National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 1
Promoting Appropriate Sexual Behaviors
for Individuals on the Autism Spectrum:
Effective Curricula and Teaching Strategies
Frank Cicero, PhD, BCBA
Presented at the National Autism Conference
State College, PA
August 4, 2016
Questions to be Discussed
1. What types of sexual encounters do
individuals on the spectrum desire?
2. Why do individuals on the spectrum
encounter issues with sexuality
development?
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 2
3. Are there any sexuality curricula out
there specifically designed for ASD?
4. What should sexuality curricula for
individuals on the spectrum include?
5. How do I assess an individual’s needs
when it comes to sexuality education and
what should I teach?
6. What teaching strategies can I use to promote
appropriate sexual expression and sexual
knowledge given my child’s level of ASD and
cognitive impairment?
7. What if my learner does not seem to have any
interest in sexual behavior?
8. What do parent attitudes have to do with
anything and why is this so awkward and
difficult to address?
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 3
9. Are individuals with autism at a higher risk for
sexual abuse from others and what can I do to
prevent it?
10. How do I encourage and teach appropriate
masturbation?
11. What do I do about inappropriate masturbation
or other inappropriate sexual behaviors?
13.What are some issues with legal consent
that I have to think about?
14.How do I promote appropriate social
knowledge and social skills?
15.Your questions…
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 4
What types of sexual
encounters do
individuals on the
spectrum desire?
• MYTH 1
– Individuals on the spectrum do not desire any sexual behavior because
they are unsocial
• MYTH 2
– Individuals on the spectrum (as well as people with other developmental
issues) engage in uncontrolled sexual behavior towards others and are
overly sexual
• MYTH 3
– Given their level of disability, individuals with autism and cognitive
impairment cannot learn more appropriate sexuality skills
• MYTH 4
– Even though individuals with autism and cognitive impairment grow
older chronologically, they remain “children” when it comes to sexuality
development
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 5
• Studies have found that 75% of individuals on
the spectrum desire and engage in some form of
sexual behavior. (actually a typical percentage
for the population at large)
• Reported behaviors range from masturbation to
intercourse and many steps along the way.
• Range of knowledge, desire and experience is
related to level of cognitive abilities and social
skills
• Haracopos & Pedersen (1992), when studying the
reported sexual behaviors and desires of high
functioning adults on the spectrum found that:
– Masturbation was the most frequently reported expression of
sexuality
– 10% expressed a strong desire to have a romantic relationship
– 35% expressed a sexual interest in both sexes and 9%
expressed interest only in same sex individuals
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 6
• Stokes & Kaur (2005) found that many high
functioning individuals with autism indicated a
desire for social contact and sexual relations.
• Their social disabilities hindered their ability to
make and maintain these relationships
• Surveyed individuals displayed poorer social
behaviors, had fewer privacy related behaviors
and had less knowledge of privacy issues and
sex education than typically developing peers.
Sexual Development:
Typical Development and ASD
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 7
Sexual Development
• Infancy (birth to 1 year)
– Discovery of pleasure areas (not limited to genitals)
– Rubbing of genitals for self stimulation
– Initiation of physical closeness with primary
caregivers including holding, clinging, cuddling and
nursing
Infancy (birth to 1 year)
– Adjustment of self stimulation to conform to
the reactions from others
– Responding to others with touching, hugging
and kissing.
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 8
Sexual Development
• Early Childhood (2-5 years)
– Interest in one’s body and its function
– Increased curiosity and awareness of the physical
differences between boys and girls
– Labeling/naming of body parts, feelings and functions
– Body exhibitionism
Early Childhood (2-5 years)
– Questions about how babies are made
– Jokes about genitalia and bodily functions
– Fascination with obscene words
– Modeling of parental affection behaviors with
continued hugging, kissing and touching
– Beginnings of peer exploration
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 9
Sexual Development
• Middle to Late Childhood (6-12 years)
– Continued self stimulation (but now in private)
– Continued exploration with peers and sexual
play (but now secretive from adults)
– Peer discussion involving sexual behaviors
Middle to Late Childhood (6-12 years)
– Interest in children of the opposite sex
– “boyfriends” and “girlfriends” begin to be
established
– Increased need and desire for personal
privacy
– Onset of puberty and secondary sexual
physical characteristics.
