puberty, sexuality, and relationships: the road to adulthood for adolescents with asd

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Puberty, Sexuality, and Rela<onships: The Road to Adulthood for Adolescents with ASD

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WES DOTSON, PH.D., BCBA Burkhart Center for Au<sm Educa<on and Research & College of Educa<on

Texas Tech University

Dr. Wes Dotson is the Interim Co-‐Director and the Director of Out-‐Pa<ent Services for the Burkhart Center for Au<sm Educa<on and Research and an Assistant Professor in the Special Educa<on Program at Texas Tech University. He earned his Master’s in Applied Behavioral Science in 2007 and his Ph.D. in Behavioral Psychology in 2010 from the University of Kansas. He has spent over 15 years in special educa<on, working with individuals with au<sm and other developmental disabili<es of all ages. He has worked as a high school special educa<on teacher, a behavioral consultant, and an in-‐home therapist for individuals with severe disabili<es before moving into higher educa<on. His primary areas of research are social skills, rela<onship development, and successful life outcomes for adolescents and young adults with au<sm, as well as the prepara<on of teachers and other professionals to work successfully with students with au<sm.


GOALS OF TALK

•  Describe changes associated with puberty and transi<oning affect individuals with ASD

•  Discuss common challenges faced during this <me •  Provide specific <ps and ideas to help overcome those challenges •  Provide recommenda<ons for building a quality, full life (including

rela<onships and reciprocity).


OPENING IDEAS

•  Rela<onships are building blocks of adult independence and happiness •  Not all rela<onships and friendships are the same •  Different people value different levels and types of rela<onship •  Rela<onships are building blocks of adult independence and happiness •  Not all rela<onships and friendships are the same •  Different people value different levels and types of rela<onship


CONTEXT FOR DISCUSSION

What does the scien<fic literature say about puberty, sexuality, adolescents, social skills, building rela<onships, and

posi<ve life outcomes?


WHAT THE RESEARCH TELLS US

•  Quality of life, healthy sexuality, employment, and successful independence closely <ed to development of rela<onships

•  Few children and adolescents with disabili<es develop friendships with same-‐aged peers

•  Ability to develop posi<ve rela<onships linked with level of social skills


PUBERTY AND DISABILITY

•  Adolescents with disabili<es experience puberty and develop sexual urges and interest exactly like their peers

•  Increased interest in and seeking of peer friendships •  Majority express desire for in<mate rela<onships (da<ng,

marriage, family)


PUBERTY

Consequences for inappropriate behavior more severe as individuals move into

adolescence and adulthood


PUBERTY

•  Increased desire for friends + poor social skills = Increased risk for bullying and exploita<on

•  Desire for in<macy + Failure to dis<nguish social/non-‐verbal cues =

Increased risk of nega<ve social and legal consequences


SOCIAL SKILLS

Developing posi3ve peer rela3onships in adolescence and adulthood requires a different set of social skills

•  Manners and politeness versus having an uncomfortable conversa<on with a friend

•  Iden<fica<on and ini<a<on of social opportuni<es •  Conversa<on with platonic friends versus conversa<on with poten<al da<ng

partners •  Boundaries and appropriate sexual behavior


THE GOOD NEWS! A number of interven3ons used to develop social, rela3onship, and sexuality skills, including:

•  Visual supports •  Video modeling •  Script fading •  Peer mediated strategies •  Teaching Interac<ons •  Social stories

All have successfully taught these skills


EFFECTIVE INTERVENTION

Interven3on to help people with disabili3es develop rela3onships should:

•  Provide/iden<fy opportuni<es for increased par<cipa<on in community ac<vi<es

•  Teach/work where peer rela<onships are most likely to form for that person

•  Involve the person directly in their own program to increase likelihood of compa<bility with goals, target peers, and desired outcome


BUILDING RELATIONSHIPS

It is important to teach how posi3ve rela3onships form: •  Rela<onships built on reciprocity •  Goal is to create rela<onships that involve regular, voluntary exchange of

reinforcers between both people


TIPS FOR BUILDING POSITIVE RELATIONSHIPS

Developing rela3onships between people with disabili3es and their peers: •  Exposure is not enough!

