Sexuality and Disability (2019) 37:259–274

https://doi.org/10.1007/s11195-018-9534-z

ORIGINAL PAPER

Sexuality of Persons with Autistic Spectrum Disorders (ASD)

Monika Parchomiuk1 

Published online: 5 September 2018

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Abstract
The following is a review article on psychosexual development and functioning of persons
with autistic spectrum disorders (ASD). The article discusses how the diagnosed qualities
of the autistic spectrum in two main areas, i.e. difficulties in social contacts and specific
behaviors (according to DSM-5), affect the development of psychosexual experiences. The
first area encompasses: difficulties in building relationships with peers, problems in non-
verbal communication, deficits in social skills such as compliance with social rules in rela-
tionships and empathy. The second area includes the role of specific interests, adherence to
routine and specificity of sensory functioning (being oversensitive or undersensitive). The
article examines the significance of following the rules, honesty, responsibility, altruism,
and disorders (such as anxiety and depression) in persons with ASD for their social and
psychosexual functioning. The main aspects of psychosexual experiences investigated in
the article are: gender and sexual identity, partner relationships (friendships and intimate
relationships), sexual behaviors (in a relationship, outside the relationship, like masturba-
tion). Within these aspects categories of experiences, sensations, needs, attitudes, desires,
expectations, and difficulties are analyzed. Special attention was devoted to adolescence in
persons with ASD. Differences in experiences of persons with ASD were presented with
reference to the complexity and variety of autistic spectrum disorders both in the quan-
titative and the qualitative dimension. Thorough assessment of the situation, including
individual possibilities and limitations, and their environmental determinants is crucial to
really understand the issue and avoid taking a stereotypical approach to interpreting prob-
lems related to i.e. emotional-affectionate experiences of persons with ASD.

Keywords  Autistic spectrum disorders (ASD) · Sexuality · Autism · Asperger syndrome ·

Psychosexual aspects · Poland

* Monika Parchomiuk
mparchomiuk@o2.pl
1
Faculty of Pedagogy and Psychology, Institute of Pedagogy, University of Maria Curie
Sklodowska, Narutowicza Street 12, 20‑004 Lublin, Poland

13
Vol.:(0123456789)
 260 Sexuality and Disability (2019) 37:259–274

Introduction

There is much interest in the literature on the subject in the functioning of individuals
with autistic spectrum disorder (ASD), presumably because the population of individu-
als with this type of disability is growing. Researchers are exploring the psychosexual
sphere and notice the need to analyze it not only from the external perspective of a
parent, caregiver, or a specialist, but mainly from the personal perspective—including
the experiences of individuals with ASD. Information from these two sources is not
always identical, especially if frequency of some phenomena, such as masturbation, is
concerned. Research shows that in many respects the psychosexual sphere of persons
with ASD bears much resemblance to the psychosexual sphere of the so-called neuro-
typical population. There are also some phenomena and specific characteristics related
to autistic disorders and environmental conditions (socialization). Sexuality of individu-
als with ASD is as diverse as it is in the general population, which is reflected in atti-
tudes, needs, opportunities, and limitations. In the light of empirical evidence, the belief
in the pathologisation of this sphere of life and its minor importance in persons with this
developmental disability has been disproved.
According to the findings of the American Psychiatric Association reported in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013), the basic crite-
ria for ASD are:

A Persistent deficits in social communication and social interaction across contexts, not
accounted for by general developmental delays, and manifested by 3 of 3 symptoms:
A1 Deficits in social–emotional reciprocity; ranging from abnormal social approach and
failure of normal back and forth conversation through reduced sharing of interests,
emotions, and affect and response to total lack of initiation of social interaction
A2 Deficits in nonverbal communicative behaviors used for social interaction; ranging
from poorly integrated-verbal and nonverbal communication, through abnormalities
in eye contact and body-language, or deficits in understanding and use of nonverbal
communication, to total lack of facial expression or gestures
A3 Deficits in developing and maintaining relationships, appropriate to developmental
level (beyond those with caregivers); ranging from difficulties in adjusting behavior
to suit different social contexts through difficulties in sharing imaginative play and in
making friends to an apparent absence of interest in people
B Restricted repetitive patterns of behavior, interests, or activities as manifested by at
least 2 of 4 symptoms:
B1 Stereotyped or repetitive speech, motor movements, or use of objects; (such as sim-
ple motor stereotypes, echolalia, repetitive use of objects, or idiosyncratic phrases)
B2 Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior,
or excessive resistance to change; (such as motoric rituals, insistence on same route
or food, repetitive questioning or extreme distress at small changes)
B3 Highly restricted, fixated interests that are abnormal in intensity or focus; (such as
strong attachment to or preoccupation with unusual objects, excessively circum-
scribed or perseverative interests)
B4 Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of
environment; (such as apparent indifference to pain/heat/cold, adverse response to
specific sounds or textures, excessive smelling or touching of objects, fascination
with lights or spinning objects)

13
Sexuality and Disability (2019) 37:259–274 261

C Symptoms must be present in early childhood (but may not become fully manifest
until social demands exceed limited capacities)
D Symptoms together limit and impair everyday functioning” [1]

Depending on the severity of these symptoms, there are 3 levels of disorders: (1)
“Requiring very substantial support; (2) Requiring substantial support; (3) Requiring sup-
port” [1].
Furthermore, other mental disorders and developmental disabilities, such as intellectual
disability, ADHD, motor impairments, psychiatric disorders (depression, anxiety), may
also be present in ASD, largely determining the ultimate possibilities and limitations of the
individual in various spheres of their life.
In this study selected issues of psychosexual development and functioning of persons
with ASD are analyzed. In the paper sexuality is defined as a complex phenomenon that
encompasses “sex, gender identities and roles, sexual orientation, eroticism, pleasure,
intimacy and reproduction; sexuality is experienced and expressed in thoughts, fantasies,
desires, beliefs, attitudes, values, behaviors, practices, roles and relationships.” [2]. This
definition can be supplemented by saying that “human sexuality (…) deals with the anat-
omy, physiology, and biochemistry of the sexual response systems; with roles, identity and
personality; with individual thoughts, feelings, behaviors, and relationships. It addresses
ethical, spiritual, and moral concerns, and group and cultural variation” [3]. The follow-
ing study focuses on psychosexual aspects, and specifically on: psychosexual socialization
(interpersonal dimension); psychosexual personality (intrapersonal dimension) and sexual/
intimate behaviors [4]. The psychosexual dimension, as demonstrated by research, may be
most affected by the modifying effects of ASD-specific characteristics, resulting in a num-
ber of problems and difficulties arising in this sphere.

