Download - Transition Planning for Individuals with ASD: Part 3 of 4 ... · Involuntary erections‐These will occur without the penis being touched and without sexual thoughts triggering them

Tri-State Autism Collaborative Webinar 2/15/2017

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Transition Planning for Individuals with ASD: Part 3 of 4: The Central Importance

of Sexual Education in ASD

PeterF.Gerhardt,Ed.D.ExecutiveDirector,TheEPICSchool

Acknowledgements

Iwouldlikerecognizefollowingindividualsfortheircontributionsinthedevelopmentofthispresentation:• MeganAtthowe,R.N.,M.S.,BCBA• FrankCicero,Ph.D.,BCBA• JoanneGerenser,Ph.D.• IsabelleHenault,Ph.D.• LisaMitchell,LCSW• BobbyNewman,Ph.D.BCBA• Sorah Stein,M.S.,BCBA• Zosia Zaks,M.A.,BCBA,and• Many,manystudents,adults,andfamilies.


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AnoteonterminologyAsageneralruleItrytoavoidusingtheterms“highfunctioning”or“lowfunctioning”todescribewheresomeonefallsontheautismspectrum.Thereasonisthatthesetermsoftenjustdescribesomeone’sdegreeofvocalverbalbehaviorthananyactualleveloffunctioning.SoinsteadItrytouse“highverbal”or“lowverbal”whichIthinkismoreaccurate.That,howeverisapersonalchoicemaintainedsolelybyselfreinforcement.Youare,ofcourse,freetoignore.

SometimesIthinkIamanautismprofessionalwhoworksinthefieldofappliedbehavioranalysis.AtothertimesIthinkIamabehavioranalystwhoworksinthefieldofautism.ThetruthisthatIamboth.


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ThisisimportantbecauseIfyouworkwithyoungkidsyougettobeaspecialist.Whetheryou’reaspecialeducator,speechpathologist,occupationaltherapist,orboardcertifiedbehavioranalyst,yougettobeaspecialist.Whenworkingwithadolescentsandyoungadultsyoudon’tgettobeaspecialistand,instead,needtobesomethingofgeneralist.Inotherwords,youneedagoodworkingknowledgeofABA,IDEA,NCLB,DepartmentofLaborregulations,SocialSecurityandSocialSecurityWorkIncentivePrograms,MentalHealthconcerns,medicationsideeffects,sexuality,menstrualcare,jobdevelopment,jobcoaching,community‐basedinstruction,generalizedsystemsofcommunication,stafftraining,communitytraining,andthat’sjusttostart.

Thankfully…

AppliedbehavioranalysishasmyriadapplicationsfarbeyondASDsomyknowledge,expertise,andexperienceintheABA/ASDfieldisgeneralizabletotheseotherareasofneed.TherestofwhatIknowisjustabunchoffactsequallyuseful(andnecessary)inmyworkorasacontestantonJeopardy.


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Itisrelativelyeasytobesuccessfulinourclassroomsaswecontrolmost,ifnotall,oftherelevantvariables.ButgiventhatABAisintendedtodealwithproblemsofsocialimportance,producestrong&sociallyimportanteffects,andoperateinnewenvironments&continueafterformaltreatmentends(Baer,Wolf,&Risley,1968),successinourclassroomsshouldonlybeourfirststepinbehavioralinterventioninASD.

However

Sexualityandsexualbehaviorarecomplex,context‐basedandsocietallymediated

topographyofadaptivebehavior


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AdaptiveBehavior“AdaptiveBehaviorisdefinedasthoseskillsorabilitiesthatenabletheindividualtomeetstandardsofpersonalindependenceandthatwouldbeexpectedofhisorherageandsocialgroup.Adaptivebehavioralsoreferstothetypicalperformanceofindividualswithoutdisabilitiesinmeetingenvironmentalexpectations.Adaptivebehaviorchangesaccordingtoaperson’sage,culturalexpectations,andenvironmentaldemands.”(Heward,2005).

TVMA

Thispresentationcontainslanguageandimageryofasexualnatureandmaybeconsideredinappropriateforyoungerviewersandlisteners.

YourWelcome.


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Remember,youneedtoknowthelimitsofyourexpertiseandthebreadthofyourbehavioranalyticcompetencebeforeventuringdeeplyintothisaspectofourfield.Whenindoubt,getassistancefromsomeonemoreexpertinthisarea.

ForBCBAs(alongwitheveryoneelse)


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PrudishPromiscuity?Sexandsexuality,asserioustopicsfordiscussion,areonesthatmanyofuswouldratheravoidthanaddress.Infact,accordingtotheCDCfewerthanhalfofallhighschoolsandonly20%ofmiddleschoolsofferacomprehensiveSexEdcurriculum.Further,only23statesmandateSexEdatalland,ofthose,only13requireittobemedicallyaccurate.(Orenstein,2016)

Orenstein,P.(March20,2016).Whendidpornbecomesexed? NewYorkTimesSundayReview.pp1,6.

Nowaddtothatthepersonalandsocietalconstraintsthatmovesexualbehavioroutoftherealmofsimplebehaviorandwehaveacohortofskillsinwhichthereishighinterestbutlimited

knowledge.


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Butlet’snotforgetthereis,historically,morethanatouchofmisogynyinallthis…

AndwhenitcametoindividualswithDD

Richards,etal(2006)notedthat,historically,individualswithDDbeenviewedassexuallydeviant,pronetocriminality,asexual,andproblematictosociety.Despitesignificantprogressoverthelast5decadesinmanyareas,thesexualityofindividualswithDDisstillgrosslymisunderstoodbysociety.AndalthoughtodaythesexualityofindividualswithDDisnotentirelyignored,norissexualbehavioruniversallypunished,theperceptionthatpeoplewithdevelopmentaldisabilitiesasperpetualchildren,irrespectiveoftheirage,stilllingerswithsignificant,negativeconsequences.Richards,D.,Miodrag,N.,&Watson,S.L.(2006).Sexualityanddevelopmentaldisability:Obstaclestohealthysexualitythroughoutthelifespan.DevelopmentalDisabilitiesBulletin,34(1‐2),137‐155.


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Puberty

PubertyAccordingtoMedilexicon'son‐linemedicaldictionarypubertyisasequenceofeventsbywhichachildbecomesanadult,characterizedbythebeginningofgonadotropinsecretion,gametogenesis,secretionofgonadalhormones,developmentofsecondarysexualcharacteristics,andreproductivefunctions.Ingirlsthefirstsignsofpubertymaybeevidentafterage8withthebiologicalprocesslargelycompletedbyage16.Inboys,pubertynormallybeginsatage9andislargelycompletedbyage18.Ethnicandgeographicfactorsmayinfluencethetimeatwhichtypicalmilestonesmayoccur.


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PubertyandGirls Sexualorgans ‐ thegirl'sclitorisandtheuterus(womb)will

grow. Menstruationbegins ‐ oneofthefirstthingsthathappens

duringagirl'spubertyisthestartofhermonthlymenstrualcycle. Breastchanges ‐ thegirl'sbreastwillstarttogrow. Vaginaldischarge ‐ vaginaldischargemaystartorchange. Bodyhair ‐ hairwillbegintogrowinherpubicarea‐ firstly

alongthelabiaandthenunderherarmsandonherlegs. Skin ‐ asthegirl'soilandsweatglandsgrowherskinwill

becomemoreoilyandshewillsweatmore.Acneiscommonamonggirlsduringpuberty.

