Journal of Autism and Developmental Disorders

https://doi.org/10.1007/s10803-019-04077-y

ORIGINAL PAPER

Sexuality in the Autism Spectrum Study (SASS): Reports from Young

Adults and Parents
Kathrin Hartmann1   · Maria R. Urbano1 · C. Teal Raffaele1,2 · Lydia R. Qualls3 · Takeshia V. Williams4 · Clay Warren5 ·
Nicole L. Kreiser1 · David E. Elkins1 · Stephen I. Deutsch1

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Abstract
Previous research indicates that although those with ASD desire sexual relationships, they may not effectively engage in
romantic and intimate interactions. The purpose of this study was to compare reports from young adults with ASD and parents
from the same families on the young adult’s sexual behavior, experiences, knowledge, and communication. 100 young adults
(18–30 years) and parents completed an online survey. Results indicated that young adults reported more typical privacy
and sexual behaviors, and higher sexual victimization than their parents reported on their behalf. Our findings indicated that
individuals with ASD desire and pursue sexual relationships typical of most people and suggest the need for sex education
and communication about topics generally covered for neurotypically developing young adults.

Keywords  Sexuality · Young adults · Parents · Family · Autism spectrum disorder

Introduction at one point in their lives. These adults reported having

It was once believed that young adults with ASD did not
develop an interest in romantic relationships and sexuality
(Gilmour et al. 2014; Kellaher 2015; Pecora et al. 2016).
However, recent studies have shown that young adults with
ASD do develop these interests (Byers et al. 2013; Dewinter
et al. 2015; Gilmour et al. 2011). A survey of adults with
ASD (ages 21 to 73, mean age 35.3) conducted by Byers
et al. (2013) found that 59% of the sampled group had expe-
rienced a romantic relationship lasting 3 months or more
* Kathrin Hartmann
Hartmak@evms.edu
1
Department of Psychiatry and Behavioral Sciences, Eastern
Virginia Medical School, 825 Fairfax Avenue, Suite 710,
Norfolk, VA 23507, USA
2
Catholic University of America, 620 Michigan Avenue, NE,
Washington, DC 20064, USA
3
Virginia Consortium Program in Clinical Psychology, 555
Park Avenue, Norfolk, VA 23504, USA
4
Children’s Hospital of the King’s Daughters, 601 Children’s
Lane, Norfolk, VA 23507, USA
5
Department of Organizational Sciences and Communication,
George Washington University, 600 21st Street, NW,
Washington, DC 20052, USA
experienced sexual anxiety or difficulties only sometimes
during the past month, on average. However, more positive
sexual experiences were found in those who had lower ASD
symptomology, as measured by the Autism Spectrum Quo-
tient (AQ; Baron-Cohen et al. 2001). Another study found
that partnered sexual acts occurred with the same frequency
when comparing ASD males to non-ASD males (Dewinter
et al. 2015). Gilmour et al. (2011) compared sexuality in a
community based sample of adults with and without ASD
and found no significant differences in sexual behaviors. A
review by Pecora et al. (2016) found that more females than
males with ASD without co-occurring intellectual disability
engaged in some sort of sexual behavior (76% compared
with 68%). It was also found that parents might underesti-
mate aspects of their children’s sexuality (Dewinter et al.
2016).
The extant literature suggests that sexuality in individuals
with ASD may differ from the general population. Individu-
als with ASD are more likely to identify as sexual minorities
compared to their typically developing peers. Compared to
approximately 8% of individuals in the general population
(Twenge et al. 2016), an estimated 42–69% of individuals
with ASD identify as same-sex attracted or a sexual minor-
ity (Byers et al. 2012; George and Stokes 2018). Further-
more, elevated autistic traits in the general population are

13
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associated with increased same-sex attraction, behavior, fan-
tasies, and sexual minority identity in typically developing
individuals (Qualls et al. 2018).
Despite research suggesting sexual interest in individu-
als with ASD, those with ASD may receive less formal
and informal sexual education compared to their typically
developing peers. Interviews with caretakers of young adults
with ASD reveal that often the topic of sexuality does not
extend beyond education about personal space and hygiene
(Ballan 2012; Holmes and Himle 2014). Mehzabin and
Stokes (2011) found that adults with ASD displayed less
knowledge about sexual behavior when compared to adults
without ASD with the exception of topics related to hygiene
and privacy. Recently, there have been efforts to improve
formal sex education for populations with intellectual and
developmental disabilities. However, research has shown
that traditional sex education does not lead to as large of
an increase in sexual awareness for those with ASD when
compared to typically developing young adults. It may, in
fact, be associated with increased issues of vulnerability,
social anxiety, and confusion for this population (Hannah
and Stagg 2016). This finding indicates that current formal
sex education may not be as effective for adolescents and
young adults with ASD. Therefore, there is a need for alter-
native routes to successfully provide sexual knowledge to
this population. Due to the social difficulties and heterogene-
ity found within individuals with ASD, it has been recom-
mended that parents and caregivers should provide more
personalized methods of communicating information about
sex which may be more effective than traditional forms of
sex education for these individuals (Sullivan and Caterino
2008). While the caretakers do agree that broader sexual
education should occur, little agreement about content and
delivery has occurred with a major concern about the het-
erogeneity of developmental levels present in individuals
with ASD (Ballan 2012). Currently, young adults with ASD
are often learning about sexuality on their own. Surveys of
young adults with ASD have found that they learn about sex-
uality more often from television and the Internet than from
peers, teachers, or their parents (Brown-Lavoie et al. 2014).
Lack of formal education about sexuality and reliance upon
non-social and non-professional sources for sexual informa-
tion may contribute to young adults with ASD receiving
inadequate and/or inaccurate information. Indeed, one study
found that adults with ASD had less perceived and actual
sexual knowledge when compared to adults without ASD
(Brown-Lavoie et al. 2014).
Importantly, research has begun to show that individuals
with ASD may be more likely to engage in risky or inappro-
priate sexual behaviors and to experience sexual victimiza-
tion as compared to their typically developing peers. For
example, some young adult males with ASD have their first
sexual experiences through contact with the sex industry
13
Journal of Autism and Developmental Disorders
(Eastgate et al. 2012), compared with typically develop-
ing males, whose first sexual experiences are most often
with peers (Caputo 2009). Another study found that young
adults with ASD tended to display more inappropriate sexual
behavior when compared to those without ASD of the same
age (Stokes and Kaur 2005). A study comparing rates of sex-
ual victimization between people with intellectual disabil-
ity (PWID) and a community comparison group found that
PWID were almost 6 times as likely to experience sexual
victimization (Nixon et al. 2017). Although not all individu-
als with ASD have an intellectual disability, one study esti-
mated that 79% of young adults with ASD have experienced
at least one case of sexual victimization (Brown-Lavoie et al.
2014). In a study that interviewed mothers of adolescent
girls with ASD, a number of them shared concerns about
their daughters agreeing to engage in sexual activity with
boys with whom they wanted to remain friends (Cridland
et al. 2014).
Particularly given the elevated rates of adverse sexual
experiences encountered by individuals with ASD, a better
understanding of sexual knowledge, experiences, struggles,
and desires of young adults with ASD and their caregivers
is needed. While individuals with ASD are certainly not
at fault or responsible for experiences of sexual abuse or
victimization, misinformation about healthy sexuality (e.g.,
personal space, communication of consent, appropriate and
inappropriate sexual behaviors) may in some cases contrib-
ute to adverse sexual encounters, including encounters in
which the experience is unwanted by the individual with
ASD and encounters in which the individual with ASD
initiates an experience that is unwanted by another party.
Research in neurotypical populations has identified frequent
and productive communication about sex within a family to
be an effective means to facilitate a child’s open discussion
with dating partners and favorably influence his/her attitudes
about sexuality (Warren and Neer 1986; Warren and Warren
2015). In contrast to the teaching approach of sex education,
communication about sex is a didactic process that involves
an active discussion between all parties. Understanding
family communication about sex within ASD families may
provide a unique perspective and means to better improve
the sexual knowledge and experiences for young adults with
ASD.
Purpose of Study
The present study aimed to build upon the previous literature
by examining self- and parent-report of young adults with
ASD regarding their respective perceptions of the young
adults’ sexuality, sexual knowledge, and sexual experiences.
This study expands upon the literature on sexuality in ASD
by examining both young adult and parent perceptions
Journal of Autism and Developmental Disorders

