Jessica Cauchi - Peter Gerhardt - Justin B Leaf - Mary Jane Weiss - Clinician's Guide To Sexuality and Autism - A Guide To Sex Education For Individuals With Autism Spectrum Disorders-Elsevier (2023)

Clinician’s Guide to
SEXUALITY AND
AUTISM
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Clinician’s Guide to
SEXUALITY AND
AUTISM
A Guide to Sex Education for
Individuals with Autism
Spectrum Disorders
JESSICA CAUCHI
Atlas Behaviour Consultation, Endicott College, Canada
PETER F. GERHARDT
The EPIC Programs, Endicott College, Canada
JUSTIN B. LEAF
Autism Partnership Foundation, Endicott College, United
States
MARY JANE WEISS

Dean, Institute for Applied Behavioral Science, Endicott
College, United States
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Dedication
To individuals with autism and with other disability labels who have been
denied access to, and acknowledgement of, their sexuality for far too long.
Contents
Acknowledgments xi
PART ONE Introduction and foundational material
1. Why is this book necessary? 3

Sexual abuse, violence, and victimization 5
Sexual rights and pleasure 6
Conclusion 7
2. How to use this book 9

When to start teaching sex education? 9
Who should teach these skills? 10
How to teach? 11
Consent and assent 12
Where should sex education be taught? 13
Who should receive sex education? 13
The use of peers 13
Values and preference 14
Other resources 14
Final considerations 15
3. Interventions 17
The interventions 20
Conclusion 32
PART TWO Curriculum
4. Age ranges 35
5. Body parts 37
Body partsdbio 41
Body partsdslang 42
vii
viii Contents
6. Menstrual care 43
Management of sanitary materials 46
Tracking of cycle 47
7. Reproduction and birth control 49

Reproductive system 51
Birth control 51
8. Health and hygiene 53

Hygiene 57
Tolerates medical procedures 58
Monitors health 59
Puberty 60
9. Sexuality and the law 61

Laws as a victim 63
Laws as a Perpetrator 63
Laws related to pornography 64
Laws related to public acts 64
10. Online activity 65

Privacy 68
Social interactions 69
Online navigation 70
11. Sexual acts 71

Sexual acts 75
Vocabulary 76
12. Consent 79
Demonstrating consent 83
Consent and assent recognition 85
13. Social skills 87

Type of interactions 92
Initiation of interactions 93
Responding to interactions 94
Making plans 95
Communicating preferences 96
Contents ix
14. Sexual abuse prevention and reporting 97

Functional protest 103
Recall events 104
Discrimination of people and events 105
Safety assessment 106
Abuse 107
15. Masturbation 109

Privacy 112
Toy and material management and hygiene 113
Effective masturbation 113
16. Sexual orientation 115

Recognition of sexual orientation 118
Disclosure of sexual orientation 118
Vocabulary related to sexual orientation 119
17. Gender identity 121

Recognition of gender identity 124
Disclosure of gender identity 125
Vocabulary related to gender identity 126
18. Individual preferences 127

Menstrual care 130
Birth control 131
Masturbation aids 132
Dating activities 133
Sexual acts 134
19. Types of relationships 135

Types of relationships 139
Expectations of relationships 141
20. Problem solving and critical thinking 143

Planning ahead 146
In-the-moment decisions 146
Resources 147
x Contents
Appendix
21. Resources 151

Online resources 151
Teaching social skills 152
Books about sex 152
Books about puberty 153
22. Concluding thoughts 155
References 159
Index 167
Acknowledgments
The authors would like to thank Amy Gravino, Dr. Tracee Parker, and
Dr. Thomas Zane for their insightful comments at various points in this
process. They were all gracious with their time and talents and their efforts
are greatly appreciated.
xi
PART ONE
Introduction and
foundational material
1
CHAPTER 1
Why is this book necessary?
Abstract
Sexuality education is of paramount importance for all, but especially for people on
the Autism Spectrum. This book provides a comprehensive sexuality education cur-
riculum for learners of all ages with autism. With an emphasis on assent and respect,
this curriculum targets component skills across a variety of domains related to sex
education. A review of evidence-based teaching strategies is also included, with
reference to suggested methods for teaching throughout.
Keywords: ABA; Autism; Sex education; Sexuality.
For decades, sex education has been, and continues to be, perhaps the most
controversial and complex instructional domain that (ideally) exists in
educational curricula (Kendall, 2014). The reasons behind this controversy
range from personal privacy to parent and/or student rights, community
norms and personal biases, to religious beliefs and prohibitions. Beyond the
controversy, human sexuality is complex in that it involves biology, psy-
chology, personal preferences and idiosyncrasies, personal and familial
values, sociocultural norms (Parchomiuk, 2022), and what may or may not
constitute pleasure on an individual basis. To that end, the World Health
Organization (2006) defines sexuality as being “experienced and expressed
in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices,
roles and relationships. [.] Sexuality is influenced by the interaction of
biological, psychological, social, economic, political, cultural, legal, his-
torical, religious and spiritual factors.” (World Health Organization, 2006).
In other words, human sexuality, and sex education, is complicated (e.g.,
Kendall, 2014).
At the same time, autism spectrum disorder (ASD) represents a complex
expression of neurodivergence that is different for each person on the
spectrum. The autism spectrum includes individuals with profound intel-
lectual disabilities on one end and individuals with above-average intelli-
gence on the other. It includes individuals with severely limited
communication skills and social awareness to those with fluent language
Clinician's Guide to Sexuality and Autism
ISBN 978-0-323-95743-4 © 2024 Elsevier Inc.
https://doi.org/10.1016/B978-0-323-95743-4.00007-2 All rights reserved. 3
4 Clinician's Guide to Sexuality and Autism
and significant social awareness. And it includes individuals who display