Emotions ‐ agirl'semotionsmaychange,especiallyaroundthetimeherperiodcomeseachmonth.Theseemotionalroller‐coastertypechanges,whichmayincludeirritability,aremainlyduetofluctuatinghormonelevelsthatoccurduringthemenstrualcycle.

PubertyandBoys Scrotum,testiclesandpenis ‐ theboy'sscrotumwillbegintothinandreddenandhis

testicleswillgrow.Later,usuallyaroundtheageof13hispeniswillgrowandlengthenwhilethetesticleswillcontinuetogrow.

Voicechange ‐ theboy'svoicewill"break"or"crack”duetomaturationoflarynx. Wetdreams ‐ boysmayejaculateduringtheirsleepandwakeupinthemorningwith

dampsheetsandpajamas.Thisdoesnotmeantheboywashavingasexualdream. Involuntaryerections ‐ Thesewilloccurwithoutthepenisbeingtouchedandwithout

sexualthoughtstriggeringthem. Breastenlargement ‐ swellingofthebreastsoccurswithmanyboysduringpuberty. Skin ‐ theboy'sskinwillbecomemoreoilyduringpuberty.Hewillalsosweatmuch

more.Itisnotuncommonforboystodevelopacneduringpuberty. Bodysize ‐ growthspurtsoccurduringaboy'spuberty.Thisgrowthpeaksatabouttwo

yearsaftertheonsetofpuberty. Bodyhair ‐ hairwillstarttogrowaroundthepubicarea,underhisarms,onhislegsand

arms,andonhisface.Facialhairusuallystartsaroundtheupperlipandchin. Emotions ‐ boysmayexperiencemoodswings;onemomenttheyarelaughingandthen

theysuddenlyfeellikecrying.Boysmayalsoexperienceintensefeelingsofanger.Thisispartlyduetotheincreasedlevelsofhormonesintheirbody,aswellasthepsychologicalaspectsofcomingtotermswithallthephysicalchangesthataretakingplace.Ithelpsiftheboycantalktoafamilymember,oragoodfriend.Arecentstudy*indicatesthatmoodswingsmaybeexplainedbybiologicalchangesintheadolescentbrain.

*"Reversalofneurosteroideffectsatalpha4beta2deltaGABAAreceptorstriggersanxietyatpuberty."HuiShen,QiHuaGong,ChiyeAoki,MaoliYuan,YevgeniyRuderman,MichaelDattilo,KeithWilliamsandSherylSSmith.NatureNeurosciencePublishedonline:11March2007;doi:10.1038/nn1868.


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PubertyandASD5ThingstorememberaboutpubertyandASD:

1. ThediversityoftheemotionalimpactofadolescenceonindividualswithASD.

2. Reflex,orspontaneous,erectionsarenottheproductofsexualarousal.

3. Genitalstimulationisuniversalandshouldnotbeasourceofpanic.

4. Poorhygieneskillsnowbecomefarmorelimitingsocially

5. Personal(i.e.,sexual)safetyandthe5‐yearrule

ASD,Adolescence,andMentalHealth

Beginninginadolescence,individualswithaDDaretwotofourtimesmorelikelytohaveapsychiatricdisorderthantheirNeurotypicalpeers.(Fletcher,etal.,2007)


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Spencer,D.,Marshall,J.,Post,B.,Kulakodlu,M.,Newschaffer,C.Dennen,T.,Azocar,F.,&Jain,A.(2013).Psychotropicmedicationuseandpolypharmacyinchildrenwithautismspectrumdisorders.Pediatrics.Nov;132(5):833‐40.

Spencer,etal.,(2013)examinedratesofpsychotropicuseamonginsuredchildrenwith(ASD).Usingmedicalandpharmacyclaimslinkedwithhealthplanenrollment[]from2001to2009,theresultsindicatedthatamongchildrenwithASD64%hadafilledprescriptionforatleast1psychotropicmedication,35%hadevidenceofpoly‐pharmacy(≥2classes),and15%usedmedicationsfrom≥3classesconcurrently.Medianlengthofpoly‐pharmacywas346days.

Theauthorsconcludedthatdespiteminimalevidenceoftheeffectiveness[]ofmultidrugtreatmentofASD,psychotropicmedicationsarecommonlyused,singlyandincombination,forASDanditsco‐occurringconditions.

PsychotropicMedicationUseinASD

Sexandsexuality areextensivelyunder‐researchedareasofbehaviorinadolescents&adultswASD


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Butreally,howmuchresearchisthereonsexualityeducation&interventioninASD?

Well,almost“0”actually


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Thereisresearchontheprevalenceofsexualbehaviors,selfreportsofsexuality,parentreports,andparenttrainingonsexeducationandASDbutbasicallynothingintheareaintervention.Forexample….

Knowledgebase

(McCabe&Cummins,1996;Szollo&McCabe,1995)concludedthatindividualswhohaveanintellectualdisabilityhavelowerlevelsofsexualknowledgeandexperienceinallareasexceptmenstruationandbodypartidentificationwhencomparedtoatypicalstudentpopulation.

Watson,Griffiths,Richards,&Dysktra,(2002).SexEducation,InGriffiths,Richards,Federoff,&Watson(Eds.).EthicalDilemmas:SexualityandDevelopmentalDisability.(pp175‐225).Kingston,NY:NADDPress


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SexualityinAdultswithASDinResidentialPrograms

VanBourgondien,Reichle,&Palmer(1997)surveyedthedegreetowhichgrouphomeresidentswithautismengagedinsexualbehavior.Thebehaviorof89adults(72males,17females)wasobservedindicatingthatthemajorityofindividualswereengaginginsomeformofsexualbehaviorwithmasturbationbeingmostcommonsexualbehavior(68%including54malesand4females). Sexualbehaviorwithsignsofarousaldirectedtowardanotherpersonawaspresentinone‐thirdofthesample.

VanBourgondien,M.E.,Reichle,N.C.,&Palmer,A.(1997).Sexualbehaviorinadultswithautism.JournalofAutismandDevelopmentalDisorders,27(2),113‐125

Stalkingmaybeaproblem…Stokes,Newton,&Kaur(2007)examinedthenatureofsocialandromanticfunctioninginadolescentsandadultswithASD.WhattheyfoundwasthatindividualswithASDweremorelikelythantheirNTpeerstoengageininappropriatecourtingbehaviors;tofocustheirattentiononcelebrities,strangers,colleagues,andexes;andtopursuetheirtargetforlongerlengthsoftime(i.e.stalking).Stokes,M.Newton,N.&Kaur,A.,(2007).StalkingandsocialandromanticfunctioningamongadolescentsandadultswithASD.JournalofAutismDevelopomentalDisorders.37,1969‐86.


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Self‐reportsofSexualityinASDGilmour,etal,(2012)viaanon‐linesurvey,comparedthesexualityattitudesandbehaviorsof82(55femaleand17male)adultswithautismwith282typicaladults.TheresultsindicatedthatadultswithASDdisplayedalevelinterestinsexandengagedinavarietyofsexualbehaviorssimilartothatofcontrolgroup.However,ahigherrateofasexualitywasfoundamongindividualswithASD.Inaddition,femaleswithASDreportedalowerdegreeofheterosexualitythandidmaleswithASDalongwithslightlyhigherreportsofhomosexuality.

