Regarding the very difficult question of sterilization, Dr. Gerhardt says, "... the true issue is prevention of abuse, not pregnancy. So it comes down to education directed to personal and sexual safety - starting with closing and locking the bathroom door, knowing who can and can't help with menstrual care, and understanding the difference between good touching and bad touching. If we take these proactive steps, the reasons for considering sterilization drop off dramatically. Sterilization does nothing to prevent sexual abuse, so it should only be considered as a last-step scenario."
Very few programs exist to teach young people with autism about sex and sexuality, and because people with autism are often unaware of social cues and peer expectations, clear, direct education is often critical. For example, says, Dr. Gerhardt, "they need to know they should lock the bathroom stall, and they need to learn how to do it. Sometimes parents think it's safer if they take their child into the bathroom with them, but the challenge with that is that the person most likely to cause abuse is someone the child knows, not someone the child doesn't know. And if you don't teach your son to close and lock the door in a public bathroom, he's too open to abuse."
Beyond day-to-day hygiene and the issues of bathroom and locker room safety, it's important to address the social aspects of sexuality. Unlike most youngsters, teens on the autism spectrum are unlikely to learn about sexual norms from peers or even from teachers. So it's up to parents to pick up the slack. Some things that almost anyone on the autism spectrum can learn about include:
- circles of comfort (who may touch you or ask you to undress)
- good touch/bad touch
- bathroom and locker room independence
- reporting of past events such an inappropriate touch
Says Dr. Gerhardt, "for kids with autism going to middle school, if we're not pre-teaching, they'll get a very skewed vision of human sexuality. Right now, there's no curriculum that truly addresses the prorammatic issues in a functional way, and there's little research on the topic - there's some for mental retardation, but with sexuality you're not just teaching information. You're also teaching values and social competence."
How can parents begin to think about this issue? Dr. Gerhardt recommends that parents:
- Think ahead - be proactive ("pre-teach")
- Be concrete (talk about the penis or vagina, not the birds and bees)
- Be consistent and repetitive about sexual safety
- Find someone of the same gender to teach the basics of safety and hygiene
- Be sure to address the social dimension of sexuality
- Strongly reinforce for all appropriate behavior
- Redirect inappropriate behaviors. For example, if a child is likely to masturbate in class or in public, give him something to carry or hold, etc.
Interview with Dr. Peter Gerhardt, January, 2007
Attwood and Henault. "Sexual Profile of Adults with Asperger's Syndrome he need for understanding, support, and education." [Presentation] Inaugural World Autism Congress, Melbourne Australia, 2002.