of sexuality. The study is novel in exploring congruence Table 1  Demographic information

between parent and young adult perception as well as com-
Young adult gender
munication about sex. The topic of family communication
 Male 52%
about sexuality is particularly important for sexual knowl-
edge within this population given that previous research  Female 47%
suggests that young adults with ASD may be less likely to  Transgender 1%
learn about sex and sexuality by communication with peers.  Young adult age M = 22; SD = 3
The first aim of this study was to replicate and expand Young adult race
upon the previous literature on sexuality in ASD by char-  White 32%
acterizing sexuality, sexual experiences, and sexual knowl-  Black/African American 20%
edge in young adults with ASD and their parents. This study  Hispanic, Latino 26%
explored topics that have not previously been examined in  Asian 16%
the literature incorporating parent and young adult perspec-  Native American 2%
tives on more specific topics of interest, including sexual  Bi/multiracial 4%
interests, sexual behaviors, current method of sex educa-  AQ M = 8.5; SD = 1.2
tion, and sexual orientation. The second aim of the study Young adult comorbid diagnosis
takes a novel approach to specifically examine communica-  Anxiety 60%
tion about sexuality between young adults and their parents.  Depression 30%
Most importantly, the third aim of the study was to examine  ADHD 8%
how young adults with ASD and their parents compare on  Brain disorder 8%
sexuality topics including the young adult’s sexual behav-  Intellectual disability 3%
ior, experiences (including victimization and inappropriate/  Sensory processing disorder 8%
aggressive behavior), and knowledge, as well as communi-  Tubular sclerosis 2%
cation about sex. Young adult marital status
 Life partner/domestic partnership 2%
 Single 98%
Methods Most of young adult day spent
 Home 75%
Participants  Job 43%
 Vocational training 15%
Participants were recruited to the Sexuality in the Autism  High school 14%
Spectrum Study (SASS) from the patient populations of  College 5%
mental health professionals at a large East Coast medi-  Shelter 2%
cal center as well as partner organizations throughout the Parent report of young adult IQ
nation. Flyers, social media, and advocacy group websites  Above average (≥ 110) 3%
were also used to recruit participants. Participants for the  Average (90–109) 35%
current study were part of the larger SASS study and con-  Below average (70–89) 54%
sisted of young adults with ASD between the ages of 18  Intellectual disability (˂ 70) 1%
and 30 with a previous diagnosis of ASD and parents of a  Do not know 6%
young adult with ASD who meet the young adult criteria. Parent relationship to young adult
Data analyzed for this manuscript came from 100 young  Mother 54%
adults (mean age = 22) and 100 parents (mean age = 51) who  Father 44%
were determined to be from the same family (see Table 1 for  Step-father 1%
additional demographic information). Additional informa-  Other 1%
tion about the selection of the sample is described in the  Parent age M = 51; SD = 5
Data Screening section. Parent education
 Elementary school 1%
Procedures  Middle school 3%
 Some high school 4%
This study was approved by the investigators’ IRB. The  High school diploma 28%
survey was administered online via the online survey plat-  Technical school 12%
form Qualtrics. Participants first read an introductory letter  AA 17%
that welcomed them to the study and briefly explained the  Some college 15%

