Relationships and sexuality within High Functioning ... - Amaze

© 2012 Dr Mark Stokes
Background
• Current knowledge of the sexuality in autism is limited
– Persons with autism are regarded as sexually immature
– Some think having a social deficit renders you sexuality irrelevant
– (Konstantareas & Lunsky, 1997)
• Adolescents with ASD have more difficulty forming relationships
than Conduct Disordered adolescents
– Green, Gilchrist, Burton & Cox (2000)
• Many individuals with autism are interested in marriage and sexual
relationships but lack experience & knowledge
– (Newport & Newport, 2002 ; Ousley & Mesibov, 1991; Henault & Attwood, 2006)
• Previous research has found that individuals with autism may
display inappropriate sexual behaviour
– (Haracopos & Pedersen, 1992 ; Hellemans & Deboutte, 2002; Ruble & Dalrymple, 1993)
– Undertaken using mixed samples of low and high functioning

© 2012 Dr Mark Stokes
Aberrant behaviour in Clinical Literature
• Aberrant behaviours found with younger adult or adolescent
males inappropriately pursuing females in search of relationships
– (Clarke et al., 1999; Green et al., 2000; Howlin, 1997; Smith-Myles & Simpson 2002; Murrie et al., 2002)
– Pursuing even when threatened with assault by others
– (Howlin, 1997)
– Following and touching strangers
– (Clements & Zarkowska, 2002)
– Undressing and masturbating in public
– (Haracopos & Pedersen, 1992; Ruble & Dalrymple, 1993)
– Genital exposure
– (Howlin, 1997)
– Kissing of strangers
– (Clements & Zarowska, 2000)
– Kidnap and bondage
– (Murrie et al., 2002)
– Attempted strangulation of the victim
– (Howlin, 1997)

How do adults & adolescents with
autism develop sexuality with Kaur
• Stokes & Kaur (2005)
• Social Behaviour, Sexual Behaviour, Privacy, Sex
Education, Parental Concerns
• Parental response scale
Scale Items Reliability
Social Contact 22 0.91
Social Insight 8 0.89
Sexual Behaviour (mod) 6 0.62
Parental Concerns 10 0.94
• Parents of:
– 50 TD adolescents &
– 23 adolescents with HF ASD
© 2012 Dr Mark Stokes

© 2012 Dr Mark Stokes
1
0.9
0.8
Social Behaviour
Difference in slopes: t= 2.54, p< 0.01
©1
ASD
Typical
Linear (HF ASD)
Linear (TD)
Score
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
10 11 12 13 14 15 16
Age

© 2012 Dr Mark Stokes
1
0.9
Problematic Sexual Behaviours
Difference in Slope: t=-1.70, p=0.09 ©1
Scale Score
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
10 11 12 13 14 15 16
Age

© 2012 Dr Mark Stokes
Privacy
ASD
Typical
Linear (HF ASD)
Linear (TD)
Score
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
*
0.1
0
Difference in slopes: t= -0.94, p= 0.35
10 11 12 13 14 15 16
Age

Parental Concerns
© 2012 Dr Mark Stokes
1
0.9
0.8
0.7
Difference in slopes: t= -2.77, p

© 2012 Dr Mark Stokes
Are behaviours seen in adolescents and adults
with autism consistent across culture with Kaur
• Kaur & Stokes (2011 submitted); Kaur (2009)
• Cross cultural study to estimate the effect of
culture in social & sexual behaviour
• Parental Survey of children 10 to 20 years
(M=14.87)
• Sexual Behaviour Scale – II
TD HFA DS Total
Australia 55 32 42 129
India 58 26 36 120
Singapore 40 8 33 81
Total 153 66 111 330

