Skip to main content
SpringerLink
Log in

Autism and Adult Sex Education: A Literature Review Using the Information–Motivation–Behavioral Skills Framework

Sexuality and Disability volume 37, pages 339–351 (2019)Cite this article

Abstract

Adults on the autism spectrum report comparable levels of desire for sex and sexual satisfaction as adults who are not on the spectrum. However, there has been little empirical focus on the need for sexual and relationship-oriented education for youth on the spectrum as they transition to adulthood. In this review, we use the Information–Motivation–Behavioral Skills Model of sexual health behavior change as a lens through which to understand the experiences of adults on the autism spectrum. We present those insights infused with emerging data and best practices in the field. Overall, it appears clear from the extant literature that providers need to recognize the specific characteristics of autism when developing sexual education curricula. Specifically, the social communication and sensory profile of people on the autism spectrum appears to interact with access to information, motivation to engage in healthy sexual activities, and the development of skills needed to engage in healthy sexual behavior. Finally, the voice of adults on the spectrum is essential to guide the emerging understanding of healthy sexuality.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Individuals with Disabilities Education Act, 20 U.S.C. § 1400 (2004)

  2. Murphy, N.A., Elias, E.R.: Sexuality of children and adolescents with developmental disabilities. Pediatrics 118(1), 398–403 (2006)

    Article  PubMed  Google Scholar 

  3. Wagner, S.: Educating the female student with Asperger’s. In: Asperger’s and Girls, pp. 15–32. Future Horizons, Arlington, TX (2006)

    Google Scholar 

  4. Wrobel, M.: Preparing for puberty and beyond. In: Asperger’s and Girls, pp. 65–78. Future Horizons, Arlington, TX (2006)

    Google Scholar 

  5. Travers, J., Tincani, M.: Sexuality education for individuals with autism spectrum disorders: critical issues and decision making guidelines. Educ. Train. Autism Dev. Disabil. 45(2), 284–293 (2010)

    Google Scholar 

  6. Tullis, C.A., Zangrillo, A.N.: Sexuality education for adolescents and adults with autism spectrum disorders. Psychol. Sch. 50(9), 866–875 (2013)

    Article  Google Scholar 

  7. Hannah, L.A., Stagg, S.D.: Experiences of sex education and sexual awareness in young adults with autism spectrum disorder. J. Autism Dev. Disord. 46(12), 3678–3687 (2016)

    Article  PubMed  Google Scholar 

  8. Hartmann, K., et al.: Sexuality in the Autism Spectrum Study (SASS): reports from young adults and parents. J. Autism Dev. Disord. 49(9), 3638–3655 (2019)

  9. Cheak-Zamora, N.C., Teti, M., Maurer-Batjer, A., O’Connor, K.V., Randolph, J.K.: Sexual and relationship interest, knowledge, and experiences among adolescents and young adults with autism spectrum disorder. Arch. Sex. Behav. (2019). https://doi.org/10.1007/s10508-019-1445-2

    Article  Google Scholar 

  10. Fisher, J.D., Fisher, W.A.: Changing AIDS-risk behavior. Psychol. Bull. 111(3), 455–474 (1992)

    Article  PubMed  Google Scholar 

  11. Fisher, W.A., Fisher, J.D., Shuper, P.A.: Social psychology and the fight against AIDS: an information–motivation–behavioral skills model for the prediction and promotion of health behavior change. Adv. Exp. Soc. Psychol. 50, 105–193 (2014)

  12. Pantalone, D.W., Puckett, J.A., Gunn, H.A.: Psychosocial factors and HIV prevention for gay, bisexual, and other men who have sex with men. Soc. Personal. Psychol. Compass 10(2), 109–122 (2016)

    Article  Google Scholar 

  13. Newcomb, M.E., Mustanski, B.: Cognitive influences on sexual risk and risk appraisals in men who have sex with men. Health Psychol. 33(7), 690–699 (2014)

    Article  PubMed  Google Scholar 

  14. Roth, M.E., Gillis, J.M.: ‘Convenience with the click of a mouse’: a survey of adults with autism spectrum disorder on online dating. Sex. Disabil. 33(1), 133–150 (2015)

    Article  Google Scholar 

  15. Moore, T.R., Symons, F.J.: Adherence to treatment in a behavioral intervention curriculum for parents of children with autism spectrum disorder. Behav. Modif. 35(5), 570–594 (2011)

    Article  PubMed  Google Scholar 

  16. Mehzabin, P., Stokes, M.A.: Self-assessed sexuality in young adults with high-functioning autism. Res. Autism Spectr. Disord. 5(1), 614–621 (2011)