13

Table 1  (continued)
 Bachelor’s degree 18%
 Master’s degree 2%
Parent marital status
 Married 85%
 Life partner/domestic partnership 2%
 Separated 6%
 Divorced 7%
 Parent income Median = $65,000
M Mean, SD standard deviation
study purpose. The informed consent was obtained from all
individual participants included in the study and indicated
that each participant would take their own section of the
survey and emphasized privacy while taking the survey
(e.g. adults/parents should not be present while they com-
pleted their survey questions). Participants were reminded
that their responses would not be shared with the other
party involved. Young adults and parents were directed to
the informed consent page where they were reminded of
their rights as a participant in this voluntary project. The
survey took approximately 1 h to complete. At the start of
the survey, participants were given the option to provide a
four-digit code that was unique to their family. Parents and
young adults from the same family who both took the sur-
vey would provide the same four-digit code. Therefore, par-
ents and young adults from the same family could be paired
together later for analyses. Participants received a ten-dollar
($10) amazon.com electronic gift card as compensation for
participation in the study.
All participants were encouraged to complete the sur-
vey within 24 h of starting, however automated reminders
were sent through the Qualtrics system to start/complete the
survey if it had been longer than 48 h since the start of the
survey. Participants received up to three reminders to com-
plete the survey.
Once participants had completed all measures, partici-
pants were given the option to indicate their desire for a copy
of summarized study results by providing an e-mail address.
Participants were also able to choose to provide an e-mail
address to receive a ten-dollar electronic amazon.com gift
card for participation. This email address was not linked to
participants’ responses on the measures.
Measures
There were two separate surveys administered for this
study, a young adult and a parent version that were largely
similar. The major difference between the two versions
of the surveys was wording (e.g. “I” for the young adult
and “Your child” for the parent survey). The following
13
Journal of Autism and Developmental Disorders
measures were used with slight modifications to the origi-
nal versions of the following scales to better fit the context
of the current study. For example, scales were phrased
differently for the parent and young adult surveys to avoid
confusion and some scales were reformatted to better
address a young adult population with ASD. Additionally,
the following measures were not specifically designed to
be administered online. However, Cronbach alphas were
analyzed for each measure to compare current results
with results presented in each measure’s manual. These
alpha coefficients are specifically addressed in more detail
below, where possible, across all measures.
Demographic Questionnaire/Background Information
Questionnaire
The Demographic/Background Information Questionnaire
is a study-specific 19 item questionnaire prepared by the
study investigators to gather information on the partici-
pant’s demographics, prior treatment and diagnoses.
Autism Quotient10 (AQ‑10; Adapted from Baron‑Cohen
et al. 2001)
The AQ-10 is a short form version of the autism spec-
trum quotient (AQ) questionnaire. The AQ is a 50-item
questionnaire published in 2001 by Baron–Cohen and his
colleagues. In 2012, Allison, Auyeung and Baron–Cohen
identified 10 items to aid quick referral decision making
for ASD assessment and created the shortened AQ-10.
This measure aims to investigate whether adults of average
intelligence have symptoms of an autism spectrum disor-
der diagnosis. Each question allows the subject to indicate
an answer ranging from “Definitely agree” to “Definitely
disagree” in five different areas: social skill, attention
switching, attention to detail, communication, and imagi-
nation. To score, each item is given 1 point if the respond-
ent records the abnormal or autistic-like behavior either
mildly or strongly and 0 points if the respondent records
the typical behavior either mildly or strongly. Approxi-
mately half the items are worded to produce a neurotypi-
cal response of “agree” and half are worded to produce
a neurotypical response of “disagree”. With a cut point
of 6, previous research has confirmed the validity of the
AQ-10 in comparison to the full scale AQ to sensitively
identify persons with ASD from persons without ASD
(Allison et al. 2012; Booth et al. 2013). Only the young
adult participants completed this measure. Allison et al.
(2012) report internal consistency scores for the AQ-10
for adolescents of 0.89. The current study obtained a Cron-
bach alpha of 0.57 for the AQ-10.
Journal of Autism and Developmental Disorders
Sexual Behaviour Scale (SBS; Stokes and Kaur 2005)
The SBS was created to assess sexual behavior in adoles-
cents with high functioning ASD, defined by Stokes and
Kaur (2005) as individuals with ASD without intellectual
disability. The scale consists of 5 subscales: social behav-
ior, privacy (seeking and awareness), sex education, sexual
behavior, and parental concerns. Subscale scores are calcu-
lated for each of the five constructs by dividing each item
for each subject by the maximum score for the item, then
totaling the items for each subscale, and dividing the sum by
the number of items in that subscale. Subscale scores range
from zero to one. Scores closer to one reflect more typical
behavior compared to scores closer to zero that reflect atypi-
cal behavior. Both the young adult and parent participants
completed this measure.
The social behavior construct includes seven items
evaluating social companions and activities. This scale
was designed to assess whether the adolescent social-
izes with others outside the family and school, and with
whom these activities were undertaken. The study authors
modified this subscale by adding two questions; “Do(es)
you (your child) show interest in social relationships with
members of the same sex?” and “Do(es) you (your child)
show interest in social relationships with members of both
sexes?”. Both of these questions showed excellent inter-
nal reliability within the subscale for both parents and
young adults (all α > 0.89). The rationale behind including
these questions was to capture a broader range of social
behaviors. The privacy subscale of the SBS consists of
questions regarding the participant’s privacy behaviors,
awareness of the social rules concerning privacy, and,
how they learned these rules. The sex education construct
examines knowledge about sexually related issues such as
sexual hygiene and acceptable behavior towards a person
of romantic interest; the ways in which this knowledge
was acquired; and parents’ response to sex education.
This seventeen-question subscale has the dichotomous
“Yes/No” response options. Questions within the sexual
behavior subscale were developed to assess the presence
of prior inappropriate sexual behavior, awareness of typi-
cal sexual physical responses measured with dichotomous
“Yes/No” responses. Lastly, the parents were administered
a parental concerns subscale that had questions relating
to their concerns regarding sexuality for the individual
child with ASD including finding a partner and misin-
terpretation by others of their child’s behaviors. Previous
research has noted that this measure demonstrates good
internal validity across scales, with alpha coefficients
ranging from 0.13 to 0.88 [Social Behavior = 0.82, Pri-
vacy = 0.60, Sex Education = 0.76, Sexual Behavior = 0.13,
and Parental Concerns = 0.88]. The authors of the measure
note that the alpha obtained for the Sexual Behavior scale
increases from 0.13 to 0.55 when all but one item (“Has
your child behaved unacceptably toward someone they
were romantically interested in?”) were analyzed (Stokes
and Kaur 2005). The current study obtained alphas rang-
ing from 0.30 to 0.90 for parents [Social Behavior = 0.90,
Privacy = 0.74, Sex Education = 0.62, Sexual Behavior
without removal = 0.50, and Parental Concerns = 0.30]
and 0.39 to 0.91 for young adults [Social Behavior = 0.89,
Privacy = 0.76, Sex Education = 0.67, and Sexual Behavior
without removal = 0.39].
Sexual Experiences Survey (SES; Koss and Oros 1982)
The Sexual Experiences Survey contains items concern-
ing various degrees of sexual victimization and aggression.
Statements focus on victimization, sexual coercion, sexual
contact, attempted rape and rape. For this study, 10 questions
are used with a dichotomous Yes/No response format. The
SES has shown good internal consistency and reliability in
a neurotypical population with a Cronbach alpha of .74 for
women and .89 for men and a test retest correlation of 93%.
Cronbach alphas obtained for the current study were 0.73
and 0.70 for female parents and young adults, respectively,
and 0.68 and 0.65 for male parents and young adults. Both
parents and young adults received this measure.
General Sexual Knowledge Questionnaire (GSKQ; Talbot
and Langdon 2006)
The General Sexual Knowledge Questionnaire is divided
into 6 parts, which assess an individual’s knowledge of
human anatomy and physiology, sexual intercourse, preg-
nancy, contraception, sexually transmitted diseases and
sexuality, respectively. The original measure was devel-
oped for those with intellectual disabilities and consisted of
open-ended questions. Therefore, 10 questions were adapted
for this study in a format that allows for multiple-choice
answers to facilitate its use online. The items consist of a
question with multiple correct and incorrect answer options.
Respondents scored one point for each correct answer and
there were three correct options for each question there-
fore, the total maximum score for the measure is 30. For
the current study, both parents and young adults completed
this measure. Reliability of the GSKQ has been reported
as alpha = 0.94 for the combined items of the measure with
scale-level alphas ranging from 0.35 to 0.86. Similarly, the
split-half reliability estimate obtained for the full measure
was 0.80 with individual scales ranging from 0.43 to 0.85
(Talbot and Langdon 2006). The Cronbach alphas obtained
for the current study were 0.83 and 0.88 for the combined
items for parents and young adults, respectively.
13

