Abstract
Purpose of Review
The goal of this paper is to provide an update on recent findings relating to sexuality and gender in autism. The following questions were posed in the review of recent literature: What are the key emerging trends in sexuality and gender within autism, and how might these issues have clinical significance?
Recent Findings
After many years of misinformation, it is now recognised that most autistic people are interested in romance and sexuality. There is growing awareness of reduced heterosexuality and increased diversity and dysphoria in gender identity in autistic people, and initial clinical guidelines for the potential co-occurrence of autism and gender dysphoria are emerging. There is a heightened risk of inappropriate sexual behaviours and victimisation in autism, and autistic women appear to be more vulnerable in having unwanted sexual experiences than autistic males and typically developing females.
Summary
Sexuality and gender are importance topics for most autistic people. Experience and expression of sexuality and gender may differ in the autistic population compared with typically developing people, which underlies the importance of identifying, understanding and supporting the development and maintenance of intimate relationships in autistic people. We suggest a biopsychosocial and developmental framework be used to tailor individual support for sexuality and gender-related issues for autistic youth.
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References
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Association AP. Diagnostic and statistical manual of mental disorders fifth edition ed. Washington, DC.: Author; 2013.
Baio J, Wiggins L, Christensen DL, Maenner MJ, Daniels J, Warren Z, et al. Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR Surveill Summ. 2018;67(6):1. https://doi.org/10.15585/mmwr.ss6706a1.
Kenny L, Hattersley C, Molins B, Buckley C, Povey C, Pellicano E. Which terms should be used to describe autism? Perspectives from the UK autism community. Autism. 2016;20(4):442–62. https://doi.org/10.1177/1362361315588200.
Kim YS, Leventhal BL, Koh Y-J, Fombonne E, Laska E, Lim E-C, et al. Prevalence of autism spectrum disorders in a total population sample. Am J Psychiatr. 2011;168(9):904–12. https://doi.org/10.1176/appi.ajp.2011.10101532.
Randall M, Sciberras E, Brignell A, Ihsen E, Efron D, Dissanayake C, et al. Autism spectrum disorder: presentation and prevalence in a nationally representative Australian sample. Aust N Z J Psychiatry. 2016;50(3):243–53. https://doi.org/10.1177/0004867415595287.
Gerhardt PF, Lainer I. Addressing the needs of adolescents and adults with autism: a crisis on the horizon. J Contemp Psychother. 2011;41(1):37–45. https://doi.org/10.1007/s10879-010-9160-2.
Howlin P, Taylor JL. Addressing the need for high quality research on autism in adulthood. Autism. 2015;19(7):771–3. https://doi.org/10.1177/1362361315595582.
Torisky D, Torisky C, Elgar S. Sex education and sexual awareness building for autistic children and youth: some viewpoints and considerations. J Autism Dev Disord. 1985;15(2):213–27.
Howlin P, Goode S, Hutton J, Rutter M. Adult outcome for children with autism. J Child Psychol Psychiatry. 2004;45(2):212–29. https://doi.org/10.1111/j.1469-7610.2004.00215.x.
Stokes MA, Kaur A. High-functioning autism and sexuality: a parental perspective. Autism. 2005;9(3):266–89. https://doi.org/10.1177/1362361305053258.
Ruble LA. & Dalrymple, N. J. social/sexual awareness of persons with autism: a parental perspective. Arch Sex Behav. 1993;22(3):229–40. https://doi.org/10.1007/BF01541768.
Ousley OY, Mesibov GB. Sexual attitudes and knowledge of high-functioning adolescents and adults with autism. J Autism Dev Disord. 1991;21(4):471–9. https://doi.org/10.1007/BF02206871.
Bennett M, Webster AA, Goodall E, Rowland S. Intimacy and romance across the autism spectrum: unpacking the “not interested in sex” myth. Life Autism Spectrum. Springer. 2018:195–211.
Dewinter J, Vermeiren R, Vanwesenbeeck I, Lobbestael J, Van Nieuwenhuizen C. Sexuality in adolescent boys with autism spectrum disorder: self-reported behaviours and attitudes. J Autism Dev Disord. 2015;45(3):731–41. https://doi.org/10.1007/s10803-014-2226-3.
George R, Stokes MA. Sexual orientation in autism spectrum disorder. Autism Res. 2018;11(1):133–41. https://doi.org/10.1002/aur.1892.