significant, potentially dangerous challenging behavior and those who do
not. So, if we layer this diversity on top of the complexities of human
sexuality, we get an extraordinarily complex multidimensional matrix of
human behavior.
But everyone along the continuum of neurodiversity has the right to
understand, to the greatest extent possible, their own sexual personhood; to
express, to the greatest extent possible, their own sexual personhood; and to be
safe, to the greatest extent possible, in their own sexual personhood. As such,
comprehensive and individualized sex education tailored to the needs of
autistic individuals should be considered an essential part of autism education
(e.g., Bloor et al., 2022; Herrick & Datti, 2022).
Unfortunately, despite the importance of sex education, there is limited
research documenting what constitutes effective sex education and/or
intervention (e.g., Picard-Pageau & Morales, 2022) and for whom (e.g.,
Davies et al., 2021; McDaniels & Fleming, 2016; Stanojevic et al., 2021).
This is not entirely surprising given (1) the historical infantilization of
people with developmental disabilities (Stevenson et al., 2011), societal
discomfort with the topic of sexuality in general, let alone the sexuality of
learners with autism (Herson et al., 1999), and (2) cultural disagreements as
to the appropriateness of sex education provided outside of the nuclear
family. For example, the Sexuality Education, and Information Council of
the United States (SEICUS, 2021) noted sex education within a general
education curriculum is a piecemeal collection of laws, ideologies, religious
beliefs, and a mix of accurate and inaccurate information across states. They
go on to report:
• Only 29 states and the District of Columbia mandate sex education.
• 35 states require schools to stress abstinence education.
• Just 16 states require instruction on condoms or contraception.
• 15 states do not require sex education to be any of the following: age-
appropriate, medically accurate, culturally responsive, or evidence-
based/evidence-informed.
• Only 9 states require sex education to include information on consent.
• Only 8 states require culturally responsive sex education.
• Just 7 states have policies that include affirming sexual orientation in-
struction on LGBQT identities or discussion of sexual health for
LGBQT youth.
• 9 states explicitly require instruction that discriminates against LGBTQ
people.
Why is this book necessary? 5
Source: Sex Ed State Law and Policy Chart: SIECUS State Profiles 2021.
https://siecus.org/wp-content/uploads/2021/12/2021-Sex-Ed-State-Law-
and-Policy-Chart-3.pdf.
This, in turn, results in an aspect of being human where there is high
interest but little research, few programs, or even agreed-upon parameters
for instruction/intervention.
The intent of sex education is to help individuals understand sexuality
and sexual health, learn how to make safe decisions while decreasing rates of
sexually transmitted diseases, and how to prevent sexual abuse (e.g.,
Schmidt et al., 2019). This, however, gets complex for autistic learners,
given each individual’s social, communication, and sensory profiles, which
appear to “interact with access to information, motivation to engage in
healthy sexual activities, and the development of skills needed to engage in
healthy sexual behavior” (Solomon et al., 2019, p. 339). In addition, much
of what constitutes the sex education provided to autistic learners is
knowledge-based (e.g., completing quizzes or worksheets) instead of based
in behavior skills training (BST) and dependent on the acquisition of the
actual skills (e.g., Davies et al., 2021; Sala et al., 2019). In other words,
successful outcomes are more often based on verbal responses to questions
rather than on the display of an actual, relevant skill or skill set (Gerhardt
et al., 2022) in the environment where it is most likely to be displayed. This
is also troubling given that high verbal adults may know the language of
sexuality, but this knowledge does not generally translate into the corre-
sponding behavior (e.g., Kellaher, 2015).
Therefore, the necessity for this book that you now hold in your hand.
Sexual abuse, violence, and victimization

Sexual abuse, violence, and victimization generally refer to a broad range of
perpetrator behavior including, but not limited to, rape, attempted rape,
sexual assault, drug facilitated sexual assault, unwanted touching, incest, and
sexual violation. What connects these topographies of criminal behavior is
that all such acts are perpetrated in the absence of consent by the target/
victim (Garvey & Senn, 2014). As such, a central goal of comprehensive sex
education is the development of the skills associated with increased sexual
safety (including personal advocacy and understanding boundaries) and a
subsequent reduction in the prevalence of sexual victimization and violence
(e.g., Schneider & Hirsch, 2020). Despite the importance of this goal, the
majority of children, adolescents, and adults on the spectrum receive little, if
any, in the way of such instruction (Barnard-Brak, et al., 2014). Further,

Herrick and Datti (2022) suggest that since autistics generally receive
limited sex education and are somewhat more likely than the general
population to identify as a sexual minority (see Graham & Padilla, 2014),
the need for comprehensive sex education may be even more critically
important than it is for other groups.
Reported rates of sexual abuse and victimization of autistic adults are
consistently higher than those reported by their neurotypical peers. Åker
and Johnson (2020) reviewed the transcripts of actual police interviews with
individuals with ASD and Intellectual Disability (ID) following allegations
of sexual abuse in Norway. The authors reported that the majority of
victims were female in their early twenties and were abused by someone
they knew. Ohlsson Gotby et al. (2018) conducted a large (4500 in-
dividuals) population-based study in Sweden on the prevalence of the
coercive sexual victimization or individuals with ASD and individuals with
ADHD. The authors reported that women on the spectrum experienced a
threefold increased risk of coercive sexual victimization while women with
ADHD experienced a doubled risk. Most recently, Cazalis et al. (2022)
reported the results of an online survey of 225 autistic women in France
who were asked to complete an open question survey and a questionnaire
derived from the Sexual Experiences Survey - Short Form Victimization.
The results indicated that between 68.9% (open question survey) and 88.4%
(sexual experiences survey) had experienced sexual violence, 66% of who
reported being very young at the time of first assault. Multiple episodes of
victimization were reported by 75% of the women.
Of particular relevance in Cazalis et al. (2022) is the author’s argument
that sexual victimization is more a function of personal vulnerability, than it
is of being autistic (although autism acts as a vulnerability factor). This is
important as it supports the importance of educating individuals on how to
protect themselves more effectively from threats and acts of sexual violence;
in other words, by being provided an evidence-based and comprehensive
sex education.
Therefore, the necessity for this book that you now hold in your hand.
Sexual rights and pleasure