Klein Sexual Orientation Grid (KSOG; Klein 1993)
The Klein Sexual Orientation Grid investigates sex-
ual orientation in the past, present and future. The grid
uses a Likert scale of 1–7 to describe a continuum from
exclusively opposite-sex to exclusively same-sex attrac-
tion along seven dimensions including sexual attraction,
sexual behavior, sexual fantasies, emotional preference,
social preference, self-identification, and heterosexual/
homosexual lifestyle. The measure has previously shown
excellent internal reliability. For the use of this study, the
original 18 questions were shortened to 6 questions about
sexual orientation in only the present time frame. Ques-
tions have been adapted to the study population by adding
an answer option for asexuality. Young adults and par-
ents completed this measure. Klein et al. (1985) report the
internal consistency and test–retest values of the original
version of the measure were “generally determined to be
excellent” with no specific data presented. The Cronbach
alphas obtained for the greatly reduced and revised current
version of the KSOG were 0.44 and 0.60 for parents and
young adults, respectively.
Family Sex Communication Quotient (FSCQ; Warren 2011)
The goal of the FSCQ is to measure sex communication or
the exchange of verbal and nonverbal messages in a mutual
effort to create meaning about sexual beliefs, attitudes, val-
ues or behavior within a family. The measure evaluates both
quality and content of family sex communication along three
domains, comfort (degree of openness with which sex is
discussed), information (amount of information learned and
shared during the discussion), and value (overall importance
of the family role in sexual learning). The FSCQ consists
of 18 Likert-like items rang from Strongly Disagree (1) to
Strongly Agree (5), where higher scores indicate better fam-
ily sex communication. As defined by the measure authors,
a strong overall FSCQ score is greater than 72. The FSCQ
has been noted by the authors of the measure as suitable
for American and Canadian respondents. Multiple previous
studies have found the measure has good internal validity
and the measure’s authors report an average alpha of 0.90
across the years (Warren 2006; Warren and Warren 2015).
The current study obtained Cronbach alphas of 0.91 for both
parent and young adult subjects separately.
Data Analyses
Independent samples t-tests were used to compare parent
and young adult report on the SBS, SES, FSCQ, and GSKQ.
Additionally, Cohen’s Kappa was used as a follow up to
13
Journal of Autism and Developmental Disorders
identify how parent and young adult reports aligned on indi-
vidual items.
Results
Data Screening
Of the 523 individuals (young adults and parents) who fin-
ished the SASS, 41 participants did not meet the 2/3 com-
pletion criteria and were removed. Of the remaining 482
participants, 246 were removed because they were not a part
of a matching young adult and parent from the same family.
Of the young adult and parent pairs from the same family,
18 young adults reported an AQ-10 score less than 6 and
were thus removed from analysis, along with their respective
18 matched parent participants. This left a total of 200 par-
ticipants with 100 young adults and 100 parents who were
matched by family, henceforth referred to as matched dyads.
Participant demographics (see Table 1) showed equal
gender distribution for young adults and parents. Distribu-
tion of young adult self-report of race/ethnicity in the current
sample closely followed US Census expectations and parent
report of young adult intellectual quotient (IQ) indicated that
the majority of participates were of average or below average
intelligence. The majority of young adults reported spend-
ing much of their day at home versus in other settings and
99% parent reported young adults have received treatment
in their lifetime, often including multiple services such as
behavioral, medication, and counseling interventions.
Aim 1
Regarding the characterization of participant’s sexuality,
sexual experiences, and sexual knowledge, both young
adults and parents reported a high level of typical behav-
ior for SBS Privacy, Sex Education, and Sexual Behavior
(Table 2; M = 0.84 and 0.82; M = 0.94 and 0.93; M = 0.83
and 0.80, respectively) while both also reported more atypi-
cal behavior on SBS Social Behavior (M = 0.58 and 0.56,
respectively). Additionally, both young adults and parents
reported moderately high levels of functioning within sexu-
ality on the GSKQ (M = 22.30 and 21.75, respectively). Fur-
thermore, only 3% of young adults reported sexual attrac-
tion, behavior, or fantasies regarding the same sex. Of these
individuals, none of the parents accurately reported knowing
of their child’s same sex orientation (Table 11).
Aim 2
Regarding the second aim of the study, communication
about sexuality between young adult and parent participants,
both young adults and parents reported overall FSCQ scores
Journal of Autism and Developmental Disorders

Table 2  Summary of t-test Measure Young adult (M, SD) Parent (M, SD) t p
results
SBS
 Social behavior 0.58, 0.19 0.56, 0.20 1.86 0.07
 Privacya 0.84, 0.10 0.82, 0.10 4.00 < 0.001
 Sex education 0.94, 0.08 0.93, 0.08 0.74 0.46
 Sexual ­behaviora 0.83, 0.08 0.80, 0.09 3.54 0.001
SES
 Aggression 1.00, 0.89 0.94, 0.80 0.56 0.58
 Victimizationa 1.41, 1.30 1.16, 1.30 2.26 0.03
FSCQ
 Overalla 58.31, 12.74 63.87, 11.20 5.94 < 0.001
 Comforta 17.02, 4.49 21.48, 4.72 13.70 < 0.001
 Informationa 20.42, 5.20 21.83, 4.11 3.79 < 0.001
 Value 20.87, 5.00 20.56, 3.84 0.53 0.60
 GSKQ 22.30, 5.56 21.75, 5.52 1.14 0.26
a
 Represents statistically significant results of p < .05

