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Isa b elle Hénault M.A. , Ph.D. Montreal, Canada

Understanding Relationships, Intimacy & Sexuality in I ndividuals with ASD and Asperger’s Syndrome. Isa b elle Hénault M.A. , Ph.D. Montreal, Canada. Definition of sexuality. Few research & clinical attention Normal part of development and life

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Isa b elle Hénault M.A. , Ph.D. Montreal, Canada

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  1. Understanding Relationships, Intimacy & Sexuality in Individuals with ASD and Asperger’s Syndrome Isabelle Hénault M.A., Ph.D. Montreal, Canada

  2. Definition of sexuality • Few research & clinical attention • Normal part of development and life • Complexity of sexuality: more than behaviours!

  3. www.jkp.com

  4. ASD & Asperger’s profile • Social skills: free of social rules • Communication abilities: verbal and non verbal • Theory of Mind: different ways of thinking? • Emotions: detecting, reading, expressing • Sensory issues

  5. ASD & Asperger’s profile • Sexual behaviours: self-stimulation, exploring sexuality, lack of experience • Frustrations and inappropriate behaviours: paedophilia, preferences, fetishism, compulsions • Gender identity & role definition: « My way » • flexibility, conflict, confusion • cross-dressing, transsexualism • Social imitation: context, consent

  6. ASD & Asperger’s profile • Interpretation of emotions: black & white! • Interpersonal relationships: couples, empathy, intimacy. Confusion & anxiety, resentement • Sexual drive, desire, curiosity • Accepting the diagnosis

  7. Factors influencing social and sexual development (Griffiths, 1999) • Information • Basic knowledge • Experiences • Social support • Limitations of the environment • Gender segregation • Social network • Rules • Sex education

  8. Factors influencing social and sexual development • Intimacy • Interests and limits • Private and public setting • Exploration • Medication • Secondary effects • Synergic effects • Infections • Monitored

  9. HFA- Asperger’s Syndrome and SexualityResearch • Do individuals diagnosed with HFA-AS have a sexual profile dinstinct from their peers?

  10. Actual literature • Lack of research, data • Sexual development and interest • Communication and social skills difficulties • Depression, anxiety and other psychiatric disorders • Sexual development • Inappropriate behaviours

  11. Experimentation • Derogatis Sexual Functioning Inventory (DSFI, 1982) • Self-report questionnaire, confidential • 11 aspects of sexuality measured • Scores compared to norm of general population • AQ Test (Baron Cohen et al., 2002)

  12. Experimentation • Subjects • N: 131 adults • 88 men and 43 women (3 transgendered male to female) • Age: M: 38 • Range 18 to 68 years • Diagnosis: • 126 AS • 5 High Functioning Autism

  13. Experimentation • Nationality • 22 Canada 6 France 28 Denmark • 61 Australia 3 Belgium • 7 USA 4 UK • Status • 60 single • 71 relationship

  14. Subscales Results • 1-Information (M= 43 SD= 13) • 2-Experience (M= 42 SD= 13) • 3-Drive (M= 44.5SD= 10.4) • 4-Attitude (M= 46.5SD= 12.6) • 5-Symptoms (M= 35.7SD= 9.4) • 6-Affects (M= 37SD= 11.4) • 7-RoleDefinition (M= 48SD= 13.4) • 8-Fantasy(M= 51SD= 14.5) • 9-Body Image (M= 35.5SD= 12.7) • 10-Satisfaction (M= 41 SD= 11.3) • 11-GSS (M= 47 SD= 12.1)

  15. Low Scores • Body Image: 35.5 • Negative self-image • Unhappy about genitals, physicalappearance • Unattractive: decrease of sexualactivity • Sensitivity about self-image • Symptoms: 35.7 • Pain in the body, insomnia, digestive problems • Agitation, loneliness • Guilt, anxiety and depression in 65% AS(Attwood,CBT, 2002) • Comorbidity

  16. Low Scores • Affects: 37 • Sadness, tense and bitter • Depression and anxiety • Low self-esteem • Sexual satisfaction: 41 • Activities, partner, variety, interest • “There is not enough variety in my sex life” • “Often, I worry about my sexual performance”

  17. Mean scores • Experience: 42 • Age sexual interest: 14 years • First experience: 21 years • 26 virgins subjects (18 to 40 years) • Lack of experience • Information: 43 • Mediocre general knowledge: superficial-practical • Curiosity • Sexual experience

  18. Mean scores • Sexual drive: 44.5 • Frequency of behaviours (actual and desired) • Sexual fantasy • Despite limited experience, sexual desire

  19. High scores • Positive attitude: 46.5 • Moral judgement and social conventions • Liberal values • Open-minded • General Sexual Satisfaction: 47 • All subscales • Importance of sexuality in one ’s life • Improvement, experiences, knowledge

  20. Highest scores • Role Definition: 48 • Gender issues according to their personality • Gender flexibility/social rules • Fantasy Life: 51 • Rich and diverse • Stimulations, positions, homosexual, erotic material • Variety larger than list!