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 10
Sexual Development
• Early to Late Adolescence (12-18)
– Strong motivation to obtain access to desired
sexual gratification
– Increased knowledge of sexual intercourse
and alternate forms of sexual expression
Early to Late Adolescence (12-18)
– Casual sexual encounters (practice and
experience)
– Peer pressure/peer coaching/peer discussion
– Development of long term intimate
relationships
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 11
Sexual Development and ASD
• In ASD, physical maturity and
development are linked to chronological,
not mental age.
• Therefore secondary sex characteristics,
behaviors and desires often emerge in
early adolescence as scheduled
• Difficulties with appropriate sexual development
and expression are related more to deficits in
social skills and social awareness than in deficits
or issues with sexuality per se.
• Because deficits in social skills are observed
across all levels of the ASD spectrum, issues
related to sexuality expression are observed
across the entire spectrum.
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 12
Sexual Development
• Infancy (birth to 1 year)
– Discovery of pleasure areas (not limited to genitals)
– Rubbing of genitals for self stimulation
– Initiation of physical closeness with primary caregivers including
holding, clinging, cuddling and nursing
– Adjustment of self stimulation to conform to the reactions from
others
– Responding to others with touching, hugging and kissing.
Sexual Development
• Early Childhood (2-5 years)
– Interest in one’s body and its function
– Increased curiosity and awareness of the physical
differences between boys and girls
– Labeling/naming of body parts, feelings and functions
– Body exhibitionism
– Questions about how babies are made
– Jokes about genitalia and bodily functions
– Fascination with obscene words
– Modeling of parental affection behaviors with
continued hugging, kissing and touching
– Beginnings of peer exploration
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 13
Sexual Development
• Middle to Late Childhood (6-12 years)
– Continued self stimulation (but now in private)
– Continued exploration with peers and sexual play (but
now secretive from adults)
– Peer discussion involving sexual behaviors
– Interest in children of the opposite sex
– “boyfriends” and “girlfriends” begin to be established
– Increased need and desire for personal privacy
– Onset of puberty and secondary sexual physical
characteristics.
Sexual Development
• Early to Late Adolescence (12-18)
– Strong motivation to obtain access to desired sexual
gratification
– Increased knowledge of sexual intercourse and
alternate forms of sexual expression
– Casual sexual encounters (practice and experience)
– Peer pressure/peer coaching/peer discussion
– Development of long term intimate relationships
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 14
Sexual Development in ASD
– Discovery of pleasure areas (not limited to
genitals)
– Rubbing of genitals for self stimulation
– Interest in one’s body and its function
– Increased awareness of the physical
differences between boys and girls
Sexual Development in ASD
– Labeling/naming of body parts, feelings and
functions
– Body exhibitionism
– Continued self stimulation
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 15
Sexual Development in ASD
– Onset of puberty and secondary sexual
physical characteristics
– Strong motivation to obtain access to desired
sexual gratification
– Increased knowledge of sexual intercourse
and alternate forms of sexual expression (only
if they have been exposed and have cognitive
capacity)
Why do individuals on the
spectrum seem to know less
about sexual behaviors even
if they do not have cognitive
deficits?
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 16
Lack of Knowledge
• Exposure to sexual talk, visual information and
practice with peers is lacking.
• Remember that by middle childhood sexual
topics get discussed in the absence of adult
presence
• Deficits in social skills which limit typical peer
interaction
• Segregated environments (with relation to
disability and gender)
Lack of Knowledge
• Lack of unstructured, private time in the
home.