that do not reach the level of strong communication labeled
by the FSCQ authors (Table 2; M = 58.31 and 63.87, respec-
tively). Parents reported moderate levels of communication
on Comfort, Information and Value (M = 21.48, 21.83, and
20.56, respectively), while young adults also reported mod-
erate levels of communication on Information and Value
(M = 20.42 and 20.87, respectively) while reporting even
lower levels of communication on Comfort (M = 17.02).
Aim 3
The third and principal aim of the study was to examine the
alignment of young adult and parent participant reports on
topics of sexuality, including sexual behavior and knowl-
edge, sexual experience, and communication about sex.
Results are initially presented at the scale level, followed by
item-level analyses.
Primary Analyses
report on SBS Social Behavior, SBS Sex Education, and
SES Sexual Aggression. There were no statistical differences
in reported GSKQ. For the FSCQ, young adults reported sig-
nificantly lower levels of comfort with communication about
sex, information sharing, and overall scores (i.e., a reported
lower level of family communication about sex) when com-
pared to what their parents reported. The two groups did
not differ on the value subscale, which refers to the reported
overall importance of the family role in sexual learning.
Both parents and young adults reported significantly lower
than “strong” overall FSCQ scores (FSCQ ≥ 72), indicating
a decreased level of family communication about sex. The
KSOG was omitted from t test analyses as only 6 of the
scale’s items were used for this study and there was the addi-
tion of a response option of asexuality that was not included
in the original measure. Therefore, if a participant chose the
asexual choice it would artificially alter their overall score
to appear more other sex attracted rather than asexual which
would improperly characterize the data.

Paired samples t-tests with a significance value of 0.05
were used to evaluate parent and young adult reports on
SBS, SES, GSKQ, and FSCQ. Results showed young adults
reported significantly higher scores on the SBS privacy sub-
scale, SBS sexual behavior subscale, and SES victimization
subscale when compared to parent report (Table 2). These
results suggest that the young adults reported a higher level
of privacy and sexual behavior than their respective parent,
comparable to what would be expected in the neurotypi-
cal population. Young adults also reported a higher level of
sexual victimization than reported by their parents, which
may be related to the typically associated privacy and shame
concerning sexual victimization. However, there were no
significant differences between young adult and parent
Item Level Analyses
Item level analyses included percentages and Cohen’s Kappa
and were applied to evaluate individual items of interest
(Tables 3, 4, 5, 6, 7, 8, 9, 10, 11). Cohen’s Kappa was used
to determine if the level of agreement between parents and
young adults goes beyond that of chance. Significance value
below 0.05 indicates that the parent and young adult partici-
pants from the same family agreed in their responses on the
item beyond chance, while significance above 0.05 indicates
that any similarity in the responses is likely due to chance.
Almost 62% of young adults reported experiences of victim-
ization through endorsement of at least one item and 54% of
parents endorsed at least one item on the SES victimization

13
 Journal of Autism and Developmental Disorders

Table 3  SBS social behavior

Young adult Parent report Agreement (%) Kappa
report (%) (%)

Socialize with others 75 .56; p < .001

 Never 5 5
 Rarely 38 40
 Sometimes 52 54
 Often 5 1
Socialize with members of the opposite sex 75 .57; p < .001
 Never 10 17
 Rarely 56 57
 Sometimes 33 26
 Often 1 0
Interested in social relationships with members of the opposite sex 85 .68; p < .001
 Yes 71 66
 No 28 32
 Do not know 1 2
Interested in social relationships with members of the same sex 87 .78; p < .001
 Yes 53 49
 No 45 49
 Do not know 2 2
Interested in social relationships with members of both sexes 87 .77; p < .001
 Yes 45 47
 No 50 46
 Do not know 5 7
Engage in actives outside of school 76 .65; p < .001
 Never 7 7
 Rarely 44 47
 Sometimes 23 22
 Often 3 1
 Does not attend school 23 23
Engage in activities outside of school with same age peers 72 .59; p < .001
 Never 6 7
 Rarely 42 44
 Sometimes 28 24
 Often 0 2
 Does not attend school 24 23
Engage in activities outside of school with members of the same sex 75 .64; p < .001
 Never 7 7
 Rarely 41 46
 Sometimes 26 20
 Often 2 4
 Does not attend school 24 23
Engage in activities outside of school with members of the opposite sex 74 .60; p < .001
 Never 12 16
 Rarely 51 52
 Sometimes 12 7
 Often 1 2
 Does not attend school 24 23

13
Journal of Autism and Developmental Disorders

Table 4  SBS privacy
Young adult Parent Agreement (%) Kappa
report (%) report (%)

Seek privacy when undressing 90 .82; p < .001

 Never 1 0
 Rarely 7 6
 Sometimes 41 46
 Often 51 48
Seek privacy when bathing or showering 71 .52; p < .001
 Never 0 0
 Rarely 15 10
 Sometimes 41 52
 Often 44 38
Seek privacy while using toilet 65 .48; p < .001
 Never 1 0
 Rarely 35 42
 Sometimes 26 30
 Often 38 28
Seek privacy if they masturbate 73 .60; p < .001
 Never 7 15
 Rarely 39 38
 Sometimes 13 13
 Often 41 34
Seek privacy to be alone for other activities 57 .30; p < .001
 Never 50 60
 Rarely 29 25
 Sometimes 12 9
 Often 9 6
Aware of social rules about undressing in private 97 .56; p < .001
 Yes 97 95
 No 3 5
Aware of social rules about not touching private body areas in public 90 .45; p < .001
 Yes 92 88
 No 8 12
Aware of social rules about closing door when using bathroom or toilet 90 .33; p < .001
 Yes 95 89
 No 5 11
Aware of social rules about not letting others touch their private body areas 90 .24; p < .05
 Yes 95 91
 No 5 9
Aware of social rules about knocking on closed doors 90 .65; p < .001
 Yes 85 80
 No 15 20
Understand other social rules about privacy 75 .47; p < .001
 Yes 66 59
 No 34 41

subscale. Despite this high report of at least one type of raped?” (Young Adult ‘yes’ = 2%, Parent ‘yes’ = 3%). How-
victimization of the young adult, a low number of partici- ever, a high number of participants also endorsed at least
pants endorsed the explicit item meant to indicate rape, one item on the SES Aggression scale (Young Adult = 65%,
as measured by the question “Have you (your child) been Parent = 67%), suggesting that both young adults and parents