  21. Discussion • Sexual desire, rich fantasies, sexual roles • Positive attitude • Incidence of homosexuality • Role definition and Gender Identity Disorder • Comorbidity of AS & GID? • Flexibility in sexual orientation

  22. Sexual and social behaviours No distinction between men and women, cultural: • Negative body image • Limited knowledge • Symptoms of depression and anxiety and other psychiatric disorders • Restrictive environment • Confusion in socio-sexual situations and need for sex education • Higher risk of sexual abuse in ASD

  23. Support and strategies • Goals • Improve self-esteem and interpersonal exchanges • Decrease isolation and depression • Establish friendships and intimacy • Provide knowledge and positive experiences • Consultations: individual couples & groups • Healthy sexuality = Quality of life

  24. Outcomes • Dinstinct sexual profile of ASD & Asperger ’s adults • Need for ongoing research • Development of sex education and counseling programs

  25. Typical History of Relationships. • Late developer in social/emotional maturity. • Not sexist, ageist or culturally biased in choice of friends and partner. • Wanting to be a friend and lover but with little intuitive knowledge and experience of how to do either.

  26. What Attracted You to Your Partner? • The silent handsome stranger. • Admiration of intellect or abilities. • Compassion for his/her limited social skills. • Belief his or her character was due to childhood circumstances and the person will change in a new relationship.

  27. What Attracted You to Your Partner? • Shared interests (hobbies, animals). • The degree of adulation. • Fidelity in relationships.

  28. What Attracted You to Your Partner? • ‘Pillar’ of the community. • Child like quality, a ‘Peter Pan’. • Creative in his/her work and good career prospects. • Similar characteristics to a parent (learned the language and culture in childhood).

  29. What Attracted You to Your Partner? • A challenge to get to know. • I was his first serious relationship. • Not ‘macho’.

  30. Choice of Partner • Women with AS may prefer a relationship with a man with As. • Extreme neurotypicals more likely to fall in love with an Aspie. • Adults with High Functioning Autism less likely to seek a partner.

  31. The development of the relationship • An initial extremely deep love for the partner with ASD-AS. • In the early years of the relationship, not expecting the partner with ASD-AS to know what the person is thinking or needs. • The extreme neurotypical can imagine the ASD-AS perspective but the partner with ASD-AS can have great difficulty imagining the NT perspective.

  32. What signs indicated he/she was different? • Indifference e.g. Early attentions in courtship stage vanished • Dominance of hobbies in time • Resist being changed • Reduction in social life • Emergence of obsessive compulsive routines • Less need for social relationship with partner

  33. Problem processing what you say and cannot change mind with more information • Paranoia- e.g. you did something deliberately to annoy them • All your fault • Phenomenal memory of what you have said and repeating it • Unaware of how to handle people close to you

  34. Difficulty resolving conflict • Unable to discuss issues • Wanting to be mothered but fighting and resisting that • No concept of time

  35. Individual Activity: List the characteristics of love

  36. Love is: Tolerance, non-judgemental, supportive. • Love is: A complex of beliefs that tap into our childhood languages and experiences; it is inspired when you meet someone that has a quality that maybe you admire, or do not have (admiration and respect) – or that they (someone you admire) reflects back to your ideal self – which is what you want to be or see yourself as.

  37. Love is: Passion, acceptance, affection, reassurance, mutual enjoyment. • Love is: What I feel for myself when I am with another person.

  38. Emotional bonding • Sharing and support • Balance of independence and dependence and being comfortable with that person • Long term commitment

  39. ASD-AS Partner Definitions

  40. ASD-AS definitions • Love is: Helping and doing things for your lover. • Love is: An attempt to connect to the other person’s feelings and emotions. • Love is: Companionship, someone to depend on to help you in the right direction. • Love is:I have no idea what is involved. • Love is: Tolerance, loyal, allows ‘space’.

  41. Four aspects of love: everybody, friends, family, erotica. • Love cannot be observed. • Love is yet to be felt and experienced by myself. • What is Love? I don’t know the correct answer.

  42. Euphoric feeling without logic • A good roast meal • Understands needs and how you feel • Looks after the kids so I can pursue my special interest • Someone that will try to understand the Aspie way and still be there in the morning.

  43. Partners • Two magnets - that either attract or repel each other. • Adored or despised. • Attract: Seek affection and approval. • Seek a partner with a similar profile of abilities.

  44. Understanding Relationships • Issues of relationships: two individuals or an entity? • Sexuality and intimacy as a whole: much more than intercourse! • Communication, emotions, comittment • Personal history, experiences, sexuality & values, education, etc. • Development and interest • Isolation • Conflicts

  45. Addiction (Carnes, 2007) • Obsession-Compulsions • Pornography • Continuation despiteconsequences • Unsuccessful efforts to control • Irritability, escape • Lying, illegalacts • Jeopardizingrelationship-employment • Financial consequences

  46. Inappropriate Behaviors • Organic factors (25% serious health problems) no complains… • Psychologic/psychiatric condition: dual diagnosis • Depression, anxiety • PTSD-ADHD • Addictions • Phobia, OCD, etc.

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