•  Mo<va<on: More likely to build rela<onships with preferred people

•  Engagement: More willing to par<cipate when learning environment fun/preferred

•  Relevance: More willing to engage in target behaviors which they see as func<onal

and important


SEXUALITY

Must be as proac3ve as possible: Individuals with ASD and other disabili<es more likely to stalk, pursue longer, ignore partner’s interests/needs, stare, inappropriately touch, masturbate in

public, be vic<ms of sexual assault, etc.


TIPS FOR NAVIGATING THIS MAZE

•  Listen, don’t judge •  If you don’t answer their ques<ons, someone else will •  Assume nothing –be explicit –be visual •  Monitor as much as you can and take advantage of the controls you have •  Prac<ce makes perfect –you can’t and won’t get it 100% right every <me –

the environment you create is the most important thing


BEST INSTRUCTIONAL PRACTICES From Urbano, et al., 2013 •  Individuals of ALL levels need assistance to deal with sexual urges •  Parent involvement and par<cipa<on is cri<cal •  Must be taught in highly structured way using concrete examples •  Must be a behavioral priority given stringent expecta<ons of society •  Must be tailed to individual & family values, sexual iden<ty, environmental

context, and developmental level


BEST INSTRUCTIONAL PRACTICES

From Gerhardt & colleagues •  Human Growth, Development, Puberty •  Pregnancy, childbirth, birth control •  Public versus private behavior •  Good touch versus bad touch •  Proper names of body parts •  “Improper” names of body parts •  Personal boundaries/personal spaces •  Masturba<on (“Private Touching”) •  Avoidance of danger/Abuse preven<on •  Social skills and rela<onship building •  Da<ng skills •  Personal responsibility and values


Sources and Resources

From Gerhardt & colleagues •  Human Growth, Development, Puberty •  Pregnancy, childbirth, birth control •  Public versus private behavior •  Good touch versus bad touch •  Proper names of body parts •  “Improper” names of body parts •  Personal boundaries/personal spaces •  Masturba<on (“Private Touching”) •  Avoidance of danger/Abuse preven<on •  Social skills and rela<onship building •  Da<ng skills •  Personal responsibility and values


Sources & Resources •  Sexuality & Sexuality Instruc<on with Learners with Au<sm Spectrum Disorders and Other

Developmental Disabili<es© Peter F. Gerhardt, Ed.D.: hlp://www.howard-‐au<sm.org/docs/Workshops/Gerhardt.pdf

•  Adolescents and Adults with Au<sm Spectrum Disorders; Fred R.Volkmar, Brian Reichow, James C. McPartland: hlp://download.springer.com/sta<c/pdf/414/bok%253A978-‐1-‐4939-‐0506-‐5.pdf?auth66=1403900747_d746684d5c41120f55a1361b8e719f89&ext=.pdf

•  PUBERTY AND SEX EDUCATION RESOURCES FOR CHILDREN WITH DEVELOPMENTAL DISABILITIES By Elizabeth A. Jackson: hlp://humboldt-‐dspace.calstate.edu/bitstream/handle/2148/1931/Jackson_Elizabeth_Sp2014.pdf?sequence=1

•  Holmes, L. G., Himle, M. B., Sewell, K. K., Carbone, P. S., Strassberg, D. S., & Murphy, N. A. (2014). Addressing Sexuality in Youth with Au<sm Spectrum Disorders: Current Pediatric Prac<ces and Barriers. Journal of Developmental & Behavioral Pediatrics, 35(3), 172-‐178.

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Thank you.

For addi<onal informa<on, contact: wesley.dotson@`u.edu

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puberty, sexuality, and relationships: the road to adulthood for adolescents with asd

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