13
 Journal of Autism and Developmental Disorders

Table 5  SBS sex education

Young adult report Parent report (%) Agreement (%) Kappa
(%)

Received sex education 99 .66; p < .001

 Yes 99 98
 No 1 2
Has knowledge about sexually related behavior 90 .24; p < .05
 Yes 95 91
 No 5 9
Aware of physical changes that occur through puberty 94 .22; p < .05
 Yes 97 95
 No 3 5
Has knowledge of sexual hygiene 80 .17; p = .08
 Yes 88 84
 No 12 16
Aware of different kinds of sexual relationships 87 .41; p < .001
 Yes 87 88
 No 13 12
Understand how someone has a baby 83 .17; p = .08
 Yes 86 91
 No 14 9
Understand the concept of birth control 79 .24; p < .05
 Yes 85 82
 No 15 18
Know about sexual transmitted diseases 71 .11; p = .25
 Yes 82 77
 No 18 23
Understand what is and what is not acceptable behavior 64 .25; p < .05
towards someone they are romantically interested in
 Yes 61 59
 No 39 41
Would be assisted by appropriate sex education 97 .56; p < .001
 Yes 95 98
 No 5 2

Table 6  SBS sex education Young adult Parent report Agreement (%) Kappa
method report (%) (%)

Method used for the most sex 62 .48; p < .001

education
 Parent 40 42
 School 23 38
 Another person 6 7
 Internet 17 9
 Pictures/videos/reading 8 1
 Peers/friends 1 1
 Self 5 2

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Journal of Autism and Developmental Disorders

Table 7  SBS sexual behavior

Young adult Parent Agreement (%) Kappa
report (%) report (%)

Touched private body areas in public 76 .46; p < .001

 Yes 32 34
 No 68 66
Touch anyone inappropriately 82 .63; p < .001
 Yes 43 43
 No 57 57
Speak about sexual activities in a way not normally discussed 74 .47; p < .001
 Yes 56 56
 No 44 44
Masturbated in public 88 − .05; p = .58
 Yes 3 9
 No 97 91
Removed clothing inappropriately in public 92 .76; p < .001
 Yes 20 22
 No 80 78
Romantic interest in a person 83 .62; p < .001
 Yes 73 61
 No 27 39
Behaved unacceptably toward someone they were romantically interested in 61 .35; p < .001
 Yes 22 15
 No 29 25
 N/A 49 60
Aware of sexual physical responses 89 .29; p < .05
 Yes 92 89
 No 8 11
Concerns about sexual physical responses 90 .70; p < .001
 Yes 18 22
 No 82 72
 N/A 0 6
Displayed sexualized behaviors that was difficult to understand what is and 94 .81; p < .001
what is not appropriate
 Yes 17 23
 No 83 77

were aware of the young adults themselves having com-

mitted at least one type of sexual transgression toward a
partner, such as misinterpreted level of sexual desire of the
Table 8  SES Intercourse other person and/or failing to stop themselves from pro-
Young Parent Agreement (%) Kappa ducing unwanted sexual advances toward the other person.
adult report report Parents and young adults similarly reported young adults
(%) (%) having a romantic interest in another person (Young Adult
Had sexual 99 .92; p < .05
‘yes’ = 73%, Parent ‘yes’ = 61%), and young adults (not) hav-
intercourse ing engaged in sexual intercourse with a consenting partner
with a (Young Adult ‘yes’ = 59%, Parent ‘yes’ = 57%).
consenting As noted above, there were no differences in the GSKQ
partner
or SBS Sex Education scores. However, there were notable
 Yes 59 57
discrepancies on items within the sex education subscale of
 No 41 43
the SBS. These include having knowledge of sexual hygiene

13
 Journal of Autism and Developmental Disorders

Table 9  SES aggression
Young adult Parent report Agreement (%) Kappa
report (%) (%)

Another person has misinterpreted the level of sexual intimacy desired 54 .08; p = .45
 Yes 52 56
 No 48 44
Become so sexually aroused that they could not stop even though the other 62 .19; p = .05
person did not want sexual intercourse
 Yes 42 32
 No 58 68
Used some degree of physical force to make partner engage in sexual 94 .47; p < .001
activities even when they don’t want to
 Yes 6 6%
 No 94 94
Endorsed at least one item in scale 62.0 .15; p = .12
 Yes 65 67
 No 35 33

Table 10  SES victimization
Young Parent Agreement (%) Kappa
adult report report
(%) (%)

Been in a situation where someone else became so sexually aroused that they felt it was 70 .31; p < .05
useless to stop them even if they did not what intercourse
 Yes 34 30
 No 66 70
Had sexual intercourse even though they didn’t really want to because the partner threat- 79 .46; p < .001
ened to end the relationship otherwise
 Yes 26 27
 No 74 73
Had sexual intercourse even though they didn’t really want to because they felt pres- 72 .21; p < .05
sured by the partner’s continual arguments
 Yes 26 21
 No 74 79
Found out partner had obtained sexual intercourse with them by saying things they 72 .32; p = .001
didn’t really mean
 Yes 34 22
 No 66 78
Been in a situation where a partner used some degree of physical force to try to make 82 .33; p < .001
them engage in sexual activities when they didn’t want to
 Yes 19 13
 No 81 87
Been raped 97 .39; p < .001
 Yes 2 3
 No 98 97
Endorsed at least 1 item on scale 88 .755; p < .001
 Yes 62 54
 No 38 46

13
Journal of Autism and Developmental Disorders

Table 11  Klein sexual orientation grid

Young adult report Parent report Agreement (%) Kappa
(%) (%)

To whom are you/is your child sexually attracted? 69 .41; p < .001

 No one 23 30
 Other sex only 63 64
 Other sex mostly 11 5
 Other sex somewhat more 0 1
 Both sexes equally 2 0
 Same sex somewhat more 1 0
With whom do you/does your child form strong emotional con- 54 .42; p < .001
nections?
 No one 17 22
 Other sex only 37 33
 Other sex mostly 16 15
 Other sex somewhat more 8 6
 Both sexes equally 7 8
 Same sex somewhat more 1 0
 Same sex mostly 7 9
 Same sex only 7 7
With whom do you/does your child have sexual contact? 90 .81; p < .001
 No one 36 39
 Other sex only 59 57
 Other sex mostly 3 4
 Both sexes equally 1 0
 Same sex mostly 1 0
About whom do you/does your child have sexual fantasies? 81 .54; p < .001
 No one 16 23
 Other sex only 79 69
 Other sex mostly 2 8
 Both sexes equally 2 0
 Same sex mostly 1 0
With whom do you/does your child prefer to spend time? 36 .25; p < .001
 No one 14 23
 Other sex only 15 9
 Other sex mostly 12 13
 Other sex somewhat more 4 6
 Both sexes equally 27 19
 Same sex somewhat more 15 15
 Same sex mostly 4 8
 Same sex only 9 7
With whom are you/is your child friends? 55 .21; p < .03
 Asexual 0 1
 Heterosexual only 63 67
 Heterosexual mostly 34 31
 Heterosexual somewhat more 2 0
 Heterosexual and homosexual equally 1 1

