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Abstract

This short report presents recommendations to promote health and well-being relating to sexuality and gender diversity in autistic individuals. The recommendations were developed based on the latest available scientific knowledge coupled with a community-driven approach. An international group of autistic and non-autistic experts in the fields of autism, sexuality, and gender diversity and autistic advocates worked together to develop the initial recommendations; these recommendations were subsequently checked within the wider community through an online survey. Out of the original 11 recommendations, eight were rated above a consensus threshold. The final recommendations cover three themes: (1) providing education and information on sexuality, relationships, and gender diversity to autistic individuals and their families; (2) improving expertise in and accessibility to healthcare for sexuality, relationships, and gender-related questions, with specific attention to prevention of and support after sexual victimization; and (3) meaningful inclusion of the autism community in future research that addresses well-being related to sexuality, relationships, and gender diversity. The recommendations emphasize the need for additional awareness and offer cues to parents, professionals, and policymakers to promote sexual health and well-being of autistic individuals.

Lay Abstract

In this article, we propose recommendations on what we can do to promote that autistic people can enjoy their sexuality and gender identity, because that contributes to overall well-being.

First, we briefly summarize the existing research on sexuality and gender diversity in autistic individuals.

Next, we propose recommendations for how to promote sexual and gender diversity-related health and well-being. Based on what is known about sexuality, gender diversity, and relationships in autistic adolescents and adults, we convened an international group of autistic and non-autistic researchers, advocates, parents, and professionals to develop recommendations to promote sexual and gender health in autistic people.

The resulting recommendations were checked through an online survey distributed to autistic people across the world. The online participants endorsed the importance of eight final recommendations related to:

1. Providing education and information on sexuality, relationships, and gender diversity to autistic individuals and their families;

2. Improving expertise in and accessibility to healthcare for sexuality, relationships, and gender-related questions, with specific attention to prevention of and support after sexual victimization; and

3. Meaningfully including the autism community in future research that addresses well-being relating to sexuality, relationships, and gender diversity.

These community-driven recommendations aim to promote sexual health and well-being in autistic individuals internationally.

Keywords

autism gender diversity policy recommendations sexual health sexuality

Introduction

Policy recommendations to promote sexual and gender diversity-related health and well-being in autistic¹ youth and adults are lacking. This study developed recommendations based on the latest scientific evidence through an iterative, inclusive, community-driven approach to promote sexual rights and well-being of autistic youth and adults across various cultural and socio-economic backgrounds, information processing and communication styles.

Sexuality is “a central aspect of being human throughout life (that) encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction (. . .)” (World Health Organization (WHO), 2006, p. 5). Gender can refer to a range of experiences including identities, gender-related expressions, and culturally driven associations, such as gender roles. Sexual health and well-being are closely related to overall health and well-being of individuals, partners, and families, and to the social and economic development of communities and countries (WHO, 2022). Therefore, people must have access to accurate and comprehensive information about gender and sexuality, to sexual healthcare and environments that support and promote sexual health. Human rights apply to sexual and gender diversity rights, including the right to freedom of thought and expression, equality, non-discrimination, privacy, autonomy, integrity, information, education, and health.

Views on autism, sexuality and gender have changed over the years (Dewinter et al., 2013, 2020; Bertilsdotter Rosqvist, 2014), from (1) ignoring the sexuality of autistic people; to (2) focusing on possible “sexual problems,” “inappropriate behaviors,” or assumptions that autistic people are “confused” regarding their experience of sexual orientation or gender diversity; and more recently, (3) a shift toward recognition that sexuality and gender development are part of being human for autistic and non-autistic adolescents and adults alike, and include a wide range of expressions and identities. However, for many autistic people, human, sexual, and gender diversity–related rights have not been realized.

Autism, sexuality, and gender diversity: summarizing the evidence base

Over the past four decades, the number of studies on sexuality and sexual and gender identity in autistic individuals has increased rapidly. Approximately 300 peer-reviewed scientific articles on this topic have been published in English. Most studies have been conducted in Western Europe, the United Kingdom, and North America (United States and Canada) and have primarily included participants with Western cultural backgrounds without intellectual disability. Notwithstanding the diversity in gender identities in autistic people (see below), sex and gender identity are often conflated in autism research (Strang et al., 2020). In this section, we refer to individuals in accordance with reported study results, which may or may not have reported participants’ gender identity versus their assigned sex at birth. However, we affirm that people can experience a variety of gender identities outside the gender binary model, which may or may not align with one’s assigned sex at birth, and this should be a part of research reporting moving forward.