© 2012 Dr Mark Stokes
4
Social contact
4
Social insight
3.5
3.5
3
3
2.5
2
1.5
1
Australia
India
Singapore
2.5
2
1.5
1
Australia
India
Singapore
0.5
0.5
0
TD HFA DS
0
TD HFA DS
1.6
Problematic Sexual behaviour
4
Parental concerns
1.4
3.5
1.2
3
1
0.8
0.6
0.4
Australia
India
Singapore
2.5
2
1.5
1
Australia
India
Singapore
0.2
0.5
0
TD HFA DS
0
TD HFA DS
• Country by Condition interaction reveals Social Insight & Parental Concerns
responded to differently in each country
• (conditions are not seen consistently across culture)
• Suggests Social Insight interventions may be effective
– Sexual Behaviour or Social Contact had no interaction because differences over Country
relatively small
• Sexual Behaviour over Country was the only effect that was NOT significant
• Michelle Garcia Winner – www.socialthinking.com (Speech Therapist)

© 2012 Dr Mark Stokes
Do persons with HFA have insight into
their behaviour with Mehzabin
• MEHZABIN, P. & STOKES, M.A. (2011).
• SBS-II was used modified for adolescents
• Young adults 18 to 30 years
• 46 TD, 24 HFA responses
1
0.8
0.6
HFA
TD
0.4
0.2
0
Social
Behaviour
Privacy
Sex
Education
Sexualised
Behaviour
Sexual
Experience
Future
Concerns

© 2012 Dr Mark Stokes
How do adolescents with ASD develop
relationships with Newton & Kaur
• STOKES, M.A.., NEWTON, N., & KAUR., A. (2007)
• Parental survey of 25 ASD, 38 TD
• Aged 13 – 36 (2 cases 30+ not different so included)
A
1
B
1
0.8
0.8
Social Function
0.6
0.4
Romantic Function
0.6
0.4
TD
0.2
0.2
ASD
0
10 15 20 25 30 35 40
Age
0
10 15 20 25 30 35 40
Age

© 2012 Dr Mark Stokes
What are the sources of learning for social &
romantic function with Newton & Kaur
• Social function: TD adolescents & adults learn
– most from their PEERS & OBSERVATION, and
– least from their PARENTS
• Romantic function: TD adolescents & adults learn
– most from their PEERS & SOCIAL FUNCTION, and
– least from their PARENTS & SIBLINGS
0.2
0.1
0
-0.1
-0.2
-0.3
Social Function
TD sr
ASD s r
Romantic Function
0.8
TD sr
0.6
ASD sr
0.4
0.2
0
-0.2
-0.4
Parents
Media
Sex Education
Sibling
Peers
Observation
Siblings
Parents
Media
Observation
Social Function
Sex Education
Peers

© 2012 Dr Mark Stokes
What are the sources of learning for social &
romantic function with Newton & Kaur
• Social function: adolescents & adults with ASD learn
– most from their PEERS, SIBLINGS, & SEX ED, and
– least from the MEDIA
• Romantic function: adolescents & adults with ASD learn
– most from their SOCIAL FUNCTION, PARENTS, & OBSERVATION, and
– least from their PEERS, SEX ED, & SIBLINGS
0.2
0.1
0
-0.1
-0.2
-0.3
Social Function
TD sr
ASD s r
Romantic Function
0.8
TD sr
0.6
ASD sr
0.4
0.2
0
-0.2
-0.4
Parents
Media
Sex Education
Sibling
Peers
Observation
Siblings
Parents
Media
Observation
Social Function
Sex Education
Peers

© 2012 Dr Mark Stokes
Relationship Initiation
• Relationship initiation involves behaviours such as:
– Ask person out on a date
– Telephone or send them letters
– Wait for them outside work or
– Make other attempts to initiate social contact
• Subtle distinction between appropriate and inappropriate
behaviours
• If attention is unwanted persistence is typically described as
harassment or stalking

© 2012 Dr Mark Stokes
Many adolescents & adults with HFA:
– Have experienced considerable social
rejection and exclusion
– DON’T LEARN to read normal social
conventions
– DO LEARN that associations with others
available with persistence