Sexual rights can be understood as including the freedoms, opportunities,
and protections such that individuals or groups can engage in sexual
expression, develop healthy sexualities, and have their sexualities accepted
Why is this book necessary? 7
by the society in which they live (Tolman, 2006). Collectively, this can be
understood as the right to access sexual pleasure (e.g., Alexander & Gomez,
2017). Calabrò et al. (2022) recently argued that autistic adults, just like the
rest of the neurodiversity continuum, have the right to experience the best
possible quality of life, including sexual well-being. The authors go on to
argue that autistic adolescents and adults may require access to a sex coach
which they define as “a trained professional who helps people with sexual,
intimacy and relationship issues, [.] but also guides their clients to fully
grasp their sexual potential through education, training, and communica-
tion” (p. 964). While this may be ideal, the continuing challenges to the
simple provision of sex education make it difficult to imagine how this
might become accepted practice in the near future.
Sexual pleasure, however, is about more than biology or physiology.
Emotional context and relationships play a major role in feeling sexual
pleasure or satisfaction. The sexual interest of adolescents and adults on the
spectrum is comparable to that of neurologically typical adolescents and
adults (e.g., Hancock et al., 2020) as is, to a somewhat lesser extent, the
desire to be in a relationship. Dewinter et al. (2017) surveyed 675 autistic
adolescents and adults and compared their reported sexual orientation and
intimate relationship experience with general population peers (n ¼ 8064).
The results indicated that a majority of respondents with and without ASD,
identified as congruent with their assigned gender at birth, have been
attracted to someone of the opposite gender, and have been in at least one
heterosexual intimate relationship. Autistic women reported a higher level
of same-sex attraction and, and the same time, did not necessarily identify as
female. About 50% of respondents with ASD reported being in a generally
satisfying relationship and those in a relationship tended to live with their
partner. Hancock et al. (2020) reported the results of a separate online study
and noted that while the autistic adults who responded reported a similar
level of interest in relationships to their general population peers, they also
reported fewer opportunities to meet potential new partners and had
shorter relationship duration. Importantly, they also reported learning less
about sexuality from their peers.
Conclusion
At least in North America, sex education continues to be controversial and
the sexual abuse and victimization of individuals on the spectrum, partic-
ularly females on the spectrum, remains unacceptably high (although,
arguably, there is no acceptable level of abuse or victimization). While

about 50% of high verbal adults reported being in a committed relationship,
50% did not, and we continue to know little about the sexual satisfaction of
autistic adults either in isolation or in a relationship. More challenged in-
dividuals are, unfortunately, substantially absent the review literature. But
for this group, there is more behavior analytic research on decreasing the
“inappropriate” sexual behavior people on the spectrum (Mann & Travers,
2020), than there is on teaching appropriate, enjoyable, and safe sexual
behavior in the form of masturbation (Cicero, 2019); problematic, but not
exactly surprising.
As a society and as a field, we still have long way to go before evidence-
based sex education is widely available and individuals with autism who
want to be in romantic relationship can access the support they need, if they
need it. We have a long way to go before the prevalence and associated
trauma of sexual abuse and violence for individuals with, minimally,
reduced. We have a long way to go before autistic individuals move from
being marginalized members of society to just being members of society.
We have a long way to go before more challenged autistic adults are seen,
universally as true adults and no longer are infantilized when it comes to
sexuality, independence, and participation in their own lives.
Basically, we have a long way to go. Therefore, the necessity for this
book that you now hold in your hand.
CHAPTER 2
How to use this book
Abstract
This book is designed to be used with learners of all ages on the autism spectrum, with
education provided by behavior analysts, teachers and educators, and parents. This
chapter covers an outline of how to use the book to provide effective teaching in
sexuality education with an emphasis on individualization for specific learners.
Keywords: ABA; Autism spectrum disorders; Caregiver; Clinician; Sex education;

Sexuality.
When to start teaching sex education?

The short answer is as soon as possible! Most sexuality-related skills are
complex and are comprised of myriad small, composite skills. Surprisingly,
many of these composite skills are, on the surface, not related to sex at all.
However, building strong foundational skills across the different domains
will help lead to acquisition of the more complex skills related to sexuality.
Throughout the book, each skill has a suggested target age range listed.
This is, as is everything else in this book, meant to be a guide. The age range
listed alongside each skill is an indicator of when it may be appropriate to
begin teaching the selected skill. Several skills should be targeted in the
preschool/early school age years. It is possible that the individual you know
is older than the suggested age range when you begin to use this book. In
that case, you may need to go back and teach skills that were indicated for
acquisition at a younger age. In other cases, you may not need to; use your
best judgment about the appropriateness of skill and its priority in the in-
dividual’s educational programming. Some skills simply do not apply to
older learners; that is, one should ensure their 8-year-old learner has the
preschool aged skill of saying no to unwanted physical contact, but would
not need to ensure they can use preschool-appropriate slang for body parts.
In a broader sense, sex education should begin as early as possible.
Sexuality is complex, and waiting until the skills are expected to be used is,
unfortunately, too late. Many skills will take a significant amount of time to
teach, and it’s important that they are mastered before they are expected to
be used in everyday life. Including sex education as an early, and ongoing
part of an education or treatment plan for someone with autism will help
increase the likelihood that they will be safe, have an improved sense of
well-being, and have an overall positive quality of life down the line. In
addition, normalizing the discussion of these topics, as well as instruction in
sexuality-related skills, helps to demystify these skills for instructors, autistic
individuals, and family members. It is important to approach these skills as
normal, appropriate, and essential. The earlier those messages can be sent,
the earlier we are establishing the kind of positive, open environment that
will help in the acquisition of these skills.
Who should teach these skills?

This book is designed for use by behavior analysts, teachers and other edu-
cators, parents, and anyone else involved in the consensual education of
autistic individuals. Further considerations are warranted however. The first is
the overall comfort level of the individual providing sex education. The
person providing sex education should be knowledgeable in the topics pre-
sented, and comfortable discussing sexuality clearly, openly, and with direct
language. When we are uncomfortable with the subject matter, we tend to be
less direct, use more euphemisms and representative language, and “dance
around” the topic. For learners on the autism spectrum, this makes under-
standing the facts of sexuality more complicated and more difficult. Ensuring
that the instructor is presenting the information in a direct, clear, and neutral
manner will help promote a much more positive educational outcome. Not
all members of instructional teams will be comfortable in these roles; as with
other elements of instruction, matching the instructor to the content area is an
important element of successful teaching. In addition, we all have have
limitations on our areas of instructional competence. As familar as many of us
may be with masturbation or other physical aspects of sexuality, such famil-
iarity does not translate into an ability to safely, effectively, or legally provide,
say, hand over hand instruction in those areas.
The nature of some skills related to sexuality may make certain people
in the learner’s life more or less appropriate to function as the teacher/
instructor. For example, it may be appropriate for a clinician in an ABA
clinic to teach a 4-year-old child to label body parts, including penis, by
using pictures, but it should be that child’s parent or caregiver that teaches
How to use this book 11
him to label that body part on himself. Conversely, when targeting slang for
sexual acts, the learner’s parents may not be the most knowledgeable or
comfortable instructors.
A final consideration is the extent to which there may be unintentional
lessons being taught alongside the intended lesson. For example, if multiple
instructors are working with an individual in the bathroom to teach
menstrual care the skill may be acquired, but so will, potentially, an un-
derstanding and/or acceptance that it is appropriate for different people to
be in a private washroom with the student while she is performing a very
personal and private skill. From a safety perspective, this is not something
we would want the learner to be comfortable with; rather, we would like
them to learn that unfamiliar adults should not be in private washrooms
alone with you. There are many of these potential unintentional lessons
within sex education, and careful consideration should be given to who is
providing instruction, where instruction is provided, and how it is being
provided. The team should consider these issues for each and every skill.
How to teach?
As will be reviewed in the next chapter, there are many evidence-based,
behavior-analytic teaching strategies appropriate to teach skills to people with
autism. Within each domain, the recommended teaching strategies are listed.
These are cross-referenced with the strategies outlined in the following
chapter and are provided as a recommendation only; consider them to be
clinical suggestions. Overall, each skill should be broken down and taught to
the learner in the way that best matches his or her individual learning profile.
In many cases, sex education will be provided to a learner as a part of a
more comprehensive overall program of instruction. The clinician,
educator, or caregiver likely already knows effective teaching strategies for a
particular individual learner. The target skills within this book should be
taught using evidence-based strategies that best apply to that individual
learner. In many cases several teaching strategies are listed for the same skill
domain. In these cases, all teaching strategies may be appropriate and the
instructor should choose the one they think will be most effective based on
what they already know about the learner. It may be that the same
instructor teaches one skill to a particular learner using one teaching strategy
and the same skill to another learner using a different strategy. In other
words, interpret the information as guidelines and suggestions based upon
your knowledge and history with the learner in question.
Consent and assent