Hancock GIP, Stokes MA, Mesibov GB. Socio-sexual functioning in autism spectrum disorder: a systematic review and meta-analyses of existing literature. Autism Res. 2017;10(11):1823–33. https://doi.org/10.1002/aur.1831.
Kellaher DC. Sexual behavior and autism spectrum disorders: an update and discussion. Curr Psychiatry Rep. 2015;17(4):562. https://doi.org/10.1007/s11920-015-0562-4.
Byers ES, Nichols S, Voyer SD. Challenging stereotypes: sexual functioning of single adults with high functioning autism spectrum disorder. J Autism Dev Disord. 2013;43(11):2617–27. https://doi.org/10.1007/s10803-013-1813-z.
Byers ES, Nichols S, Voyer SD, Reilly G. Sexual well-being of a community sample of high-functioning adults on the autism spectrum who have been in a romantic relationship. Autism. 2013;17(4):418–33. https://doi.org/10.1177/1362361311431950.
Teti M, Cheak-Zamora N, Bauerband L, Maurer-Batjer A. A qualitative comparison of caregiver and youth with autism perceptions of sexuality and relationship experiences. J Dev Behav Pediatrics. 2019;40(1):12–9. https://doi.org/10.1097/DBP.0000000000000620.
Pecora LA, Hancock GI, Mesibov GB, Stokes MA. Characterising the sexuality and sexual experiences of autistic females. J Autism Dev Disord. 2019;49(12):4834–46. https://doi.org/10.1007/s10803-019-04204-9.
Shakespeare T. Disability rights and wrongs revisited. London: Routledge; 2013.
Turban JL, van Schalkwyk GI. "gender dysphoria" and autism dpectrum disorder: is the link real? J Am Acad Child Adolesc Psychiatry. 2018;57(1):8–9 e2. https://doi.org/10.1016/j.jaac.2017.08.017.
Brown-Lavoie SM, Viecili MA, Weiss JA. Sexual knowledge and victimization in adults with autism spectrum disorders. J Autism Dev Disord. 2014;44(9):2185–96. https://doi.org/10.1007/s10803-014-2093-y.
Sullivan A, Caterino LC. Addressing the sexuality and sex education of individuals with autism spectrum disorders. Educ Treat Child. 2008;31(3):381–94. https://doi.org/10.1353/etc.0.0001.
Vine Foggo RS, Webster AA. Understanding the social experiences of adolescent females on the autism spectrum. Res Autism Spectr Disord. 2017;35:74–85. https://doi.org/10.1016/j.rasd.2016.11.006.
Bellini S. The development of social anxiety in adolescents with autism spectrum disorders. Focus Autism Other Dev Disabil. 2006;21(3):138–45. https://doi.org/10.1177/10883576060210030201.
DeFilippis M. Depression in children and adolescents with autism spectrum disorder. Children. 2018;5(9). https://doi.org/10.3390/children5090112.
Bargiela S, Steward R, Mandy W. The experiences of late-diagnosed women with autism spectrum conditions: an investigation of the female autism phenotype. J Autism Dev Disord. 2016;46(10):3281–94. https://doi.org/10.1007/s10803-016-2872-8.
Strang JF, Janssen A, Tishelman A, Leibowitz SF, Kenworthy L, McGuire JK, et al. Revisiting the link: evidence of the rates of autism in studies of gender diverse individuals. J Am Acad Child Adolesc Psychiatry. 2018;57(11):885–7. https://doi.org/10.1016/j.jaac.2018.04.023.
Pecora LHG, Hooley M, Mesibov G, Attwood T & Stokes MA. Gender identity, sexual orientation and adverse sexual experiences in autistic females. Mol Autism. 2019; in press.
Schöttle D, Briken P, Tüscher O, Turner D. Sexuality in autism: hypersexual and paraphilic behavior in women and men with high-functioning autism spectrum disorder. Dialogues Clin Neurosci. 2017;19(4):381–93.
Pecora LA, Mesibov GB, Stokes MA. Sexuality in high-functioning autism: a systematic review and meta-analysis. J Autism Dev Disord. 2016;46(11):3519–56. https://doi.org/10.1007/s10803-016-2892-4.
Dewinter J, De Graaf H, Begeer S. Sexual orientation, gender identity, and romantic relationships in adolescents and adults with autism spectrum disorder. J Autism Dev Disord. 2017;47(9):2927–34. https://doi.org/10.1007/s10803-017-3199-9.