Interpersonal Dimension of Psychosexual Functioning of Persons

with ASD

Human sexuality, including its manifestations, attitudes, and needs is a sum of experiences
gained from personal activity and social influence. Socialization of the sexual need (its ulti-
mate individual character) and its subordination to certain principles (moral, legal) and val-
ues are affected by parents and other significant people. Any negligence and irregularity on
their part may impede understanding of one’s sexuality, promote negative attitudes to this
sphere of human life, or lead to the development of undesirable behaviors. As individuals
mature, peers become more and more important in the socialization process. They become
not only a source of knowledge, but also of experiences strengthening one’s identity, devel-
oping sexual orientation, sexual preferences and behaviors. Relationships with peers shape
psychosocial competencies needed to realize social roles (of a partner, a fiancée, and a
spouse) and the peer community becomes the place for establishing intimate relationships.
Diagnostic criteria for ASD show that people with this developmental disorder may expe-
rience difficulties in social relationships, which can negatively affect the extent of their
developmental experiences and learning opportunities. Table 1 presents significant trends
in sexuality of persons with ASD, and factors shaping these trends.
Rich data on the psychosexual experiences of ASDs can be found in autobiogra-
phies, which are most often a joint effort of the person who reports their own experi-
ences and the person who helps them to write the book (autistic people have problems

13
 262 Sexuality and Disability (2019) 37:259–274

Table 1  Trends presenting problems in the interpersonal dimension of psychosexual functioning of persons

with ASD
Trends Suggested related factors (causal and cause-effect
relationships)

Difficulties in making friends, inability to integrate
into peers, feelings of loneliness and alienation
(sense of “being an outside observer”)
Specific understanding of friendship (focus on com-
mon forms of activity or practical aspects, e.g.
financial help), wishful thinking about friends, or
inability to distinguish coincidences from more
advanced relationships
Incorrect orientation of friendship and intimate rela-
tionships at people not interested in such relation-
ships; harassing behavior; taking risk (trying to
establish closer relationships with strangers)
Rare intimate partnerships despite the need to enter
into intimate relationships; forming relationships
late compared to trends predicted for the age group
Difficulties in partnering: the partner notices lack of Poor sexual and social competences, problems
emotional commitment, expressions of emotions
and feelings; limited communication; lack of under-
standing for the partner’s needs, egocentric tenden-
cies; focus on the physical side of the relationship
(active sex life as a criterion of a good relationship) of sensual integration)
or avoiding sexual intercourse
Poor social competencies (difficulty in reading and
understanding social signals, hints and situations,
language specificity, avoiding eye contact due to
various disorders in information integration via
various channels), negative experiences in rela-
tionships leading to anxiety and depression, low
self-esteem, psychotic disorders (social anxiety),
not sharing peers’ interests, excessive parental
care, poorly developed social need (also as a
result of the aforementioned factors)
Excessive preoccupation with objects and things;
significant concentration on their own interests
absorbing time and energy
Difficulties in interpreting other people’s social
signals, emotional-affective states and thoughts;
difficulties understanding one’s own emotions and
feelings; desire for striking relationships
Poor social competences (difficulty in reading and
understanding social signals, language specific-
ity), gender segregation in institutions, negative
experiences in relationships leading to anxiety
and depression, low self-esteem, psychotic disor-
ders (social anxiety), not sharing peers’ interests
with reading and understanding other people’s
emotional and cognitive states; difficulty in under-
standing and controlling one’s own emotions and
feelings, sensory problems (hypersensitivity, lack

Author’s own analysis based on: [5–12]

with systematization of their reports), which may have some influence on the message [13].
These materials have cognitive value and may supplement research data. Persons with ASD
may have difficulties in their relationships during adolescence and adult life. They are often
rejected and harassed by peers, they may have problems striking intimate relationships
based on a deep emotional-affective bond, some are unable to reciprocate emotions and
feelings, or even to experience deeper feelings. In addition, they may experience sexual and
physical violence [14, 15]. They might also have a tendency to establish friendly or inti-
mate relationships with people who are “similar” in some respects, e.g. socially rejected,
perceived as “weird”, having unusual interests, or revealing deficits in emotional and social
competencies [14].
Deficits in social functioning are seen as the primary source of difficulty in the ana-
lyzed interpersonal area. Such deficits include problems related to social judgment, diffi-
culties in acquiring adaptive social behavior in an unstructured manner; recognizing subtle
affectionate cues, communicating appropriately, adopting other people’s perspective [16].

13
Sexuality and Disability (2019) 37:259–274 263

Forms of social “mismatch” of people with ASD may include lack of elementary behav-
iors, which are socially desirable for the quality of communication, such as looking in the
eye of the interlocutor. Qualitative analyzes, including reports in autobiographies, show
that persons with ASD may experience great difficulties understanding the message of the
interlocutor’s utterances when they are forced to look them in the eye. This may result
from impaired integration of sensory transmissions, hypersensitivity, and dysfunctional
sensations (“frightening sense of losing oneself” [14, p. 106]). Lack of empathy, attributed
to people with ASD, is not always the case, some authors write about “apparent lack of
empathy” which is explained in relation to other characteristics of the functioning of these
individuals, such as manifested lack of concern for other people, difficulties in understand-
ing emotions and feelings (especially cognitive ones, such as curiosity, fear, boredom) or
excessive preoccupation with objects as a source of interest while ignoring other sources
of stimulation such as people present around them [10]. Grandin [6] describes her emo-
tionality by comparing it to a child’s emotionality, with a limited repertoire of experiences
gained mainly by her interests and professional accomplishments (satisfaction, deep calm
and serenity) and inability to feel emotional ambivalence. Her autobiography points to
one of the major deficits of persons with ASD: the inability to understand complex, often
subtle and conflicting emotions, feelings and behaviors in interpersonal relationships [17].
This inability leads to many failures when attempting to establish and continue closer rela-
tionships, sometimes leading to behavior that compromises the integrity of another per-
son. Language specificity and its excessive pedantism, the use of rotund words or bizarre
expressions unfit for the situation, speaking too loud, too slow or fast, lack of adequate
voice modulation, and sometimes bizarre interests deviating from those that are impor-
tant to peers, and rigid attachment to principles are the reasons why these people experi-
ence many forms of social ostracism, including avoidance, mockery and many advanced
forms of harassment (including verbal and physical violence). This type of experience is
particularly difficult during school years when relationships with peers are an indispensa-
ble element of everyday life. People with ASD experience negative effects of such experi-
ences to a varying degree, which may in part result from the intensity of their need for
social interaction (according to Szatmary [18], the need for relationships, that is often very
important for teens, “stays in the background” for people with Asperger’s Syndrome) but
also from the degree of self-awareness and the ability to assess the situation. Some persons
with ASD may experience acute feelings of loneliness, stigmatization, low self-esteem, and
more advanced consequences such as depression, anxiety disorders1 and social phobia [17,
19, 20]. An adolescent with AS recalls that he struggled to reconcile the social demands
of teenage life (company, common passions, going out) with the specific characteristics
of the disorder (the need for solitude to develop one’s own interests, strong attachment to
rules and principles of social life) [15]. The situation can be described as a vicious circle:
lack of competence raises problems in building social relationships. If such relationships
are not established, it is not possible to learn many useful forms of functioning, norms
and principles (such as those found in partnerships). This, in turn, increases difficulties in
social functioning, already complicated by harmful psychological consequences such as
anxiety, sense of inadequacy, inequity [21]. Persons with higher cognitive competencies (in
the intellectual norm, with preserved verbal communication skills) have greater opportuni-
ties to compensate for social difficulties and, to a certain extent, to develop competences

