Now I know this episode wasn't about sex and sexuality, but it was about a date - a special date to the prom. A moment like this would be a great teaching opportunity about dates and romance, and, as appropriate, of how these activities and feelings foreshadow relationships, marriage, sex and procreation. For most parents of children entering adolescence, teaching about sex and sexuality is one of the many difficult tasks we reluctantly undertake, dread, or in many cases simply avoid. For parents of children with high-functioning Autism Spectrum Disorder (ASD), teaching the physical changes that occur during puberty, the mechanics of reproduction, etc., is the "easy" part. The really difficult task is helping children with high-functioning ASD to at least be aware of all of the very complicated social and romantic conventions woven into our culture's views of sexuality. Of course, discussing even these conventions is nothing when compared to trying to describe the relationship between two people who are intimate emotionally, physically, and sexually.
Kids on the spectrum develop the same sexual drives and desires that we all do, as well as the many variations of those drives and desires. What they don't generally develop is an understanding of romantic feelings or of all the social subtleties that go into the dance of romance and sexuality.
Quite often in my practice, issues and problems directly related to this manifestation of the disability are the main topic of discussion and, at times, intervention. Every school year, there are several situations in which adolescents (usually boys, but sometimes girls) get into trouble for an infraction of the social rules that regulate behavior related to romance and sexual desire. I give several lectures every year to parents and professionals and, invariably, when I'm asked to present on a certain topic, it's almost always on kids with autism and sexuality.
A colleague of mine tells the story of a young man with high-functioning ASD who approached a girl he found attractive at his school and asked her in front of a group of her friends, "May I touch your breast?" The girl was understandably shocked and mortified. She reported the incident to the school authorities and they spoke with the boy. When asked, "Why did you ask the question?" He stated, "I wanted to know if I could or not. How would I ever know unless I asked?" When he was told that the girl was upset and offended by the question he asked, "Why? I asked and she said no. I would never have touched her breast unless she said yes." He just couldn't understand why there was a problem. He had asked and asked politely, he thought. He had used the "proper" word. He had no clue about the social implications of his question, how he asked it or where it was asked.
With our kids on the spectrum, we have to begin talking very early about what's okay and not okay romantically and sexually. We have to work constantly to let them know what's private and what's not: the rules about touching, talking, sharing. When you can talk about what you know about sex, or what you want sexually, and when you can't. When it's okay to ask certain kinds of questions, and when it is not.
With Frank, we started the discussions about body and sexuality very early - from about the time he was conversational. We discussed what was okay to say and ask with others his age, and what wasn't. He has had several formal courses with other kids his age about puberty, sexuality, and romantic expression. These courses have been at school, in therapy groups, and at our church. As parents, we have discussed love, commitment, sex and sexuality to the point that he has told us to "stop talking about sex!" Even so, just like most 14-year-old boys, his hormones are raging, and we've had several occasions in which we were very glad that we had already begun the conversation. We were in a position to help him concretely and practically in a way that was meaningful to him.
Kids with ASD have to learn these lessons in order to navigate a very complicated social world. If we don't take the opportunities like the one in this week's episode of "Parenthood" to have the discussions, we're missing concrete and real world examples we can use to help teach them the lessons and skills they will (hopefully) eventually need in order to form fulfilling romantic relationships with others.
Written by Roy Q. Sanders, M.D.
