Sex and Autism

Sex education and puberty

Here are some ideas for talking to your child about puberty, sex, sexuality and relationships, as well as links to some useful resources. You can also read our top tips for sex education.

When to talk to your child about puberty, sex, sexuality and relationships

School classes address puberty, sex, sexuality and relationships at an age-appropriate level. Find out what your child’s school will be teaching, and when. By working with the school, you will help to ensure consistency between school and home explanations. You might decide that these lessons are paced inappropriately for your child. Perhaps they progress too fast and assume too much prior knowledge, or don’t start at an early enough age. Children on the autism spectrum often need a longer period of time to adjust to and understand any changes in their lives. Your child may do things that will be considered inappropriate as an adolescent or adult, like removing their clothes at unexpected moments. It may be easier to address these behaviors before puberty begins.

Talking about puberty:How to talk to your child about puberty

Answer honestly any questions your child has about puberty and their body. This will help your child to learn that puberty is not something to be embarrassed about and that they can trust you to give them the right information. If you are unsure of the right answer, it is better to say that you are unsure. Your child may be confused if your answer is not clear. Your child might ask a question at an inappropriate moment. You could develop a standard response, which everyone in the family can use, such as ‘That’s a good question. Let’s talk about it once we get home’ (National Children’s Bureau, Sex Education Forum, 2003). Remember to deal with the question when you get home or your child may be reluctant to ask you questions again. Your GP or practice nurse may be able to help, especially if your child will only be satisfied with an accurate, full and scientific answer. Involving the GP or practice nurse may help your child to feel comfortable talking to them about their bodies in the future, about sexual health or contraception.

Be careful how you use language. Saying that your son’s voice is “breaking” may be very worrying for a child with autism, who may take it literally. Instead you could say that your voice is changing and likely to become deeper. You could then refer to their father’s/uncle’s/older brother’s voices and explain that men’s voices are usually deeper than women’s. You may want to explain that there are different names for private body parts, and that the words you are using might be different to words your child might hear in the playground. You could explain that they should not feel they need to join in with playground conversations about private body parts if they don’t want to.

While you are talking to your children about puberty and sex, you may also need to provide some guidelines about the difference between public and private:
* who they can talk to about any concerns they have, like mum, dad, the GP and school nurse
* which rooms are private and which are public
* that they should only undress or masturbate in a private room (like their bedroom)
* that people should always knock on a bedroom door before entering (you will need to make sure that everyone who visits your home is aware of this rule).

Physical changes: Explaining physical development
You could use visual supports to explain the basics of development, such as:
* photos – you could show your child photos of themselves as a baby and toddler, and of yourself or other family members at different ages, to help your child to understand about when puberty happens in a person’s life
* a body outline, labeling all of the body parts, and highlighting how each part will change, and talking about what fluids come from each part – sweat, tears, urine, semen, menstrual blood, vaginal discharge.

Encourage your children to feel positive about these changes by talking about some of the advantages of being an adolescent and adult, then you can make your own decisions about how to have your hair cut, you can vote – whatever will appeal to your child.

Menstruation (periods)
You daughter may need reassurance that menstruation is a normal biological process, and that she will not bleed to death. Tell your daughter who to go to at school if she gets her period while there. Your daughter could carry a small notebook around with her with information or reassurance for those moments when you will not be there. This will also encourage independence and could be used in various ways throughout her life. Show your daughter how to use sanitary products, pointing out any particular features which might help her to remember how to use them correctly. Put sanitary products in a particular drawer in your daughter’s bedroom, or in the bathroom, so she can be reassured that they will always be there when she needs them. You could use a calendar to help your daughter to understand when her period is due. This may help her to feel less anxious. Alternatively, a period tracking app for her tablet or smartphone may be more subtle and could promote independence.

Be prepared to talk about masturbation with your child so that they do not develop any anxieties about what they are doing. Reassure them that masturbation is a normal activity. It is important that your child knows know how to clean themselves if necessary after masturbation. You could perhaps supply tissues/wet wipes or an appropriate towel. You may want your child to tell you if bedclothes need changing. If your child would find this difficult, you could introduce a symbol or hand signal that they could use to let you know.