1
  Depression and anxiety, conditioned by multiple factors with possible involvement of biological factors.

13
 264 Sexuality and Disability (2019) 37:259–274

[22]. With experience, learning from many mistakes, and observing others, they assimilate
certain rules and patterns of behavior in social situations, including intimate ones. This
gives at least some sense of control over their functioning in society [6]. Studies show that
girls with ASD rather than boys have these opportunities; compared to boys, girls have a
higher level of social competence, communication, social imitation and attention. Further-
more, they show behavioral problems less often (research review [23]). However, girls’
level of competency may be so low that they cannot cope with more complex situations
that occur with age. On the other hand girls’ peer relationships are characterized by a
greater complexity, requiring advanced skills such as sharing, offering support, and solving
social problems. Boys’ relationships are more often based on actions. Thus, with weaker
competencies compared to neurotypical peers, girls with ASD tend to show higher levels of
social isolation and mental health problems compared to boys with ASD and neurotypical
girls [24]. There are studies, though, which show that competencies of girls with ASD are
sufficient to establish successful, friendly relationships similar to those of their neurotypi-
cal peers [24]. Girls with ASD are more social, emotional and friendly than boys with ASD
[25].
Research and clinical observations suggest that persons with ASD show significant
delays in the development of intimate relationships determined not only by life circum-
stances but also by their own choice [12, 26]. Assessing whether it is a conscious choice is
difficult, since it is determined by a number of problems and unfortunate experiences that
shape a certain assessment of the self in interpersonal relationships (as someone inexperi-
enced and incompetent) and presumably also of others [10, 12]. Intimate contacts, based
on physical proximity, may be difficult for people with ASD, since they trigger anxiety,
claustrophobic sensations, a feeling of alienation of one’s body, which prevent experienc-
ing pleasure. The reason for this may be lack of sensory integration and hypersensitivity,
causing negative sensations, including pain [12]. There is a specific attitude towards sex
visible in memories of persons with ASD—sex is seen as a relatively insignificant part of
life that can be disposed of [14]. Perhaps this attitude is formed on the basis of unsuccess-
ful experiences and the aforementioned lack of satisfaction. Sometimes it is accompanied
by abandoning intimate relationships completely and choosing celibacy as a way of life [5,
6].
Delay in intimate relationships is, on the one hand a manifestation, and on the other
hand a consequence of delayed emotional and social maturation. The latter correlate with
negative experiences, social isolation, and limiting one’s activities to pursuing interests.
While adolescents look for partners and opportunities to meet arising psychosexual needs,
persons with ASD often remain at the stage of friendly relationships (based on common
interests and intellectual attainments) developing sexual interests and the need to build
relationships much later [5]. However, the indicated delay can vary substantially in this
population. A study conducted by Dewinter et al. [26] showed a comparable age for enter-
ing partner relationships by neurotypical adolescents and adolescents with ASD.
Studies show that most people with high-functioning ASD show interest and the need
to enter into intimate relationships. For example, studies of adults with high-function-
ing autism (HA) and Asperger’s syndrome (AS)2 show that 76% of the respondents in
both groups show such interest [27, p. 214]. A similar indicator has been obtained in
studies involving parents of young people with ASD (76%) [28]. Few, however, have

2
  This research was conducted before the new DSM-5 classification, hence both diagnostic categories were
indicated.

13
Sexuality and Disability (2019) 37:259–274 265

the opportunity to fulfill this need (15% for HA and 1% for AS [27]). Other explora-
tions by Atwood and Henault [10] show that less than 50% of adults with ASD and
high-functioning autism are in a relationship. Similar indicators have been obtained in
other explorations involving these individuals (33%—Renty, Roers; 59%—Byers et  al.
[in 12]). The above studies determined that 50% of adolescents attempted (no indication
if they were successful) to fulfill their desire to be in a romantic relationship [28]. The
majority of ASD boys were in love (82%) or dating (70%), and the indicators were very
close to those achieved by their neurotypical peers (respectively: 85,6%; 73.3%) [26].
Interestingly, parents confirmed the credibility of their sons’ testimonies—in most cases
they reported the existence of a relationship [29]. This group, which achieved relatively
good results, included only boys, which could have an impact on the discovered trend.
Other studies have shown that men with high-functioning autism show greater interest
in sexual relationships than women [30].
Quality of partnership experience varies and depends on many factors, not just
on characteristics specific for ASD. As in every relationship, the choice of a partner
is important, as are partners’ mutual expectations and needs. Neurotypical partners
acknowledge their ASD partner’s positive qualities such as truthfulness and attachment
to principles and fidelity, but they often report problems such as lack of emotional-
affective reciprocation, introduction of bizarre intimate rituals (e.g. compulsory bath-
ing or the use of latex gloves), insufficient involvement in family life (caused by, for
example, lack of awareness that such involvement is necessary or preoccupation with
one’s own interests) or concentrating on the physical side of the relationship (sexual
intercourse), recognizing it as the most important aspect of the relationship [5, 11]. The
latter aspect may not so much result from these individuals’ needs, though, as it may
be rooted in their beliefs embedded in cultural scripts (successful sex life as the basis
for a good relationship). People with ASD may have difficulties in interpreting such
scripts and their flexible adaptation to their own lives and needs (rigidity), especially if
simultaneously they are experiencing difficulty in identifying the latter [31]. The need
for physical intimate contact varies in this population and some persons with ASD may
even find it satisfactory to avoid such contact [11, p. 76]. Although there are significant
differences in sexual needs among the neurotypical population, the extreme intensifica-
tion of these needs (avoidance—high concentration) may be caused by sensory distur-
bances. Penwell Barnett and Maticka-Tyndale [12] who have interviewed adults with
ASD, report that for some people each form of sex is painful and difficult to bear, for
others achieving sexual pleasure frees them from negative sensations caused by hyper-
sensitivity or hyposensitivity (sounds, textures). Partner relationships of two persons
with ASD are often based on mutually shared interests and functional characteristics.
Williams in her memories [14], reports positive, though not long-lasting, relationships
with people experiencing problems in different areas of functioning (similar people). In
these relationships the author most valued “the freedom to be herself”, i.e. maintaining
emotional isolation and not trying make the partner understand it. In her accounts, the
key feature of these partners was their reluctance to open up and to bond, resulting from
emotional and social difficulties, limited competences and experienced defeats. Empiri-
cal evidence on the quality of matrimonial/partner relationships of persons with ASD is
very limited. Interesting studies involving marriages of persons with ASD (one spouse/
both spouses), families with a spouse and a child with ASD, and neurotypical parents
and children show a similar level of marital satisfaction in all groups. The authors note
that partner’s ASD is not significant in this regard. They explain this situation, i.e. by
the positive characteristics of ASD, such as high intelligence and loyalty [32].