Sexual development

In general, pubertal timing does not differ between autistic and non-autistic adolescents (Corbett et al., 2020; May et al., 2017). Most autistic adolescents have an interest in sexuality and relationships and gain experience with solo and partnered sexual behaviors at the same age as non-autistic peers (Dewinter et al., 2015; Weir et al., 2021). However, a higher proportion of autistic compared to non-autistic individuals, especially men, start later with partnered sexual activity. Greater sexual anxiety and less interest in sexuality and sexual desire have been reported by autistic individuals with no partnered sexual experiences (Byers et al., 2013). Also, limited autism-specific information about sexuality, perceived lack of sexual experience, difficulties finding a partner, challenges communicating with partners, and managing sensory needs and preferences are themes that have been recurrently reported in the literature as hindrances for autistic people in establishing intimate relationships and enjoying sexuality (Barnett & Maticka-Tyndale, 2015; Strunz et al., 2017). Recent studies on menstruation, menopause (Groenman et al., 2022; Moseley et al., 2021), and pregnancy (Hampton et al., 2023) in autistic people revealed specific sensory and physical challenges individuals may experience. Attention to developmental milestones relevant to sexuality, relationships, and gender later in life is still lacking.

Intimate relationships

Up to three-quarters of adults with autism without intellectual disability have romantic relationship experience (Dewinter et al., 2017). Some autistic individuals report more satisfaction with their relationship if their partner is autistic as well (Strunz et al., 2017). Autistic adults have reported similar concepts regarding intimate relationship as non-autistic peers (e.g. the importance of communication and dedication to working on the relationship; Sala et al., 2020).

Sexual attraction and identities

Relatively more autistic individuals, especially those assigned female at birth, reported non-heteronormative interest and identities compared to general population peers (Dewinter et al., 2017; George & Stokes, 2018a; Weir et al., 2021). Intersecting marginalized identities (i.e. being autistic and identifying as lesbian, gay, bisexual, asexual, or any other sexual minority identity (LGB+)) may result in specific personal challenges (e.g. feeling different), adverse social dynamics (e.g. stigmatization and exclusion), and a higher risk for mental health problems compared to the neurotypical majority (George & Stokes, 2018b; Hall et al., 2020).

Sexual violence and victimization

Contrary to ongoing myths, autism does not increase the risk for sexual offense (Higgs & Carter, 2015). However, research has shown that autistic people, especially women, are more than four times as likely to experience sexual and physical violence and abuse as non-autistic individuals (Dike et al., 2022; Gibbs et al., 2021). The consequences of victimization and needs of autistic survivors may be different from those in the general population. The adverse impact of sexual victimization on autistic people might be exacerbated by previous negative experiences, social exclusion, and inadequate reactions from others when seeking support (Pearson et al., 2023).

Sexuality education

Parents have reported concerns about the sexual well-being of their autistic children and want to support their sexual development. Some parents hesitate to provide comprehensive sexuality education (CSE) and indicate the need to discuss this with professionals (Ballan, 2012; Holmes & Himle, 2014). Professionals, on the contrary, do not consistently address or support sexuality in their interactions with autistic youth and their families (Holmes et al., 2014). Practice guidelines (Hannah & Stagg, 2016) and sexuality education programs tailored to adolescents with autism are becoming available (Visser et al., 2017), but are still scarce.

Sexual and reproductive healthcare

Autistic individuals report more unmet healthcare needs, lower healthcare satisfaction, and lower rates of preventive care (e.g. cervical cancer screenings; Nicolaidis et al., 2013). The need for clear communication and information, attention to environmental features (e.g. light and sounds), knowledge about autism, and professionals’ awareness of sexual healthcare issues has been emphasized (Hampton et al., 2023).

Gender identity diversity and gender incongruence

Research has shown that compared with non-autistic people, autistic people are more likely to identify as transgender or gender diverse (i.e. identify as a gender different than their assigned sex at birth; George & Stokes, 2018a; van der Miesen et al., 2016) and more often experience gender dysphoria or incongruence (Kallitsounaki & Williams, 2023). In addition, autistic gender diverse individuals report more severe mental health challenges as compared to cisgender autistic and gender diverse non-autistic individuals (George & Stokes, 2018b). Access to attuned support and gender-affirming care is not available everywhere, and autistic individuals have reported difficulties with navigating gender-related medical and psychological care (Strang et al., 2018).

Directions for future research in this field

Based on the input from researchers, advocates, and clinicians, future research should focus on advancing insight into sexuality, gender diversity, and relationships in autistic individuals. Relevant topics include autism-related experiences across the lifespan in the areas of sexuality and gender development, relationships, LGBT+-related experiences and needs, and the intersection with intellectual disabilities. Research should focus on support and interventions to promote sexual health and satisfying relationships, and will benefit from being performed in close collaboration with the autistic community. The inclusion of the perspectives of autistic people in future research, healthcare, and the societal debate on autism and sexuality, including gender diversity, is needed (Dewinter et al., 2020).