Perhaps more so than in any other instructional domain, both parent/
guardian consent and student assent needs to be obtained prior to in-
struction being provided. Parameters of instruction including specific goals,
teaching methodology, and potential benefits and risk need to be explained
to both the parent guardian and the individual learner. In addition, aspects
such as who will be providing instruction, how often instruction is to take
place, where it is to place, and how acquisition will be measured need to be
fully disclosed in advance of teaching. Barriers and limits to confidentiality
should be delineated as well, to help ensure everyone is comfortable with
their particular roles in the process.
In terms of assent, both verbal and behavioral indicators of student assent
should be identified prior to the onset of instruction. In addition, the
student needs to be free to terminate instruction should they desire. This
does not necessarily mean that instruction completely stops. Rather, it
indicates that, perhaps, a reevaluation of how instruction is provided is
necessitated. Overall, recognizing that sex education can be a deeply per-
sonal, value-heavy, and sometimes uncomfortable topic means that
ongoing assent to teaching should be emphasized.
One way to think about sexual behavior is to think about it as, well,
behavior. The skills included here in sex education are all overt or covert
behavior, meaning they can be taught the same way that other skills are
taught to individuals with autism. The same behavior analytic principles of
reinforcement, prompting, social validity, generalization and maintenance
all apply. This can help make the inherent instructional challenges seem a
bit less formidable.
Finally, the skill sets focused on within sexuality instruction are broad,
multifaceted, chained, and context-specific. While the skills listed are
considered component skills, as in, they are smaller components of broader
composite skills, they will likely still need to be broken down into smaller
parts to teach. The ways in which skills can be chained together is indi-
vidualized and, often, nuanced. Contextual factors can change everything
about identifying the best behavioral option in a situation; hence, the
individualization of strategies is the most important message. As in all other
behavioral intervention approaches, it is important for us to assess the needs
and tailor intervention for the individual in a highly specific, individualized
manner.
Where should sex education be taught?

This will vary by learner. In general, teaching should only occur in a
classroom or larger group setting once the learner has demonstrated ability
to learn effectively in that type of setting. For some individuals, group
instruction may be difficult and 1:1 teaching may be required. Conversely,
many of the social interaction type skills will be more difficult to teach
without peers to practice with. As such, some of the more overt social skills
may be more appropriate for group instruction. Additionally, while some
skills are objective (e.g., body parts), others may be more personal (e.g.,
preference in sexual acts), and may be more appropriate to target in a less
shared setting.
Who should receive sex education?

Everyone! While this book is intended to provide a comprehensive
overview, some skills will be more or less relevant to individual learners.
Adaptations can be made for nonvocal communicators, those that use
alternative forms of communication, and those with lower levels of inde-
pendence in self-care. It should not be assumed that there is anything about
an individual’s diagnosis, level of communication, current social in-
teractions, cognitive functioning, or academic performance can tell us
anything about their interest in sex. The skills contained in this book are
important for helping ensure an individual’s safety, independence, and
quality of life related to sex.
The use of peers

Throughout the various instructional domains in this book. special
consideration is given to the use of peers as a resource. As “with it” or well-
informed any practitioner may consider themselves, they are most definitely
missing information about the kind of slang teens use, what sort of apps
school-age kids are using, and how preteens talk about sex, and how teens
are accessing pornography. The only accurate point of reference for this
information is the community in which the learner belongs. Same age
peers, people in their school, and other community members will provide
valuable information as to how to modify instructional targets, what should
be the most “current” goal, and how to prioritize instruction. However, the
issues of risk can never be separated from goal development or the selection
of instructional methods; safety and risk must be embedded into every

instructional decision.
Values and preference

There is arguably no area more tied to individual preference than sexuality.
People are attracted to the gender to which they are attracted, like different
sexual positions, are attracted to different physical characteristics, and they
swear by different brands of tampons. Simply put, people are individuals.
Individual preference needs to be considered and respected within all as-
pects of sexuality education. This may be even more true for individuals
with disabilities given their recognized limited access to information. Sadly,
the recognition of sexual needs, desires, pleasures, and preferences of autistic
individuals has been delayed, if not ignored entirely. As such, our attention
to this is overdue and an essential element of service provision.
Values are equally important to acknowledge. All individuals have
values and biases, including the learner, their family and community, and
the instructors themselves. Working within the family unit to recognize and
be respectful of values, while at the same time teaching fact-based education
is challenging. Clear identification of everyone’s roles in the teaching and
goal selection process from the outset may help prevent future difficulty.
Instructors will also be approaching sex education with their own biases
and values. Instructors need to be aware of this and remain as neutral and
fact-based as possible. Occasionally, situations may arise where the values of
the learner, their family, or the instructor are too different from the values
of the instructor and this can be problematic. In these situations, it may be
best to refer the provision of sex education to someone else whose values
may be more compatible with those of the individual or their family. This
may not be discussed as the discussion can be uncomfortable. However, the
effective management of these issues helps to ensure that instruction con-
tinues, that these goals remain in focus, and that the individual with autism’s
needs remain paramount.
Other resources
Many additional resources are provided at the end of this book. This book
is meant to help instructors know what to teach within sex education, but is
not meant to be a resource about sexuality in and of itself. Resources related
to content are included, and practitioners are recommended to familiarize

