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By Maria R. Urbano, Kathrin Hartmann, Stephen I. Deutsch, Gina M. Bondi Polychronopoulos and Vanessa Dorbin. The purpose of this chapter is to provide a brief overview of Autism Spectrum Disorders ASD and sexuality, as there is a paucity of this information in the literature. Specific attention is given to sexuality Adult married wanting nature sex the self, others, and interpersonal relationships.

Problematic sexual behaviors, legal concerns, and sexual abuse including victimization and perpetration are also discussed. Finally, intervention strategies for ASD children, adults, and families are addressed. The overall aim of this chapter is to highlight major themes regarding Autism Spectrum Disorders and sexuality while contributing to the existing literature.

Autism has been conceptualized under this diagnostic rubric as a spectrum of disorders with symptoms ranging from severe to minimally impaired [ 1 ]. The DSM-5 envisions autism as a unitary diagnosis with multiple levels of symptom severity impairing Adult married wanting nature sex ability to function [ 2 ]. The DSM-5 will use a system of three modifiers to ify level of severity: Level 1 is characterized for patients requiring support as they display difficulty initiating social situations and demonstrate atypical social responses.

Rituals and repetitive behaviors cause ificant interference for these individuals. They also resist redirection and attempts to be interrupted when involved in restricted interests or repetitive behaviors. They demonstrate limited ability to initiate social interaction and have a reduced or abnormal response to social overtures from others.

Repetitive behaviors and restricted interests are obvious enough to be noticed by a casual observer. These patients become distressed or frustrated when they are interrupted or redirected. Level 3 is characterized for patients requiring very substantial support, as they have severe deficits in verbal and nonverbal social communication skills.

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Repetitive behaviors or rituals markedly interfere with functioning in all spheres. They demonstrate marked distress when routines are interrupted, and they are very difficult to redirect [ 2 ]. Further, the proposed DSM-5 criteria reflect the tension between considering core symptoms from a dimensional perspective i. A dimensional approach suggests that the core symptoms are quantitative traits which vary along a continuum and reflect the expression of, and interactions between, commonly occurring genetic variations and effects of environmental factors, whereas categorical approaches favor models attributing risk of illness to large effects of single genes, especially genes involved in brain development or maintenance of synaptic architecture [ 3 ].

In fact, the DSM-5 diagnostic criteria may be best represented by an empirically-derived hybrid model that merges the dimensional and categorical aspects of symptoms of autism i. From a biological perspective, although symptoms may be viewed along a continuum, the diagnosis of autism implies the altered, albeit subtle, architecture of the brain. The two core symptom domains of DSM-5, whose severity can vary along a continuum, were validated independently and include 1 impaired social communication and interaction SCIand 2 restricted, repetitive behavior RRB [ 34 ].

There is still work left to be done with respect to determining the of criteria that must be satisfied in order to as an ASD diagnosis. Additional research must be conducted to determine the discriminative diagnostic value Adult married wanting nature sex be placed [ 4 ]. Along with the proposed diagnostic criteria, estimates of the prevalence of autism have also changed.

The overall estimated prevalence of autism spectrum disorders was 1 in 88 children, demonstrating a steady increase in prevalence since [ 6 ]. Although the ADDM Network sites are not a nationally representative sample, the methodology used in obtaining prevalence estimates of children aged 8 years has been consistent since the monitoring began, so valid comparisons can be made with earlier years. The increase in prevalence may simply reflect greater awareness and better ascertainment of autism spectrum disorders by health agencies Adult married wanting nature sex schools, as suggested in a community mental health surveillance study in England [ 7 ].

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The England study showed that the prevalence of autism in adults, when properly diagnosed, was approximately the same as in children. Sexual development is a complex process that includes sexuality in relation to oneself and others. Sexuality encompasses a broad variety of physical, emotional, and social interactions. It includes sexual beliefs, attitudes, knowledge, values, and behavior and concerns the anatomy, physiology, and biochemistry of the sexual response system. As with other individuals, those with ASD grow and mature along many developmental lines [ 9 ].

The social developmental line includes the development of sexuality, while the physical line includes that of puberty. Sexuality begins in infancy and progresses through adulthood until death. Each life stage brings about physical changes and psychosocial demands that need to be achieved for sexual health to be attained. The capacity for a sexual response, both male and female, has been found as early as in the hour period after birth. The rhythmic manipulation of genitals similar to adult masturbation begins at 2.

Also during the first three years of life, forms an attachment to his or her parents that is facilitated by physical contact. A stable, secure attachment with parents enhances the possibility of such an attachment when an adult is preparing to meet an intimate partner [ 10 ].