13
 266 Sexuality and Disability (2019) 37:259–274

Table 2  Trends showing problems in the intrapersonal dimension of psychosexual functioning of persons

with ASD
Trends Suggested related factors (causal and cause-effect
relationships)

Low self-esteem in social and sexual functioning,
lower motivation to seek social contacts
Problems with establishing one’s own sexual iden-
tity (sexual orientation)
Knowledge about sexuality is selective and disor-
derly; constructing one’s own, often distorted,
image of sexuality; tendency to use non-formal
education (less reliable, selective sources)
Failures in social relationships, experiencing different
forms of discrimination
No psychosexual experience in partner relationships;
limited support from significant people; social
stigma caused by signs of “otherness”; cognitive
limitations (in the low-functioning persons); rigid
thinking
Difficulties in ordering information and under-
standing it, even with a relatively rich amount of
memorized data, tendency to understand informa-
tion literally; limited experience in relationships,
especially at the stage of natural peer socialization;
limitation of school sex education

Author’s own analysis based on: [8, 10, 12, 17, 33–35]

Intrapersonal Dimension of Psychosexual Functioning of Persons

with ASD

This dimension of psychosexual functioning encompasses self-image and assessment of

one’s own psychosexual competences, including knowledge [4].
Basic trends are summarized in Table 2.
Henault [8], based on research conducted in collaboration with T. Atwood, with AS
and HA adults, points out that their sexual profile differs in many respects from the neu-
rotypical persons’ sexual profile. Researchers have found that people with ASD have low
self-esteem of their physical self. They are also interested in its aesthetics and they are sen-
sitive to its social reception. Sexual knowledge is below average, and its sources are mostly
media—very rarely sexual education. Sexual needs, as in the non-disabled population,
manifest themselves during adolescence (around 14 years of age), but the first sexual expe-
rience seems to be delayed compared to neurotypical peers (after 20 years of age) [10]. The
mean age of sexual initiation in neurotypical persons is 16.5–18.5 for men and 7.5–18.5 for
women [Wellings et  al. in 36]. Personal, internal tendencies have a much greater impact
on developing one’s image of their body, sense of gender identity, and needs and desires
than social factors. Presumably, this results from the specific propensity for stereotypi-
cal behavior, specific interests, and routines (excessive resistance to change). There are,
however, a number of environmental factors that affect the sexuality of persons with ASD,
which may be considered, at least quantitatively, to be specific: lack of socio-sexual knowl-
edge, segregation (in institutions), lack of privacy, prescribed medication (antidepressants,
antipsychotics) which affect sexual reactions adversely (e.g. erectile dysfunctions) [8]. Dif-
ficulties in developing self-image including self-acceptance, evaluation of one’s physicality
(body), attractiveness, and social functioning may be associated with the negative social
experiences described in this article, but they may also be caused by disturbances of sen-
sory integration. Maturation is especially difficult, since it is the time when the abovemen-
tioned aspects of self image crystallize. During this period of turbulent hormonal changes,
increased self-reflection on their own place in the world and in the future, and social

13
Sexuality and Disability (2019) 37:259–274 267

comparison, some abnormalities and problems such as: increased social isolation, anxiety,
depression, increased stiffness of behavior, aggravation of obsessive interests, and behav-
ioral disorders (oppositionist and rebellious behavior) may intensify in persons with ASD
[19, 37, 38]. Adolescents with ASD tend to develop defense mechanisms in self-esteem,
inadequate self-esteem, low self-esteem, and increased awareness of one’s otherness [38].
Persons with ASD may have difficulty understanding their own sexuality, specifically their
sexual orientation (sexual identity), especially if they are not of the same gender as the
majority of the population. They may have difficulty accepting and/or expressing their
sexuality, since they are aware of the social stereotypes that accompany it (for example,
the belief that gay or lesbian is abnormal). If they experience social discrimination against
their own “abnormal” sexuality, they may try to change it (even suppress it). Because of
negative social experiences the difference in sexuality becomes another problematic factor
aggravating the social stigma especially in adolescence, when, as it was noted before, sen-
sitivity to social attitudes and a sense of not fitting the society intensify [39, 40].
DeClerq [41, p. 285] writes about “sexual echo-behaviors” in people with ASD result-
ing from fixation of certain situations or images. Based on these echoes, they create certain
beliefs about desirable behaviors (e.g. after watching pornography they form convictions
about what a sexual intercourse should look like). Without the ability to experiment, learn
from peers or be educated by parents and at school, their knowledge about sexuality is
often based on selected sources such as the media, and the Internet. People with ASD tend
to be poor at generalizing situations, which reduces their chances of using the competencies
they have acquired in a specific context successfully. Studies show that people with ASD
are less likely to gain knowledge about sex from parents, teachers, and peers, compared to
their neurotypical peers, and more often use media and pornography as a source. They are
often aware of their shortcomings in this area, which in turn affects their social relation-
ships (uncertainty as to what proper behavior is) [12, 21, 35]. In contrast to this negative
image, parents of adolescents with ASD reported in a study that their children participated
in sexual education (75%), and thus are aware of physical changes during adolescence, and
understand reproductive processes; hygiene, STD risks and contraception perhaps not as
much [28]. Another trend, indicating a comparable proportion of different sources of infor-
mation about sex in ASD and neurotypical boys, has been reported by Dewitner et al. [26].
Persons with higher developmental potential (in the intellectual norm and above the
norm) have relatively good learning capacity, but due to their tendency to be preoccupied
with specific (often narrow) subjects and objects, they limit their activities to aspects of
their interests only. This can result in little motivation for learning topics that are not inter-
esting to them (which may affect their participation in sexual education).

Sexual Behavior of Persons with ASD

This dimension of psychosexual functioning is particularly diverse among individuals.

