Experiences of Sex Education and Sexual Awareness in Young Adults with Autism Spectrum Disorder

Abstract

The research investigated feelings towards sex education and sexual awareness in young adults with autism spectrum disorder (ASD). Data were generated from the sexual knowledge, experiences, feelings and needs questionnaire (McCabe et al. 1999), the sexual awareness questionnaire (Snell et al. 1991) and semi-structured interviews. Twenty typically developing and 20 ASD individuals participated. Feelings toward sex education did not differ between the groups, but the groups differed significantly on measures of sexual awareness. Negative experiences of sex education and issues of vulnerability, social anxiety, and confused sexuality were prominent features of the qualitative interviews. This report suggest that mainstream sex and relationship education is not sufficient for people with ASD, specific methods and curricular are necessary to match their needs.

Appendices

Appendix A: Qualitative Questions

• Have you ever used the internet to find information about sexual issues? What did you learn/want to discover?

• Do you feel you have been given the right tools and information to lead a safe and fully functioning sex life? Is there anything you feel you have not been prepared for?

• Is there anyone in your life who has been significantly helpful in providing you with sex and relationship advice? Who? What have they done? Why have they been important?

• What would your ideal intimate relationship be? Why?

• Where/how do you meet potential partners?

• Have you used any internet dating websites?

• What is your biggest difficulty when meeting potential partners?

• Do you use social media/text messaging/multimedia messaging to contact potential or current partners? Do you feel this has helped overcome social anxiety?

• What would you tell your teenage self about sex and intimate relationships, knowing what you know now?

• What has been your most positive experiences with an intimate partner?

Appendix B: Full Qualitative Analysis

Qualitative Interview Analysis

Thematic analysis revealed five semantic themes: dissatisfaction with sex education in school, sexuality, social difficulties, negative experiences and understanding others.

Participants

M1: James, male with ASD; M2: Daniel, male with ASD; F1: Emily, female with ASD; F2: Fiona, female with ASD; M3: Matthew, typically developing male; M4: Mark, typically developing male; F3: Emma, typically developing female; F4: Sarah, typically developing female.

Dissatisfaction with Sex Education in School

All of the participants with ASD felt that the sex education received from school had not been sufficient.

I feel like I’ve been given the tools, but I just didn’t use them because they weren’t clear enough. (F1)

Because I’ve got autism, I’m a year behind everyone else. So I thought I was maybe not quite ready for it. I wanted it to have been explained in more depth. Then I went to an all-girls school for autistic people and I think they need to do a much better job there. (F2)

Participants with ASD additionally signified a need for more help and education in specific areas of sex and relationships.

I think they’ve got to teach people who are the right people to go with ….more skills on how to find the right sort of partner. (F2)

F2 revealed how she felt ill-equipped to cope with certain aspects of sexual relationships. In particular, she mentioned the notion of “dirty talk”.

I just don’t know what it is. So when they are all having a joke about it, I might misunderstand or take it the wrong way. I take things too literally, so I feel like someone could have sat down and said “These are the sort of things people probably talk about”, and “These are what they mean”. So then I can go out, actually say “I don’t want to get involved with that” or “Yes I do”. (F2)

M2 mirrored these viewpoints and stated that he did not feel the sex and relationship education from school had been “very helpful”. When asked if there was anything he felt particularly unprepared for he answered “a relationship”. Furthermore, M2 stated he would tell his teenage self to “try and understand what school is trying to teach you”.

These findings indicate that the young people with ASD in our sample were not only dissatisfied with the content and value of the sex and relationship education, but also that they had difficulties with how it was presented to them and internalising what he was being taught. In comparison three of the four TD participants stated that they felt they had been provided with the right tools and information to lead a safe and fully functioning sex life, and that there was not anything that they felt unprepared for. The typically developing participant who felt differently had attended a Catholic school, which had an impact upon the sex education he received. However, he felt he had been able to seek advice from close friends and he had “learnt it all himself”. Other typically developing participants also touched upon “finding things out for yourself” (F4), and “learning through experience” (M3), viewing it as a natural progression, rather than a desire for more education.

Sexuality

The theme “sexuality” refers to the notion of sexual orientation and how this presented itself in the participants’ realities.

M1 said he knew he was “gay” from the age of 12; however, he felt that his rigid thinking patterns, that are associated with autism, prevented him from accepting his sexuality and understanding his identity. After the interview M1 disclosed that he had previously been admitted onto an adolescent psychiatric unit. He explained how an accumulation of the problems he experienced with autism accompanied with issues surrounding his sexuality had contributed to him becoming depressed.

I sort of denied it to myself. Because I have very concrete, black and white thinking… it didn’t quite fit. And it caused me a lot of sort of emotional problems. (M1)

F1 reported that she had experienced multiple sexual interactions with members of the same sex, despite thinking she was heterosexual and not attracted to girls. These reports mirror the low scores ASD participants recorded on sexual consciousness subscale. Assistance with reflecting upon one’s sexual desires, motivations and thoughts is something that would be beneficial in a sex and relationship education for young people with autism.