    Article  Google Scholar 

  17. Brown-Lavoie, S.M., Viecili, M.A., Weiss, J.A.: Sexual knowledge and victimization in adults with autism spectrum disorders. J. Autism Dev. Disord. 44, 2185–2196 (2014)

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hénault, I., Attwood, T.: The sexual profile of adults with Asperger’s syndrome: the need for support and intervention. In: Hénault, I. (ed.) Asperger’s Syndrome and Sexuality: From Adolescence through Adulthood, pp. 183–192. Jessica Kingsley Publishers, London (2006)

    Google Scholar 

  19. Kellaher, D.C.: Sexual behavior and autism spectrum disorders: an update and discussion. Curr. Psychiatry Rep. 17(4), 25 (2015)

    Article  Google Scholar 

  20. Holmes, L.G., Himle, M.B., Sewell, K.K., Carbone, P.S., Strassberg, D.S., Murphy, N.A.: Addressing sexuality in youth with autism spectrum disorders: current pediatric practices and barriers. J. Dev. Behav. Pediatr. 35(3), 172–178 (2014)

    Article  PubMed  Google Scholar 

  21. Ballan, M.S.: Parental perspectives of communication about sexuality in families of children with autism spectrum disorders. J. Autism Dev. Disord. 42(5), 676–684 (2012)

    Article  PubMed  Google Scholar 

  22. Meister, C., Honeyman, S., Norlock, D., Pierce, K.: Sexuality and autism: a parenting skills enhancement group. Can. J. Hum. Sex. 3(3), 283–289 (1994)

    Google Scholar 

  23. Dewinter, J., Vermeiren, R., Vanwesenbeeck, I., Van Nieuwenhuizen, C.: Parental awareness of sexual experience in adolescent boys with autism spectrum disorder. J. Autism Dev. Disord. 46(2), 713–719 (2016)

    Article  PubMed  Google Scholar 

  24. Holmes, L.G., Himle, M.B.: Brief report: parent–child sexuality communication and autism spectrum disorders. J. Autism Dev. Disord. 44(11), 2964–2970 (2014)

    Article  PubMed  Google Scholar 

  25. Volkmar, F.R., Wiesner, L.A., Westphal, A.: Healthcare issues for children on the autism spectrum. Curr. Opin. Psychiatry 19(4), 361–366 (2006)

    Article  PubMed  Google Scholar 

  26. Barnett, J.P., Maticka-Tyndale, E.: Qualitative exploration of sexual experiences among adults on the autism spectrum: implications for sex education. Perspect. Sex. Reprod. Health 47(4), 171–179 (2015)

    Article  PubMed  Google Scholar 

  27. Lehan Mackin, M., Loew, N., Gonzalez, A., Tykol, H., Christensen, T.: Parent perceptions of sexual education needs for their children with autism. J. Pediatr. Nurs. 31(6), 608–618 (2016)

    Article  PubMed  Google Scholar 

  28. 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(11), 3519–3556 (2016)

    Article  PubMed  Google Scholar 

  29. Attwood, T.: Romantic relationships for young adults with Asperger syndrome and high-functioning Autism (2009) Retrieved from http://www.iancommunity.org/cs/articles/relationships

  30. 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. 45(3), 731–741 (2015)

    Article  PubMed  Google Scholar 

  31. Ousley, O.Y., Mesibov, G.B.: Sexual attitudes and knowledge of high-functioning adolescents and adults with autism. J. Autism Dev. Disord. 21(4), 471–481 (1991)

    Article  PubMed  Google Scholar 

  32. Gilmour, L., Schalomon, P.M., Smith, V.: Sexuality in a community based sample of adults with autism spectrum disorder. Res. Autism Spectr. Disord. 6(1), 313–318 (2012)

    Article  Google Scholar 

  33. Dewinter, J., Vermeiren, R., Vanwesenbeeck, I., Van Nieuwenhuizen, C.: Adolescent boys with autism spectrum disorder growing up: follow-up of self-reported sexual experience. Eur. Child Adolesc. Psychiatry 25(9), 969–978 (2016)

    Article  PubMed  PubMed Central  Google Scholar 

  34. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC (2013)

  35. Garcia Winner, M.: Social Behavior Starts with Social Thought: The Four Steps of Perspective Taking (2015) Retrieved from https://www.socialthinking.com/Articles?name=social-behavior-starts-social-thought-perspective-taking

  36. Attwood, T.: The profile of friendship skills in Asperger’s syndrome. Jenison Autism J. 14, 3 (2002)

    Google Scholar 

  37. Fernandes, L.C., Gillberg, C.I., 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. 46(9), 3155–3165 (2016)

    Article  PubMed  Google Scholar 

  38. Stokes, M., Newton, N., Kaur, A.: Stalking, and social and romantic functioning among adolescents and adults with autism spectrum disorder. J. Autism Dev. Disord. 37(10), 1969–1986 (2007)