themselves with the related content prior to teaching.
Additionally, the scope of this book was narrowed to only skills related
to sexuality education. There are many domains included here where
broader education is likely to be of benefit to the learner (e.g., social skills,
health, and hygiene). The skills recommended here are only those that
directly pertain to sexuality.
Final considerations
Use real, direct, and clear language when teaching. Avoid innuendo
and euphemism. Likewise, real materials and realistic visuals should be used
wherever possible.
Consider independence as a spectrum rather than a binary
measure. While the best outcome may be for an individual to tolerate
wearing sanitary pads, recognize when they need to be changed, monitor
their cycle, and manage all needed materials; some learners may not attain
this level of mastery. It is suggested that teaching the individual to use
period underwear independently is preferential to requiring support to
complete all of the above skills from a paraprofessional. Likewise, a
nonvocal communicator may be taught to take photos on their phone of
relevant events in their day to share with a caregiver, instead of presuming
they are unable to recall and talk about their events. Creativity in pro-
gramming and a broad definition of independence will be important to
ensure each learner reaches their maximum potential.
Defining transfer to the natural environment as the end goal. A
limitation associated with teaching sexuality skills to autistic learners is
transferring individual skills to real-life environments. For example, learning
to put on a condom effectively and independently in practice alone in one’s
room is much different than doing so in a sexual situation with a partner
when one’s body is full of hormones, adrenaline, and overall excitement.
Simply put, just because the individual has been taught the skill doesn’t
mean they will be able to use it when they need it. Practicing in as close to
real-life as possible may help. Mastery criteria for safety skills and those with
high risk (e.g., proper use of menstrual materials, proper use of birth
control) should have stringent mastery criteria, while skills that are more
social in nature should be taught to a level of mastery that is common for
other peers in their setting (e.g., most of us stumble on first dates!).
Be flexible in instruction. Finally, sexuality and all its components are

some of the most complex aspects of human life. While teaching in this
area, especially for those on the autism spectrum, is so incredibly important,
it is also challenging. Skills may require multiple attempts to find the best
way to teach, and many skills should be reassessed and retaught as learners
grow and develop and mature. Instructors maintaining some patience,
creativity, and sense of humor will go a long way to making this a
comfortable situation for their learner.
CHAPTER 3
Interventions
Abstract
When teaching about sexuality to people, it is extremely important to utilize evidence-
based teaching strategies. This chapter will review several evidence-based teaching
strategies used commonly within the field of ABA including Behavioral Skills Training,
Teaching Interaction Procedure, Cool vs. Not Cool, Video Modeling, and others. It is
important to individualize teaching per the individual in all cases, and by providing an
overview in this manner it is our hope that the clinician will be able to create a
teaching plan that is evidence-based and well suited for the individual learner.
Keywords: ABA; Autism; Behavioral skills training; Discrete trial teaching; Evidence-
based practice; Learner; Parent coaching; Practitioner; Sex education; Video modeling.
As this book reflects, sex education is of the upmost importance for in-
dividuals diagnosed with autism spectrum disorder (ASD). Teaching the
concepts of sex, sexual health, and dating should occur as early as the learner
is ready for such instruction. These skills are often difficult to teach and
require the learner to make fine discriminations. For example, when
teaching a learner how to ask someone out on a date, they will have to pay
a great deal of attention to behavioral indicators of whether the other
person is interested in going on a date with them. Further, a learner might
also have to discriminate where to display certain skills and where not to
display certain skills. For example, if we were teaching a client about
masturbation we would want to teach them that they should engage in this
behavior in the privacy of their own room or home (if it is not a shared
space) as opposed to masturbating in public.
These discriminations are important to make because if the learner
makes an incorrect discrimination there may be serious negative conse-
quences. For example, in the previous examples, if a learner fails to
recognize the signs that a person is not interested in dating them, this can
result in everything from being ridiculed to involvement with the criminal
justice system. In the second example, if a learner fails to correctly
discriminate when to masturbate it can mean the difference of self-pleasure
Clinician’s Guide to Sexuality and Autism
18 Clinician’s Guide to Sexuality and Autism
versus arrest for indecent exposure. Professionally we are ethically required to

implement procedures that are effective, evidence-based (APA Presidential
Task Force on Evidence-Based Practice, 2006), and empirically supported
(LaRoche & Christopher, 2009). If we fail to implement procedures that
meet these criteria we may be inadvertently causing harm to our learners.
In 2017, DiGennaro-Reed et al. defined evidence-based practice as:
“the process of using results from high-quality research to inform clinical
practice, while also taking into consideration clinical experience and
expertize, and the individual characteristics, culture, and preferences of a
client (p. 142).” Within this definition, it is critical that a practitioner takes
into consideration the preferences of the client and/or the caregivers. If a
client and/or the caregivers prefer a procedure, as long as it is a proven
effective procedure, it would be wise for the practitioner to implement that
procedure. If, however, a client and/or the caregivers prefer a procedure for
which there is no evidence of effectiveness, the practitioner should not be
implementing that procedure, as it could cause harm to the learner. Instead,
the practitioner should discuss with the client and/or caregiver why
implementing that procedure is not in their best interest and offer alter-
native solutions.
In the most recent version of the Ethics Code for Behavior Analysts
Certification Board (2020), the (second) Core Principle, Treating Others
with Compassion, Dignity, and Respect, emphasizes the importance of
personal choice in care, and also discusses the importance of ensuring that
clients have knowledge to make informed choices. Furthermore, the Code
now explicitly highlights and values self-determination. As such, practi-
tioners need to focus on collaboration with clients, and on empowering
them to chart, to whatever extent possible, their own course. Navigating
the commitment to empowering clients along with the commitment to
evidence-based practice can be challenging. However, these values are
neither incompatible nor negotiable.
The second consideration is that practitioners should only implement
procedures for which they are trained, and which falls under their scope of
competence (Behavior Analysts Certification Board, 2020). For example, if
a practitioner is trained in implementing video modeling but not trained in
the teaching interaction procedure, then they should be implementing
video modeling. If, however, the learner requires a procedure for which
they are not trained in (e.g., the teaching interaction procedure) then the
practitioner should refer the learner to a professional who can provide the
needed intervention with a high degree of quality and fidelity, or the
Interventions 19
practitioner should seek out additional training or mentorship. These