• Lack of exposure to “age-inappropriate”
pictures, television and movies
• Sexual education not specifically
addressing the mechanics of sex and
forms of sexual behavior
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 17
Are there any sexuality
curricula out there specifically
designed for ASD?
• Many sexual education curricula for typically
developing individuals have been modified for
individuals with cognitive impairments.
• Typically the content of the curricula is explained
in more detail and language is simplified.
• Focus is placed on knowing one’s body and
protection against abuse
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 18
• Given the different challenges in ASD, these
curricula are often not appropriate for this
population.
• Not enough focus on social skills training
• Based on didactic teaching through lessons and
worksheets (often in groups) with some addition
of visual aides
• No focus on direct teaching methods using
applied behavior analysis
McLaughlin, K., Topper, K., & Lindert, J. (2010). Sexuality
Education for Adults with Developmental Disabilities,
Second Edition. (structured group model)
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 19
Hanault, I. (2006). Asperger’s Syndrome and Sexuality: from
Adolescence through Adulthood. (information and lessons for
students on the less cognitively impaired end of the
spectrum)
Davies, C., Dubie, M. (2012). Intimate Relationships &
and Sexual Health: A Curriculum for Teaching
Adolescents/Adults with High Functioning Autism
Spectrum Disorders and Other Social Challenges.
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 20
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 21
How do I assess my child’s
needs when it comes to
sexuality education and what
should I teach?
• Teach everything vs. Teach some things
• Remember that there is no link between gaining
knowledge in sexuality and engaging in uncontrolled
sexual behavior. If anything, sexuality education can
reduce problem behavior
• What you teach and how you teach it should be
individualized
• Begin by observing what the individual does now
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 22
• Be realistic with future possibilities of sexual
expression
• Remember that you can always introduce other
skills as the individual changes and develops
• Do not stick to any one curriculum task analysis
(i.e. you can teach masturbation without
teaching independent hygiene etc.)
• In general, you want whatever you teach to be
habilitative and socially significant for the
individual at the time
• Maximize the opportunities for reinforcement
and minimize the opportunities for punishment
• Take a look at yourself and your own biases,
expectations and desires
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 23
Important Topic Areas of a
Comprehensive Sexuality Curriculum
• Public versus private behavior
• Masturbation
• Male hygiene
• Female hygiene
• Male sexual body parts and function
• Female sexual body parts and function
• Male adolescent development
• Female adolescent development
• Identifying different relationships
• Appropriate social space, touch and conversation topics
• Theory of mind/Perspective taking
• Interpersonal sexual behaviors (physical)
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 24
• Interpersonal sexual behaviors (social)
• Assessing consent in the individual
• Sexually transmitted diseases
• Reproduction and pregnancy
• Flirting and dating
• Inappropriate or unsafe interpersonal
behavior
• Abstinence
• Avoiding being naïve about sexual topics
and situations
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 25
What teaching strategies can I
use to promote appropriate
sexual expression and sexual
knowledge?
• There is an absence of research specifically
addressing teaching strategies and sexuality
• Basically, you should guide your choice of
teaching strategies by what has worked in the
past to teach other skills
• Teach different skills through different mediums
• Individualize instruction
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 26
• Use visual aids frequently
– Use realistic pictures rather than drawings or
medical pictures
– Use pictures actually displaying sexual
information
– Teach using their own body where
appropriate
• Use concrete language
– Use language the individual will hear with regard to
body parts and sexual behaviors
– Use repetition
– Describe in detail
– Do not overestimate receptive understanding due to
expressive language skills
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 27
General Things to Think About
• Foster an open atmosphere of tolerance and acceptance
regarding sexual issues and behaviors
• Use task analyses when needed to break down complex
skills into smaller steps
• Foster an atmosphere of privacy in the home. Build in
privacy to regular routines
• Avoid unnecessary touching
• Allow unstructured private time
• Teach skills early (before the issue actually arises)
• Keep relationships as clear and clean as possible
• Model appropriate social behavior yourself to avoid
confusion
• Speak with others (teachers, babysitters) about fostering
age-appropriate behavior
• Gain knowledge of what the person is already doing and
what they want to do. What teaching is required? What
safety measures are required?