Dewinter,J.,Vermeiren,R.,Vanwesenbeeck,I.,Lobbestael,J.,&VanNieuwenhuizen,C.(2015).Sexualityinadolescentboyswithautismspectrumdisorder:Self‐reportedbehavioursandattitudes.JournalofAutismandDevelopmentalDisorders,45(3),731‐741.

InappropriateSexualBehaviorinASDBeddows&Brookes(2015)conductedaliteraturereviewtoidentifythetypographiesofinappropriatesexualbehaviordisplayedbyadolescentswithASD.Atotalof5,241articleswerefoundofwhich42metinclusioncriteria.ThereviewindicatedthatadolescentswithASDmayengageinhyper‐masturbation,publicmasturbation,inappropriateromanticgestures,inappropriatearousal,andexhibitionism.TheyattributethistoacombinationoftheabsenceofappropriatesexeducationandthedegreeofseverityofASD. Theauthorsnotethatdespitethisbeingacommonproblemtheliteratureissurprisinglysparseregardingwhyinappropriatebehavioroccursandwhateducationiseffective.Beddows,N., &Brooks,R.(2015).Inappropriatesexualbehaviourinadolescentswithautismspectrumdisorder:Whateducationisrecommendedandwhy.EarlyInterventioninPsychiatry. Advanceonlinepublication8/12/15


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AdditionalresearchoutoftheIntellectualDisabilitiescommunitycanbefoundbutmuchofitisnotdirectlygeneralizabletoindividualswithASD.Besides,muchofitwaspoorlydone,focusedoncongregatepopulations,andisgenerallyprettydated.

AFewReasonsWhyWeShouldTeachHumanSexualityEducationToIndividualsWithAutismSpectrumDisorders


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Number5TheyHaveTheSameHormones&Urges&NeedToMakeThe

SameChoicesAsTheirPeers

Number4Allsexualbehaviorissocialbehaviorand,assuch,isparticularlychallengingforindividualswithASD


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Number3

TheInternetandotherreadilyaccessiblemedia

Mitchell,K.J.;Finkelhor,D,;andWolak,J.(2003).Theexposureofyouthtounwantedsexualmaterialontheinternet:Anationalsurveyofrisk,impact,andprevention.YouthSociety,34,330‐358.

Inanationalsurveyofyouthages10‐17years,Mitchell,etal(2003)reportedthat25%ofyouthhadunwantedexposuretosexualpicturesontheInternetinthepastyear.Theuseoffilteringandblockingsoftwarewasassociatedwithamodestreductioninunwantedexposure,suggestingthatitmayhelpbutisfarfromfoolproof.Theauthorsurgethatsocialscientificresearchbeundertakentoinformthishighlycontentiouspublicpolicycontroversy.

Justhowaccessibleispornography?


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Forexample,asearchfor“womaninkitchen”inBingimageswiththesafefilterofffinds:

Fortypicalkids…AccordingtoCrabbeandCorlette(2010),pornhasbecomeacentralmediatorofyoungpeople’ssexualunderstandingandexperienceanda“goto”sourceforinformationofsexandsexualityintheabsenceofanyformalsexeducation.

Crabbe,M.&Corlette,D.(2010)Eroticizinginequality:Technology,pornography,andyoungpeople.DVRCVQuarterly. 3,1‐6.Accessedonlineon3/36/16at:http://www.awe.asn.au/drupal/sites/default/files/Crabbe%20Corlett%20Eroticising%20Inequality.pdf


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AndthenthereisRule34:“Ifitexists,itexistsasinternetporn.NoExceptions.”


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Butmostproblematic,atleastinmyopinion,isHentaiwhichispornographicAnimethatisoftenverymisogynisticand

violent


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Fromanew friend

"Hey,Iaddedyousinceyoulookfamiliar,butonceIlookedatyourpageIknewIwasmistaken..buthey,youseemlikeagoodguysoi'lljustintroducemyself:)Imquirky,funny,andneverafraidtohaveagoodtime..IrecentlymovedhereaboutsixmonthsagofromasmalltowninIdahoforworkandlikeitsofar!Checkoutmyprofile..ifyouwanttoIwouldlovetomeetsometimeforlunch.Anyway..Iwantedtoattachmorephotosofmebutitsgivingmesomestupiderror!IfyougivemeyouremailaddyIcansendthepicstoyouthatway.Hopetohearfromyousoon!"

Fromanothernew friend

Howareyoudoingtoday??youareareallycoolandenchantingdudethat'swhyididoptforamessagetoyouokwinks....Justwanttoknowmoreaboutyouwithduerespectthat'sifyoudon'tmind.dotakecareandhaveawonderfuldayfeelfreetoreplyok.....withregardsFiona


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Arecent(2/2016)friend

AutismSpecificInternetDating


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Number2

PerhapsthemosturgentissueinsexualityandASDisthepreventionofsexualabuse

ThoughresearchonsexualabuseandASDislimitedSobsey,(1994),reportedthat25percentofwomenwithIDreferredforfamilyplanninghadahistoryofsexualabuse.Inastudyofover55,000childrenwithID,Sullivan&Knutson(2000)foundthatchildrenwithIDwere4timesmorelikelytobethetargetsofsexualabusethentheirtypicalpeers.Mostrecently,Brown‐Lavoie,Viccili,andWeiss(2014)examinedthesexualknowledgeandvictimizationriskinagroup(N=95)ofadultswithhighfunctioningautism.78%oftherespondentswithASDreportedatleastoneincidenceofsexualvictimization(i.e.,unwantedsexualcontact,sexualcoercion,orrape)comparedto47%ofthecomparisoncontrolgroup.Brown‐Lavoie,S.M.,Viecili,M.A.,&Weiss,J.A.(2014).Sexualknowledgeandvictimizationinadults

withautismspectrumdisorders.JournalofAutismandDevelopmentalDisabilities. 44,2185‐2196.

Sobsey,D.(1994).Violenceandabuseinthelivesofpeoplewithdisabilities:Theendofsilentacceptance?Baltimore:PaulH.BrookesPublishingCo.

Sullivan,P.M.&Knutson,J.F.(2000).Maltreatmentanddisabilities:Apopulation‐basedempidemiologicalstudy.ChildAbuseandNeglect,24,1257‐1273.


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Self‐Protection Teachthatrefusingtobetouchedisaright Teachself‐protectionskills Whocan/can’ttouchtheindividualand

whereonhis/herbody Howandwhentosay“No” Howtoaskforassistance Howtorecallremoteeventsandconvey

whereanindividualtouchedhim/her

(AmericanAcademyofPediatrics,1996;Nehring,2005;Roth&Morse,1994;Volkmar&Wiesner,2004)

Number1

BecauseTheyArePeople&LikeAllPeopleIndividualswithAutismHaveTheRightToLearnAllTheyCanToEnableThemToBecomeSexuallyHealthyPersons


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WhyABA‐basedinterventionstoteach

sexuality?