From evidence to policy: developing recommendations based on a community-driven approach

The policy recommendations were developed by a core group of researchers, community members, and clinicians (JD, MGO, MLM, EvB, RC, AIRvdM), including three autistic and three non-autistic members, in close collaboration with a broader international expert group (N = 21) who met online in May and August 2022. The project was approved by the Ethical Review Board of the Tilburg School of Social and Behavioral Sciences, Tilburg University (TSB_RP431). Before the first meeting, the experts received an overview of research findings on autism, sexuality, and gender diversity to date (see above). During the first expert meeting, attendees divided across three small groups developed recommendations following the Nominal Group Technique guidelines, a structured method for group discussions to reach consensus (McMillan et al., 2014). The recommendations developed by these experts during the meeting were merged into a set of 11 policy recommendations by the core group and arranged into four themes: (1) education and information, (2) supportive communities, (3) healthcare, and (4) research (see Supplemental Appendix 1). Between the two expert meetings, the recommendations were evaluated through an online survey distributed globally to autistic people, their families, researchers, and professionals. A call for participation was made available in six languages (English, Spanish, French, German, Dutch, and Chinese) and distributed through the broader international group of experts, (networks of) advocacy groups, and autistic-led organizations on all continents. Despite these efforts, only a limited number of participants were reached outside Europe and the United States. Between May and July 2022, 353 autistic adults and 140 family members of autistic people, researchers, and professionals completed the survey.

Survey participants (N = 493) completed demographic questions (see Table 1) and rated the 11 policy statements on a scale ranging from 0 (“Totally not important”) to 10 (“Very important”). The consensus threshold was defined at 80% rating a recommendation 8 or higher. Participants were invited to add additional comments and recommendations or adjustments to the policy recommendations. In the second expert meeting, the final eight policy recommendations were discussed, refined, and approved.

Table 1.

Demographic characteristics.

	Autistic participants		Non-autistic participants
	(N = 353)		(N = 140)
	n	%	n	%
Role^a
Autistic adults	353	100.0	0	.0
Parent	60	17.0	53	37.9
Partner	36	10.2	6	4.3
Professional	29	8.2	95	67.9
Continent and country of living
Africa	1	0.3	0	.0
Ghana	1	0.3	0	.0
Asia	6	1.7	4	2.9
China	1	0.3	0	.0
India	4	1.1	1	0.7
Japan	1	0.3	0	.0
Vietnam	0	0	3	2.1
Australia	21	5.9	6	4.3
Australia	21	5.9	6	4.3
Europe	247	70.0	72	51.4
Belgium	94	26.6	22	15.7
Croatia	6	1.7	0	.0
Czech republic	1	0.3	0	.0
Denmark	51	14.4	8	5.7
Finland	3	0.8	0	.0
France	2	0.6	0	.0
Germany	3	0.8	4	2.9
Greece	1	0.3	0	.0
Ireland	6	1.7	2	1.4
Italy	2	0.6	0	.0
The Netherlands	56	15.9	30	21.4
Slovakia	1	0.3	0	.0
Spain	1	0.3	0	.0
Sweden	2	0.6	0	.0
UK	18	5.1	6	4.3
North America	51	14.4	22	15.7
Canada	2	0.6	0	.0
United States	49	13.9	22	15.7
Central & South America	27	7.6	35	25.0
Argentina	20	5.7	27	19.3
Chile	2	0.6	4	2.9
Mexico	5	1.4	3	2.1
Uruguay	0	.0	1	0.7
Missing	0	.0	1	0.7
Age (years)
< 18	2	0.6	0	.0
18–24	50	14.2	3	2.1
25–34	122	34.6	38	26.2
35–44	100	28.3	45	31.0
45–54	51	14.4	35	24.1
55–64	21	5.9	15	10.3
> 65	7	2.0	2	1.4
Missing	0	.0	2	1.4
Sex
Assigned female at birth (AFAB)	276	78.1	125	89.3
Assigned male at birth (AMAB)	74	20.9	15	10.7
Intersex (AFAB)	3	0.8	0	.0
Gender identities
Cis woman	181	65.6	122	97.6
Cis man	55	74.3	15	100.0
Female + other (queer, non-binary, fluid, agender)	23	—^b	0	—^b
Male + other (queer, non-binary, fluid, agender)	10	—^b	0	—^b
(Trans) male	12	—^b	1	—^b
(Trans) non-binary	7	—^b	0	—^b
(Trans) female	2	—^b	0	—^b
Non-binary/fluid/queer	50	—^b	1	—^b
Agender	3	—^b	1	—^b
Still figuring it out	8	—^b	0	—^b
Relationship status
Single	145	41.2	N/A	N/A
In a relationship, not living together	54	15.3	N/A	N/A
In a relationship, living together	152	43.2	N/A	N/A
Missing	2	0.3	N/A	N/A
Living situation
Own place	285	81.0	N/A	N/A
With parents	52	14.8	N/A	N/A
Group home/supported/hospital	5	1.4	N/A	N/A
No stable housing	5	1.4	N/A	N/A
Other (student housing, co-housing)	4	1.1	N/A	N/A
Missing	2	0.6	N/A	N/A
Received sexuality education
Yes	287	81.5	N/A	N/A
No	65	18.5	N/A	N/A
Rating (0–10) mean (SD) (n = 275)^c	4.7 (2.5)	—^b	N/A	N/A