• Choose a “safe person”
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 28
• While teaching make sure you are aware
of issues regarding consent, legalities in
your state, wishes of the parents, policies
of your agencies and how your
intervention will look to others.
Issues of Consent
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 29
Consent to Sexual Activity
• Despite differences in country/state law, there are
common principles that apply:
– Legal age of consent Age of Consent Map
– The goal of a sexuality policy should be to strike a reasonable balance
between a person’s sexual expression and fulfillment and reasonable
protection from harm.
– Knowledge of the sexual act in consideration Questionnaire Talbot &
Langdon (2006)
– Voluntariness in self and others
– The understanding that a person’s disability might prevent capacity to
consent to some sexual acts and activities, but not others.
TALK-SC by Hingsburger et al, 2015.
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 30
Categories of Consent to Consider
• Activities not generally regulated by the
state
– Consist of adult sexual acts that do not
require traditional, formal or legal consent.
This involves displays of affection, friendship,
dancing, choice of dress, privacy for hygiene,
access to sexual health information,
masturbation and access to legal forms of
erotic material.
• Activities involving mutual agreement and
consent
– This category includes sexual acts involving
another person such as sexual petting, mutual
masturbation, some forms of oral sex or other
sexual stimulation by another person. The law
generally requires the clear, mutual
agreement of both parties involved in these
acts.
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 31
• Activities requiring the highest level of consent
– This category involves sexual intercourse.
Professionals should formally assess the person’s
understanding of the act, voluntariness and consent
before the participants engage in the act. State laws
and regulations should be consulted regarding
individuals with developmental disabilities and
consent.
Problem
• What do you do when you are teaching an
individual who is underage?
• No easy answer.
• What are you teaching? Why are you teaching
it? How are you teaching it?
• Think of how others would perceive what you
are doing (professional? vs. unprofessional?)
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 32
Topic Areas and Suggested
Teaching Methods
Private vs. Public Space
• Topics that should be taught
– Discriminating private environments from
public environments
– Discriminating behaviors that are appropriate
in different environments
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 33
Private vs. Public Space
– Discrimination training with pictures
• Discrete trial instruction
• Matching/categorizing
• Receptive and expressive labeling
• Private vs. Public Pictures
– Discrimination training in vivo
• Discrete trial format moving from location to location
• Identification with pictures or expressive responding
– Matching behaviors to locations using pictures
• Discrete trial instruction at desk
• Discrete trial format moving from location to location
• Matching/categorizing
• Expressive responding
• Private vs. Public Behavior Pictures
Private vs. Public Space
• Social Stories
– Individualize to the learner’s reading level
– Use pictures to enhance content
• Didactic Instruction
– Verbal lessons
– Requires attention to verbal tasks with good receptive
language
– Guided by a lesson plan
– Enhanced with visual aides and activities such as
worksheets
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 34
Male Hygiene
• Topics to be taught
– Showering
– Shaving
– Wiping after bowel movements
– Cleaning penis
– Applying deodorant
– Wearing clean clothing
– Indentifying marks on the body
Male Hygiene
• Task analyses (teaching steps with discrete trial
instruction where necessary)
– Dressing Task Analysis
• Backwards and forwards chaining with graduated
guidance
• Picture schedules
– Showering Picture Schedule
• Didactic instruction
• Written schedules
• Social stories
• Video modeling
– Can easily find on sites such as youtube
• Live modeling
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 35
Female Hygiene
• Topics to be taught
– Showering
– Shaving (If desired)
– Menstrual care
• Menstrual Care Picture Schedule
– Wiping after toileting
– Applying deodorant
– Wearing clean clothing
– Identifying marks on the body
– Applying make up (if desired)
Identification of Body Parts
and Functions
• Topics to be taught
• Male
– Names for private body parts (use common language)
– Functions of penis
– Functions of anus
