1. Curtis, Anya MSN, RN, FNP-BC


A proactive approach may prevent inappropriate behaviors, sexual victimization.


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Imagine your son being accused of sexual assault because he hasn't yet learned that touching another's private body parts can be perceived as a threat. Imagine your daughter being the victim of sexual violence because she lacks the sexual awareness to protect herself. Perhaps your child masturbates in public because he simply doesn't understand his changing body or the social cues that signal what behaviors are publicly inappropriate. These are just some of the challenges individuals with autism spectrum disorder (ASD) and their families face as they enter sexual maturity. These challenges, combined with the social deficits of those with ASD, make sex education critical to these adolescents' health and safety. Yet studies outlining specific curricula are sparse. Nurses can help by educating these adolescents on their physical, sexual, and emotional maturation.

Figure. Anya Curtis... - Click to enlarge in new window Anya Curtis

Growing up alongside a girl with ASD, I saw that she responded to puberty differently than my other peers; it wasn't unusual for her to expose and grope her developing breasts while at the dinner table, for example. My work as a nurse with adolescents with ASD has illuminated the fact that these behaviors are common, and very troublesome for families. Evidence-based sexual education for individuals with ASD is underdeveloped, yet the need for such education increases as adolescents enter sexual maturity.


ASD is a developmental disability that involves impaired communication, relationships, and social interactions. Approximately one in 68 children (notably, one in 189 girls, but one in 42 boys) has been diagnosed with it. As these children mature and sexuality and its social intricacies come into play, social deficits can become more pronounced. Inadequate knowledge about personal boundaries, in conjunction with sensory fascinations, further complicates development as these adolescents respond to their changing bodies, often not in private. Because of behaviors such as public masturbation, stalking, and touching others inappropriately, individuals with ASD can be at increased risk for legal trouble and for being convicted as sex offenders. Furthermore, reports from caregivers and mental health professionals, studies, and surveys of individuals with the condition all suggest that these adolescents are more likely to be victims of sexual exploitation, coercion, and abuse. While most children learn sexual norms through peer interactions and sex education, children with ASD have fewer of these opportunities and often have more difficulty adjusting to the physical changes of puberty. Sex education designed specifically for them is important not only for teaching social rules but also for abuse prevention education.


Studies have found that many parents don't discuss sexuality with their adolescent with ASD out of fear that talking about it will increase sexual behaviors; they may also assume that sex will not be a part of the young adult's life. However, sexuality is more than just engagement in sex; it is a spectrum of social, emotional, and physical manifestations. Nurses can provide reproductive and health education and teach adolescents important skills: self-examination, using sanitary pads, using contraception, and protecting against sexually transmitted diseases. Unfortunately, few nursing programs incorporate sexual education for people with developmental disabilities into their curriculum.


While not every individual with ASD will choose to engage in sexual activity, parents and health professionals must recognize that sex education for these adolescents is important to forming romantic relationships, understanding bodies and boundaries, increasing personal safety, and avoiding legal trouble. Families need support when educating adolescents about sexual health. Nurses can provide anticipatory guidance to parents and adolescents during this time of sexual development, and assess for sexual skills and knowledge in regard to contraception, sanitary care, and pubertal development.