N/A: not asked; SD: standard deviation. Bold numbers are aggregated results per continent

Participants could combine roles.

Percentages were not calculated as participants could endorse multiple options to best describe their gender identities.

How would you rate the sexuality education you received? (0 = very poor to 10 = excellent and comprehensive).

Community involvement

Autistic and non-autistic researchers, self-advocates, clinicians, and parent organization representatives collaborated in applying for funding, designing and conducting the research, interpreting and reporting the data, and disseminating the results.

Policy recommendations

Eight of the 11 policy recommendations were maintained based on the ratings of the autistic survey participants. Three recommendations on supportive communities did not survive the consensus cut-offs (see Table 2). Additional comments by the autistic participants were analyzed and used to further refine the recommendations. It is beyond the scope of this study to concretize and discuss the specific implications of the recommendations on policy and daily life. However, key references are listed below each recommendation, presenting the state of the research and starting points to translate these recommendations into policy and practice.

Table 2.

Rating of the recommendations.

Recommendations	Autistic participants					Non-autistic participants					All participants
	n	Rating (n)			Cumulative %	n	Rating (n)			Cumulative %	n	Rating (n)			Cumulative %
	n	8	9	10	Cumulative %	n	8	9	10	Cumulative %	n	8	9	10	Cumulative %
Education and information
1. Comprehensive sexuality education	343	57	51	176	82.8	136	19	22	80	89.0	479	76	73	256	84.6
2. Accessible information	339	59	56	172	84.7	136	23	18	74	84.6	475	82	74	246	84.6
Supportive and inclusive communities
1. Inclusive advocacy groups	334	65	46	141	75.4^a	135	26	30	55	82.2	469	91	76	196	77.4^a
2. Societal awareness and views	330	59	45	118	67.3^a	134	30	26	55	82.8	464	89	71	173	71.8^a
3. Meeting opportunities	330	50	44	116	63.6^a	132	27	28	58	85.6	462	77	72	174	69.9^a
Healthcare
1. Train professionals	346	59	64	167	83.8	138	16	30	80	91.3	484	75	94	247	86.0
2. Accessible (health)care	335	69	55	148	81.2	138	23	33	67	89.1	473	92	88	215	83.5
3. Prevention of and support after sexual violence	345	32	46	225	87.8	136	15	27	85	93.4	481	47	73	310	89.4
Research
1. Include autistic individuals in research	343	40	50	208	86.9	136	21	29	70	88.2	479	61	79	278	87.3
2. Fund research that contributes to well-being	334	54	57	155	79.6	135	27	18	63	80.0	469	81	75	218	79.7
3. Research on understanding sexuality and gender identities in underserved groups	333	51	50	175	82.9	136	18	23	71	82.4	469	69	73	246	82.7

Less than 80% of participants rated this recommendation ⩾8 (on a 0–10 scale, with 0 representing the lowest priority/least important and 10 the highest priority/most important).

Theme 1: education and information

1. Provide all autistic individuals with comprehensive and accurate sex education that addresses sexuality, intimate relationships, and gender identity (diversity) from a positive perspective. Sex education can help individuals learn to understand their personal preferences, boundaries, and identities, build skills to develop healthy relationships and recognize harmful relationships.

In addition to this recommendation, autistic adults stressed the need for attention to diverse interests and experiences (e.g. specific sexual interests, asexuality, sensory experiences and preferences, masturbating to regulate stress) in CSE. Awareness about cultural differences (e.g. in some countries CSE is not yet provided in schools so other venues may be needed), the differing needs of specific groups (e.g. individuals with high IQs, people with intellectual disability), the mode in which CSE is offered (individual, in group, in schools, or otherwise), and the timing of sexuality education (e.g. early in development, attuned to the developmental level of youth, making CSE available to adults) were stressed.

