Supporting Sexual Health in Neurodiverse Populations
A recent review of research on psychosexual functioning in autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) highlights important considerations for supporting sexual health in neurodiverse populations.
Overall Findings
The review found that overall, individuals with ASD or ADHD report poorer psychosexual functioning compared to neurotypical peers. They describe feeling different in their sexual orientation, behaviors, and experiences. Dissatisfaction in relationships, sexual dysfunction, risky sexual behaviors, and sexual victimization were commonly reported in both groups.
Females with neurodiversity appear especially affected. Studies consistently showed greater risk and poorest outcomes amongst females with ASD or ADHD. They reported higher rates of non-heterosexual orientation, ambivalence in gender identity, lack of interest in sex, sexual dysfunction, negative sexual experiences, and sexual victimization.
Research priorities differed between groups, but the review emphasized looking for common experiences across neurodiverse conditions. Broad research across topics is needed to elucidate shared risk factors and prevent bias.
Research Gaps
Major gaps exist in understanding risky sexual behaviors, sexual health practices, vulnerability to victimization, and sexual perpetration in these groups. In-depth qualitative and longitudinal research is needed to clarify mechanisms leading to adverse outcomes and inform supportive interventions.
Overlaps between ASD and ADHD
The review also highlighted significant overlaps between ASD and ADHD, conferring a “double deficit” for psychosexual problems. Clinicians should consider neurodevelopmental symptoms as indicators of potential sexual health risk, and routinely inquire about sexual orientation, behaviors, experiences, and risks.
Interventions and Education
Tailored sex education from childhood through adulthood was recommended for those with ASD, as they report difficulty understanding standard sex education. Accurate information on social sexual rules and appropriate behaviors is needed to support healthy development.
For ADHD, interventions targeting educational achievement, substance use, early sexual health discussions, and mother-child relationships may help reduce risky sexual behaviors and adverse outcomes like teen pregnancy. Improved ADHD treatment engagement in adolescence is also needed.
Overall, research findings consistently indicate increased vulnerability in sexual health and experiences for those with neurodiversity, especially females. Attention is needed to elucidate and support the needs of these populations through further research, tailored education, clinical inquiry, and early interventions. With understanding and support, those with neurodiversity can gain knowledge, skills and access to resources to empower healthy psychosexual lives.
Here's a summation of the key points
For ASD:
Evidence of sexual ambivalence, more non-heterosexual orientation compared to neurotypicals
Parent concerns about inappropriate sexual behaviors in ASD, potentially stemming from lack of knowledge
ASD individuals report difficulty understanding sex education compared to peers
Increased negative sexual experiences and victimization in ASD
Need for tailored lifelong sex education and skills training to support healthy sexuality
For ADHD:
More homosexual experiences reported, especially among females who also report gender identity ambivalence
Mixed findings on sexual dysfunction; comorbidities may play a bigger role
Evidence of risky sexual behaviors like earlier sexual debut, more partners, early pregnancy
Risky behaviors mediated by factors like academic problems, delinquency, substance use
Protective effects of ADHD medications against early pregnancy and STIs
Developmental pathway of risk implicates need for interventions targeting education, substance use, clinician guidance on sexual health, and family relationships
In summary, the review highlights psychosexual challenges and risks faced by those with ASD and ADHD compared to neurotypicals. Further research priorities include risky behaviors, victimization, and perpetration. Findings point to tailored supports needed to improve sexual knowledge, behaviors and experiences in these populations.