guidelines exist to ensure that clients are not subjected to inferior care, and
to ensure that intervention provided is always in the best interests of the
client.
Finally, a practitioner must adhere to the empirical evidence for any
given procedure. When evaluating the research on a procedure, the prac-
titioner first should determine if the procedures are effective, or if there
could be some other explanations to why behavior change occurred (e.g.,
other procedures were also provided). For example, there has been a
plethora of research on Social Stories (Backman & Pilebro, 1999; Chapman
& Trowbridge, 2000; Rowe, 1999). However, when closely examining the
research, in most studies evaluating Social Stories, they are usually imple-
mented concurrently with other behavior modification procedures that
may be the more likely reason for behavior change (Reynhout & Carter,
2006; Test et al., 2011). Second, a practitioner should also determine if the
procedures are well defined within the research, so that the practitioner can
either replicate or partially replicate them in clinical practice. Further, the
practitioner should evaluate if the researchers implemented the procedures
to a high degree of fidelity. Third, the practitioner should evaluate if there is
a functional relationship between the procedure and the change of
behavior. Fourth, the practitioner should analyse if the results did not only
result in a change in behavior but if that change was meaningful. Finally,
the practitioner should conduct a deep dive to identify if the results have
been replicated across different studies and research labs (Horner et al.,
2005). If a procedure meets all of these criteria, then a practitioner should
feel confident in implementing that procedure. If a procedure does not
meet these criteria, the practitioner should avoid the procedure.
Today, there are myriad interventions out there for individuals diag-
nosed with ASD (e.g., social thinking or the Circles (tm) curriculum), many
of which would be considered fad treatments (e.g., Addison et al., 2012;
Chambless et al., 2001; Esch & Carr, 2004; Jacobson et al., 1995; Jacobson
et al., 2015; Jacobsonb & Mulick, 1994; Matson et al., 2013; Mostert,
2001). Some of these fad treatments may just be a waste of time or money
for the families; other fad treatments can cause serious negative harm for the
learner. As such, when teaching sexual education, it is imperative for the
practitioner to avoid fad treatments. Fortunately, there are many in-
terventions that have been found to be effective, that are evidence-based,
and that are empirically supported for individuals diagnosed with ASD.
Further, there are numerous interventions that are conceptually systematic
with behavior analysis. In this chapter we will provide the reader with a
description of different interventions that can be implemented and sug-
gestions on how they could be implemented. It should be noted that this is
not a comprehensive list; it is a description of those procedures that we have
found to be some of the most effective within our research and clinical
practice.
The interventions
Discrete trial teaching
One of the most common procedures in the field of behavior analysis is
discrete trial teaching (DTT; Lovaas, 1981, 1987). Discrete trial teaching is a
systematic teaching procedure that breaks skills down into smaller com-
ponents and teaches these steps one at a time. Discrete trial teaching consists
of the practitioner implementing a series of teaching trials within a given
session. These teaching trials consist of three mandatory components. First,
the practitioner provides an instruction/discriminative stimulus (e.g.,
“Name a person who is your friend”). Next, the learner responds to that
instruction (e.g., saying “Kenny”). Finally, the practitioner provides a
consequence based upon the learner’s response. If the learner responds
correctly, then the practitioner would provide reinforcement (e.g., a toy,
token, social praise). If the learner responds incorrectly, then the practi-
tioner would provide feedback (e.g., saying “no,” removing a token,
providing the correct answer).
Often, the learners we work with have difficulty in responding correctly
and, therefore, the practitioner might need to prompt the learner to
respond correctly. Thus, the fourth optional step of discrete trial teaching is
the provision of a prompt. When the practitioner provides a prompt, they
should do so following the instruction but prior to the learner’s response.
There are numerous ways a practitioner can provide a prompt (e.g., verbal,
gestural, multiple alternatives, physical, etc .). A practitioner should not be
providing or fading prompts without a system in place. Prompting systems
are guidelines of when a learner should provide a prompt and when an
instructor should fade a prompt (Cengher. et al., 2018; MacDuff et al.,
2001). There are many different prompting systems that are used for in-
dividuals diagnosed with ASD today. These include most-to-least
prompting (Fentress & Lerman, 2012; Longino et al., 2022), least-to-most
prompting (Libby et al., 2008), constant time delay (Miller & Test, 1989),
progressive time delay (Walker, 2008), simultaneous prompting (Waugh
Interventions 21
et al., 2011), and no-no prompt (Leaf et al., 2010). While research has
shown that these prompting systems are effective, they can be administered
in a very rigid manner. Ideally, prompts should be individualized and
applied in flexible ways.
As such, we would recommend practitioners use flexible prompt fading
when implementing discrete trial teaching (or any procedure for that
matter). When a practitioner uses flexible prompt fading, they make in-the-
moment decisions about if they should prompt, if they should not prompt,
and what prompt type to use (Leaf, Leaf, Alcalay, et al., 2016). Thus, with
this system a practitioner can use any of the prompt types at any time as they
see fit. However, this is not based upon a gut feeling or done randomly, but
rather following certain guidelines. First, the goal of the practitioner should
be to keep the learner responding correctly (prompted or unprompted) at
80% accuracy within a teaching session. Second, when a practitioner de-
cides to prompt, they should provide a prompt that they have deemed will
likely result in a correct response but that is the least assistive as possible.
Third, the goal should be that the practitioner reduces the provision of
prompts as quickly as possible. During each trial, the practitioner should ask
themselves if they believe the learner is going to respond correctly. If the
answer to that question is yes, then the practitioner would not provide a
prompt. If the answer to that question is no, then the practitioner should
decide what is the least assistive prompt necessary to elicit a correct
response. This should occur during every teaching trial. The reason for the
preference for flexible prompting is because it promotes independence and
guards against dependency on cues from the instructor.
Although discrete trial teaching is often associated with younger learners
or learners with more impacted cognition, the reality is it can and should be
used with learners of all types (Smith, 2001). It is a great approach as it is
systematic, breaks the skills down, and provides the learners with multiple
opportunities to learn the targeted skill. Research and clinical practice have
demonstrated that DTT can be effective in teaching conversation skills
(e.g., Ingvarsson & Hollobaugh, 2010), play and social skills (e.g., Nuzzolo-
Gomez et al., 2002; Shillingsburg et al., 2014), and language skills (e.g.,
Conallen & Reed, 2016; DiGennaro-Reed, Reed, Baez, & Maguire,
2011). It is also a procedure that can teach a variety of skills in regard to
sexual education. For example, it could be utilized to teach the learner to
discriminate among different relationships, how to talk to people they are
interested in dating, how to buy different sexual prevention and/or sex
toys, and to discriminate healthy and unhealthy sexual relationships and
behavior. Discrete trial teaching is often used to teach conditional dis-

criminations (Kodak & Grow, 2011), and thus could be used to teach skills
in areas related to how to determine if consent is or is not being given,
determinations regarding the appropriateness of online behavior, and even
whether a pad should be changed.
Cool versus Not Cool

