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Sexuality in High-Functioning Autism: A Systematic Review and Meta-analysis

Abstract

Preliminary research examining sexuality within High-Functioning Autism (HFA) has been yet to consider the impact sex may have on the sexual/romantic functioning of this population. A systematic database search was carried out to identify 27 observational and cross-sectional publications meeting predetermined inclusion criteria. Using standardised mean differences, a random-effects meta-analysis pooled data from 9 eligible studies. Exhibiting higher levels of sexual understanding, females with HFA were subject to more adverse sexual experiences than males with HFA and neurotypical counterparts. Males reported greater desire for, and engagement in both solitary and dyadic sexual contact. Findings have provided initial insight into characterising the sexuality of males and females with HFA, yet also necessitated the need for future research in the field.

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Notes

  1. (Note: Adopting definitions from the World Health Organisation (WHO 2016), all references to “sex” in this paper refer to the biological and physiological characteristics that define and differentiate males and females. “Gender” refers to the socially constructed norms, beliefs, and behaviours that a given culture associates with a person’s biological sex. As the studies included in this meta-analysis focus on adolescents and adults, the difficulty in separating out the effect of sex and gendered socialisation has seen that some articles refer to “sex”, “gender” (WHO 2016, para. 3), or use the concepts interchangeably. In order to acknowledge both this issue, and the purpose of this meta-analysis, which was to examine the impact of “sex” (as a biological construct) on sexuality in HFA; all references to “sex/gender” differences cited in included studies will be referred to as “sex” in this paper).

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Acknowledgments

Author Contributions

All authors contributed to the analytic methods and written work presented in this paper. LP and MS conceived, and participated in the design of the study. LP conducted all systematic search and meta-analysis procedures, and drafted the original manuscript. GM provided expertise regarding the study, critically evaluated all key sections of the review, and assisted in drafting the manuscript. MS oversaw all analyses, participated in the interpretation of data, reviewed, and was involved in the write up of all drafts. All authors were involved in the final revisions and approval of the published manuscript.

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Correspondence to Laura A. Pecora.

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Research Involving Human Participants and/or Animals

This study has been approved by the Deakin University Human Research Ethics Committee (Project ID: 2014-210). As this article was a review of a number of primary publications, it did not directly conduct research on human participants. However, of the procedures performed in included studies that did involve human participants, all were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

As this was a review article, formal consent of participants was not required. However, informed consent was obtained from all parents and carers of/individual participants in each of the studies reviewed in this article.

Appendix: Complete Search Strategy and Search Terms Used for Database Searching

Appendix: Complete Search Strategy and Search Terms Used for Database Searching

See Table 2.

Table 2 Complete search strategy for all included studies: sex differences in sexuality (HFA and TD)

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Pecora, L.A., Mesibov, G.B. & Stokes, M.A. Sexuality in High-Functioning Autism: A Systematic Review and Meta-analysis. J Autism Dev Disord 46, 3519–3556 (2016). https://doi.org/10.1007/s10803-016-2892-4

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Keywords

  • Autism spectrum disorder
  • High-functioning autism
  • Sexuality
  • Female profile
  • Systematic review and meta-analysis