© 2012 Dr Mark Stokes
Do adults & adolescents with HFA persist
unduly with Newton & Kaur
• Persist significantly
longer than TD
• Negative responses
have less effect on
persons with HFA
than TDs
Duration of persistance (days)
21
14
7
0
No response
Negative
response
Negative
response from
person's family
or friends
TD
HFA

© 2012 Dr Mark Stokes
Why do persons with HFA persist in the face
of such negative responses with Broadbent
• Broadbent & Stokes (2012); Broadbent (2012)
• HFA N=50, TD N=50.
• Wisconsin Card Sort Task (WCST)
– Four suits (crosses, circles, triangles, stars), four colours
(red, yellow, blue, green), & four symbols (#1, 2, 3, & 4)
• Two groups: Traditional WCST; Modified WCST
– Traditional WCST participants receive positive and negative
feedback
– Modified WCST participants receive only positive feedback

© 2012 Dr Mark Stokes
Why do persons with HFA persist in the face
of such negative responses with Broadbent
• Individuals with HFA get more correct responses when they
don’t get negative feedback
Correct Responses
80
78
76
74
72
70
68
66
64
62
60
Traditional WCST
Modified WCST
HFA
TD

© 2012 Dr Mark Stokes
Why do persons with HFA persist in the face
of such negative responses with Broadbent
• These result suggest persons with an ASD
– Do not respond when they have negative
information guiding them
– Need positive information and alternate strategies

© 2012 Dr Mark Stokes
How important is it to understand the mood & intent of
others in establishing a relationship with de Quadros-Wander
• de QUADROS-WANDER, S. & STOKES, M.A. (2007)
• 30 females and 30 males undergraduates
• Induced positive & negative moods using film
• Asked about sexual intent or commitment intent in response to a
situation description

© 2012 Dr Mark Stokes
How important is it to understand the mood & intent of
others in establishing a relationship with de Quadros-Wander
• Positive mood shift female increases female sexual intent
• Negative mood shift doesn’t adjust sexual or commitment intent
• Positive mood shift
– Females raise own sexual
intent
– Males estimated higher female
sexual intent
• Same was NOT found for male
commitment intent
Rating
1.8
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
Female Self
Male assess female
Female assess female
Positive
Mood
Negative
Mood
Negative
Mood
Positive
Mood
PN Mood shift
NP Mood shift

© 2012 Dr Mark Stokes
What behaviours do adults & adolescents with HFA
use to initiate romantic relationships with Newton & Kaur
• HFA is 9 times more
likely to act
inappropriately than TD
• Appropriate behaviour
• TD 90%
• HFA 51%
• Inappropriate
behaviour
• TD 10%
• HFA 49%
• HFA as likely to
damage property as to
ask on a date, write a
letter, or give a gift
Telephone
Attempt to initiate social contact
Asked out on a date
Letters or email
Waited for them
Made contact with family
Shown exagerrated affection
Gifts
Fantasised about them
Touched inappropriately
Believed target reciprocated their feelings
Made inappropriate comments
Monitored their activities
Followed them
Persued in threatening manner
Shown obsessional interest
Made threats
Threatened to hurt self
Made inappropriate gestures
Stolen or damaged their property
Relative probability
- 0.05 0.10 0.15 0.20 0.25
TD
HFA

© 2012 Dr Mark Stokes
How do people with HF ASD go dealing with
initial attraction & presentation With Galic
• Dressing when going to a Birthday Party
• 10 to 15 y/o

© 2012 Dr Mark Stokes
How do people with HF ASD go dealing with
initial attraction & presentation With Galic
• Dressing when going to a Birthday Party
• 10 to 15 y/o

What is important in initial attraction for
persons with HF ASD With Goldsworthy
• Goldsworthy (2010); Goldsworthy & Stokes (2011 in preparation)
• N=94 (21 M & 73 F) (17 HF ASD, 76 TD partners of people with HF ASD)
© 2012 Dr Mark Stokes
TD Female Partners Preferences
• Resources accounts for
32% of variance
• TD females with a partner
who has an ASD rated the
resources factor as more
important for initial
attraction than TD
females with a TD partner