• Sala G, Hooley M, Stokes MA, Mesibov GB. Romantic intimacy in autism: a qualitative analysis. in press. 2019. Qualitative exploration of romantic intimacy.
Strunz S, Schermuck C, Ballerstein S, Ahlers CJ, Dziobek I, Roepke S. Romantic relationships and relationship satisfaction among adults with Asperger syndrome and high-functioning autism. J Clin Psychol. 2017;73(1):113–25. https://doi.org/10.1002/jclp.22319.
May T, Pang KC, Williams K. Brief report: sexual attraction and relationships in adolescents with autism. J Autism Dev Disord. 2017;47(6):1910–6. https://doi.org/10.1007/s10803-017-3092-6.
Rudolph CES, Lundin A, Ahs JW, Dalman C, Kosidou K. Brief report: sexual orientation in individuals with autistic traits: population based study of 47,000 adults in Stockholm County. J Autism Dev Disord. 2018;48(2):619–24. https://doi.org/10.1007/s10803-017-3369-9.
Qualls LR, Hartmann K, Paulson JF. Broad autism phenotypic traits and the relationship to sexual orientation and sexual behavior. J Autism Dev Disord. 2018;48(12):3974–83. https://doi.org/10.1007/s10803-018-3556-3.
Statistics ABo. General Social Survey https://www.aihw.gov.au/getmedia/61521da0-9892-44a5-85af-857b3eef25c1/aihw-aus-221-chapter-5-5.pdf.aspx. 2014.
Gates GJ. How many people are lesbian, gay, bisexual and transgender? https://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf. 2011. Accessed 01/11 2019.
Barnett JP, Maticka-Tyndale E. Qualitative exploration of sexual experiences among adults on the autism spectrum: implications for sex education. Perspect Sex Reprod Health. 2015;47(4):171–9. https://doi.org/10.1363/47e5715.
Hannah LA, Stagg SD. Experiences of sex education and sexual awareness in young adults with autism spectrum disorder. J Autism Dev Disord. 2016;46(12):3678–87. https://doi.org/10.1007/s10803-016-2906-2.
Kanfiszer L, Davies F, Collins S. 'I was just so different': the experiences of women diagnosed with an autism spectrum disorder in adulthood in relation to gender and social relationships. Autism. 2017;21(6):661–9. https://doi.org/10.1177/1362361316687987.
Roth ME, Gillis JM. “Convenience with the click of a mouse”: a survey of adults with autism spectrum disorder on online dating. Sex Disabil. 2014;33(1):133–50. https://doi.org/10.1007/s11195-014-9392-2.
Dewinter J, Van Parys H, Vermeiren R, Van Nieuwenhuizen C. Adolescent boys with an autism spectrum disorder and their experience of sexuality: an interpretative phenomenological analysis. Autism. 2017;21(1):75–82. https://doi.org/10.1177/1362361315627134.
• Hartmann K, Urbano MR, Raffaele CT, Qualls LR, Williams TV, Warren C, et al. Sexuality in the Autism Spectrum Study (SASS): reports from young adults and parents. J Autism Dev Disord. 2019;49(9):3638–55. https://doi.org/10.1007/s10803-019-04077-yDemonstrates differences between self-report and parent-reported sexual behaviour in autistic adolescents.
George R, Stokes M. “Gender is not on my agenda!”: gender dysphoria and autism spectrum disorder. Psychiatric symptoms and comorbidities in autism spectrum disorder. Springer. 2016:139–50.
Glidden D, Bouman WP, Jones BA, Arcelus J. Gender dysphoria and autism spectrum disorder: a systematic review of the literature. Sex Med Rev. 2016;4(1):3–14. https://doi.org/10.1016/j.sxmr.2015.10.003.
Auyeung B, Baron-Cohen S, Ashwin E, Knickmeyer R, Taylor K, Hackett G. Fetal testosterone and autistic traits. Br J Psychol. 2009;100(1):1–22. https://doi.org/10.1348/000712608X311731.
Grimbos T, Dawood K, Burriss RP, Zucker KJ, Puts DA. Sexual orientation and the second to fourth finger length ratio: a meta-analysis in men and women. Behav Neurosci. 2010;124(2):278–87. https://doi.org/10.1037/a0018764.
Landén M, Rasmussen P. Gender identity disorder in a girl with autism—a case report. Eur Child Adolesc Psychiatry. 1997;6(3):170–3. https://doi.org/10.1007/BF00538990.