Sexisjustbehavior.Whateverbodypartsareinvolveditisalljustbehavior.


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Despiteafocusonself‐determinationinadulthoodtherecontinuestobeanabsenceofanysignificantresearchintotheeffectivenessofsexeducationandtrainingforpersonswithASDwhichBehaviorAnalysisisabletoprovide.

Manyofthebasicinstructionalgoalsinsexualityeducationboildowntocomplexdiscriminationskills.Forexample: BoyorGirl

Men’sroomorLady’sroom(orBlokesv.Shielas;Senorsv.Senoritas;Mv.W;andsoon…)

Whereorwithwhoyoucan/cannot: Benaked

Masturbate

Curse

Helpwithtoiletingormenstrualcare

Touchcertainpartsofyourbody


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ButhumansexualityisnotanareawhereweinBehaviorAnalysishavedoneourbest

work,orevenmuchwork,atall.

ABSTRACT:Thisarticlepresentsabehavior‐analyticviewsuggestingthatbiologicalfactors,whethergeneticorotherwise,havelittletodowithourpreferenceforsame‐genderoropposite‐gendersexualstimulation.Thisviewstressestheimportanceofbehavioralhistoryandcurrentbehavioralcontingenciesinunderstandingthecausesofanindividual'sbehaviorandvalues.Thisviewstatesthatgeneticandotherbiologicalfactorsarecrucialindeterminingthebehavioralprocessesthatinteractwithourbehavioralhistoryandcurrentbehavioralcontingencies;howeverbiologicalfactorshavelittledirecteffectondifferencesamonghumanbeingsintheirbehaviorandvalues.Inaddition,thisbehavior‐analyticviewsuggeststhattheparticularformsofbehaviorarearbitrary;whateverthehumanbehaviorwithwhichweareconcerned,thecontingenciesofreinforcementandpunishmentdetermineitsparticularforms.


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In1974Bancroft(1974)notedthatthetwobasictreatmentsforsexualdeviancyareaversiontreatmentanddesensitization.Aversiontherapyconsistedofthepresentationofapotentiallyarousing(deviantstimulus)followedbytheadministrationofnoxiousstimulus,oftenelectricshock.Theauthorsnoted,however,thebehavioraltreatmentsengenderthefullireofthedeviantsubculture.

Bancroft,J.(1974).DeviantSexualBehavior:ModificationandAssessment.ClaredonPress:Oxford,UK.

ThingsarestartingtochangehoweverStein,(2013)notesthatwhenworkingwithinsexualityandwithpeoplewhoengageinvaryingtopographiesofsexualbehavior,thefirstthingtorememberisthatsexisbehavioranditfollowsthesamerulesasallothertopographiesofbehavior.Thefieldsofsextherapy,sexualityeducation,sexresearch,andreproductivemedicineallmaintainadescriptiveandevolvingvernacularthatisusedbycliniciansandacademiciansthroughout.However,therearefewwhoworktooperationallydefinethesetermsinbehavioralwaysandthencarryoutresearchandinterventionwithafocusonbehavioranditscontextinsteadofmentalevents.Whileitisdifficultformanyreasonswecanidentifydiscretepatternsofactivityinwhichhumans[]engagebetweensexualarousalandsatietyHowever,itcanbecomeparticularlyconfusingwhenassessingsexualbehaviorwithinthecontextofbehavioranalysisbecausesexualstimulicanservemultiplefunctions.

Stein,S.(2013).Tacklingtermsandconditioningconfusion:Sexualbehaviorandappliedbehavioranalysis.PosterpresentationOctober9,2913.SouthBend,IN.


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RememberInABAandASDinteractionsbetweenstudentandtheBehaviorAnalystmaybemorephysicalthanmostotherprofessionalrelationships.Forexample: Wemayusetickles,hugs andkissesassocialreinforcersfor

younglearnersbutthenneglecttodiscriminateastowhom,what,where,andwhen.

Wemayprovidehelp,intheformofprompting,ingenerallyprivatesituationssuchastoileting,showering,ormenstrualcarebutneglecttodiscriminateastowhom,what,where,andwhen.

Instructioninappropriatesocialdistancinginearlyadolescenceandbeyondisoftenneglectedundertheguiseofsafety.

WorkingDefinitions… Sexuality isanintegralpartofthepersonalityof

everyone:man,woman,andchild.Itisabasicneedandanaspectofbeinghumanthatcannotbeseparatedfromotheraspectsofhumanlife.Sexualityisnotsynonymouswithsexualintercourse[andit]influencesthoughtsfeelings,actions,andinteractionsandtherebyourmentalandphysicalhealth”(WHO,1975)

Sex cansimplymeangender,whetheryou’remaleorfemale.

Sex canalsomeanthephysicalactofsexualintercourse.


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Furthercomplicatingthings

Thereare4levelsofofsexuallanguageincluding: Formal/polite– Vagina Technical – Labia,Cervix,Clitoris,Vulva Cute – Va‐jay‐jay,Muffin,Littlemanintheboat,Punani,Ladyparts,etc.

Slang– Snatch,Beaver,Twat,Pussy,etc.

Further

Individualswithautismcanbeconcretethinkerswhointerpretthingsliterally,so… Beconcreteandfactualduringinstruction

Provideclearvisualandverbalexamples Avoideuphemisms

Forexample…(RatedR)


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Someresponsesofadultswithautismduringanassessment*ofsexualknowledge

Q:Tellmeaboutthispicture.

A:“[T]hepeopleweresittingonthecouch‘beingfriends’.”

http://www.camboday.com/UnderstandingSex/healthsex/img/sex_sofa.jpg

Konstantareas,M.&Lunsky,Y.(1997),Sociosexualknowledge,experience,attitudes,andinterestsofindividualswithautisticdisorderanddevelopmentaldelay.JournalofAutismandDevelopmentalDisorders,27,397‐413.

Someresponsesofadultswithautismduringanassessment*ofsexualknowledge

Q:Whatdoesthispictureshow?

A:“twopeoplelyingonatowel.”

http://www.ural.ru/gallery/news/people/sex/bed.jpg


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MythsaboutSexuality&ASD

Myth1:Folksonthespectrumhavelittle

ornointerestinsexuality


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Myth2:Peopleonthespectrum

arehypersexual

Myth3:Peopleonthespectrumaresolelyheterosexual


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ButtheTruthIs…

PersonswithASDaresexualbeings.However,individualinterestinsexorindevelopinganintimatesexualrelationshipwithanotherpersonvarieswidelyacross,andwithin,individualsatallabilitylevels.Assuch,thereisasignificantneedforindividualized,effectiveinstructionforpersonswithASDacrosstheabilityspectrum.