Ragaglia et al. (2023) provided an overview of best practices and validated programs, recommendations regarding the content, modalities of CSE, the possible role of different actors, and caveats in the available research.

2. Make information on sexuality and relationships available and easily accessible to autistic individuals and to the people supporting them.

Autistic adults stressed the need to make accurate and comprehensive information accessible to autistic children, adolescents, and adults and their family members, caretakers, and partners. Crehan et al. (2022) explored sexuality and relationship education resources for autistic and neurotypical adults and discussed the importance of using online resources.

Theme 2: healthcare

Train professionals to understand, discuss, and respond to the diverse needs of autistic individuals regarding sexuality, intimate relationships, and gender identity.

This recommendation applies to professionals from diverse backgrounds/disciplines (e.g. teachers, mental health professionals, and medical specialists).

The WHO (2015) already strongly recommended the training of professionals in sexual health knowledge and communication skills. Attention to the specific healthcare experiences and needs of autistic people (Holmes et al., 2023) relating to gender and sexuality should be integrated into the training of professionals.

2. Provide accessible expert (health)care to address the needs of autistic individuals regarding sexuality, intimate relationships, and gender diversity across the lifespan.

Autistic adults call for specific attention to care in the areas of menstruation, pregnancy, parenthood, and menopause.

Holmes et al. (2023) identified facilitators and barriers to sexual and reproductive healthcare for autistic individuals and integrated them in a conceptual model to guide practice, future research, and policy.

3. Improve prevention and/or support services for autistic survivors of sexual violence.

Autistic survey responders pointed out the need for attention to personal expectations and boundaries, and to recognize safe relationships in CSE. In addition, the need for trauma-informed/specialized care for autistic individuals who experience sexual violence was pointed out.

Dike et al. (2022) reviewed the available research on sexual violence among autistic individuals and emphasized the importance of the development of treatment and support strategies for autistic individuals who have experienced sexual violence. Insights based on lived experience of autistic people are essential to understand how to help people who were harmed (Pearson et al., 2023).

Theme 3: research

Ensure that autistic people are included in research projects studying sexuality, gender and related health, and well-being.

The value and importance of participatory research in the field of autism has been emphasized (Fletcher-Watson et al., 2019) and guidelines for participatory autism research are available (Nicolaidis et al., 2019).

2. Promote and fund research that contributes to the well-being of autistic individuals regarding their sexuality, intimate relationships, and gender identities.

Research priorities regarding autism, sexuality, and gender identity have been published (Dewinter et al., 2020) which may have a positive impact on the daily lives of autistic people and their families.

3. Promote and develop research on how to understand and support sexuality, intimate relationships, and gender diversity-related needs in people with intersecting identities—such as autistic people of color, autistic people with limited verbal communication, and autistic people with intellectual disabilities.

The need for attention to the experiences of autistic individuals with intersecting identities has been emphasized and approaches to reducing barriers to research participation have been suggested (Lopez et al., 2022 (intersectionality); Lebenhagen, 2020 (speaking and nonspeaking individuals); Shaia et al., 2020 (Black and African-American families); Strang et al., 2020 (gender diverse individuals)).

Conclusion

These community-based recommendations for education, clinical practice, research, and policy are developed to promote well-being in autistic youth and adults through a positive approach to sexuality and gender diversity. We believe implementation of these recommendations will lead to improved well-being and quality of life of autistic individuals.

Supplemental Material

sj-docx-1-aut-10.1177_13623613231188349 – Supplemental material for Short report: Recommendations for education, clinical practice, research, and policy on promoting well-being in autistic youth and adults through a positive focus on sexuality and gender diversity

Supplemental material, sj-docx-1-aut-10.1177_13623613231188349 for Short report: Recommendations for education, clinical practice, research, and policy on promoting well-being in autistic youth and adults through a positive focus on sexuality and gender diversity by Jeroen Dewinter, Morénike Giwa Onaiwu, Maria L Massolo, Reid Caplan, Els Van Beneden, Nikki Brörmann, Eileen T Crehan, Lisa A Croen, Susan Faja, Dena L Gassner, Laura Graham Holmes, Cat Hughes, Morrigan Hunter, Monique Huysamen, Paola Jelonche, Meng-Chuan Lai, Ilse Noens, Heta Pukki, Mark A Stokes, John F Strang and Anna IR van der Miesen in Autism

Footnotes

Acknowledgements

We thank everyone who completed the survey and those who advised and supported us during the process of developing these policy recommendations. Special thanks to Annika Kooke and Ross Howard-Hildige for reviewing the available research; to Cora Coehorst, Elizabeth Graham, Ann De Keersmaecker, Ingrid Verhaegen, and Karen Wangari for their contribution in the expert meetings; and to the participants at the LAVA— Autistic Adults’ Reading and Advisory Group reading session who provided feedback on this article.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funds to support this research were provided by the International Society for Autism Research (INSAR). INSAR is not responsible for, nor does it endorse, the content of this report.