Gender identity, i. A clear, secure gender identity allows for satisfying, intimate adult relationships. Children may display masturbatory behaviors and engage in a variety of sexual play activities that coincide with the development of socially expected norms in the context of natural curiosity about themselves and their environment. Between the ages of 3 to 7, children explore their own body parts, recognize them as male or female, and become interested in the genitals of their peers, leading to sexual play [ 10 ].

During the latency years, overt sexual play becomes covert, with children beginning to have experience with masturbation, should libidinal urges occur. As latency-age children segregate along sexual lines, any sexual experiences are usually with those of the same gender [ 10 ].

More overt behaviors and interests emerge again in adolescence with the onset of puberty. Similar statistics were reported as recently as by the CDC, with Cultural differences are also apparent among groups regarding premarital intercourse [ 10 ]. Pubertal changes can begin as early as 9 years of age or as late as 14 years of age. With the Adult married wanting nature sex of puberty, sexual development moves to the forefront. Puberty, governed by hormonal changes, is defined as the time when a male or female is capable of sexual reproduction. A growth spurt, skeletal changes, increases in muscle and fat tissue, development of breasts, pubic and axillary hair, and the growth of genitalia are all hallmarks of the pubertal process [ 12 ].

Citing a study by Bancroft Adult married wanting nature sex colleaguesDelamater and Friedrich noted that many males begin to masturbate between the ages of 13 and 15, whereas the onset for girls is more varied [ 10 ]. As older adolescents and young adults develop, more teens engage in sexual intercourse and develop a sexually active heterosexual lifestyle. This exploration may be a transient experience, or it may develop into an Adult married wanting nature sex homosexual identity [ 10 ].

Sexual development is an intricate process that examines sexuality in regard to oneself and others. This process is often thought of in terms of normal development; however the developmentally disabled also go through sexual stages as they physically mature. This concept can be difficult to accept for some providers and caretakers, due to their tendency to view the developmentally disabled as perennial children [ 14 ]. For much of our history, the concept that individuals with any disability as sexual beings was unthinkable [ 15 ].

Those with developmental disabilities were frequently subjected to involuntary sterilization in the first half of the 20 th century. It has also been viewed similarly with ASD individuals, whose sexuality is further complicated by social communication and language deficits [ 15 ].

Only recently has it been acknowledged that persons with ASD have the universal right to learn about relationships, marriage, parenthood, and appropriate sexuality [ 8 ]. People with autism of all levels of severity experience sexual drives, behaviors, or Adult married wanting nature sex with which at some point in their lives they need assistance. Parent involvement and participation is a crucial ingredient in the area of sexual education. Sexual education must be taught in a highly structured, individualized way using concrete strategies with less of an emotional overtone.

Sexual behaviors must be an important behavioral priority with less tolerance for deviations in this area due to the stringent expectations of society. Sexual education must be taught in a specific individualized, developmental manner [ 16 ]. This report was one of the first to acknowledge that individuals with autism have the same human sexual urges and behaviors as all humans and that those with ASD have the right to express their sexuality to the greatest level possible.

Keeping in mind that quite often individuals with ASD may also have an intellectual disability [ 18 ], studies of individuals with a disability in general become important for the ASD population as well. The current literature already being conducted for those with disabilities is being applied to the expressed needs for education of those with ASD on how to develop sexual and intimate relationships. One study identified that those under the age of 18 had only limited knowledge about pregnancy and sexual anatomy while most individuals including adults were aspiring to form relationships and marriage [ 19 ].

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In addition, general reluctance of family members and caregivers to acknowledge Adult married wanting nature sex respect the sexual rights of those with an intellectual disability was identified because these concepts created a certain level of Adult married wanting nature sex in those family members. Education about legal rights should be provided to those with ASD and extended especially to those whom they encounter, e.

Although those with an ASD diagnosis have the right to date, marry and have children, there is a paucity of empirical research on family units and relationships for this particular group. Though some evidence does exist anecdotally, e. Therefore, future research should generate empirical studies that focus on interpersonal relationships within the family unit and examine which factors or skills may contribute to their success. While levels of romantic and sexual functioning typically increase with age, a developmental lag was reported for individuals with ASD [ 21 ]. In a survey of parents of 38 neurotypically developing adolescents and young adults and 25 adolescents and young adults with ASD, Stokes and colleagues found support for their research hypotheses that individuals with ASD had less access to peers and friends, engaged in more unacceptable behaviors in attempting to initiate romantic relationships, and persisted in their pursuit of the relationship even when non-mutual interests were evident [ 21 ].

also suggested that having a mild disability increased the likelihood of having sexual intercourse with a stranger for the first time, rather than with a steady dating partner [ 22 ]. Several characteristics of those with ASD interfere with the capacity to develop meaningful adult social relationships, which are necessary for developing sexual, intimate relationships. Foremost is the difficulty with social judgment [ 8 ], i. Lack of experience in peer relationships prevents the development of the common pathway through which adolescents learn about sexuality [ 23 ].