Body image
You may need to be careful that your child does not develop an unrealistic view of what their body or other people’s bodies should look like. Some children and teenagers may look at the images in the media and social media and believe that their body will look like those, or they may think that their body will look just like the bodies in the visual materials you have used. Stress that all bodies are a bit different.

Personal hygiene
Address personal hygiene issues as your child approaches puberty. Prepare your child for the need to wash more often, for shaving and for using deodorants. You will need to explain how to do these things, as well as the social rules determining why we do them. If your child already has an established routine or tick list for their morning schedule, washing themselves, changing their clothes or their bed sheets, you could perhaps adjust it to include the use of deodorants, showering every day, shaving every other day and so on.

Relationships and sex

Your child might need help to understand social interaction in order to sustain a relationship. You may need to discuss why some people get married or choose to live permanently with one person. You could explain these things by discussing your relationship with your partner or those of other family members.
This could be supported visually by drawing stick figures, or using photographs, of each significant person in this individual’s life, including themselves, their family members, support workers, teachers and doctors, if appropriate. You may want to use a different piece of paper for each person. The pictures should be placed in the middle of the paper and connections should be made to a variety of drawings, words or photographs that surround this person. These other pictures or words should symbolize this person’s role for the individual concerned and perhaps other members of the family.

You could change the person in the center from the person on the autism spectrum to mum, dad or a sibling, as this may help your child to understand how other people view the relationships in the family. You may want to discuss another family that is different from your own, perhaps one headed by a single parent or vice versa.

Sensory issues
Because of your child’s sensory issues, they may be worried about the idea of hugging or kissing in future relationships. Reinforce that when it comes to relationships, they should only do what they are comfortable with. A number of autistic adults describe their love or need for a particular object. Donna Williams, who is on the autism spectrum, writes how she “… fell in love with the things in people’s homes far more than I fell for the people themselves.” (Williams, 1999). Perhaps Donna felt this way because objects are predictable, solid and reliable, unlike her family members who appeared to change who they were from one minute to the next. This is understandable when we appreciate the world from her point of view. Sexual health You will need to discuss smear tests, contraception, and sexually transmitted infections.

Staying safe and appropriate behavior

It is often non-autistic individuals who have decided this behavior is inappropriate. Autism affects a person’s ability to understand what is considered to be socially appropriate behavior and to imagine what other people might feel or be about to do. A behavior might have a very significant and specific meaning for them which isn’t ‘just being rude’ or sexually motivated. For example, if a person with autism touches of brushes against a particular woman’s breasts every time they meet, this could be because:
* this is a routine action they have developed to work out what mood that person is in today, finding it difficult to glean this from a person’s facial expressions and body language
* they like the reaction they get – the shock on the person’s face, or the verbal response which follows
* they got sensory stimulation the first time they brushed against the woman’s body, and want to repeat this
* they may be curious about what that part of a person’s body feels like and are acting on an impulse.

If a person with autism kisses someone unexpectedly, this could be because:
* they have seen two people kissing on the television and think the other person will react the way the person they saw being kissed did
* they think the other person wants to kiss, because they themselves want to kiss.

It can be hard to break the cycle of inappropriate behavior. Here are some strategies you could try.

Behavior diaries
Completing a behavior diary, which records what is occurring before, during and after the behavior, could help you to understand the purpose of the behavior. A diary may be completed over a couple of weeks or longer if needed. This may be difficult to do if the behavior is particularly unpleasant for the individual or those around them but it is an important stage in understanding and trying to solve the behavior. Please note that while it is understandable that the immediate reaction to a person’s behaviors could be negative and comprise feelings of shock or alarm, a calm reaction and level tone should be maintained if at all possible.

Circles Concept
Circles Concept can be used to visually demonstrate socially appropriate behavior in different locations and contexts. This can be adapted to many situations.