ORCID iDs

Jeroen Dewinter

Lisa A Croen

Susan Faja

Mark A Stokes

Supplemental material

Supplemental material for this article is available online.

Notes

References

Ballan

M. S.

(2012). Parental perspectives of communication about sexuality in families of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 676–684. https://doi.org/10.1007/s10803-011-1293-y

Barnett

J. P.

Maticka-Tyndale

(2015). Qualitative exploration of sexual experiences among adults on the autism spectrum: Implications for sex education. Perspectives on Sexual and Reproductive Health, 47(4), 171–179. https://doi.org/10.1363/47e5715

Bertilsdotter Rosqvist

. (2014). Becoming an ‘autistic couple’: Narratives of sexuality and couplehood within the Swedish autistic self-advocacy movement. Sexuality and Disability, 32(3), 351–363. https://doi.org/10.1007/s11195-013-9336-2

Bottema-Beutel

Kapp

S. K.

Lester

J. N.

Sasson

N. J.

Hand

B. N

. (2021). Avoiding Ableist Language: Suggestions for Autism Researchers. Autism in adulthood : challenges and management, 3(1), 18–29. https://doi.org/10.1089/aut.2020.0014

Buijsman

Begeer

Scheeren

A. M

. (2023). ‘Autistic person’ or ‘person with autism’? Person-first language preference in Dutch adults with autism and parents. Autism, 27(3), 788–795. https://doi.org/10.1177/13623613221117914

Byers

E. S.

Nichols

Voyer

S. D.

(2013). Challenging stereotypes: Sexual functioning of single adults with high functioning autism spectrum disorder. Journal of Autism and Developmental Disorders, 43, 2617–2627. https://doi.org/10.1007/s10803-013-1813-z

Corbett

B. A.

Vandekar

Muscatello

R. A.

Tanguturi

(2020). Pubertal timing during early adolescence: Advanced pubertal onset in females with autism spectrum disorder. Autism Research, 13(12), 2202–2215. https://doi.org/10.1002/aur.2406

Crehan

E. T.

Rocha

Dufresne

(2022). Brief report: Sources of sexuality and relationship education for autistic and neurotypical adults in the U.S. and a call to action. Journal of Autism and Developmental Disorders, 52, 908–913. https://doi.org/10.1007/s10803-021-04992-z

Dewinter

De Graaf

Begeer

(2017). Sexual orientation, gender identity, and romantic relationships in adolescents and adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(9), 2927–2934. https://doi.org/10.1007/s10803-017-3199-9

10.

Dewinter

van der Miesen

A. I. R.

Holmes

L. G.

(2020). INSAR Special Interest Group report: Stakeholder perspectives on priorities for future research on autism, sexuality, and intimate relationships. Autism Research, 13(8), 1248–1257. https://doi.org/10.1002/aur.2340

11.

Dewinter

Vermeiren

Vanwesenbeeck

Lobbestael

Van Nieuwenhuizen

(2015). Sexuality in adolescent boys with autism spectrum disorder: Self-reported behaviours and attitudes. Journal of Autism and Developmental Disorders, 45(3), 731–741. https://doi.org/10.1007/s10803-014-2226-3

12.

Dewinter

Vermeiren

Vanwesenbeeck

Van Nieuwenhuizen

(2013). Autism and normative sexual development: A narrative review. Journal of Clinical Nursing, 22, 3467–3483. https://doi.org/10.1111/jocn.12397

13.

Dike

J. E.

DeLucia

E. A.

Semones

Andrzejewski

McDonnell

C. G.

(2022). A systematic review of sexual violence among autistic individuals. Review Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s40489-022-00310-0

14.

Fletcher-Watson

Adams

Brook

Charman

Crane

Cusack

, . . . Pellicano

(2019). Making the future together: Shaping autism research through meaningful participation. Autism, 23(4), 943–953. https://doi.org/10.1177/1362361318786721

15.

George

Stokes

M. A.

(2018a). Gender identity and sexual orientation in autism spectrum disorder. Autism, 11(1), 133–141. https://doi.org/10.1177/1362361317714587

16.