    Article  PubMed  Google Scholar 

  39. Byers, E.S., Nichols, S., Voyer, S.D.: Challenging stereotypes: sexual functioning of single adults with high functioning autism spectrum disorder. J. Autism Dev. Disord. 43(11), 2617–2627 (2013)

    Article  PubMed  Google Scholar 

  40. Holmes, L.G., Himle, M.B., Strassberg, D.S.: Parental romantic expectations and parent–child sexuality communication in autism spectrum disorders. Autism 20(6), 687–699 (2016)

    Article  PubMed  Google Scholar 

  41. Visser, K., Greaves-Lord, K., Tick, N.T., Verhulst, F.C., Maras, A., van der Vegt, E.J.M.: Study protocol: a randomized controlled trial investigating the effects of a psychosexual training program for adolescents with autism spectrum disorder. BMC Psychiatry 15(1), 207 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

  42. Visser, K., Greaves-Lord, K., Tick, N.T., Verhulst, F.C., Maras, A., van der Vegt, E.J.M.: A randomized controlled trial to examine the effects of the Tackling Teenage psychosexual training program for adolescents with autism spectrum disorder. J. Child Psychol. Psychiatry Allied Discip. 58(7), 840–850 (2017)

    Article  Google Scholar 

  43. McLaughlin, K., Topper, K., Lindert, J.: Sexuality education for people with developmental disabilities. ETR, Scotts Valley (2018)

  44. Tissot, C.: Establishing a sexual identity. Case studies of learners with autism and learning difficulties. Autism 13(6), 551–566 (2009)

    Article  PubMed  Google Scholar 

  45. Kirby, D.B., et al.: The ‘Safer Choices’ intervention: its impact on the sexual behaviors of different subgroups of high school students. J. Adolesc. Health 35(6), 442–452 (2004)

    Article  PubMed  Google Scholar 

  46. Stanton, B., et al.: Randomized trial of a parent intervention: parents can make a difference in long-term adolescent risk behaviors, perceptions, and knowledge. Arch. Pediatr. Adolesc. Med. 158(10), 947–955 (2004)

    Article  PubMed  Google Scholar 

  47. Philliber, S., Kaye, J.W., Herrling, S., West, E.: Preventing pregnancy and improving health care access among teenagers: an evaluation of the Children’s Aid Society-Carrera program. Perspect. Sex. Reprod. Health 34(5), 244–251 (2002)

    Article  PubMed  Google Scholar 

  48. Klin, A., Jones, W.: Attributing social and physical meaning to ambiguous visual displays in individuals with higher-function autism spectrum disorders. Brain Cogn. 61(1), 40–53 (2006)

    Article  PubMed  Google Scholar 

  49. Spek, A.A., Scholte, E.M., Van Berckelaer-Onnes, I.A.: Theory of mind in adults with HFA and asperger syndrome. J. Autism Dev. Disord. 40(3), 280–289 (2010)

    Article  PubMed  Google Scholar 

  50. Scarpa, A., Williams White, S., Attwood, T.: CBT for children and adolescents with high-functioning autism spectrum disorders. Guilford Press, New York (2013)

  51. Adolphs, R., Sears, L., Piven, J.: Abnormal processing of social information from faces in autism. J. Cogn. Neurosci. 13(2), 232–240 (2001)

    Article  PubMed  Google Scholar 

  52. Freitag, C.M., Kleser, C., Von Gontardf, A.: Imitation and language abilities in adolescents with autism spectrum disorder without language delay. Eur. Child Adolesc. Psychiatry 15(5), 282–291 (2006)

    Article  PubMed  Google Scholar 

  53. Attwood, S.: Making Sense of Sex: A Forthright Guide to Puberty, Sex, and Relationships for People with Asperger’s Syndrome. Jessica Kingsley Publishers, London (2008)

    Google Scholar 

  54. McIlwee Myers, J.: Aspie do’s and don’ts: dating, relationships, and marriage. In: Asperger’s and Girls, pp. 89–116. Future Horizons, Arlington (2006)

  55. Hellemans, H., Colson, K., Verbraeken, C., Vermeiren, R., Deboutte, D.: Sexual behavior in high-functioning male adolescents and young adults with autism spectrum disorder. J. Autism Dev. Disord. 37(2), 260–269 (2007)

    Article  PubMed  Google Scholar 

  56. May, T., Pang, K.C., Williams, K.: Brief report: sexual attraction and relationships in adolescents with autism. J. Autism Dev. Disord. 47, 1910–1916 (2017)