– Function of testicles (non technical)
• Female
– Names for private body parts (use common language)
– Function of breasts
– Function of urethra
– Function of vaginal opening (as and when appropriate)
– Function of clitoris (as and when appropriate)
– Function of anus
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 36
Identification of Body Parts
and Functions
• Receptive and expressive labeling programs
using pictures of and actual body parts
• Didactic instruction
• Matching body part to function using pictures
and/or video
• Activities such as worksheets and puzzles
– Body Parts Puzzles
Identifying Different Social
Relationships
• Topics to be taught
– Identifying who is a friend, family member,
staff, stranger or romantic partner
– Identifying behaviors which are appropriate
and inappropriate with each type of
relationship
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 37
Identifying Different Social
Relationships
• Discrimination training using pictures of people known to the leaner
• Discrimination training in vivo
• Identifying cues to relationships using pictures
– Identifying Relationship Pictures
• Didactic instruction
– Different Relationships Between People Didactic Lesson
– Relationship Pyramid
• Video instruction
• Social stories
– Interacting with children social story
• Matching behaviors to relationship using pictures
Male and Female Adolescent
Development
• Some topics to be taught male
– Growing larger and taller
– Growing hair on face, body and genitals
– Erections of the penis
– Developing body odor
– Development of ejaculation and semen
• Some topics to be taught female
– Development of hair in pubic areas, under arms and legs
– Growth of breasts
– Menstruation
– Vaginal lubrication based on sexual feelings
– Development of body odor
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 38
Male and Female Adolescent
Development
• Picture or video aides
• Didactic Instruction (group or individual)
– Your Changing Body lesson
• Social Stories
– “Secret Girl’s or Boy’s Business”
– Make your own
– Growing Older Boy Social Story
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 39
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 40
Advanced Sexual Knowledge
(Physical)
• Some topics to be taught
– Basic knowledge of sexual intercourse
– Knowledge of alternative forms of sexual play
– Understanding heterosexuality and homosexuality
– Understanding the feelings and physical output of
orgasm
– Signs and symptoms of sexually transmitted diseases
– Sexually transmitted disease protection
– Understanding pregnancy
– Pregnancy prevention
Advanced Sexual Knowledge
• Didactic instruction using visual aides
• Didactic instruction using videos
• Task analyses
• Ensure that information is presented with
enough detail to be truly understood and
practical
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 41
Theory of Mind and
Perspective Taking
• The concept that people have different
thoughts than you might have and that
they might have different perspectives on
ideas, topics, opinions and sensations
• Difficult skill to assess and teach
• Sally-Anne false
belief tasks
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 42
• You go out on a date and it did not seem to go
well. Your date seems kind of annoyed and is
not really talking to you. At the end of the date
you ask her out for the following night and she
says that she is busy for the next few weeks.
What do you think she is thinking?
a) She is hoping she is free soon so you can go out again
b) She is upset that she is so busy
c) She is thinking that she does not want to go out with you
again
• You have been dating this guy for five months.
You have not yet done anything sexual
besides kissing, but you think you want to. You
let him know that you think you should move to
the next level sexually and he says that he
would rather wait to do anything further. He
says that he will let you know when he feels
ready but only wants to kiss for now. What do
you think he is thinking?
a) He is thinking he would rather wait to do anything further
b) He is thinking that he wants to have sex
c) He is thinking that he no longer wants to go out with you
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 43
What do I do about
masturbation?
• Masturbation in both sexes is normal, let it
happen
• Masturbation is part of typical development and
is seen in the majority of typically developing
people of all ages, married and unmarried,
frequently and intermittently
• Think about your own biases and expectations
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 44
What do I do about
inappropriate masturbation or
other inappropriate sexual
behaviors?