Human sexual behaviors are manifested with various intensity and in various ways, as
determined by both biophysical determinants (such as sexual drive) as well as psychoso-
cial factors, including the previously mentioned effects of socialization on the part of the
family and peer groups. Self-activity and the ability to organize it developed by purposeful
teaching and learning play a significant role here. Sexual orientation, sexual preferences
and needs are reflected in sexual behaviors. Sexual behavior, as the most visible manifes-
tation of human sexuality, is subject to normative judgment whose criteria may include

13
 268 Sexuality and Disability (2019) 37:259–274

Table 3  Trends showing problems in sexual behaviors of persons with ASD

Trends* Suggested related factors (causal and cause-effect
relationships)

Specific behavior interpreted as deviant, e.g. the
need to touch feet and women’s stockings (to
feel different textures); paraphilic behaviors and
disorders
Occurrence of abnormal, compulsive behaviors
and sexual activities such as a ritual of daily mas-
turbation before getting up in the morning, use
of objects for sexual stimulation, and self-harm
during masturbation.
Sexual dysfunctions that hinder or prevent sexual
intercourse, sexual aversion
Boundary decision-making and reading cues dif-
filucty, especially in women
Bringing up intimate topics with strangers or
acquaintances (asking questions, relating one’s
own experiences)
Sexual violence against people with ASD; behav-
iors violating other people’s integrity by individu-
als with ASD
Specific interests, sensory disorders; paraphilia-
specific factors (predicted importance of biological
and psychosocial factors)
Emotional and sensory problems, negative emotional
and physical experiences, lack of stimulation (in
people with lower intellectual functioning)
Sensory disorders, medication use, psychotic disor-
ders (anxiety), negative sexual experiences
Lack of experience, inability to discern situations and
actions in terms of personal good, difficulties in
establishing boundaries of behavior, strong need for
contact that cannot be satisfied in any other way.
Lack of familiarity with standards governing social
relations and human behavior; inability to control
one’s own thoughts and utterances, truthfulness
Inability to recognize situations and actions as
threatening; social naiveté, unfamiliarity with one’s
own rights; economic, psychological and physical
dependence on others, tendency to be submissive
and respect rules, low self-esteem

Author’s own analysis based on: [9–11, 41, 42]

*Such behaviors are not absolute in the population

developmental, statistical, medical, moral, cultural, and legal norms. Assessment based on
these norms is used to determine whether a particular behavior promotes the development
and functioning of the individual, without violating their personal dignity or the good of
others.
Table 3 provides information on issues related to sexual behavior of persons with ASD
and suggests the possible etiological basis.
Individuals with ASD exhibit sexual behavior in various forms and in different
ways. Masturbation is relatively common. Data indicates that frequency of masturba-
tion is comparable between this population and the neurotypical population. Indicators
obtained in studies involving adolescents and adults with ASD at various levels of intel-
lectual development range from about 20% to more than 90%, depending on sex—more
often in men [10, 26, 29, 30, 33]. Studies with representatives of the general population
show that indicators range from about 30% to over 90% while maintaining gender differ-
entiation [36]. Sexual behavior targeted subjectively is significantly less frequent, which
is related with the interpersonal aspects analyzed above. Byers et al. [43] showed that
most high-functioning adults with ASD (79%) had not recently engaged in any partner
activity; they sometimes experienced sexual anxiety, agitation with specific stimuli, and
moderate desire for intercourse. In the case of persons who do not have partners, who
live in various care institutions (prevalent forms of traditional care), with different lev-
els of intellectual functioning, such behavior may be directed towards caregivers and

13
Sexuality and Disability (2019) 37:259–274 269

fellow residents. They include forms such as touching, being touched, holding hands,
kissing, rarely attempting to have a sexual intercourse [33]. A number of various sexual
partner behaviors were reported in studies with adult care givers in institutions: petting
(46%), kissing (71%), sexual touch (71%), and sexual intercourse (67%). Interestingly,
there were also behaviors in which the person with ASD did not consider the consent of
another person (caressing 17%, kisses 13%) [42]. Studies with boys with ASD without
intellectual disability demonstrate that they have various partner behaviors of compara-
ble scope to their neurotypical peers. These behaviors vary in how advanced they are:
French kisses (56—65%), petting (52—63%), masturbating another person (40—41%),
being masturbated (34—37%), oral sex (22—32%), vaginal intercourse (24—33%), anal
sex (6–3%). No differences were found in the age at which the behavior occurs [26].
However, many studies have shown that age differences between groups in terms of fre-
quency of sexual partner behavior may increase to the detriment of ASD patients, which
in turn is due to the absence of intra-individual changes in the latter group [29]. Indica-
tors obtained in the studies of sexual behavior vary depending on the place of residence,
age, sex and source of information. Typically, the control group is neurotypical. An
interesting study on the topic was conducted by Oulsley and Mesibov [30] with adult
respondents. They showed, somewhat surprisingly, that people with intellectual disabil-
ity (without autism) have more sexual experiences than individuals with ASD without
intellectual disability. Having verified sexual knowledge in both groups of respondents,
the authors state that this knowledge is irrelevant for sexual experiences—vast sexual
knowledge is not correlated with broader sexual experiences.
Studies in this population show an increased incidence of asexuality, defined as lack
of interest in sexual intercourse (an indicator for individuals with high-functioning ASD
M = 1.29; for neurotypical persons M = 0.27) [44]. These data should be interpreted with
caution, bearing in mind the difficulty of establishing social relations in persons with ASD.
Various studies show different results as far as declarations of being gay man and lesbian
and heterosexual by respondents with ASD. For example, in studies by Brown-Lavoie
et al. [35], 78% of people with high-functioning ASD and 67% of neurotypical respond-
ents reported heterosexual orientation. A similar indicator for the high-functioning ASD
group was found in the studies by Byers and Nichols [31]. Gilmour et al. [44] showed that
heterosexual orientation was lower in ASD patients than in control group (M = 14.45 and
M = 20.59 respectively), and lesbian and gay male sexual orinentation was higher (M = 4.71
and M = 1.16). Making an accurate estimate of the scale of the phenomenon based on ASD
persons’ declarations is difficult because they may have difficulty understanding their own
sexual identity. Relying on their behavior alone, on the other hand, can lead to creating a
misleading image of the phenomenon, as heterosexual and lesbian and gay male orienta-
tion are not a homogeneous construct—they include sexual interests, behavior and identi-
fication [44]. Same-sex oriented sexual activity may result from situational conditions or
greater understanding of the needs of the same sex. In some people with ASD, preference
of a partner is not based on their gender, but on their other characteristics (“the gender
blindness” hypothesis). Authors associate this with bisexual behaviors, but not necessarily
with bisexual orientation [45]. In studies conducted by Byers and Nichols [31], the bisexu-
ality index was relatively high at 15%. Differences in neurotypical persons were found in
the cited research by Gilmour et al. [44]—for the ASD group M = 4.47, for the neurotypi-
cal group M = 1.6, but already in the explorations of Bejerot and Eriksson [45], bisexuality
indices were similar in the group of adults with ASD and non-disabled people (one per-
son–two persons respectively). In the cited studies by Hellemans et al. [42] 3 persons, as
reported by care givers, revealed bisexual behavior.