Sexualityeducationshouldbeproactive

Mostlearnerswithadevelopmentaldisabilityreceivesexualityeducationonlyafterhavingengagedinsexualbehaviorthatisconsideredinappropriate,offensiveorpotentiallydangerous.Thismaybeconsideredsomewhatakintoclosingthebarndoorafterthehorsehasrun.(Griffiths,1999)


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Thethreeprimarygoalsinsexualityeducation

1. Provideaccurateinformation(Relativelyeasy)

2. Developthenecessarysocialcompetence(Relativelyhard)

3. Developpersonalvalues(Somewherebetweenhardandimpossible)

GoalsofComprehensiveSexualityEducation:

INFORMATION


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Basicguidelinesforteaching

Thinkaheadandbeproactive

Beconcrete

Serious,calm,supportive

Taskanalyzeeverythingthatcanbetaskanalyzed

Beconsistent,berepetitive

Whatarethepractical/functionalimplications

Teachallstepsandinthecorrectorder

Considerusingmultipleinstructionalmediums

Incorporatethesocialdimensionofsexuality

CentralInstructionalConcepts Publicversusprivatebehavior Goodtouchversusbadtouch Propernamesofbodyparts “Improper”namesofbodyparts Personalboundaries/personalspaces Masturbation Avoidanceofdanger/Abuseprevention Socialskillsandrelationshipbuilding Datingskills Personalresponsibilityandvalues


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Whattoteachandwhen:Somegeneralguidelines.*

PreschoolthroughElementary Boysv.girls Publicv.private Basicfactsinc. bodyparts Introductiontopuberty(yourchanging

body) Introductiontomenstrualcare Appropriatev.inappropriatetouching

Source:Schwier,K.M.,&Hingsburger,D.(2000)

BoysversusGirls


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Boys versus Girls

MiddleSchooltoHighSchoolandBeyond.. Puberty&Menstruation(ifnotyetaddressed) Ejaculationandwetdreams(ifnotyetaddressed) Howtosay“no”(ifnotyetaddressed) Masturbation(ifnotyetaddressed) Publicrestroomuse Attractionandsexualfeelings Relationshipsanddating Personalresponsibilityandfamilyvalues Lovev.sex Sexualpreference Lawsregardingsexuality Pregnancy,safesex,birthcontrol Etc.


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The6RulesofPresentation:

Simple Visual Individualized Repetitive Fun Concrete

K.I.S.S.B.K.I.A.(KeepItSimpleStupidButKeepItAccurate)

BADVISUAL


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PAINFULANDNOTMUCHBETTER


PRETTYDECENT


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Whatwewouldactuallyuse

PenisShaft

HeadofPenisorGlans

ScrotumorTesticles

or[FamilyChoice]

Foreskin


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TeachingMaterials

Creatingyourowniseasyandlesscostly

Resourcesinclude: Medicalandnursingtextbooks Patienteducationmaterials Sexualityeducationbooksatthelibrary GoogleImagesearch PlannedParenthood Homemadedigitalphotos&videos(NOTofnudityorprivateactivities)


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Commercialproductsinclude: Anatomically‐correctdolls Anatomicalmodelsofbodyparts Writtenmaterialsandpictures Slideshowsandvideos

Shopcarefully‐‐ mostproductswerenotcreatedforpeoplewithASD,andtheyareexpensive

Thescoopaboutmasturbation

Isnormalandshouldnotbecondemned

Explorationofgenitalsforself‐pleasurebeginsininfancy

Mostpeoplewithautismlearntodoitontheirown,althoughsomemayhavedifficultyreachingorgasm

Ineffectivemasturbationmaycontributetoritualisticbehaviorsinsomepeoplewithautism

Masturbationmaybetheonlyrealisticoutletforsexualreleaseforsomepeoplewithautism

(Aileyetal.,2003;Koller,2000;Nehring,2005;Volkmar &Wiesner,2004)


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Preventingproblemswithmasturbation

TeachwhereitisOKtomasturbate Individual’sbedroom Avoidteachinguseofbathroom

Teachrulesforappropriatetime/place

Teachthatsometimesitisnotanoption

Provideopportunitiesforprivatetime

(Baxley&Zendell,2005;Koller,2000;NICHCY,1992;Volkmar&Wiesner,2004)


VALUES


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Thegoalherewouldbetodeveloppersonalvaluesreflectiveoffamily,religious,andculturalvaluesinsuchareasas: Personalresponsibility Justice Inclusivity Fairness Rightv.wrong Selfesteem Interpersonalrespect Personallimits

“Values”themselvesfallintotherealmofprivatebehavior.Valuesthemselvesaredifficulttodefine,target,andmeasureaccurately.

BehaviorbaseduponvaluestendstorequireempathywhichmaybelackinginindividualswithASD.

Valuesaregenerallyaconcernofthefamilyandnotthespecialeducator,BCBA,etc.

Onceestablished,valuesaredifficulttoalter

“Values”interventionissomewhatexternaltoourareaofinterestandexpertisegiventhat


48


SOCIAL

Promotethedevelopmentofadequateandeffectivesocialrepertoiresinclusiveof: Decisionmakingskills Variableresponding Advocacyskills Safetyskills Dating&relationshipskills Andsomuchmore

Source:NICHCYNewsDigest,Vol.1(3),1992.Availableon‐lineatnichcy.org


49

\\


50

OneThingBehaviorAnalystsNeedtoUnderstandabout

SocialSkills

SocialSkillsareNOTLinear

Hi!Hi! What's Up?

What's Up?

Not Much. You?

Not Much. You?

Not MuchNot

Much


51

Butratherarelogarithmic

Hi!

Hi!What’sUp?Yo!

Howyadoing?What’s

happening?Sup?

How’sithanging?

Notmuch?You?Nada.You?

SameoldsameoldWhereyoubeen?

Justwork,really.You?Hanginglowmy

brother

Notmuch.Nada.

SamethingmanBeenaround.Busy.Justbusy

Aslongastheyarehanging

Soremember

"Agreetingisasocialskillthatisthoughttobesimple.However,furtheranalysisshowsthisskill,whichmosttakeforgranted,tobeextremelycomplex.Howachildgreetsafriendintheclassroomdiffersfromthetypeofgreetingthatwouldbeusedifthetwometatthelocalmall.Thegreetingusedthefirsttimethechildseesafrienddiffersfromthegreetingexchangedwhentheyseeeachother30minuteslater.Further,wordsandactionsforgreetingsdiffer,dependingonwhetherthechildisgreetingateacherorapeer....[G]reetingsarecomplex,asaremostsocialskills.”

Myles&Simpson(2001)


52

Walton&Ingersoll(2013)notethatmostworkonsocialskillinterventionshasbeenconductedwithyoungchildren,andthatanumberofpotentiallyeffectiveinterventionshavebeendeveloped.Whilesocialskillsinterventionneedsbebeginsoonafterdiagnosis,socialskillinterventionremainsimportantacrossthelifespan.ThisisofparticularimportancegiventhatthesocialdeficitsassociatedwithASDdonotresolvewithdevelopmentandmay,infact,bemorepronouncedgiventhenormativesocialrepertoireoftypicalpeers.

Watson,K.M.&Ingersoll,B.R.,(2013)Improvingsocialskillsinadolescentsandadultswithautismandseveretoprofoundintellectualdisabilities:Areviewoftheliterature.JournalofAutismandDevelopmentalDisorders.43,594‐615

TheIncreasingDemandsoftheSocialWorld

Yoursocialdemandsareoftenlowestwithinyourhome.Why?Becauseyousettherulesofacceptablebehavior.

Yoursocialdemandsatworkarehigher.However,workisasomewhatscriptedsocialenvironmentandonewithasecondarymeasureofcompetence(i.e.,production).