What is important in initial attraction for
persons with HF ASD With Goldsworthy
© 2012 Dr Mark Stokes
Males Preferences
Item 67 ‘The person was or is yielding.’ 31% of variance
Item 93 ‘The person made/makes decisions easily.’ 27 % of variance

• Ponnampalam (2010); Ponnampalam & Stokes (2011).
• Trade-offs and Implicit Preferences in Human
Mate Selection
• 148 men, 186 women
• Conjoint design
© 2012 Dr Mark Stokes
What do TD persons value in long term
relationships with Ponnampalam

© 2012 Dr Mark Stokes
What do TD persons value in long term
relationships with Ponnampalam
30
H2 F>M H3 M>F H4 F>M H5 F>M H6 F older M
Location score of choice
25
20
15
10
5
M
F
0
Partner
Warmth
Physical
Attraction
Sexiness
Future
Earning
Potential
Ambition
Desire to
have
Children
Relative Age

N=75 persons with ASD, and 137 TD
Attractiveness Resources Security
© 2012 Dr Mark Stokes
What will TD partners trade off for their long term
partner with ASD With Goldsworthy

© 2012 Dr Mark Stokes
What will TD partners trade off for their long term
partner with ASD With Goldsworthy
Security Emotional Resources

© 2012 Dr Mark Stokes
Where do persons with ASD find partners
With Goldsworthy
• Goldsworthy (2010); Goldsworthy & Stokes (2011 in preparation)
• 75 persons with ASD, and 137 TD
• 56% married (mean: 13.75 yrs), rest in long term relationships
25
20
Frequency
%
15
10
TD
ASD
5
0
Friend Internet Work School Bar/Nightclub Family Dating
agency

© 2012 Dr Mark Stokes
Do persons with an ASD see themselves
as good potential mates with Goldsworthy

© 2012 Dr Mark Stokes
Summary
• Persons with an ASD
– Have normal sexual desires
– Lack of awareness of critical issues involved in this, such as
privacy
– Show different levels of Social insight in different countries,
and thus this may be developed
– Show development in Romantic Skills with increasing age
– Learn Social Function from peers and siblings
– Learn Romantic skills from Social Skills, Parents, Observation
& Media
– Have insight into their difficulties

© 2012 Dr Mark Stokes
Summary
• Persons with an ASD
– Have little understanding of how to develop a relationship
appropriately
– Do not know how to dress appropriately
– Will frequently use inappropriate strategies to pursue a
relationship
– Will persist inappropriately with persons of romantic
interest
– Will need to be assisted by being offered alternative
strategies rather than persistence
– When rebutted by a romantic target will need to be guided
positively about this
– May need coaching in judging a romantic target’s mood and
intent

© 2012 Dr Mark Stokes
Summary
• Persons with an ASD
– When they do develop a relationship it is generally
through family or the internet
– Suggesting organised social structures may be
useful in helping develop relationships
– However, when obtained, relationships are sought
with persons with an ASD because they offer:
• Attractiveness
• Resources
• Security

© 2012 Dr Mark Stokes
Summary
• TD persons attracted to partner with an ASD sought
– Attractiveness, Resources, & Security,
– But will seek social skills over emotional skills
– Want their needs supported (selfish orientation)
• Thus we enhance the romantic potential of persons with ASD by
–Teaching positive strategies around relationship development
–Improving social skills
–Providing formal structures for social opportunities