Another procedure that can be used to teach sexual education is the Cool
versus Not Cool (tm) Procedure (Leaf et al., 2012). The Cool versus Not
Cool Procedure is a social discrimination procedure that is empirically
evaluated and has been found to be effective to teach a variety of skills to
autistic/individuals diagnosed with ASD (Ferguson et al., 2021; Leaf, Leaf,
Milne, et al., 2016; Milne et al., 2017). The purpose of this teaching
procedure is to help the learner discriminate what behaviors are socially
appropriate (e.g., “Cool”) and what procedures are socially inappropriate
(e.g., “Not Cool”) and, ultimately, display the appropriate behavior in their
natural environment.
The procedure starts with the practitioner stating what skill they are
going to be working on during the teaching session (e.g., the practitioner
saying “Today, we are going to be working on how to talk to someone you
might be interested in”). Next, the practitioner instructs the learner who
they should be paying attention to (e.g., the practitioner saying “I want you
to pay attention to me as I start a conversation with someone I think is
interesting”). Then, the practitioner provides a cue that they are about to
act out the scene (e.g., the practitioner saying “ready set action”). Next, the
practitioner demonstrates the behavior either the socially appropriate way
(e.g., approaching the person and asking some socially acceptable question)
or an inappropriate social way (e.g., checking out the person explicitly for a
long duration or asking an overly personal question such as, “What is your
address?” Following the demonstration, the practitioner provides a cue that
the demonstration is over (e.g., the practitioner saying “cut”) and asks the
learner if the demonstration was either “cool” or “not cool.” If the learner
responds correctly, the practitioner provides reinforcement (e.g., praise or a
token). If the learner responds incorrectly, the practitioner provides
corrective feedback. Next, the practitioner asks the learner why the
demonstration was “cool” or “not cool.” If the learner responds correctly,
the practitioner provides reinforcement (e.g., praise or a token). If the
learner responds incorrectly, the practitioner provides corrective feedback.
The practitioner then can implement further demonstrations if needed.
Interventions 23
An optional component of the cool versus not cool procedure is having

the learner role-play the targeted behavior. During the role-play compo-
nent the practitioner should set up situations for the learner to engage in the
targeted behavior. The goal of the role-play should be that the learner is
going to practice the behavior the appropriate way. The practitioner starts
off by providing a cue to the learner to start the role-play (e.g., saying
“ready set action”). The learner then role-plays the behavior. Following the
role-play, the practitioner provides a cue that the demonstration is over
(e.g., the practitioner saying “cut”) and asks the learner if they role played
the behavior either “cool” or “not cool.” If the learner responds correctly,
the practitioner provides reinforcement (e.g., praise or a token). If the
learner responds incorrectly, the practitioner provides corrective feedback.
Next, the practitioner asks the learner why the role-play was “cool” or “not
cool”. If the learner responds correctly, the practitioner provides rein-
forcement (e.g., praise or a token). If the learner responds incorrectly, the
practitioner provides corrective feedback. The practitioner then can
implement further demonstrations if needed.
There are several important guidelines that a practitioner should follow
throughout the implementation of the Cool versus Not Cool Procedure.
First, it is considered important, when appropriate, for the practitioner to
model the behavior both the appropriate way and the inappropriate way. It
is important to model the correct way so that the learner knows what
behavior they should be displaying. It is, however, also important for the
practitioner to demonstrate the skill the inappropriate way because many of
the skills may be nuanced and the practitioner must highlight what steps are
being missed or omitted. This helps with the discrimination of appropriate
versus inappropriate behavior in the particular context. Second, generally
speaking, although we want the practitioner to demonstrate both the
appropriate and inappropriate behavior, we want the learner only to model
the appropriate behavior. This way, the learner is practicing displaying the
behavior correctly and the practitioner can reinforce that behavior. Third,
when the practitioner models the behavior the incorrect way, they need to
display the behavior the way the learner is usually displaying the behavior in
the natural environment (e.g., getting steps incorrectly or omitting certain
behaviors). This way, it highlights to the learner exactly what they are not
doing in the natural environment. Fourth, both in the demonstration and
modeling components of the Cool versus Not Cool Procedure there should
be multiple exemplars; meaning that there should be different situations
being used. This consideration is important because using multiple
exemplars can help increase the learner with generalizing their behavior to
the natural environment. Fifth, there does not need to be an equivalent
number of “cool” and “not cool” demonstrations. Rather, the practitioner
should decide if it is important to demonstrate more cool behaviors or not
cool behaviors. If the learner would benefit from seeing the behavior
demonstrated correctly then the practitioner would provide more cool
demonstrations. Conversely, if the learner is missing components of the
behavior or omitting important aspect of the behavior the practitioner
might elect to have more not cool demonstrations. Generally speaking,
there will be many demonstrations of cool behavior, to assist with
strengthening this aspect of skill development. Sixth, the practitioner does
not need to use the words “cool” or “not cool”; the practitioner can use
whatever language is appropriate to the learner’s culture and geographic
location. Finally, it is important for the practitioner to be aware that this
procedure may result in the learner displaying emotional responding. This is
because the learner may be sensitive to working on sexual behaviors, and
because the procedure implies the identification of past or current missteps.
Clinicians should frame this proactive positively, ensure that all practice is
done with compassion and sensitivity, and should adjust instruction to
ensure comfort.
The Cool versus Not Cool Procedure started out as a clinical procedure
used to teach a variety of social behaviors to autistic/individuals diagnosed
with ASD. However, in the past 10 years, research has been conducted on
the effectiveness of the Cool versus Not Cool Procedure (Ferguson et al.,
2021; Leaf et al., 2016; Cihon et al., 2021; Milne et al., 2017). In 2012, Leaf
and colleagues conducted the first empirical investigation to teach three
autistic individuals how to (1) interrupt; (2) change the game; (3) appro-
priate greetings; (4) joint attention; (5) changing the conversation; (6)
abduction prevention; and (7) eye contact. The results of this study indi-
cated that participants reached mastery criterion on 87.5% of skills. Since,
this original study multiple studies have been conducted on teaching social
interaction behaviors (i.e., compromising, sharing, and assertiveness) (Leaf
et al., 2015); social communication skills (i.e., providing verbal support,
chatting, and interrupting) (Milne et al., 2017); comparing the Cool versus
Not Cool Procedure to Social Stories (Leaf, Mitchell, et al., 2016); and play
skills (Leaf, Leaf, Milne, et al., 2016).
Although research has not directly evaluated the Cool versus Not Cool
Procedure for teaching sexual education, it has been implemented clinically
for several years and should be easily extended to skills related to the pursuit
Interventions 25
of romantic relationships. It is an appropriate procedure for any discrimi-