53

TheIncreasingDemandsoftheSocialWorld

Nextcomesthecommunityatlarge.Why?Becauseinthecommunityyouhavelesscontrolovereventsandactionsthatimpactyou.

Lastlycomestheworldbeyondyourcommunity.Whetheradifferentsocialcircleordifferentcountry,chancesareyousocialskillrepertoiremaybelessthanadequate.

Thesocialcontextofurinals


54

TheUrinalGame

Selfadvocacyisaspecializedsubsetofsocialcompetence


55

Selfadvocacyrequires:1) Theabilitytoassessone’sownskillsand

abilitiesasreferencedtopersonalgoalsandtheordemandsoftheenvironment

2) Awarenessofthemostefficientwaytotomeetthesedemands(e.g.,accommodations)

3) Knowledgeoftheirrightstotheseaccommodations,and

4) TheadvocacyskillsnecessarytoexpresstheirneedsacrossmultipleenvironmentsWHILEACKNOWLEDGINGTHATSUCHSKILLSDONOTALWAYSWORK.

AreasinNeedofAdvocacyInstruction

Personalsafety Leisureandrecreation Serviceacquisitionandchoice Socialrelationships Sexualrelationships Legalandcivilrights Clotheschoice,meals,bedtime,breakfastcereal,TVshows,etc.


56

Selfadvocacyinstruction Canbeinitiallytaughtintheclassroom.

Canbetaughtusingdirectinstruction,videomodeling,roleplay,orCBTbasedinterventions(e.g.,SocialThinking).

Ismoreeffectiveiftaughtwithafocusonindividualstudentpriorities.

Needstoincludetherealitythatsometimeseventhebestadvocacywillnotwork.

Needstothenbegeneralizedtoenvironmentsandeventsoutsideoftheclassroom

SomePoorlyUnderstoodFormsofSelfAdvocacy

Aggression Selfinjury Disruption Stereotypy Elopement “Non‐compliance” “Obsessing” Naggingorbadgering


57

FunctionalAnalysisofSocialResponding

PositiveReinforcement

NegativeReinforcement

PositivePunishment

NegativePunishment

SocialGreeting

Attentionintheformofsocialgreetingreturned

Socialisolation

terminated?Promptingterminated?

Attentionintheformofsocialgreetingreturned

Socialisolationterminated

SharingFood Increasedpeer

interactions(i.e,those

reinforcedbyfood.

Socialisolation

terminated?Promptingterminated?

Increasedpeer

requestsforfood.

Removalofaquantityof

food

Allofwhichleadsmeto:


58

Top10PlacestoLiveforQOLn

① Madison,Wisconsin.② Lincoln,Nebraska③ Minneapolis,Minnesota④ St.Paul,Minnesota⑤ Omaha,Nebraska⑥ Buffalo,NewYork⑦ Lexington,Kentucky⑧ Lubbock,Texas⑨ FortWayne,Indiana⑩ Fremont,California

ButIlivehere(andwouldn’tliveanywhereelse)


59

Thepointis,QOLisaComplexConstruct

Qualityoflife(QOL)isatermusedtodescribeatemporalconditionofpersonalsatisfactionwithsuchcorelifeconditionsasphysicalwell‐being,emotionalwell‐being,interpersonalrelations,socialinclusion,personalgrowth,materialwellbeing,self‐determination,andindividualrights.(Wehmeyer &Schalock,2001)

Wehmeyer,M.L.&Schalock,R.L.(2001).Selfdeterminationandqualityoflife:Implicationsforspecialeducationservicesandsupports.Focuson

Exceptional Children,33,1‐16.


60

ButinASD,whiletheconceptofqualityoflifehasbeenusedforover30yearsinthefieldofintellectualdisabilities,thefactorscontributingtoqualityoflifeofpersonswithASDhavereceivedrelativelylittleattention(Renty&Roeyers,2006)intheliteratureandinpractice.

Renty,J.O.,&Roeyers,H.(2006).Qualityoflifeinhigh‐functioningadultswithautismspectrumdisorder:Thepredictivevalueofdisabilityandsupportcharacteristics.Autism,10,511‐524.

MuchoftheresearchonQOLandASDhasfocusedonalimitednumberofaspectsofadultlife(e.g.,employment)andprimarilyonquantitativeaspectsofthesefewdomains(e.g.,employedv.employmentsatisfaction).QOL,however,ismuchmorecomplexstateofbeing(VanHeijst&Geurts,2015).

VanHeijst,B.FC.,&Geurts,H.M((2015).Qualityoflifeinautismacrossthelifespan:Ameta‐analysis.Autism:TheInternationalJournalofResearchandPractice,19,158‐167.


61

VanHeijst&Guerts,(2015)recentlycompletedameta‐analysisonthetopicofQOLandadultswithASD.Anextensiveliteraturereviewidentifiedatotalof10peerreviewedstudiespublishedon2004‐2012.Theresultsindicatedthatthequalityoflifeissignificantlylowerforpeoplewithautismwhencomparedtotheirtypicalpeers.Age,IQandsymptomseveritydidnotpredictqualityoflifeinthissample.Acrossthelifespan,peoplewithautismexperienceamuchlowerqualityoflifecomparedtopeoplewithoutautism.

VanHeijst,B.FC.,&Geurts,H.M((2015).Qualityoflifeinautismacrossthelifespan:Ameta‐analysis.Autism:TheInternationalJournalofResearchandPractice,19,158‐167.

However…Parsons(2015)conductedanonlinesurveydesignedtosolicittheviewsofadultswithASDaboutcurrentlifesatisfaction.Fifty‐fiverespondents,mostofwhomattendedmainstreamschoolsandwerediagnosedlaterinlife,completedthesurvey.Respondentswereleastsatisfiedwiththeircurrentemploymentsituationandmostsatisfiedwithpersonalrelationships.Therewassubstantialindividualvariationinresponsesdemonstratingtheimportanceofrespectingpersonalviews,circumstancesandaspirations.ThisissignificantaslittleisknownabouttheactualviewsofadultswithASDonQOLandthat,ingeneral,"goodoutcomes"inadultlifeareoftenjudgedaccordingtonormativeassumptionsofquality.Parsons,S.,(2015)."WhyAreWeanIgnoredGroup?"MainstreamEducational

ExperiencesandCurrentLifeSatisfactionofAdultsontheAutismSpectrumfromanOnlineSurvey.InternationalJournalofInclusiveEducation.19,397‐

421


62

Thisissometimesreferredtoasthe“DisabilityParadox”

Thedisabilityparadox(Levine,1987),states:“Whydomanypeoplewithseriousandpersistentdisabilitiesreportthattheyexperienceagoodorexcellentqualityoflifewhentomostexternalobserverstheseindividualsseemtoliveanundesirabledailyexistence?”Toexamineitsparameters,Albrecht&Devlieger(1999)interviewed153personswithdisabilitiesand54%withsignificantdisabilitiesreportedhavinganexcellentorgoodQOL(i.e,disabilityparadox).Analysisoftheinterviewsindicatesthatqualityoflifewasassociatedwithfindingabalancebetweenbody,mindandspiritandonestablishingandmaintainingapositiverelationshipwiththeperson'ssocialcontextandexternalenvironment.