Tateno M, Tateno Y, Saito T. Comorbid childhood gender identity disorder in a boy with Asperger syndrome. Psychiatry Clin Neurosci. 2008;62(2):238. https://doi.org/10.1111/j.1440-1819.2008.01761.x.
Strang JF, Kenworthy L, Dominska A, Sokoloff J, Kenealy LE, Berl M, et al. Increased gender variance in autism spectrum disorders and attention deficit hyperactivity disorder. Arch Sex Behav. 2014;43(8):1525–33. https://doi.org/10.1007/s10508-014-0285-3.
Gallucci G, Hackerman F, Schmidt CW. Gender identity disorder in an adult male with Asperger’s syndrome. Sex Disabil. 2005;23(1):35–40. https://doi.org/10.1007/s11195-004-2078-4.
Perera H, Gadambanathan T, Weerasiri S. Gender identity disorder presenting in a girl with Asperger's disorder and obsessive compulsive disorder. Ceylon Med J. 2011;48(2). https://doi.org/10.4038/cmj.v48i2.3374.
Williams PG, Allard AM, Sears L. Case study: cross-gender preoccupations in two male children with autism. J Autism Dev Disord. 1996;26(6):635–42. https://doi.org/10.1007/BF02172352.
de Vries AL, Noens IL, Cohen-Kettenis PT, van Berckelaer-Onnes IA, Doreleijers TA. Autism spectrum disorders in gender dysphoric children and adolescents. J Autism Dev Disord. 2010;40(8):930–6. https://doi.org/10.1007/s10803-010-0935-9.
van der Miesen AIR, Hurley H, Bal AM, de Vries ALC. Prevalence of the wish to be of the opposite gender in adolescents and adults with autism spectrum disorder. Arch Sex Behav. 2018;47(8):2307–17. https://doi.org/10.1007/s10508-018-1218-3.
Kraemer B, Delsignore A, Gundelfinger R, Schnyder U, Hepp U. Comorbidity of Asperger syndrome and gender identity disorder. Eur Child Adolesc Psychiatry. 2005;14(5):292–6. https://doi.org/10.1007/s00787-005-0469-4.
Mukaddes NM. Gender identity problems in autistic children. Child Care Health Dev. 2002;28(6):529–32. https://doi.org/10.1046/j.1365-2214.2002.00301.x.
Van Der Miesen AI, Hurley H, De Vries AL. Gender dysphoria and autism spectrum disorder: a narrative review. Int Rev Psychiatry. 2016;28(1):70–80. https://doi.org/10.3109/09540261.2015.1111199.
•• Mahfouda S, Panos C, Whitehouse AJO, Thomas CS, Maybery M, Strauss P et al. Mental health correlates of autism spectrum disorder in gender diverse young people: evidence from a specialised child and adolescent gender clinic in Australia. J Clin Med. 2019;8(10). https://doi.org/10.3390/jcm8101503. Autistic traits amongst gender-diverse youth and linkage with mental health symptoms.
Baxter AJ, Brugha T, Erskine H, Scheurer R, Vos T, Scott J. The epidemiology and global burden of autism spectrum disorders. Psychol Med. 2015;45(3):601–13. https://doi.org/10.1017/S003329171400172X.
Janssen A, Huang H, Duncan C. Gender variance among youth with autism spectrum disorders: a retrospective chart review. Transgend Health. 2016;1(1):63–8. https://doi.org/10.1089/trgh.2015.0007.
George R, Stokes MA. Gender identity and sexual orientation in autism spectrum disorder. Autism. 2018;22(8):970–82. https://doi.org/10.1177/1362361317714587.
Cooper K, Smith LGE, Russell AJ. Gender identity in autism: sex differences in social affiliation with gender groups. J Autism Dev Disord. 2018;48(12):3995–4006. https://doi.org/10.1007/s10803-018-3590-1.
Tierney S, Burns J, Kilbey E. Looking behind the mask: social coping strategies of girls on the autistic spectrum. Res Autism Spectr Disord. 2016;23:73–83. https://doi.org/10.1016/j.rasd.2015.11.013.
Bejerot S, Eriksson JM. Sexuality and gender role in autism spectrum disorder: a case control study. PLoS One. 2014;9(1):e87961. https://doi.org/10.1371/journal.pone.0087961.