• Inappropriate sexual behavior is the number one issue
reported when parents seek consultation for sexual
issues
• Studies have found that:
– 65% of individuals with autism touch themselves in public
– 23%-52% masturbate in public
– 28% remove their clothing in public
– 90% display sexual behaviors directed towards strangers or
other inappropriate individuals such as caregivers.
– Many higher functioning individuals engage in inappropriate
sexual conversations
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 45
• Not being informed or taught in
appropriate socio-sexual skills is the most
frequently hypothesized underlying reason
for displaying inappropriate sexual
behavior.
• Of those inappropriate behaviors reported,
inappropriate masturbation is the most
frequent.
• Masturbation is considered inappropriate if:
– Masturbation is public
– Masturbation is excessive, making genital areas sore
or interferes with other responsibilities
– The person has an inability to masturbate to climax
causing frustration or preoccupation
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 46
• Masturbation is often dealt with in one of three
ways:
1. Discourage all masturbation (not
recommended)
2. Tolerate all forms of masturbation (not
recommended)
3. Teach appropriate masturbation and redirect
inappropriate masturbation (recommended)
• Teaching discrimination
– Appropriate versus inappropriate places to
masturbate
– Bedroom should be the only appropriate place taught
– Consistency in enforcing rules and boundaries
– Specific social skills and social rules (social stories,
video modeling, visual aids, written contracts etc.)
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 47
• Koller (2000)
– Interrupt the behavior
– Remind the person of the appropriate time
and place
– Redirect the person to another activity or to
an activity that requires the use of both hands
– Redirect the person to an activity that involves intense
focus or high amounts of physical movement
– Redirect the person to an appropriate place to have
privacy
– Reinforce staying in assigned areas taking breaks as
scheduled to decrease the likelihood of excessive
trips to masturbate
– Provide visual evidence of scheduled breaks for
private time
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 48
• Teaching the mechanics of masturbation
– Research indicates that individuals on all
ends of the spectrum sometimes have
difficulty masturbating to climax
– Appropriate masturbation might need to be
taught
– Didactic instruction
• Verbal discussion and lessons using visual aides
– Visual cues/picture task analysis
• Male masturbation visual TA
• Female Masturbation Visual TA
– Written Schedules/Task Analysis
• Male Masturbation Task Analysis
– Video modeling
• Hand Made Love: A Guide for Teaching about Male Masturbation
• Finger Tips: A Guide for Teaching about Female Masturbation
• Diverse City Press, Inc.
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 50
• When teaching masturbation skills make sure
you:
– Obtain all consents Consent Form Sample
– Investigate legal issues in your state
– Have multiple trainers present or a trainer with an
observer
– Obtain consent/assent from the participant
Advanced Interpersonal Skills
• Flirting and Dating
– How to start a conversation to show interest
– Talking on the telephone
– Going on a first date
– When dating starts to become exclusive
– When and how to approach the subject of “moving to the next level”
sexually
– Dealing with rejection or embarrassing situations
• Protection from Abuse
– Understanding issues of consent in others
– How to say “no” to sexual advances
– Moving away and reporting
– Avoiding potentially unsafe situations or ask a person to attend with you
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 51
• Inappropriate and unsafe behavior
– How to identify and avoid inappropriate behaviors
such as stalking, repetitive calling, being too amorous
in public, unsafe internet behavior etc.
– Identifying and avoiding potentially unsafe behavior
including behaviors that are harmful, unethical or
illegal.
• Abstinence
– Knowing that it is okay to choose to abstain from
sexual behavior for a variety of personal reasons
– Knowledge of how to turn down sexual advances
• Avoiding being naïve about sexual topics and
situations (including but not limited to)
– Prostitution
– Different types of pornography
– The relationship between alcohol and sex
– Sexually explicit clothing
– “Street names” for sexual acts
– Adult night clubs (gentlemen’s clubs, strippers, adult
video stores etc.)
