There is a misconception that people with significant disabilities have little or no interest in sex or sexual relationships. This misconception often leads to the teaching of social sexual education on the back burner for practitioners, educators, and caregivers. This chapter discusses the self-monitoring strategies taught to a teenage girl with a diagnosis of autism spectrum disorder that engaged in inappropriate sexual behavior toward herself and others while in community settings. Mia is a 16-year-old female with a diagnosis of ASD. Mia significantly struggled to respond to the norms that dictate the social conventions regarding appropriate social interactions which led to the emergence of inappropriate sexual behaviors including public masturbation and the inappropriate touching of others. Using person-centered planning and a quality-of-life assessment tool, Mia's multidisciplinary team was able to identify prosocial, desired behaviors to assist Mia in achieving ultimate outcomes and place her in least-restrictive environments across community settings.
TopLiterature Review
There exists very little information or available literature on the topic of sexuality or social sexual education for individuals on the autism spectrum (Bambara & Brantlinger, 2002; Koller, 2000). This lack of information and education puts individuals with autism at risk of being victimized at some point in their lives or becoming a victimizer due to never been taught (at least not comprehensively taught) ways to appropriately navigate social situations in which sex or sexuality may come into play. Sandfort and Rademakers (2000) cite two critical reasons for the lack of sexual education and research for individuals with a diagnosis of ASD. First, is the sensitive nature of the topic, especially when described to individuals of a vulnerable population. The second is connected to methodology. It is often challenging for caregivers to address their child’s sexuality head-on. Sexuality can be particularly difficult for caregivers of children with a diagnosis of ASD due to perceiving sexuality as a burden for their child, or because they identify their child as being asexual without the capacity to make independent decisions regarding sexuality and relationships (Lesseliers & Van Hove, 2002). Sexual behavior is characteristically something that an individual will engage in privately and typically not something that is taught outright or modeled for the learner; making the teaching of appropriate sexual interactions quite challenging.
There is a common misconception that people with a diagnosis of ASD have little or no interest in sex or sexual relationships. Often, skills being taught are driven by ones’ cognitive age rather than their physical age. Throughout recent decades, we have learned that individuals with a diagnosis of ASD have the same urges and social-sexual needs as their typically developing peers. Despite this information, there is still a very limited number of educational materials and proficient practitioners to support the much-needed social sexual education programs for these individuals (Travers & Tincani, 2010).
“More than 90 percent of people with developmental disabilities will experience sexual abuse at some point in their lives” (Valenti- Hein & Schwartz, 1995). “Other studies indicate that 39 to 68 percent of girls will be sexually abused before their 18th birthday. As many as 16% to 25% of individuals with autism have been sexually abused” (Koller, 2000), (Mandell, Walrath, Manteuffel, Sgro, & Pinto-Martin, 2005). It is imperative that a social sexual education curriculum be designed and carried out for individuals with special needs before they come into contact with natural consequences of engaging in behaviors that place them at risk of sexual violence or legal ramifications.
There exist several instructional interventions that are cited in the literature as proven effective for teaching social sexual education to individuals with a diagnosis of ASD, such as: visual strategies, social stories, behavior skills training (BST), and theory of mind (TOM).
A visual strategy uses three-dimensional representations of a concept used to teach a skill. They are widely used with individuals with a diagnosis of ASD and have been used to support the teaching of social sexual education (Wolfe, Condo & Hardaway, 2009). When paired with a visual strategy, a social story can be just as impactful. Social stories are individualized for each learner and dictate the behaviors the learner is to engage in. Social stories focus on a specific characteristic of a social skill or social situation (Gray, 2000). Social stories have been created to assist individuals with special needs to navigate topics such as sexual awareness (Tarnai & Wolfe, 2008) and puberty (Wolfe, Condo, & Hardaway, 2009).