13
 270 Sexuality and Disability (2019) 37:259–274

Sexual behavior may be compulsive when it is difficult to control it, when it is too
intense, and when it leads to neglecting other forms of activity. This includes masturbation,
which may become a mechanism for coping with anxiety and restlessness, a form of auto
stimulation in situations of deprivation of needs [9]. Chronic masturbation which produces
strong sensations, even pain, may also occur due to the pleasure as well as hyposensitiv-
ity [8]; it may be accompanied by using various objects, which could increase the risk
of injury [42]. Individuals with ASD and intellectual disability may masturbate in public.
This is not only a matter of misunderstanding the rules and inability to regulate one’s own
behavior, but often the effect of neglect in the process of socialization, for example, when a
child with intellectual disability is not taught to develop their natural sense of shame [46].
People with ASD often behave in ways that may be misinterpreted as abnormal or even
deviant by some members of the society. Such an individual is considered promiscuous and
treated as a sexual deviant posing a potential threat to others (especially children). Gran-
din [47] describes her childhood experience when she was considered sexually hyperac-
tive because she frequently touched her intimate areas as a result of an infection, and con-
stantly repeated words she had heard from others including common names of body parts
(deferred echolalia). At puberty, she did not have any basic knowledge of human sexuality,
and the need to learn about boy’s anatomy she had heard of from her peers was immedi-
ately realized: she would ask, “Show me your penis”. She uncritically behaved the way her
peers provoked her to.
The interests of people with ASD can concentrate around widely understood sexuality.
Attwood [48] explains that the tendency to collect can raise interest in pornography, which
will not be limited to the activity of collecting itself. People with ASD, due to limitations
in reading emotions and mental states of other people, emotional distress, lack of com-
petence, may have trouble selecting such materials, which entails the risk of using child
pornography [40, 48].
Specific interests, such as those listed in Table 3, may suggest paraphilic behavior and
paraphilic disorders in persons with ASD. Paraphilia is referred to as “sexual behavior that
most people reject as abominable, unusual or abnormal; it is different from genital sex
with a normal conscious adult” [49, p. 622]. Paraphilic disorders are the ones that “cause
a person to suffer or limit their functioning” [49, p. 622]. Diagnostic criteria include:
qualitative nature of paraphilia (e.g., erotic interest in children)—criterion A, and nega-
tive consequences (distress, injury, injury to others)—criterion B; both criteria need to be
met. Duration (at least 6 months) and the presence of strong sexually stimulating fantasies,
impulses and behaviors are important in the diagnosis of paraphilia [50]. Paraphilic disor-
ders include, among others: voyeurism, exhibitionism, frotteurism, masochism and sadism,
pedophilic disorders, fetishism and transvestic fetishism. Information on the occurrence of
paraphilic disorders in people with ASD is scarce. Using self assessment of 55 adults with
AS, L. Cabral Fernades and co-authors [51] reported fetishism in 6 individuals, one trans-
vestite fetish, 2 instances of sadomasochism, and 7 cases of voyeurism. Isolated cases of
pedophilia and fetishism have been reported in the cited studies of Hellemans et al. [42].
Diagnosing cases of paraphilic disorders in the population in question is difficult, since cer-
tain behaviors can be stimulated by sensory (and other) disorders, without any sexual com-
ponent. If these behaviors are associated with pleasurable sexual experiences, they may
become fixed, though [52]. The results of these few studies on this issue must be treated
with caution, given their negative social impact. They cannot be the basis for the social
stigmatization of persons with ASD, nor for their hasty assessment from a psychological,
sexual or legal perspective. Furthermore, paraphilic disorders are not a characteristic spe-
cific for ASD.

13
Sexuality and Disability (2019) 37:259–274 271

Individuals with ASD are reported to experience sexual violence in a variety of forms.
The quoted explorations of Brown-Lavoie et  al. [35] have shown that people with high-
functioning ASD are significantly more likely to experience sexual violence compared to
neurotypical people (physical contact, compulsion). Research also shows that lower level
of sexual knowledge is a risk factor for being a victim of violence. Williams [14] mentions
multiple instances of entering pathological relationships with men who would abuse her
sexually (prostitution), financially, mentally, and physically. This type of experience, plus
her mother’s violence and rejection could be the factors that caused extreme dislike for
intimacy, touch, a sense of “separation from the body” (alienation), and intense anxiety of
emotional involvement. Relationships with men who gave extremely different experiences
contributed to the reduction of these negative qualities of functioning—at least to some
extent.
Specific behavior of individuals with ASD, not necessarily grounded in paraphilia or
paraphilic disorders, can be seen as sexual abuse, and may be legally sanctioned [22].
These may be, for example, various attempts to strike a relationship defined as harassment,
insisting on physical contact, or the use of child pornography. Legal sanctions are also used
for behavior manifestations of paraphilic disorders such as pedophilia, voyeurism, sadism,
masochism, exhibitionism, zoophilia and others. Cases of men with ASD manifesting such
behaviors who are held legally responsible for their actions are described in literature of
the subject [40, 52, 53]. Careful diagnosis is vital in such cases to determine whether para-
philia or other factors are involved (such as counterfeit deviance behaviors) [54]. “Counter-
feit deviant behaviors are not typically associated with ongoing sexual fantasies or urges or
the intention to either harm or humiliate others” [55, p. 75]. There are a number of hypoth-
eses that explain the nature of these behaviors, with regard to environmental conditions
and life experiences [56]. If indeed deviant paraphilic behaviors are involved, it is neces-
sary to implement therapeutic treatment, in some cases enhanced with medication [57].
In situations of counterfeit deviance behavior it is necessary to identify the causes (usually
psychosocial) to start educational and supportive actions (including psychological therapy)
[Day, in 58].

Conclusion

Analyses conducted in this study show the diversity of psychosexual functioning of ASD
persons. Data collected to date suggests that the psychosexual development of these per-
sons falls to a large extent within the general pattern for explaining the essence of each
person’s sexuality. As indicated in this study, the criteria for ASD diagnosis are generally
important for the ASD person’s sexuality, not only at its developmental stage. This is espe-
cially true for social difficulties, rigidity, and sensory integration disorders. Symptoms of
these disorders vary in intensity within the diagnostic spectrum, which will also determine
the different possibilities and limitations in the psychosexual sphere. Emmen [59, p. 43]
uses the term “autistic sexuality” to simplify the categorization of ASD persons based on
the traditional triad of autistic disorders: (1) withdrawn, with sexuality limited to their own
body; (2) passive, targeted also at other people, and (3) active, but strange, fulfilling sexual
needs in an unusual form. However, autistic symptoms do not determine sexuality, they are
its significant determinants—but not the only ones. Socialization in the family, school, with
peers, including organized sex education is important. Activities aimed at alleviating dif-
ficulties and solving problems, compensating them and building the competences needed

13
 272 Sexuality and Disability (2019) 37:259–274

to undertake various tasks and roles related to the psychosocial sphere (e.g. social compe-
tence training) are also important. Some people may need specialized, psychological, psy-
chiatric or sexological counseling to understand their own desires, needs and orientation,
and deal with negative states, emotions and feelings.
A detailed analysis of certain issues such as paraphilic disorders and sexual violence
involving ASD victims and perpetrators has not been conducted due to space constraints of
this paper. Issues related to the biological sphere of sexuality have neither been raised. The
range of empirical material on the subject matter is varied, due to the difficulty of opera-
tionalizing certain phenomena and the low access of certain groups (such as persons with
ASD as partners).
Considering the available literature on the subject, the following research areas are
suggested:

• impact of family conditioning on socialization of sexual needs in ASD patients, includ-

ing parental and significant persons’ attitudes towards sexuality;
• determinants of the development of sexual identity in ASD patients, including its disor-
ders;
• psychosexual functioning of persons with ASD with lesbian and gay male sexual orien-
tation, taking into account social attitudes;
• experiences of persons with ASD related to sexual partner activity (motives, expecta-
tions, needs, satisfaction, disorders);
• marital/partners life quality of persons with ASD, including difficulties, sources of sat-
isfaction and the need for support;
• paraphilic disorders and counterfeit deviance in the ASD population;
• persons with ASD and sexual violence, including the categories of victims and perpe-
trators;
• sexually difficult behavior, possibility of differentiation and therapy.