– Sexual jokes
– Sexual games
– Phone and internet sex
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 52
Teaching Ideas for the Advanced
Interpersonal Topics
• Ensure an identified “safe person”
– Often a close family friend, relative or professional
– Parent is sometimes not a beneficial choice
– Person must be comfortable talking about sensitive
topics and giving advice
– Nonjudgmental
– Not dismissive or avoidant
– Not seen as a direct link to parents, however telling
information where needed to ensure safety
• Group discussion
– Often within the scope of an identified and structured therapeutic
group
– Functioning level with regard to language development, cognitive
skills, interests and experiences should be relatively equated
amongst group members
– Identify lessons with lesson plans in order to foster and guide
discussion
• Didactic lessons
– Ensure necessary receptive language and attention to verbal
discussion
Discussion of Inappropriate Sexual Behaviors
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 53
• Role play, feedback and practice
Flirting and Dating Role Play
• Movie nights
Movie Nights
• Social stories
• Video modeling
• Task analyses and written scripts
Asking for a Date Script
– Enhance with role play, feedback and practice
• Real life practice with guidance through “counseling”
– Discuss situations openly
– Nonjudgmental
– Focus on issues involving anxiety, low self esteem, confidence,
assertiveness etc.
– Ensure relative confidentiality
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 54
What if an individual does not
seem to have any interest in
sexual behavior?
• Teach vs. not Teach?
• If the individual does not show any desire for sexual
expression, leave it alone for the time being.
• You should focus on teaching non-sexual behaviors
such as body awareness, hygiene, forming relationships,
abuse prevention etc.
• Remember that research shows that approximately 25%
of individuals on the spectrum do not show sexual
interest (typical?)
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 55
Are individuals with autism at
a high risk for sexual abuse
from others and what can I do
to prevent it?
• Current research indicates that as many as
16%-25% of individuals on the spectrum have
been sexually abused
• Individuals on the spectrum are especially at risk
for abuse due to impairments in social skills,
communication skills, perspective taking,
labeling of emotions, sexual knowledge,
assertiveness and exposure to peers.
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 56
• Although there is no fail safe method to prevent
abuse, the following may limit abusive situations:
– Gaining of sexual knowledge (what is happening and
what is supposed to happen)
– Teaching privacy and self advocacy
– Teaching telling others
– Being specific with regard to who and how people are supposed
to touch you and say things to you (use visual aids and written
rules)
– Supervision in risky situations (parties, in the presence of
unfamiliar adults and peers, locker rooms, internet etc.)
– Paying close attention to new or odd behaviors (often, but not
always sexual in nature)
– Remember that introducing sexual knowledge does not make
abuse more likely…it makes abuse less likely
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 57
What do parent attitudes have
to do with anything and why is
this topic so awkward and
difficult for parents?
• Parent views vary from conservative to
liberal with regard to sexuality in their
children (both typical and ASD)
• Parent attitude guides sexual expression
in children
• Parent attitude will affect sexual
knowledge and experience
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 58
• Why is it so awkward and difficult?
– Because parents do not discuss sexuality with
their children
– Because parents have their own biases due
to upbringing, religion, beliefs and experience
– Because children typically learn to be sexual
on their own without direct parent teaching
• Although parents of typical children might
know that their children are interested in
sex, they don’t have to:
– Think about their children in a sexual way
– See their adolescent sons having an erection
– Teach their children how to masturbate
National Autism Conference August 4, 2016
Frank Cicero, PhD, LBA, BCBA 59
– Allow “private time” where they know that their
child is masturbating in the moment
– Clean up after their boy ejaculates
– Talk to others about their child’s sexual
behaviors
– Apologize to others when their child
masturbates or exposes themselves in public
– Purchase items or materials for their children
that will be used for masturbation or other
sexual behaviors
– Deal with emotional issues of loss and grief
concerning the future of romantic
relationships for their child.
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Frank Cicero, PhD, LBA, BCBA 60
Audience Questions and
Discussion