© 2012 Dr Mark Stokes
References
• BROADBENT, J. & STOKES M.A. (2011). Perseveration in Autistic Spectrum Disorders; the role of negative
feedback. IMFAR 2011, May 12-14, 2011, San Diego, California.
• CLARKE, D., BAXTER, M., PERRY, D.& PRASHER, V. (1999). The Diagnosis of Affective and Psychotic
Disorders in Adults with Autism: Seven Case Reports, Autism 3 (2): 149–64.
• CLEMENTS, J .& ZARKOWSKA, E . (2002) Behavioural Concerns and Autistic Spectrum Disorder:
Explanations and Strategies for Change. London, UK: Jessica Kingsley.
• de QUADROS-WANDER, S. & STOKES, M.A. (2007). The Effect of Mood on Opposite-Sex Judgments of
Males’ Commitment and Females’ Sexual Intent. Evolutionary Psychology, 5(3): 453-475.
• GOLDSWORTHY, B. (2010). Relationships and Attraction Among Individuals with an Autism Spectrum
Disorder. Doctor of Psychology Thesis. Deakin University.
• GOLDSWORTHY, B. & STOKES, M.A. (In preparation). Attraction Among Individuals with an Autism
Spectrum Disorder.
• GREEN, J ., GILCHRIST, A., BURTON, D.& COX, A. (2000) Social and Psychiatric Functioning in Adolescents
with Asperger Syndrome Compared with Conduct Disorder, Journal of Autism and Developmental
Disorders 30 (4): 279–93.
• HARACOPOS, D. & PEDERSEN, L. (1992) Sexuality and Autism: Danish Report. Society for the Autistically
Handicapped. Available at www.autismuk.com/index9sub.htm
• HELLEMANS, H. & DEBOUTTE, D. (2002) Autism Spectrum Disorder and Sexuality, Inaugural World Autism
Congress, Melbourne, 10-14, November.
• HÉNAULT, I. & ATTWOOD, T. (2006). The sexual profile of adults with Asperger’s syndrome: The need for
support and intervention. In: Hénault, I. (2006). Asperger’s Syndrome and Sexuality: From adolescence to
adulthood. London, UK: Jessica Kingsley.
• HOWLIN, P. (1997) Autism: Preparing for Adulthood. London: Routledge.
• Kaur, A. (2009). Cross cultural examination of social and sexual behaviour in HFA ad DS. Doctor of
Psychology Thesis. Deakin University.
• KAUR, A. & STOKES M.A. (2011 Submitted). A cross-cultural examination of social and sexual behavior in
Autism Spectrum Disorders and Down Syndrome.

© 2012 Dr Mark Stokes
References
• KONSTANTAREAS, M. & LUNSKY, Y. (1997) Sociosexual Knowledge, Experience, Attitudes, and Interests of
Individuals with Autistic Disorder and Developmental Delay, Journal of Autism and Developmental
Disorders 27 : 397-413.
• MEHZABIN, P. & STOKES, M.A. (2011). Self-assessed sexuality in young adults with High-Functioning
Autism. Research in Autism Spectrum Disorders, 5, 614–621
• MURRIE, D. C., WARREN, J . I ., KRISTIANSSON, M.& DIETZ, P. E . (2002) Asperger’s Syndrome in Forensic
Settings, International Journal of Forensic Mental Health 1: 59–70.
• NEWPORT, J. & NEWPORT, M. (2002) Autism-Asperger’s and Sexuality: Puberty and Beyond. Arlington, TX:
Future Horizons Inc.
• PONNAMPALAM, J. (2010). Trade-offs and Implicit Preferences in Human Mate Selection. PhD Thesis.
Deakin University.
• PONNAMPALAM, J. & STOKES, M.A. (2011 Submitted). Trade-offs in Human Mate Selection.
• OUSLEY, 0. & MESIBOV, G. (1991) Sexual Attitudes and Knowledge of High- Functioning Adolescents and
Adults with Autism, Journal of Autism and Developmental Disorders 21 : 471-81.
• SMITH- MYLES, B.& SIMPSON, R. (2002) Students with Asperger Syndrome: Implications for Counsellors,
Counselling & Human Development 34: 1–16.
• STOKES, M. & KAUR, A. (2005). High Functioning Autism and Sexuality: A Parental Perspective. Autism, 9,
263-287.
• STOKES, M.A.., NEWTON, N., & KAUR., A. (2007). Stalking, and Social and Romantic Functioning Among
Adolescents and Adults with Autism Spectrum Disorder. Journal of Autism & Developmental Disorders, 37,
1969-1986.