Problematic decision-making skills complicate the capacity to maintain the everyday details of a relationship, such as initiating dates, or remembering plans. Lack of flexibility, along with self-absorption, creates ificant areas of conflict in a potential relationship. Sensory sensitivities, such as inability to tolerate touch or other physical sensations, sound sensitivities, or food texture issues can cause dating to be fraught with problems [ 24 ]. Many persons with ASD have little self-awareness and as noted above, do not understand their impact on others.

Another dimension of this issue is that persons with ASD may have little knowledge about themselves. Part of what helps us create a sense of self is the ability to create an internal autobiography [ 25 ]. Persons with ASD have difficulty in this area, as they frequently cannot describe their own emotions or are unaware Adult married wanting nature sex what they are feeling i. As a result, many with ASD lack the ability to insightfully understand themselves or respond to the social climate in a meaningful way.

The ability to maintain personal safety without awareness of the environment or the behaviors of others can pose a ificant danger. Persons with ASD, either as a result of the above difficulties or due to a true lack of social interest, turn away from others into their own world. Self-absorption fosters another type of social disability. Persons with ASD frequently have restricted areas of interest e.

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Sensory sensitivities can create intolerance of what may be considered part of the human experience. For example, sensitivity to sound may prevent a person with ASD from engaging in activities where airplanes may be heard overhead or babies may be heard crying. Also, sensitivity to touch can be especially difficult in relation to others, as those with ASD may not tolerate someone touching their skin or attempting to hug them.

This particular sensitivity may also affect the choice of clothes for someone with ASD, who may be unable to wear clothes with sleeves or tags that they feel are restrictive and might lead one to wear socially inappropriate apparel.

Executive function impairments, i. Awareness of the passage of time may be compromised for someone with ASD, perhaps secondary to their self-absorption, and is an essential component of everyday function. Everyday memory problems or the ability to remember to plan and organize daily life activities can create social havoc. All of the above challenges are magnified when a person with ASD attempts to have an intimate emotional and perhaps sexual relationship.

Intimacy is the sharing of emotional, cognitive, and physical aspects of oneself with those of another. A prerequisite for intimacy is the establishment of a firm sense of self-identity. For all of the reasons above, a person with ASD may be unable to share with another or may be limited in his or her ability to do so. Case example: RJ. RJ is a 28 year-old female with ASD who was attempting to negotiate an intimate relationship with another woman her age that did not have ASD.

First of all, RJ explained that a homosexual relationship was better for her than a heterosexual relationship because her partner was more like her than another man would be, and it was already very difficult to consider an intimate relationship, let alone try to understand someone of a different gender. RJ was absorbed in her interest in drawing and Adult married wanting nature sex to get a job at some point in computer animation.

She spent most of the hours in a day drawing when she was not at her part time job at the local animal shelter. She was unable to do something other than drawing in the evening except on Saturdays, when she was able to include her partner in her Adult married wanting nature sex. Even on Saturday, she needed to find some time to herself because it took too much energy to be with her partner for a full day.

When she attempted to do so, she would experience anxiety and frustration which would frequently culminate in an episode of yelling, stamping her feet, and retreating to her room. On Saturdays, when she was attempting to spend time with her partner, RJ was only able to engage in certain activities.

Her partner would frequently ask her to go to the movies, while RJ was unable to tolerate the feel of the seat cushions on her skin, the smell of the popcorn, and the loudness of the sound track. RJ could only eat at two restaurants in the neighboring area but preferred to eat at home. RJ was able to tolerate some sexual contact but avoided it whenever possible, as it was adverse to her but she understood from reading that it was an expected part of a relationship. She understood that even Adult married wanting nature sex it may be difficult to do so, she would have to initiate contact and not rely on her friends solely to initiate such contact.

The only ificant predictor of romantic functioning among those with ASD is level of social functioning [ 21 ]. When meeting someone with ASD, several irregularities are noticeable. Persons with ASD frequently will not look into the eyes of the person with whom they are interacting; instead they may look at their mouths or perhaps even another object in the room [ 20 ].

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