Responding to Inappropriate Sexual Behaviors Displayed by Adolescents With Autism Spectrum Disorders
Adolescents with autism spectrum disorders (ASD) may exhibit many challenging behaviors during puberty. Similar to adolescents without ASD, adolescents with ASD experience hormonal changes and sexual curiosity during this time. One major difference is that individuals with ASD experience these changes in addition to communication, socialization, and behavior difficulties. It is important for parents to recognize that it is common for individuals with ASD to display sexual behaviors (Van Bourgondien, Reichle, & Palmer, 1997). The majority of parents of adolescents with ASD experience the challenge of teaching their adolescents to behave in an appropriate sexual manner.
Although it may be difficult, it is critical for parents to identify inappropriate sexual behaviors early on and respond accordingly. The longer a parent waits to intervene, the more difficult it will be to address the behavior. Frequently reported inappropriate sexual behaviors include touching self, touching others, masturbation in public, and disrobing (Haracopos & Peedersen, 1992; Ruble & Dalrymple, 1993). If appropriate social skills, self-care skills, and language skills have not been learned prior to puberty, parents may have difficulty responding to their child’s inappropriate sexual behaviors in a positive and productive manner.
Ideally, parents should seek treatment from a qualified professional in order to address their concerns and to develop an individualized treatment plan to reduce their child’s inappropriate behaviors. Parents are encouraged to contact their child’s school psychologist, a licensed psychologist with training or expertise in behavior assessment and management, or a certified behavior analyst to obtain services (see www.bacb.com for a registry of Board Certified Behavior Analysts). Individuals with ASD possess a range of skills and cognitive abilities. Therefore, an individualized plan is the most appropriate option available in order to meet the needs of the individual.
Many adolescents with ASD may benefit from a sexual education-training program, however other adolescents with limited expressive and receptive skills may benefit from a more intensive behavior modification program. Regardless of the type of program developed for an adolescent with ASD, there are some general strategies that are evident in most quality programs.
Using Environmental Modifications to Improve Behavior
An initial step in addressing inappropriate sexual behaviors is to determine what, if any, environmental changes can be made to reduce the likelihood that an inappropriate sexual behavior will occur. Parents are often very creative in their attempts to modify environments, and these simple modifications can frequently prevent inappropriate behaviors. For example, some parents have reported that purchasing different types or styles of undergarments or clothing reduced the likelihood that their child would engage in inappropriate behaviors. Other parents have reported that insisting that their child wear a belt has reduced their child’s attempts to engage in inappropriate self-touching. If a specific object is frequently associated with the behavior, limiting the adolescent’s access to the object can also be effective. Modifications such as these can produce immediate results and are often implemented with minimal effort.
Saying Yes to Appropriate Behaviors
Another effective strategy involves telling an adolescent what to do as opposed to what not to do. Often, an initial reaction is for parents to tell their child to "stop" engaging in the behavior, however this is only part of the answer. Based on the teaching principals of applied behavior analysis (ABA), when attempting to decrease any behavior, it is most effective to teach a behavior to replace the inappropriate behavior. Therefore, telling a child to "stop" may result in the child questioning, "What do I do instead?" and may result in the child engaging in another inappropriate behavior. An example of a mother implementing this strategy in the grocery store would involve her asking her son to push the cart when she observed him attempting to touch himself inappropriately. If he is told to push the cart, he is aware of the desired appropriate behavior and unable to touch himself since both hands are on the cart.
For behaviors that the parents deem appropriate in private places, but not in public places, adolescents can be taught to discriminate between private places (e.g. bedroom) and public places (e.g. outside, living room, etc.). Once adolescents can discriminate between acceptable and unacceptable locations, they can be taught to engage in the sexual behavior only in the private/acceptable location. All attempts to engage in the behavior in public locations should be interrupted immediately. This procedure allows adolescents to engage in the sexual behavior while also teaching them that it is unacceptable in public.
Additionally, it is not only important to teach the adolescents to discriminate between locations, but also between people. For example, parents may believe that it is appropriate for adolescents to be affectionate towards familiar people, but not towards strangers. Therefore, adolescents need to be taught the difference between a stranger and a familiar person with whom affection is appropriate, before they can be expected to know why affection is only sometimes appropriate.
Consistency is an additional factor that plays a critical role in addressing inappropriate displays of sexual behavior. Everyone who has a relationship with the adolescent needs to be consistent when responding to inappropriate behavior. If an adolescent receives inconsistent feedback, he or she will have more difficulty learning what is and what is not acceptable. For example, treatment of an adolescent who engages in disrobing would require the adolescent’s parents and teachers to enforce the rule of remaining dressed throughout the day, every day. By having consistent expectations, parents and teachers may avoid difficult experiences in the future.
Remember the Potential for Inadvertent Outcomes
Think ahead. When implementing any intervention, it is essential to consider how it will generalize to other settings. Often, professionals and parents strive for the generalization of skills. When a child is taught to say "please" during requesting, professionals and parents expect the child to eventually say "please" at home, at school, and with his or her parents, siblings, and teachers. Generalization is often a desirable outcome. However, it can also be undesirable. This occurs when a child is allowed to engage in sexual behaviors in the bathroom at home and then begins to engage in the same behaviors in the bathroom at school. For this reason, parents and professionals should use a great deal of consideration when choosing appropriate interventions.
It is vitally important to teach adolescents to refrain from engaging in inappropriate sexual behaviors. Adolescents who are able to manage their sexual behaviors appropriately have access to a greater number of vocational, social, and educational opportunities, and are less likely to be involved in situations which could lead to irreparable consequences. Professionals are available to help, and effective interventions do exist. Addressing concerns with professionals and seeking effective treatment for an adolescent child’s inappropriate behaviors can make a significant difference in the child’s success.
- Haracopos, D. & Pedersen, L. (1992). Sexuality and autism: Danish report. United Kingdom: Society for the Autistically Handicapped.
- Ruble, L.A. & Dalrymple, N.J. (1993). Social/sexual awareness of person’s with autism: A parental perspective. Archives of Sexual Behavior, 22(3), 229-240.
- Van Bourgondien, M.E., Reichle, N.C., & Palmer, A. (1997). Sexual behavior in adults with autism. Journal of Autism and Developmental Disorders, 27(2), 113-125.
Dr. Jenny Tuzikow is a licensed psychologist and certified behavior analyst at the New York State Institute for Basic Research in Developmental Disabilities on Staten Island. She can be reached at Jenny.Tuzikow@opwdd.ny.gov.