Compliance with Ethical Standards 

Ethical Approval  This article does not contain any studies with human participants performed by any of the
authors.

References
1. Carpenter, L.: DSM-5 autism spectrum disorder. Guidelines and criteria exemplars. https​://depts​.washi​
ngton​.edu/dbped​s/Scree​ning%20Too​ls/DSM-5%28ASD​.Guide​lines​%29Feb​2013.pdf. Accessed Dec
2016
2. Loeber, O., Reuter, S., Apter, D., van der Doef, S., Lazdane, G., Pinter, B.: Aspects of sexuality edu-
cation in Europe—definitions, difference and developments. Eur. J. Contracept. Reprod. Health Care
15(3), 169–176 (2010)
3. Brown, R. D.: The individual with intellectual disabilities and sex education: perspectives of involved
adults. Paper presented at the Annual Meeting of the International Society for the Study of Human
Subjectivity. Columbia, October 1997. https​://eric.ed.gov/?id=ED434​872 (1997). Accessed Dec 2016
4. Dekker, L.P., van der Vegt, E.J.M., van der Ende, J., Tick, N., Louwerse, A., Maras, A., Verhulst, F.C.,
Greaves-Lord, K.: Psychosexual functioning of cognitively-able adolescents with autism spectrum
disorder compared to typically developing peers: the development and testing of the teen transition
inventory-a self-and parent report questionnaire on psychosexual functioning. J. Autism Dev. Disord.
47, 1716–1738 (2017)

13
Sexuality and Disability (2019) 37:259–274 273

5. Attwood, T.: Asperger Syndrome. Introduction. Zysk i S-ka, Poznań (2006)

6. Grandin, T.: Image Thinking and Other Relationships with Autism. Fraszka Edukacyjna, Warszawa
(2006)
7. Gutstein, S.E.: Will my baby learn to dance? Research on friendship and companionship in ado-
lescents with Asperger syndrome. In: Willey, L.H. (ed.) Asperger syndrome in maturation period.
Highs, falls and all the rest, pp. 137–148. Fraszka Edukacyjna, Warszawa (2006)
8. Henault, I.: Sexuality of teens with Asperger’s syndrome. In: Willey, L.H. (ed.) Asperger Syndrome
in Maturation Period. Highs, Falls and all the Rest, pp. 98–99. Fraszka Edukacyjna, Warszawa
(2006)
9. Henault, I.: Sexual education and treatment. In: Atwood, T., Henault, I., Dubin, N. (eds.) Sexuality
of Persons with Autism in Legal Context. Harmonia, Gdańsk (2014)
10. Henault, I.: Asperger Syndrome. From Adolescence Through Adulthood. Harmonia, Gdańsk (2015)
11. Aston, M.: Asperger syndrome in the bedroom. Sex. Relatsh. Therapy 27(1), 73–79 (2012)
12. Penwell Barnett, J., Maticka-Tyndale, E.: Qualitative exploration of sexual experiences among
adults on the autism spectrum: implications for sexuality education. Perspect. Sex. Reprod. Health
47(4), 171–179 (2015)
13. Happé, F.G.: Autobiographical work of three adults with Asperger syndrome: interpretation prob-
lems and theoretical implications. In: Frith, U. (ed.) Autism and Asperger Syndrome, pp. 250–290.
PZWL, Warszawa (2005)
14. Williams, D.: No One Anywhere. Fraszka Edukacyjna, Synapsis, Warszawa (2004)
15. Jackson, L.: Swirling, Oddities and Asperger’s Syndrome. Fraszka Edukacyjna, Warszawa (2005)
16. Realmuto, G.M., Ruble, L.A.: Sexual behaviors in autism: problems of definition and management.
J. Autism Dev. Disord. 29(2), 121–127 (1999)
17. Hannah, L., Stagg, S.D.: Experiences of sex education and sexual awareness in young adults with
autism spectrum dis order. J. Autism Dev. Disord. 46, 3678–3687 (2016)
18. Szatmary, P.: Imprisoned Mind. A Story About People with Autism. Znak, Kraków (2004)
19. Gillberg, C., Schaumann, H.: Autism: specific adolescence. In: Gillberg, C. (ed.) Diagnosis and
Treatment of Autism, pp. 375–382. Springer, New York (1989)
20. Ozonoff, S., Dawson, J.D., McPartland, C.: High-Functioning Children from the Spectrum of
Autism. UJ, Kraków (2015)
21. Stokes, M., Newton, N., Kaur, A.: Stalking, and social and romantic functioning among adolescents
and adults with autism spectrum dis order. J. Autism Dev. Disord. 37, 1969–1986 (2007)
22. Ratto, A.B., Mesibov, G.B.: Autism spectrum disorders in adolescence and adulthood: long-term out-
comes and relevant issues for treatment and research. Sci. China Life Sci. 58(10), 1010–1015 (2015)
23. Cridland, E.K., Jones, S.C., Caputi, P., Magee, C.A.: Being a girl in a boys’ world: investigating
the experiences of girls with autism spectrum disorders during adolescence. J. Autism Dev. Disord.
44(6), 1261–1274 (2014)
24. Sedgewick, F., Hill, V., Yates, R., Pickering, L., Pellicano, E.: Gender differences in the social
motivation and friendship experiences of autistic and non-autistic adolescents. J. Autism Dev. Dis-
ord. 46, 1297–1306 (2016)
25. Head, A.M., McGillvray, J.A., Stokes, M.A.: Gender differences in emotionality and sociability in
children with autism spectrum disorders. Mol Autism. 5(19) (2014). http://www.molec​ulara​utism​
.com/conte​nt/5/1/19
26. Dewinter, J., Vermeiren, R., Vanwesenbeeck, I., Lobbestael, J., Van Nieuwenhuizen, C.: Sexuality
in adolescent boys with autism spectrum disorder: self-reported behaviors and attitudes. Autism
Dev. Disord. 45, 731–741 (2015)
27. Tantam, D.: Asperger’s syndrome in adulthood. In: Frith, U. (ed.) Autism and Asperger Syndrome,
pp. 180–221. PZWL, Warszawa (2005)
28. Corona, L.L., Fox, S.A., Christodulu, K.V.: Providing education on sexuality and relationships to
adolescents with autism spectrum disorder and their parents. Sex. Disabil. 34, 199–214 (2016)
29. Dewinter, J., Vermeiren, R., Vanwesenbeeck, I., Van Nieuwenhuizen, Ch.: Parental awareness of
sexual experience in adolescent boys with autism spectrum disorder. J. Autism Dev. Disord. 46,
713–719 (2016)
30. Ousley, O.Y., Mesibov, G.B.: Sexual attitudes and knowledge high-functioning adolescents and
adults with autism. J. Autism Dev. Disord. 21(4), 471–481 (1991)
31. Byers, S.E., Nichols, S.: Sexual satisfaction of high-functioning adults with autism spectrum disor-
der. Sex. Disabil. 32, 365–382 (2014)
32. Lau, W., Peterson, C.C.: Adults and children with Asperger syndrome: exploring adult attachment
style, marital satisfaction and satisfaction with parenthood. Res. Autism Spectr. Disord. 5, 392–399
(2011)