(Young Adult ‘yes’ = 88%, Parent ‘yes’ = 84%), understand- diseases (Young Adult ‘yes’ = 82%, Parent ‘yes’ = 77%).
ing how someone has a baby (Young Adult ‘yes’ = 86%, Par- Parent and young adult participants reported similar high
ent ‘yes’ = 91%), and knowledge about sexually transmitted levels on items indicating that they would be assisted by

13

appropriate sex education (Young Adult ‘yes’ = 95%, Parent
‘yes’ = 98%). Although Cohen’s Kappa was not significant,
a higher percentage of parents reported the majority of sex
education comes from school than young adults (Young
Adult = 23%, Parent = 38%) and a higher percentage of
young adults reported the majority of their sex education
comes from the Internet (Young Adult = 17%, Parent = 9%)
and pictures, videos, and/or reading (Young Adult = 8%,
Parent = 1%).
Parents and young adults were also significantly in agree-
ment with all items of the KSOG. Parents and young adults
agreed most on the gender of people with which the young
adults had sexual contact (Table 11). Parents and young
adults had very good agreement on the gender of persons
about whom the young adults had sexual fantasies and mod-
erate to good agreement on the gender of persons to whom
the young adults were sexually attracted, formed strong emo-
tional connections, and the sexual orientation of the young
adult’s friends (Table 11). Parents and young adults had fair
agreement on the gender of the person the young adult pre-
ferred to spend time with (Table 11).
Discussion
The purpose of this study was to evaluate reports from young
adults with ASD and caregivers from the same families on
the young adult’s sexual behavior, experiences, knowledge,
and communication, as well as explore more specific topics
concerning sexuality in this population, including compar-
ing young adult and parent perceptions regarding sexuality
within young adults with ASD.
Sexual Behavior, Experiences, and Orientation
This study had the novel aim of exploring topics on which
parents and young adults from the same families agreed and
differed. Overall, young adults reported more typical privacy
and sexual behaviors and higher sexual victimization than
their parents reported on their behalf.
Our data suggest that young adults seek privacy more
often than parents reported that they did. One potential
reason for this may be the time frame each participant is
utilizing to answer this question. The parent may be con-
sidering their young adult–child’s behavior across the lifes-
pan, including inappropriate behavior, when the young adult
was a child. In contrast, the young adults with ASD may be
reporting their current behavior, which is likely to be more
mature and appropriate. Alternatively, the young adults may
be seeking privacy from their parents to engage in certain
behaviors and the parents therefore are not aware of these
behaviors.
13
Journal of Autism and Developmental Disorders
While all participants reported sexual behaviors closer
to typical rather than atypical or problematic development,
young adult participants reported more typical sexual behav-
iors than parent reports of young adults. Young adults and
parents did agree on some aspects including that that the
young adults do (or do not) have romantic interests, and that
they have (or have not) had sexual intercourse. Our find-
ings build off research that indicated that individuals with
ASD desire and pursue sexual relationships and engage in
a variety of sexual behaviors typical of most people (e.g.,
Byers et al. 2013; Hellemans et al. 2007, 2010; Van Bour-
gondien et al. 1997). The typicality of sexual behavior in
young adults with ASD suggests that there is a need of sex
education and communication that covers the same topics as
that of typically developing young adults. The above trend
continues to change as dating apps, such as Tinder, are now
commonly used by adolescents and young adults for sex-
ual communication. Tinder use was correlated with risky
sexual behaviors (Shapiro et al. 2017). One protective fac-
tor in Shapiro’s study was the negative correlation between
risky sexual behaviors and the young adult living at home
with their parents. Doornwaard et al. (2014) found that less
parental rule setting regarding internet use predicted greater
engagement in sex-related online behavior. Furthermore, our
data suggest that young adult sexual behaviors are not suf-
ficiently different than those of typically developing young
adults of similar ages when assessing sexual intercourse with
a partner.
Parents were largely aware of their young adult’s sexual
orientation and sexual behavior. However, they were less
aware of the gender and sexual orientation of their children’s
friends, as well as their children’s sexual attraction and fan-
tasies, which may correspond to infrequent family commu-
nication about sex about these topics. Furthermore, although
parents were largely aware of their young adult’s sexual
behavior, especially if it was absent or heterosexual, young
adults with same-sex attractions, fantasies, and behavior may
experience difficulty communicating to their parents about
these topics. This illustrates that parents may be aware of
their young adult’s sexual behavior, which is largely absent
or heterosexual, but may be unaware of same-sex attraction
and fantasies these same young adults may be having. This
is in contrast to neurotypical young adults, where anywhere
from 25 to 65% of a sample of college-aged lesbian, gay, and
bisexual young adults reported that their parents were aware
of their same-sex sexual orientation (D’Augelli et al. 2005).
In line with Stokes et al. (2007), this study supports that
young adults with ASD can behave inappropriately sexu-
ally, with young adults and parents reporting that the young
adults with ASD in our study had engaged in at least one
instance of sexually aggressive or inappropriate behavior
with another person, on average. However, many dyads
did not align on the individual questions on aggressive
Journal of Autism and Developmental Disorders
behaviors. Both young adults with ASD and parents also
reported that the young adult had experienced at least one
instance of sexual victimization, on average. This finding
is consistent with reports from Brown-Lavoie et al. (2014),
who also found that many young adults with ASD reported
experiencing sexual victimization and highlights the need
for parents and young adults with ASD to communicate
effectively about potentially negative sexual experiences
in order to decrease these occurrences. The discrepancy
between young adult reports of sexual victimization and par-
ent report in this sample may be indicative of a broader issue
that affects both neurotypical and ASD young adults; the
under-reporting and decreased communication concerning
experiences of sexual victimization (Gardella et al. 2015).
Similar to Byers et al. (2013), the young adults and par-
ents we surveyed reported that the young adults with ASD
were interested in romantic relationships, sexual behavior,
and had had sexual intercourse. Young adults also reported
more consensual and non-consensual sexual behavior than
reported by their parents. This is probably related to young
adults reporting less communication with their parent about
sexuality and sexual behavior. It is possible that the young
adults with ASD are engaging in both more consensual and
non-consensual sexual activity than they are comfortable
talking about with their parents.
Communication About Sex, Education,
and Knowledge
Although the dyads aligned on the young adult’s general
sexual knowledge, there were some problematic areas where
they did not agree, including sexual hygiene, understand-
ing how someone has a baby, and information on sexually
transmitted diseases. Both groups reported that they could
be assisted by sex education but there were discrepan-
cies in the method of sex education (i.e., parents reported
more education occurred in the schools while young adults
reported more information from the internet and pictures/
videos). This finding partially aligns with Mehzabin and
Stokes (2011) who found that young adults with ASD were
more likely to report having learned about most sexuality
topics by themselves or from peers rather than from their
parents. However, those with ASD may be less experienced
in exchanging communication with peers overall, which may
lead them to rely more on potentially problematic sources of
sex information (e.g. Internet and porn).
Consistent with what was reported in Holmes and Himle
(2014), both parents and young adults with ASD believe
that appropriate sex education would be helpful; however,
many parents tended to discuss less sexuality and relation-
ship issues but more in the context of specific topics such
as hygiene and privacy. In the US, parents (primarily moth-
ers) communicate more often with their daughters than their
sons concerning information about sex, specifically sexu-
ally transmitted infections, contraception, and sexual assault
(Holmes et al. 2019). Low self-efficacy has also been iden-
tified as a barrier to communication of sex within families
in previous research with non-autistic youth (Hockenberry-
Eaton et al. 1996). In a survey done in Great Britain in 2015,
the sources of information for sex education changed over
time but parents continued to be a minor source of sexual
education while most young people wanted more involve-
ment with psychosexual matters from school, parents, or
health professions (Tanton et al. 2015).
Young adults reported lower comfort, information gained,
and overall family communication about sexuality compared
to their parents. Additionally, both young adults and par-
ents value communication about sex in general on the same
level. Previous research indicates that family communica-
tion about sex promotes positive sexual behavior and rela-
tionships (Warren and Warren 2015). Therefore, it may be
important to focus on aligning comfort and information fac-
ets and boosting overall family communication (particularly
for young adults), in order to increase the overall effective-
ness of family communication patterns about sex for this
target group.
Overall young adults reported lower family communica-
tion about sex than parents and both young adults and par-
ents reported lower than strong (according to neurotypical
samples) family communication about sex. Although parents
and young adults value communication about sex equally,
it is generally lower than what previous research has found
with neurotypical families (Warren and Warren 2015). This
finding may indicate that families with a young adult with
ASD do not communicate about sex as much as neurotypi-
cal families and/or communicate about sex differently than
directly being asked about it on the FSCQ.
Conclusions
The results from this study indicate that although parents
and young adults with ASD do align on some aspects of
understanding the sexual behaviors of the young adults,
there are major discrepancies that may be improved through
better family communication about sex. This study and pre-
vious research indicate that young adults with ASD desire
or engage in sexual intimacy; however, learning to navigate
the nuances of such relationships or situations is difficult
and may require a unique approach for this population.
Increasing family communication and information about sex
is valued by both young adults and parents and may be an
effective means to increase sexual knowledge and decrease
the instance of sexually inappropriate behavior and vic-
timization as well as potentially alleviating the discrepancy
between parent and young adult reports regarding young
13

