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1. Become aware of details in setting up own class (e.g., organization of lesson, testing, grading) on sexual health for individuals with Asperger's Syndrome (AS) or High Functioning Autism (HFA).
2. Be shown a curriculum that teaches both about the technical details of sex and the relationship factors involved to individuals with AS/HFA.
3. Learn how to utilize strategies that work (e.g., visuals, role play, sensory integration, concrete information, individual interests, step-by-step) for individuals with AS/HFA to apply to a sexual health curriculum.
4. Be exposed to practical activities specific for individuals identified with AS/HFA to teach sexual health including topics on anatomy, reproduction, dating, friendship and sexual relationships, partnered sex, sexual orientation, contraception options, sexually transmitted infections and sexual coercion.
5. Learn how to use different mediums and resources available to teach sexual health topics.
In many respects individuals with ASD are similar to their typically developing peers in terms of “sex education”. They undergo normal physical body changes during puberty (Henault, 2006; Nichols & Blakeley-Smith, 2010). Also, research shows that individuals with ASD are aware of and interested in sexuality issues and engage in a variety of sexual behaviors (Gabriels & Van Bourgondien, 2007). However, due to the nature of their social impairment, communication deficits, and executive functioning problems, restricted areas of interests, behaviors and sensory sensitivities; the intricacies of emotional /romantic relationships are likely to be more difficult for individuals with ASD to learn about, understand and navigate than the general population. Indeed, Stokes, Newton, and Kaur (2007) found that adolescents and adults with ASD differed significantly in their social (e.g., friendship skills), and romantic functioning (e.g., skills to initiate and pursue romantic relationships, using appropriate behaviors like stopping calling someone who asks you not to compared with typically developing peers. The same authors also noted that individuals with ASD obtained less romantic knowledge from their peers and the media than typically developing peers their lack of peers/friends largely, prevents them from accessing this learning. This “disconnect” between physical maturation and social relationship skills and understanding can lead to significant problems for individuals with ASD, both in terms of depression or anxiety linked to unmet needs and sometimes inappropriate sexual behaviors towards others (Hellemans, Colson, Verbraeken, Vermeiren, & Deboutte, 2007; Ray, Marks, Bray-Garretson, 2004; Stokes et al., 2007; Sullivan & Caterino, 2008). In addition, as Sullivan and Caterino (2008) note, the social-communication impairments of individuals with ASD together with their lack of exposure to appropriate peer interactions leave them at great risk of misinterpretation of social cues and sexual behaviors of predators.
In short, there is a wealth of evidence to support the use of a curriculum that includes both the “technical” details of sexual health and the relationship factors involved among individuals with ASD. As the landmark study by Kinsey, Pomeroy, and Martin (1948) stated, sexual expression is essential to an individual’s well-being. The notion that individuals with ASD have the same rights to sexual health as typically developing individuals is, therefore, central to this presentation. The World Health Organization’s (2006, as described in Hirst, 2008, p401) definition is key when considering important factors in teaching this topic: “Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence”.
Details of the Content:
The curriculum presented with show how each lesson plan follows a similar format to provide participants with a sense of consistency and predictability, as this can alleviate anxiety for individuals with ASD (Attwood, 2007). The lesson plans begin with:
• List of materials for each lesson
• An estimate of preparation time
• An estimate of actual lesson time
• Student objectives to keep in mind as outcomes.
Each lesson will start with the distribution of the objectives and agenda to each student. Having a written agenda can be reassuring for students as it makes your expectations clear and helps them to anticipate activities while they become more organized (Faherty, 2000). Each lesson plan includes teaching concepts that outline the main ideas for the instructor to target. At the end of each lesson there is an assignment (you could call this homework for younger students) that the students should complete before the next lesson. Assignments are a combination of priming (Wilde, Koegel, & Koegal, 1992) for the upcoming lesson and consolidation of concepts from the current lesson. In addition, you will assist your students with some basic organizational tasks (e.g., filing handouts, noting assignment in their schedules) before leaving. Each lesson concludes with guidelines for delivering the lesson to an individual student and a checklist of follow-up items for the instructor.
The curriculum is applicable to a wide variety of age groups from adolescents to adults in public school setting to private clinics or with parents as educators. The curriculum requires instructors to be honest. Being aware of what you know and what you don’t know is imperative. Adolescents are exposed to quite a bit of misinformation, they need reliable educators. When providing an answer knowing each person will assist you in knowing how much information is age appropriate to share. It is also essential to keep an open mind. The majority of human beings are sexual and have the right to become aware of their choices with regard to their own bodies (Hingsberger, 1990). While this may not always be easy or even comfortable to discuss, it is important that the instructor to remain neutral without expressing one’s personal opinion on students’ decisions while being able to share a wide range of choices. As a result, be aware of your nonverbal communication including your facial expressions (e.g., frown, wrinkled brow) which can communicate distaste or judgment even when you think you are being open and nonjudgmental.
Within the curriculum, the information is presented in a concrete manner. Your students are likely to find abstract information difficult to understand (Koller, 2000). Given that many aspects of relationships are abstract, we have attempted to make concepts as factual and concrete as possible in order to maximize understanding. If your students struggle with lessons as presented, you may need to break tasks into smaller steps, provide a model, practice, and reinforce students for their efforts and success (Nichols, Moravcik, & Tetenbaum, 2009). Be aware of accommodations (e.g., scribe, computer to type rather than write, extra time) each student may need during the lesson or for a quiz/test. Have a plan in the beginning of each chapter.
Throughout the lessons, suggestions to the instructor to add as much visual material in the form of written handouts, illustrations, photographs, icons, and video suggestions for students. The lesson is often suggested to present using Power Point or writing on a flipchart to assist in making the material clear. This is likely to be easier for your students to understand, learn, and it provides a support for their organizational deficits (Hodgdon, 1999; Hogan, 2006). Students are also shown how to organize the material from the class in an individual “Resource Binder”. In order to incorporate perspective teaching and non-verbal communication (Attwood, 2007; Winner, 2002) time is allotted for role-play and practice throughout the curriculum. Supporting your students in understanding and expressing emotions will help them in their relationships.
Knowledge of strategies that maximize the learning of students with ASD is desirable in order to effectively deliver this curriculum. Throughout the lessons, many approaches and techniques that have been shown to be effective (both from a research perspective and the presenters experiences) are described for learners with ASD.
Content Area: Education
Melissa Dubie, M.A.
Indiana Resource Center for Autism (IRCA), Indiana Institute on Disability and Community, Indiana University - Bloomington