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. Jimmy told me, “Now I know what sex is”, now “I know what to expect” from a girl. One can say with almost absolute certainty that’s not what girls want or expect.

Not a one time story 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. 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.

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

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

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

What’s the problem? Is SEX a Four letter Word? Does it need to be? 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? Larry- Generally these are persons diagnosed with Asperger Syndrome or with High Functioning Autism--

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. Claire, they often don’t appear to recognize the cues to act differently (run or hide) or to have the social sense to explain all of the circumstances or to even consider lying.

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”. Larry

Think about the thinking process 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. Larry Persons with ASD are concrete thinkers who have learned to do things in a certain way and need to have systematic teaching to get news skills to replace the “problem behaviors”.

Problem 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. 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.

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. “One of the individuals whom we will speak on has “learned” his sex offender program very well but also knows that he doesn’t know for sure what will happen in the community when discharged, when he doesn’t have supervision

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. Probably more now– ongoing study of this at Newcastle.

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. 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. Sometimes due to the authority of the new friends or because it was on television, some ASD kids interpret things literally and then often get themselves into trouble

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. What happens if the authority does not help? What might happen to that child/adolescent?

At adolesence… Combine significant deficits in social skills Rage over bullying, inability to understand or control many things Inappropriate information about sex/boy-girl relationships No peer group to use to find out information 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. Claire Typical children learn about sex from where? Peers Next question–where? on the bus, at sleepovers, summer camp, at friend’ home after school before the parents are home. Children with ASD do not have these social learning situations for better or worse.

Misunderstood by those in authority Bobby was being bullied by peers. 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. Counselor then called the principal and the police—zero tolerance rules—or does it? Larry The adolescent may seek a teacher or a police officer in the community to help with a situation and confide their problem and their potential solution only to find that help not there or that they, the ASD child is identified as a problem (the case of Bobby who sought out help from his guidance counselor, when asked he showed her the knife and ended up in a secure sex offender program for teens). Surg. General rpt.

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. To deal with his problem and because of his “black and white” thinking Robbie tires to remove the offending member by tying a rope around it, or hurting it.

Children at the YDC David – Lacks the Social Sense to LIE Rocky – Institutional Stress and Biting (self and others) Robbie - concrete understanding leads to concrete thinking and self-mutilation 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)

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

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

Rocky Regression and Biting History of institutionalization ASD issues with rigidity, black and white thinking, social skills problems Experienced stress and perception of attack 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 Needs to learn a replacement behavior “does not use his words” when upset—he bites.

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

Psycho-sexual skill development and problematic Sexual Behaviors Courtship Touching Staring Obsessing- blind infatuations Wishful thinking Understanding wants and needs Love and Friendship Sexual emotions and adolescence Communication and Sexuality Larry Obsessing Blind infatuation and Stalking – definitions Expectations and wishful thinking Understanding wants and needs Obsessing

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

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

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

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

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

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

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

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

Practical Teaching 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. 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. Claire

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.

Circles- James Stanfield Publishers http://www. stanfield. com/sexed 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. Very concrete- uses visuals Can be adapted for those with limited language

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. Authors- Leslie Walker-Hirsch, MED Marklyn P. Champagne, RN MSW

Summary 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. Be careful of “inappropriate” touching/behaviors. Teach another way to get the need met, high five, praise, teach the sexual bits early. Claire

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. 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. Teach and prepare for relationships. As with everything else with our children it won’t happen quickly. Larry