Albrecht,G.&Devlieger,P.,(1999).Thedisabilityparadox:Highqualityoflifeagainstallodd.SocialScienceandMedicine.48,977‐988.

SoinsummaryWearejustbeginningtounderstandwhatitmeanstobeanadultwithautismwithinthecontextofqualityoflife,directedhabilitation,personalfreedom,andsafety.Thiscomplexunderstandingofadulthoodnowneedstobethegoalofallthebehavioranalyticinterventionacrossanindividual’slife.Withthatwe,asbehavioranalysts,needtogetincreasinglycompetentworkingthepost‐schoolenvironmentwhereservicesareunderfundedandunderstaffed,andneedsarereallycomplicated.Sexualityisoneofthemorecomplexaspectsadulthoodbut,ifweareseriousabouttheabilityofoursciencetoproducesociallysignificantoutcomes,itsimplybecomesanotherchallengetoovercome.


63

Afewrecommendationsgoingforward

#1FocusonChoice/DecisionMakingSkills


64

Effectivechoicemakingiscentraltomanyofthecompetenciesofadulthood.However,mostofusmastersimpleeither/orchoicespretty

earlyinlife.

“Wouldyoulikeanapple?”

Apple

GrannySmith

Whole Sliced WithCheese

MaybeApplesauce?

RedDelicious Macintosh Yellow

Delicious

Ifyouhavenothingelse

Butevenmostsimplechoicesarelesssimplethanyouthink.Forexample:


65

#2

TeachResilienceasPartofProblem

Solving*(*or,asabehavioranalyst,behavioralcuspsthatare

resistancetoextinction)

Resilience isanindividual’sabilitytoproperlyadapttostressandadversity.Resilientbehaviordevelopsovertimeandisiscomposedofavarietyfactorswhichprescribethemannerinwhichwerespondtochallenges.Behavioralcompetenciesassociatedwithresilienceinclude:Perseverance,ortheabilitytocontinuewiththebehaviorinquestionintheabsenceofhighratesofpositivereinforcement.Flexibility,ortheabilitytogeneratenewstrategiestosolveaparticularproblem.Alearninghistorythathasincludederroridentificationandcorrectionasaspecificinstructionalgoal(i.e.,problemsolving)Theabilitytomanageimpulsivebehaviorand/orignoreenvironmentaldistractors


66

ProblemSolvingInanattempttoidentifyfactorsthatmaycontributetoimprovingoutcomesforindividualswithASDincollegeprogramsGiaquinto,(2015)surveyed40youngadultsages18‐26across4collegecampusesinordertoinvestigatecorrelationsbetweenmindfulness,socialproblemsolving,socialanxietyandQualityofLife.PredictiverelationshipsamongsocialanxietyandQualityofLifewerealsoexamined.ResultsindicatedPositiveProblemOrientationtosocialproblemsolvingwasapredictorof[high]psychologicalQualityofLifescores.StudentsreportedhigherphysicalQualityofLifescoresthandidtheirparents.

Giaquinto,M.B.(2015).Mindfulness,socialproblemsolving,socialanxietyandqualityoflifeincollegestudentswithautismspectrumdisorders.DissertationAbstractsInternationalSectionA:HumanitiesandSocialSciences,75(10‐A(E)).(UMINo.AAI3622265)

#3Train the Typicals

“Ifyouneurotypicalshavealltheskills,whydon’tyouadaptforawhiledammit!Whyisitalwaysmefault?

DonnaVickers


67

KnowledgecanbePowerful!

“…underappropriateconditionsinterpersonalcontactisoneofthemosteffectivewaystoreduceprejudicebetweenmajorityandminoritygroupmembers.”(Alpert,1954)

A corollary to #3

ConsiderAssessingSocialValiditySocialValidityreferstotheacceptabilityof,andsatisfactionwith,interventionprocedures,usuallyassessedbysolicitingopinionsfromthepeoplewhoreceiveandimplementthem.Interventionproceduresforchild[andadult]behavioraresociallyvalidwhenpeoplejudgethemasbeingacceptable.(Luiselli&Reed,2011)

Luiselli,J.K.,Reed,D.D.,(2011).SocialValidity,inS.Goldstein&J.Naglieri(Eds).EncyclopediaofChildBehaviorandDevelopment.Pp.1406.Newyork:Springer.


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#4Teachtherightskillsintherightcontext(i.e.,

wherethebehaviorismostlikelytobedisplayed.

GretchenRubinistheauthorof“BetterthenBefore” and“TheHappinessProject” amongotherbest‐sellingpublications.

Whatyoudoeverydaymightinclude

1. Waketoalarmclock2. Morningroutine

1. Shower,dress,hygiene,etc.

3. Coffee/Breakfast4. Rememberkeys&lockdoor5. Gettoworksomehow6. Followverbal/writtenprompts7. Userestroom8. Takeabreak9. Purchaseandeatlunch10. Fixmistakes11. Askforhelp12. Usecomputer/smartphone13. Gethomesomehow

14. Getthemail15. Unlockthedoor.16. Changeoutofworkclothes17. Getsomethingtoeat18. ADLs19. Preparedinnerandeat20. Cleanup.Usedishwasher21. Goon‐line22. Home/Officework23. Shower24. Prepforbedinc. meds25. Reviewnextdayschedule26. Setalarmclock27. Sleep


69

#5Selfmanagement&selfreinforcement

Technology,whetherlowtechorhightech,ispartoftheworldasweknowandischangingthelivesofindividualswithASD.FromassistivecommunicationtechnologyonanI‐Pad,toGPStracking,toApplePay,toselfdrivingcars,andtoinstructionviavirtualrealitywereallyhaveonlyscratchedthesurfaceintermsoftechnology’spotential.

#6AccessTechnologySupports


70

Pleasedonotlimityou,oryourstudent,to“specialneeds”apps.Manyofthemostusefulappsaredesignedforthegeneralpopulation.Thismightincludeappsthatallowyoutopurchasewithoutusingmoney,letyouknowwhatbustotakewhereandit’sschedule,identifyappropriateclothingasafunctionoftheweatherreport,orwalksafelyfromPointAtoPointBfollowingamapandverbaldirections.FormanyadolescentsandadultswithASD,thequestionisnot,“Dotheyneedsomeformoftechsupport?”butrather“Whatformoftechsupportdotheyneed?”(Gerhardt&Glickman,2016).

Gerhardt,P.F.,&Glickman,A.,(2016).Hi‐techvisualsupportsforadolescentsandadultswithASD.InM.Cohen&P.Gerhardt(Eds).VisualSupportsforPeoplewithAutism:AGuidetoParentsandProfessionals. (pp.143‐153).Bethesda,MD:WoodbineHouse.

#7RiskisPartofLife

Risksthreatensthingsthatwevalue.Whatwedoaboutthemdependsontheoptionswehave,theoutcomeswevalue,andourbeliefsabouttheoutcomeswevaluethatmightfollowcontingentoneachoptionwemaychoose.Theoutcomescanbecertainoruncertainandourchoicessimpleorcomplex.(Fischhoff&Kadvany,2011)Risk,itseems,isunavoidable.Howeverignoringrisk,undertheguiseofsafety,wouldonlyseemtoinvitegreaterriskfortheindividualinquestion.