George

Stokes

M. A.

(2018b). A quantitative analysis of mental health among sexual and gender minority groups in ASD. Journal of Autism and Developmental Disorders, 48, 2052–2063. https://doi.org/10.1007/s10803-018-3469-1

17.

Gibbs

Hudson

Hwang

Y. I.

Arnold

Trollor

Pellicano

(2021). Experiences of physical and sexual violence as reported by autistic adults without intellectual disability: Rate, gender patterns and clinical correlates. Research in Autism Spectrum Disorders, 89, 101866. https://doi.org/10.1016/j.rasd.2021.101866

18.

Groenman

A. P.

Torenvliet

Radhoe

T. A.

Agelink Van Rentergem

J. A.

Geurts

H. M.

(2022). Menstruation and menopause in autistic adults: Periods of importance? Autism, 26(6), 1563–1572. https://doi.org/10.1177/13623613211059721

19.

Hall

J. P.

Batza

Streed

C. G.

Boyd

B. A.

Kurth

N. K.

(2020). Health disparities among sexual and gender minorities with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50(8), 3071–3077. https://doi.org/10.1007/s10803-020-04399-2

20.

Hampton

Man

Allison

Aydin

Baron-Cohen

Holt

(2023). A qualitative exploration of autistic mothers’ experiences I: Pregnancy experiences. Autism, 27(5), 1271–1282. https://doi.org/10.1177/13623613221132435

21.

Hannah

L. A.

Stagg

S. D.

(2016). Experiences of sex education and sexual awareness in young adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(12), 3678–3687. https://doi.org/10.1007/s10803-016-2906-2

22.

Higgs

Carter

A. J.

(2015). Autism spectrum disorder and sexual offending: Responsivity in forensic interventions. Aggression and Violent Behavior, 22, 112–119. https://doi.org/10.1016/j.avb.2015.04.003

23.

Holmes

L. G.

Anderson

Sieber

G. S.

Shattuck

P. T

. (2023). Sexual and reproductive health services for autistic young people in the United States: A conceptual model of utilization. Perspectives on sexual and reproductive health, 55(1), 49–61. https://doi.org/10.1363/psrh.12221

24.

Holmes

L. G.

Himle

M. B.

(2014). Brief report: Parent-child sexuality communication and autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(11), 2964–2970. https://doi.org/10.1007/s10803-014-2146-2

25.

Holmes

L. G.

Himle

M. B.

Sewell

K. K.

Carbone

P. S.

Strassberg

D. S.

Murphy

N. A.

(2014). Addressing sexuality in youth with autism spectrum disorders: Current pediatric practices and barriers. Journal of Developmental and Behavioral Pediatrics, 35(3), 172–178. https://doi.org/10.1097/DBP.0000000000000030

26.

Kallitsounaki

Williams

D. M.

(2023). Autism spectrum disorder and gender dysphoria/incongruence. A systematic literature review and meta-analysis. Journal of Autism and Developmental Disorders, 53, 3103–3117. https://doi.org/10.1007/s10803-022-05517-y

27.

Lebenhagen

(2020). Including speaking and nonspeaking autistic voice in research. Autism in Adulthood, 2(2), 128–131. https://doi.org/10.1089/aut.2019.0002

28.

Lopez

Nicolaidis

Garcia

Waisman

T. C.

Cascio

M. A.

Feng

(2022). An expert roundtable discussion on intersectionality and autism in adulthood. Autism in Adulthood, 4(4), 258–264. https://doi.org/10.1089/aut.2022.29021.klo

29.

May

Pang

K. C.

O’Connell

M. A.

Williams

(2017). Typical pubertal timing in an Australian population of girls and boys with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(12), 3983–3993. https://doi.org/10.1007/s10803-017-3281-3

30.

McMillan

S. S.

Kelly

Sav

Kendall

King

M. A.

Whitty

J. A.

Wheeler

A. J.

(2014). Using the Nominal Group Technique: How to analyse across multiple groups. Health Services and Outcomes Research Methodology, 14(3), 92–108. https://doi.org/10.1007/s10742-014-0121-1

31.

Moseley

R. L.

Druce

Turner-Cobb

J. M.

(2021). Autism research is ‘all about the blokes and the kids’: Autistic women breaking the silence on menopause. British Journal of Health Psychology, 26(3), 709–726. https://doi.org/10.1111/bjhp.12477

32.

Nicolaidis

Raymaker

Kapp

S. K.

Baggs

Ashkenazy

McDonald

, . . . Joyce

(2019). The AASPIRE practice-based guidelines for the inclusion of autistic adults in research as co-researchers and study participants. Autism, 23(8), 2007–2019. https://doi.org/10.1177/1362361319830523

33.