adult’s sexual behavior and knowledge in this population.
Despite specific gender (Holmes et al. 2019), cultural (Tan-
ton et al. 2015), and now online variables (Doornwaard et al.
2014; Shapiro et al. 2017), a common finding across studies
indicated insufficient sexual communication between parent
and child and a desire from the child for that communication
to occur.
Limitations and Future Directions
One of the methodological limitations of this study was the
online self-report format. While this allowed for a broader
collection of participants, the veracity of the data relies
on the participants’ accurate and honest reporting of their
experiences. To limit this risk, researchers recruited from
reputable autism advocacy organizations. Furthermore, the
accuracy of matching young adult and parent pairs depended
on the participants providing a code that was identical to
their respective young adult/parent, but unique from other
survey respondents. However, the survey platform tracked
IP addresses, which were solely used to match young adult
and parent pairs in the case of duplicate or missing four-digit
codes. Additionally, the autism diagnosis for this study was
confirmed using the AQ-10 and self-report, as we were not
able to request medical records due to the online and anony-
mous nature of the study. Furthermore, to our knowledge,
the measures used in this study were not specifically normed
for use by individuals with ASD. However, we believe that
this is one of the first studies to explore these constructs in
this population and the Cronbach alphas that were obtained
for the current study were generally consistent with those
reported by the manuals across most measures. Correspond-
ingly, it has been noted that the numerous adaptations to
the KSOG for the current study resulted in moderate alpha
coefficients. These adaptations were employed in order to
consider the expected addition of an asexual nature of many
individuals with ASD as well as to limit these questions
to the present time frame. Another limitation of this study
likely pertains to respondent bias by omitting those families
who may not have been comfortable talking about sex in
general and thus did not participate in this study. Finally,
generalizability of this data is limited to young adults
with ASD, as participants in this age range were expressly
recruited.
Although growing, the current body of literature on ASD
and sexuality is still limited. Due to the fast-moving and
increased use of technology, generally and in particular by
autistic individuals, future studies should offer innovative
interview techniques beyond an online platform. To further
characterize sexuality in this population, future studies could
examine more in depth romantic interests, dating initiation,
partnering, and relationship maintenance and satisfaction
13
Journal of Autism and Developmental Disorders
over time in young adults with ASD. Additionally, more
information about how sexuality develops across the lifespan
and how communication within the family about sex and
sexuality evolves over time could build off the results of
this study and serve to put them in the context of a person’s
lifespan.
Author Contributions  All listed authors were involved in the creation
and revisions to this original manuscript and approved its final revision
for submission.
Funding  No funding was granted for this research study.
Compliance with Ethical Standards 
Conflict of interest  The authors declare that they have no conflict of
interest.
Ethical Approval  All procedures performed in studies involving human
participants were in accordance with the ethical standards of the insti-
tutional and/or national research committee and with the 1964 Helsinki
declaration and its later amendments or comparable ethical standards.
This study was approved by the appropriate institutional review board.
Informed Consent  Informed consent was obtained from all individual
participants included in the study.
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