(Fischhoff,B.,&Kadvany,J.(2011).Risk:AVeryShortIntroduction.NewYork:OxfordUniversityPress


71

MostStudiedRiskFactorsforCancer Growingolder Tobacco Sunlight Ionizingradiation Certainchemicalsandothersubstances Somevirusesandbacteria Certainhormones Familyhistoryofcancer Alcohol Poordiet,lackofphysicalactivity,orbeing

overweightSource:NationalCancerInstitute.AccessedJune,2016at:http://www.cancer.gov/about‐cancer/causes‐prevention/risk

Riskmeansthatlifeisnotperfect Arecentstudyfoundthat15%ofmen&7%ofwomendidn'twashtheir

handsatapublicrestroom.Whentheydidwashtheirhands,only50%ofmenusedsoap,comparedto78%ofwomen.Only5%whowashedtheirhandsscrubbedlongenoughtokillgermsthatcancauseinfections.

Inarecentstudyoncasualsexduringspringbreak,researchersfoundthat15%ofmenand13%ofwomenhadsexwithsomeonetheyjustmet.Further77%ofcollege‐agewomenand83%ofmenreportedhavinghadcasualsexatleastonce.

NationalResearchCounciloftheUSandtheInstituteofMedicine: 39%ofallsexuallyactiveU.S.highschoolstudentsdidnotuseacondomatlast

intercourse. 6%ofallU.S.highschoolstudentshadsexualintercoursebeforeage13.1 Almost14%ofallU.S.highschoolstudentshavehadsexualintercoursewith4or

morepartners. Althoughdataarelimitedonsexualbehaviorsofmiddleschoolstudentsitdoes

appearsthatapproximately20%ofhavehadsexualintercourse.

Errorsandmistakeshappenallthetime.Thetrickisminimizebigmistakeswhileacceptingacertain,“non‐dangerous”errorlevel.Soiscompetencetobeaverage?Betterthanaverage?What?Beawareofrisk,makereasonableattemptstocontrolrisk,butacceptsomelevelofrisk.


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SelectedReferencesBrown‐Lavoie,S.M.,Viecili,M.A.,&Weiss,J.A.(2014).Sexualknowledgeand

victimizationinadultswithautismspectrumdisorders.JournalofAutismand

DevelopmentalDisabilities. 44,2185‐2196.

Cederlund,M.,Hagberg,B.,Billstedt,E.Gillberg,C.,&Gillberg,C.,(2008).Aspergersyndromeandautism:Acomparativelongitudinalfollow‐up

studymore than5yearsaftertheinitialdiagnosis.JournalofAutismandDevelopmental Disorders,38,72‐85.

Glennon,T.J.,(2001).ThestressoftheuniversityexperiencewithstudentswithAspergersyndrome.JournalofAssessment,Prevention,andRehabilitation,17,183‐190.

Green,J.,Gilchrist,A.,Burton,D.,&Cox,A.(2000).SocialandpsychiatricfunctioninginadolescentswithAspergerSyndromecomparedwith

conduct disorder.JournalofAutismandDevelopmentalDisorders,30, 279‐293.

Hagner,D.,&Cooney,B.F.(2005).“Idothatforeverybody”:Supervisingemployeeswithautism.FocusonAutismandotherDevelopmentalDisabilities, 20,91‐97.


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SelectedReferences

Ivey,J.K.(2007).Outcomesforstudentswithautismspectrumdisorders:Whatisimportantandlikelyaccordingtoteachers?EducationandTraininginDevelopmentalDisabilities, 42,3‐13.

Lattimore,L.P.,Parsons,M.B.,&Reid,D.H.(2006).Enhancingjob‐sitetrainingofsupportedworkerswithautism:Areemphasisonsimulation.JournalofAppliedBehaviorAnalysis, 39, 91‐102.

Lee,H.J.,&Park,H.R.,(2007).AnintegratedliteraturereviewontheadaptivebehaviorofindividualswithAspergersyndrome.RemedialandSpecialEducation,28,132‐141.

Mazefsky,C.,Williams,D.,&Minshew,N.(2008).Variabilityinadaptivebehaviorinautism:Evidencefortheimportanceoffamilyhistory.Journal

of AbnormalChildPsychology, 37,921‐928.

McClannahan,L.E.,McGee,G.G.,MacDuff,G.S.,&Krantz,P.J.(1990).Assessingandimprovingchildcare:Apersonalappearanceindexforchildrenwithautism.JournalofAppliedBehaviorAnalysis, 23,469‐482.

SelectedReferences

Mesibov,G.B.,Currentperspectivesandissuesinautismandadolescence.InE.Schopler&G.B.Mesibov(Eds),AutisminAdolescentsandAdults,(pp.37‐56).NewYork:Plenum

Myles,B.S.,Lee,H.J.,Smith,S.M.,Tien,Y.,Swanson,T.C.,&Hudson,J.(2007).AlargescalestudyofthecharacteristicsofAspergersyndrome.EducationandTraininginDevelopmentalDisabilities,42,448‐459.

Okuda,K.(2001).Toilettrainingforanadultwithautism,severelydisturbingbehavior,andmentalretardation23‐31.JapaneseJournalofSpecialEducation, 39, 23‐31.

Quinn,M.M.,Rutherford,R.B.,Leone,P.E.,Osher,D.M.,&Poirier,J.M.(2005).Youthwithdisabilitiesinjuvenilecorrections:AnationalSurvey.ExceptionalChildren, 71,339‐345.

Sobsey,D.(1994).Violenceandabuseinthelivesofpeoplewithdisabilities:Theendofsilentacceptance?Baltimore:PaulH.BrookesPublishingCo.

Smith,M.D.,&Belcher,R.(1985).Teachinglifeskillstoadultsdisabledbyautism.JournalofAutismandDevelopmentalDisorders, 15,163‐175.


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SelectedReferencesStokes,M.,Newton,N.,&Kaur,A.(2007).Stalking,andsocialandromantic

functioningamongadolescentsandadultswithautismspectrumdisorder.JournalofAutism&DevelopmentalDisorders, 37,1969‐1986.

Sullivan,P.M.&Knutson,J.F.(2000).Maltreatmentanddisabilities:Apopulation‐basedepidemiologicalstudy.ChildAbuseandNeglect,24,1257‐1273

Topper,K.,Bremner,W.,&Holmes,E.A.,(2000).Socialcompetence:Thesocialconstructionoftheconcept.InR.Bar‐on&J.D.A.Parker,(Eds.),TheHandbookofEmotionalIntelligence, (pp.28‐39).SanFrancisco:JosseyBass.

Taylor,B.A.,Hughes,C.E.,Richard,E.,Hoch,H.,&Coello,A.R.(2004).Teachingteenagerswithautismtoseekassistancewhenlost.JournalofAppliedBehaviorAnalysis, 37,79‐82.

Watanabe,M.,Uematsu,T.,Kobayashi,S.,(1993).Teachingcommunityskills(busriding)tostudentswithautism.JapaneseJournalofSpecialEducation.31,27‐35.

Watson,Griffiths,Richards,&Dysktra(2002).SexEducation,InGriffiths,Richards,Federoff,&Watson(Eds.).EthicalDilemmas:SexualityandDevelopmentalDisability.(pp175‐225).Kingston,NY:NADDPress

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