    Article  PubMed  Google Scholar 

  57. George, R., Stokes, M.A.: Gender identity and sexual orientation in autism spectrum disorder. Autism. 22(8), 970–982 (2018)

  58. De Vries, A.L.C., Noens, I.L.J., Cohen-Kettenis, P.T., Van Berckelaer-Onnes, I.A., Doreleijers, T.A.: Autism spectrum disorders in gender dysphoric children and adolescents. J. Autism Dev. Disord. 40(8), 930–936 (2010)

    Article  PubMed  PubMed Central  Google Scholar 

  59. George, R., Stokes, M.A.: A quantitative analysis of mental health among sexual and gender minority groups in ASD. J. Autism Dev. Disord. 48(6), 2052–2063 (2018)

    Article  PubMed  Google Scholar 

  60. Grandin, T.: For me, a good career gave life meaning. In: Asperger’s and Girls, pp. 147–150. Future Horizons, Arlington, TX (2006)

    Google Scholar 

  61. Hénault, I.: Asperger’s Syndrome and Sexuality: From Adolescence Through Adulthood. Jessica Kingsley Publishers, London (2005)

    Google Scholar 

  62. Koller, R.: Sexuality and adolescents with autism. Sex. Disabil. 18(2), 125–135 (2000)

    Article  Google Scholar 

  63. Carter, J.K.: Sexuality education for students with specific learning disabilities. Interv. Sch. Clin. 34(4), 220–223 (1999)

    Article  Google Scholar 

  64. Miltenberger, R.G., et al.: Training and generalization of sexual abuse prevention skills for women with mental retardation. J. Appl. Behav. Anal. 32(3), 385–388 (1999)

    Article  PubMed  PubMed Central  Google Scholar 

  65. Sulpizi, L.K.: Issues in sexuality and gynecological care of women with developmental disabilities. J. Obstet. Gynecol. Neonatal. Nurs. 25, 609–614 (1996)

    Article  PubMed  Google Scholar 

  66. Chan, J., John, R.M.: Sexuality and sexual health in children and adolescents with autism. J. Nurse Pract. 8(4), 306–315 (2012)

    Article  Google Scholar 

  67. Quint, E.H.: Menstrual issues in adolescents with physical and developmental disabilities. Ann. N. Y. Acad. Sci. 1135, 230–6 (2008)

  68. Klett, L.S., Turan, Y.: Generalized effects of social stories with task analysis for teaching menstrual care to three young girls with autism. Sex. Disabil. 30(3), 319–336 (2012)

    Article  Google Scholar 

  69. Sukhodolsky, D.G., Bloch, M.H., Panza, K.E., Reichow, B.: Cognitive-behavioral therapy for anxiety in children with high-functioning autism: a meta-analysis. Pediatrics 132(5), e1341–e1350 (2013)

    Article  Google Scholar 

  70. Sofronoff, K., Eloff, J., Sheffield, J., Attwood, T.: Increasing the understanding and demonstration of appropriate affection in children with Asperger syndrome: a pilot trial. Autism Res. Treat. (2011). https://doi.org/10.1155/2011/214317

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This publication was supported in part by the National Institute of Mental Health under Award Number R03 MH 113966. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Division of Developmental Medicine, Boston Children’s Hospital, 1 Autumn Street, BCH3178, Boston, MA, 02215, USA

    Dasha Solomon & Susan Faja

  2. Departments of Pediatrics and Psychiatry, Harvard Medical School, Boston, 02215, USA

    Dasha Solomon & Susan Faja

  3. Department of Psychology, University of Massachusetts, Boston, 02125, USA

    David W. Pantalone

  4. The Fenway Institute, Fenway Health, Boston, 02215, USA

    David W. Pantalone

Authors
  1. Dasha Solomon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David W. Pantalone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susan Faja
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DS drafted the manuscript including the review of best practices and self-report of adults on the spectrum. DP contributed to the application of the IMB model for adults on the spectrum, and reviewed the literature related to sexuality in autism. He also revised and edited the manuscript. SF contributed to the conceptualization of the model including the emphasis on autism specific needs in intervention. She contributed to the literature review and to editing and revising the manuscript. All authors have reviewed and approved the manuscript prior to submission.

Corresponding author

Correspondence to Susan Faja.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Solomon, D., Pantalone, D.W. & Faja, S. Autism and Adult Sex Education: A Literature Review Using the Information–Motivation–Behavioral Skills Framework. Sex Disabil 37, 339–351 (2019). https://doi.org/10.1007/s11195-019-09591-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11195-019-09591-6

Keywords

search

Navigation