Nicolaidis

Raymaker

McDonald

Dern

Boisclair

W. C.

Ashkenazy

Baggs

(2013). Comparison of healthcare experiences in autistic and non-autistic adults: A cross-sectional online survey facilitated by an academic-community partnership. Journal of General Internal Medicine, 28(6), 761–769. https://doi.org/10.1007/s11606-012-2262-7

34.

Pearson

Rose

Rees

(2023). ‘I felt like I deserved it because I was autistic’: Understanding the impact of interpersonal victimisation in the lives of autistic people. Autism, 27(2), 500–511. https://doi.org/10.1177/13623613221104546

35.

Ragaglia

Caputi

Bulgarelli

(2023). Psychosexual education interventions for autistic youth and adults—A systematic review. Education Sciences, 13(3), 224. https://doi.org/10.3390/educsci13030224

36.

Sala

Hooley

Stokes

M. A.

(2020). Romantic intimacy in autism: A qualitative analysis. Journal of Autism and Developmental Disorders, 50, 4133–4147. https://doi.org/10.1007/s10803-020-04377-8

37.

Shaia

W. E.

Nichols

H. M.

Dababnah

Campion

Garbarino

(2020). Brief report: Participation of Black and African-American families in autism research. Journal of Autism and Developmental Disorders, 50(5), 1841–1846. https://doi.org/10.1007/s10803-019-03926-0

38.

Strang

J. F.

Powers

M. D.

Knauss

Sibarium

Leibowitz

S. F.

Kenworthy

, . . . Anthony

L. G.

(2018). “They thought it was an obsession””: Trajectories and perspectives of autistic transgender and gender-diverse adolescents. Journal of Autism and Developmental Disorders, 48(12), 4039–4055. https://doi.org/10.1007/s10803-018-3723-6

39.

Strang

J. F.

van der Miesen

A. I. R.

Caplan

Hughes

DaVanport

Lai

M.-C.

(2020). Both sex- and gender-related factors should be considered in autism research and clinical practice. Autism, 24(3), 539–543. https://doi.org/10.1177/1362361320913192

40.

Strunz

Schermuck

Ballerstein

Ahlers

C. J.

Dziobek

Roepke

(2017). Romantic relationships and relationship satisfaction among adults with Asperger syndrome and high-functioning autism. Journal of Clinical Psychology, 73(1), 113–125. https://doi.org/10.1002/jclp.22319

41.

van der Miesen

A. I. R.

Hurley

De Vries

A. L. C.

(2016). Gender dysphoria and autism spectrum disorder: A narrative review. International Review of Psychiatry, 28(1), 70–80. https://doi.org/10.3109/09540261.2015.1111199

42.

Visser

Greaves-Lord

Tick

N. T.

Verhulst

F. C.

Maras

van der Vegt

E. J. M.

(2017). A randomized controlled trial to examine the effects of the Tackling Teenage psychosexual training program for adolescents with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 58(7), 840–850. https://doi.org/10.1186/s12888-015-0586-7

43.

Weir

Allison

Baron-Cohen

(2021). The sexual health, orientation, and activity of autistic adolescents and adults. Autism Research, 14(11), 2342–2354. https://doi.org/10.1002/aur.2604

44.

World Health Organization. (2006). Defining sexual health: Report of a technical consultation on sexual health 28–31 January 2002, Geneva.

45.

World Health Organization. (2015). Brief sexuality-related communication: Recommendations for a public health approach.

46.

World Health Organization. (2022). Sexual health. https://www.who.int/health-topics/sexual-health#tab=tab_1

Supplementary Material

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Short report: Recommendations for education,clinical practice,research,and policy on promoting well-being in autistic youth and adults through a positive focus on sexuality and gender diversity

Abstract

Lay Abstract

Keywords

Introduction

Autism, sexuality, and gender diversity: summarizing the evidence base

Sexual development

Intimate relationships

Sexual attraction and identities

Sexual violence and victimization

Sexuality education

Sexual and reproductive healthcare

Gender identity diversity and gender incongruence

Directions for future research in this field

From evidence to policy: developing recommendations based on a community-driven approach

Community involvement

Policy recommendations

Theme 1: education and information

Theme 2: healthcare

Theme 3: research

Conclusion

Supplemental Material

sj-docx-1-aut-10.1177_13623613231188349 – Supplemental material for Short report: Recommendations for education, clinical practice, research, and policy on promoting well-being in autistic youth and adults through a positive focus on sexuality and gender diversity

Footnotes

Acknowledgements

Declaration of conflicting interests

Funding

ORCID iDs

Supplemental material

Notes

References

Supplementary Material