•• Strang JF, Powers MD, Knauss M, Sibarium E, Leibowitz SF, Kenworthy L, et al. "they thought it was an obsession": trajectories and perspectives of autistic transgender and gender-diverse adolescents. J Autism Dev Disord. 2018;48(12):4039–55. https://doi.org/10.1007/s10803-018-3723-6Longitudinal qualitative study with gender-disverse autistic adolescents.
van Schalkwyk GI. At the intersection of neurodiversity and gender diversity. J Autism Dev Disord. 2018;48(12):3973. https://doi.org/10.1007/s10803-018-3735-2.
Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97. https://doi.org/10.1037/0033-2909.129.5.674.
Fernandes LC, Gillberg CI, Cederlund M, Hagberg B, Gillberg C, Billstedt E. Aspects of sexuality in adolescents and adults diagnosed with autism spectrum disorders in childhood. J Autism Dev Disord. 2016;46(9):3155–65. https://doi.org/10.1007/s10803-016-2855-9.
Gougeon NA. Sexuality and autism: a critical review of selected literature using a social-relational model of disability. Am J Sex Educ. 2010;5(4):328–61. https://doi.org/10.1080/15546128.2010.527237.
Haracopos D, Pedersen L. Sexuality and autism: a nationwide survey in Denmark. Unpublished manuscript 1992.
Realmuto GM, Ruble LA. Sexual behaviors in autism: problems of definition and management. J Autism Dev Disord. 1999;29(2):121–7. https://doi.org/10.1023/A:1023088526314.
Stokes M, Newton N, Kaur A. Stalking, and social and romantic functioning among adolescents and adults with autism spectrum disorder. J Autism Dev Disord. 2007;37(10):1969–86. https://doi.org/10.1007/s10803-006-0344-2.
Rosqvist HB. Becoming an ‘autistic couple’: narratives of sexuality and couplehood within the Swedish autistic self-advocacy movement. Sex Disabil. 2014;32(3):351–63. https://doi.org/10.1007/s11195-013-9336-2.
Koller R. Sexuality and adolescents with autism. Sex Disabil. 2000;18(2):125–35. https://doi.org/10.1023/A:1005567030442.
Corona L, Fox S, Christodulu K, Worlock J. Providing education on sexuality and relationships to adolescents with autism spectrum disorder and their parents. Sex Disabil. 2016;34(2):199–214. https://doi.org/10.1007/s11195-015-9424-6.
•• Ohlsson Gotby V, Lichtenstein P, Langstrom N, Pettersson E. Childhood neurodevelopmental disorders and risk of coercive sexual victimization in childhood and adolescence - a population-based prospective twin study. J Child Psychol Psychiatry. 2018;59(9):957–65. https://doi.org/10.1111/jcpp.12884Demonstrates a link between general factor of neurodevelopmental disorders and sexual coercion risk.
Strang JF, Meagher H, Kenworthy L, de Vries ALC, Menvielle E, Leibowitz S, et al. Initial clinical guidelines for co-occurring autism spectrum disorder and gender dysphoria or incongruence in adolescents. J Clin Child Adolesc Psychol. 2018;47(1):105–15. https://doi.org/10.1080/15374416.2016.1228462.
•• George R, Stokes MA. A quantitative analysis of mental health among sexual and gender minority groups in ASD. J Autism Dev Disord. 2018;48(6):2052–63. https://doi.org/10.1007/s10803-018-3469-1Explores additive minority stress associated with gender and sexualtiy diversity amongst autistic and TD individuals.
Ozbay F, Johnson DC, Dimoulas E, Morgan C III, Charney D, Southwick S. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont). 2007;4(5):35–40.
Umberson D, Karas Montez J. Social relationships and health: a flashpoint for health policy. J Health Soc Behav. 2010;51(S):S54–66. https://doi.org/10.1177/0022146510383501.
Seppala E, Rossomando T, Doty JR. Social connection and compassion: important predictors of health and well-being. Soc Res Int Q. 2013;80(2):411–30.
Mushtaq R, Shoib S, Shah T, Mushtaq S. Relationship between loneliness, psychiatric disorders and physical health? A review on the psychological aspects of loneliness. J Clin Diagn Res. 2014;8(9):WE01–WE4. https://doi.org/10.7860/JCDR/2014/10077.4828.
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Sala, G., Pecora, L., Hooley, M. et al. As Diverse as the Spectrum Itself: Trends in Sexuality, Gender and Autism. Curr Dev Disord Rep 7, 59–68 (2020). https://doi.org/10.1007/s40474-020-00190-1
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DOI: https://doi.org/10.1007/s40474-020-00190-1