In comparison none of the typically developing participants mentioned feelings of sexual confusion or sexual experiences with the same sex. All typically developing participants were heterosexual and appeared to be confident in their sexual orientation and preferences.

Social Difficulties

Social anxiety and discomfort was referred to by most of the participants with ASD, M1 and F2 reported it to be their “biggest difficulty” when meeting potential partners. M1 revealed how suffering from social anxiety impacted upon his experiences of dating.

I get a lot of anxiety, and I remember, on one of the occasions I was shaking and I was going red and I was sweating and I was really nervous. (M1)

M2 and F2 reflected upon the effects of difficulties socialising and how social situations, where meeting potential partners may be possible, can be challenging for them.

I just end up being anti-social in such places. (M2)

I generally have problems meeting people because I’m not particularly social. I’m not someone who would go out to the pub tomorrow with a bunch of friends because I don’t have a bunch of friends to go to the pub with. (F2)

In comparison, three of the typically developing participants reported that their main avenue for reaching potential participants was on “a night out”, in bars and nightclubs.

Negative Experiences

All of the participants with ASD dominated the interviews with reports of negative sexual experiences. F1 stated she had “been fucked over by someone” which affected her ability to trust future partners. F1 disclosed to having a sexually transmitted illness (STI), and in hindsight wished she had used protection during sexual intercourse. Furthermore, F1 described how another female had purposely intoxicated her with alcohol with the intent of having sex with her. Another occasion was described by F1 whereby she was influenced and encouraged by others to perform sexual acts with a female. F1 did not appear to be aware that these incidences could be perceived as someone taking advantage of her or abuse.

First time I was curious, second time she got me drunk, intentionally for that. And third time was for sheer banter because someone dared me to (laughs). I was a bit tipsy. (F1)

F2 reported a negative experience whereby she felt someone had “used” her in a sexual situation.

I’ve been in a bad situation, where to be honest I know now that that person probably was using me. But at the time, I was so head over heels for that person that I didn’t really, I didn’t really think anything other than “He really likes me”. (F2)

M1 also spoke about a partner who was “abusive and took advantage”. Vulnerability to abuse was reported in the literature review, the findings emphasise the need for change and the prevalence of the issue. None of the typically participants reported being abused or expressed feelings of being “used”.

M2 also appeared to have a very negative outlook on sex and relationships and spoke about the difficulties he has faced.

M2: I just keep getting it wrong and just keep messing stuff up. Yea so, it doesn’t really happen in my world.

Interviewer: Why do you say you mess things up?

M2: Just bad college experiences. Bad outdoor, outside experiences.

Interviewer: What have these bad experiences entailed?

M2: They’ve entailed me, erm, stalking, I guess. I should just now admit stalking. Just getting on the wrong side, getting jealous. Just yea, feeling ignored.

Two of the participants with autism admitted to stalking someone they were sexually interested in. However neither appeared to display any understanding or awareness of its seriousness.

I literally just saw him on the street. And then pretty much just stalked him. (F1)

In contrast all of the typically developing participants reported many positive experiences and emotions. M3 and M4 expressed very jubilant attitudes towards sex and relationships.

It’s just a fun part of a relationship…. So just you know, enjoy it! (M3)

Two of the typically developing participants did allude to having a partner cheat on them; however, this did not appear to affect their optimistic outlook on sex and relationships.

Understanding Others

Studies have shown that young people with ASD have difficulties understanding others’ thoughts and beliefs (Baron-Cohen 2001). Therefore, it is not unexpected that this theme was something the young people with ASD experienced difficulties with in relation to sex and relationships.

M1, M2 and F2 referred to difficulties understanding and interpreting what others were thinking or feeling during dating and sexual experiences.

I’m not able to tell what someone is thinking. So, I didn’t know what they thought or the subtleties of social situations. That are so difficult in ASD anyway. (M1)

M1 recognised a connection between not being able to understand others and his social anxiety during dating. Similarly, M2 also acknowledged that not being able to understand others, and how they might be feeling, impeded upon his experiences and decision making skills, for example participating in stalking and sending inappropriate messages.

F2, also expressed difficulties understanding others, however related it to the ability of recognising ill intent.

I’ve slowly realised I need to be more careful and people try and get you in the hook without you realising…. I thought it would be much more difficult for people to be able to do that, but really it’s not. (F2)

F1 said she found it difficult to recognize when it was appropriate to advance with an intimate relationship. Additionally, F2 expressed that she felt herself and others with autism needed help understanding other’s intentions and identifying “the right sort of partner”. These statements infer that girls with ASD recognise the deficits that they face with regards to understanding others and approach sex and relationships with caution.