13
 274 Sexuality and Disability (2019) 37:259–274

33. van Bourgondinen, M.E., Reichle, N.C., Palmer, A.: Sexual behavior in adults with autism. J. Autism
Dev. Disord. 27(2), 113–125 (1997)
34. Mehzabin, P., Stokes, M.A.: Self-assessed sexuality in young adults with high-functioning autism. Res.
Autism Spectr. Disord. 5, 614–621 (2011)
35. Brown-Lavoie, M., Viecili, M.A., Weiss, J.A.: Sexual knowledge and victimisation in adults with
autism spectrum disorders. J. Autism Dev. Disord. 44(9), 2185–2196 (2014)
36. Bancroft, J.: Human Sexuality. Elsevier Urban & Partner, Wrocław (2011)
37. Baron-Cohen, S., Bolton, P.: Autism: Facts. Krajowe Towarzystwo Autyzmu, Kraków (1999)
38. Howlin, R.: Asperger’s syndrome in teens. In: Willey, L.H. (ed.) Asperger Syndrome in Maturation
Period. Highs, Falls and all the Rest, pp. 98–99. Fraszka Edukacyjna, Warszawa (2006)
39. Gallucci, G., Hackerman, F., Schmidt, C.W.: Gender identity disorder in an adult male with asperger’s
syndrome. Sex. Disabil. 23(1), 35–40 (2005)
40. Dubin, N.: My story. In: Atwood, T., Henault, I., Dubin, N. (eds.) Sexuality of Persons with Autism in
Legal Context. Harmonia, Gdańsk (2014)
41. DeClerq, H.: Autism from the Inside—a Guide, Synapsis. Fraszka Edukacyjna, Warszawa (2006)
42. Hellemans, H., Colson, K., Verbraeken, C., Vermeiren, R., Deboutte, D.: Sexual behavior in high-
functioning male adolescents and young adults with autism spectrum disorder. J. Autism Dev. Disord.
37(2), 260–269 (2007)
43. Byers, S.E., Nichols, S., Voyer, S.D.: Challenging stereotypes: sexual functioning of single adults with
high functioning autism spectrum dis order. J. Autism Dev. Disord. 43, 2617–2627 (2013)
44. Gilmour, L., Schalomon, M.P., Smitgh, V.: Sexuality in a community based sample of adults with
autism spectrum dis order. Res. Autism Spectr. Disord. 6, 313–318 (2012)
45. Bejerot, S., Eriksson, J.M.: Sexuality and gender role in autism spectrum disorder: a case control study.
PLoS ONE 9(1), e87961 (2014). https​://doi.org/10.1371/journ​al.pone.00879​61
46. Tarnai, B.: Review of effective interventions for socially inappropriate masturbation in persons with
cognitive disabilities. Sex. Disabil. 24, 151–168 (2006)
47. Grandin, T.: I was an Autistic Child. PWN, Warszawa-Wrocław (1995)
48. Attwood, T.: From an expert perspective. In: Atwood, T., Henault, I., Dubin, N. (eds.) Sexuality of
Persons with Autism in Legal Context, pp. 147–164. Harmonia, Gdańsk (2014)
49. Morrison, J.: DSM-5 Without Secrets. Practical Guide for Clinicians. UJ, Kraków (2016)
50. Highlights of changes from DSM-IV-TR to DSM-5, 2013. http://www.dsm5.org. Accessed Nov 2015
51. Cabral Fernades, L., Gillberg, C.I., Cederlund, M., Hagberg, B., Gillberg, C., Billstedt, E.: Aspects of
sexuality in adolescents and adults diagnosed with autism spectrum disorders in childhood. J. Autism
Dev. Disord. 46, 3155–3165 (2016)
52. Kellaher, D.C.: Sexual behavior and autism spectrum disorders: an update and discussion. Curr. Psy-
chiatry. Rep. (2015). https​://doi.org/10.1007/s1192​0-015-0562-4
53. Griffin-Shelley, E.: An Asperger’s adolescent sex addict, sex offender: a case study. Sex. Addict. Com-
pulsivity 17(1), 46–64 (2010)
54. Griffiths, D.M., Fedoroff, P.: Persons with intellectual disabilities and problematic sexual behaviors.
In: Bradford, J.M.W., Ahmed, A.G. (eds.) Sexual Deviation: Assessment and Treatment, pp. 195–206.
Pennsylvania, Philadelphia (2014)
55. Lunsky, Y., Frijters, J., Griffiths, D.M., Watson, S.L., Williston, S.: Sexual knowledge and attitudes of
men with intellectual disability who sexually offend. J. Intellect. Dev. Disabil. 32(2), 74–81 (2007)
56. Griffiths, D., Hingsburger, D., Hoath, J., Ioannou, S.: ‘Countefreit deviance’ revisited. J. Appl. Res.
Intellect. Disabil. 26, 471–480 (2013)
57. Higgs, T., Carter, A.J.: Autism spectrum disorder and sexual offending: responsivity in forensic inter-
ventions. Aggress. Viol. Behav. 22, 112–119 (2015)
58. Wilcox, D.T.: Treatment of intellectually disabled individuals who have committed sexual offences: a
review of the literature. J. Sex. Aggress. 10(1), 85–100 (2004)
59. Emmen, R.L.: Sexuality of persons with autism. In: Perzanowska, A., Wolińska-Chlebosz, A., Dąbek-
Malczyk, A. (eds.) Living with Autism. Selected Issues Related to the Issues of Adults with Autism,
pp. 37–38. Foundation Wspólnota Nadziei, Kraków (2002)

13
Sexuality & Disability is a copyright of Springer, 2019. All Rights Reserved.