nation training that a learner may need. For example, the procedure could
be used for teaching how to talk to someone else about your sexual
orientation, how to communicate your needs, how to engage in appro-
priate hygiene and sexual hygiene, how to ask out someone, how to
breakup with someone, or how to communicate with your partner.
Essentially, if there is a discrimination that needs to be made, this is a
wonderful program to teach the learner how to make the discrimination. It
is important to remember, however, that the goal of the Cool versus Not
Cool Procedure is not for the learner to just identify the correct discrim-
ination but for them to display the appropriate behavior in their natural
environment. This demonstration of the skill in the natural environment is
the essential outcome.
Please note, however, that conversations related to sexuality are often
associated with fear and with worry, and that they need to be approached
with maximal sensitivity. It is also imperative that care be taken to un-
derstand the individual’s environment, supports, and challenges. For
example, one should never assume that an individual is ready to disclose
their sexual identity or orientation, and should not make assumptions that
such a disclosure is in their best interests. The provision of support is the
most important element of care, and clinicians can provide a safe space to
explore these and other conversations. It may even be the case that the
clinician needs to educate the individual about risks of disclosure, so that
they can explore together any consequences that might result from the
disclosure and plan for appropriate timing, adequate support, and positive
outcomes.
The teaching interaction procedure (TIP)

A third procedure that can be implemented to teach sexual education skills
is the teaching interaction procedure. The teaching interaction procedure is
a procedure that consists of both didactic instruction, demonstration, and
role-playing. Although the teaching interaction procedure can be imple-
mented for those students who are more impacted or who have less
receptive or expressive language, it is ideally meant for those learners with
high cognitive and language skills.
The first step of the teaching interaction procedure is for the practitioner
to label and define the target behavior. For example, the practitioner might
say: “Hey today we are going to talk about how you can talk to your
parents about having independence on dates.” Then, the practitioner has
the learner repeat what they were going to talk about. For the purposes of
instruction, let’s consider an older adolescent negotiating with their parent
that they would like to go on dates without being accompanied by a
chaperone.
The second step is for the practitioner and the learner to come up with
meaningful rationales of why the learner should display the behavior. This
can be done by the practitioner stating one rationale and having the learner
repeat the rationale or by the practitioner asking the learner to come with
their own rationales. A rationale should be meaningful in that it reinforces
the learner and encourages them to want to engage in the targeted
behavior. Additionally, a good rationale usually takes the form of an “If
____ then _____ statement”. For example, a good rationale might be: “If
you tell your parents that you want to go on dates without a chaperone, it
might make you feel more comfortable on dates and reduce your annoy-
ance at your parents.” A good rationale could also serve as a self-reminder
of why a learner should engage in the behavior within the natural envi-
ronment. Further, a good rationale will allow the practitioner to fade
artificial reinforcement during teaching. Finally, a good rationale must be
meaningful and individualized to the learner’s needs and desires.
The third step of the teaching interaction procedure is breaking the
targeted skill down into smaller behavioral components. In other words, a
task analysis of the targeted behavior is created. For example, the practi-
tioner might break the skill of revealing that you are gay to your parents
into the following steps: (a) asking parents to talk; (b) finding a time to talk;
(c) finding a place to talk; (d) stating what you want to talk about;
(e) explaining that this is difficult to talk about; (f) stating what the
boundaries are of the conversation; (g) stating what you want to tell them;
and (h) attending to special considerations. The practitioner should break
the skill down into as many steps as are needed for the learner to understand
what they need to do in the natural environment. For some learners it will
require more steps and for others it will require less steps. During the first
teaching session, the practitioner will usually state the steps and have the
learner repeat the steps. During subsequent sessions, the practitioner will
just ask the learner to state the steps of the target behavior.
The fourth step of the teaching interaction procedure is the practitioner
demonstrating the target behavior to the learner. This demonstration is
identical to the demonstration in the Cool versus Not Cool Procedure. The
fifth step of the teaching interaction procedure is the practitioner having the
learner role-play the behavior. The role-play is also identical to the role-
Interventions 27
play component in the Cool versus Not Cool Procedure. The sixth and
final step of the teaching interaction procedure is the provision of feedback.
Feedback should include both positive reinforcement and corrective
feedback. This reinforcement should be based upon how the learner does
throughout the entire teaching interaction procedure, and should be
delivered with sensitivity and compassion.
Finally, special considerations should be anticipated and embedded into
instruction. In the case of this and other sexual skills, it is urgently important
to attend to safety risks. In this case, unchaperoned dating might be reserved
for circumstances where the dating partner is well-known. In addition,
unchaperoned dating might be restricted to safe neighborhoods, and might
not extend to the use of public transportation. Stages of independence can
be planned, and there can be a gradual loosening of restrictions as skills
develop, as time passes, and as experience accrues.
An important component of the teaching interaction procedure is for
the practitioner to find ways to promote generalization for the learner. This
can be done in numerous ways. First, the teaching interaction procedure
should be implemented by multiple therapists. Second, the teaching
interaction procedure should be implemented in different places and during
different times. Third, the teaching interaction procedure should increase
the provocativeness of the demonstration and role-play throughout the
course of intervention. This can be done by making initial role-plays or
demonstrations easy for the learner and gradually making it more and more
like the natural environment. For example, the practitioner might start off
by acting as a parent who asks no questions and agrees to changes in
chaperoning. Over time, the parent may ask more difficult questions or
respond not as positively.
The teaching interaction procedure was originally created as part of
Achievement Place and the teaching family model (Phillips, 1971, 1974;
Schumaker et al., 1983). Within the original conceptualization it was used
to teach juvenile offenders or those at risk for juvenile offense to improve
their behavior and overall quality of life (Phillips, 1971). Further, this
procedure was adopted as part of the curriculum used in Boys Town
(Dowd et al., 1994). The teaching interaction procedure has also been used
clinically since the 1970s to teach autistic individuals a variety of behaviors
including social skills, language development, adaptive behaviors, school
readiness behaviors, reduction of aberrant behaviors, and sexual education.
Finally, there has been a plethora of research conducted on the teaching
interaction procedure for autistic individuals. This research has evaluated
the procedure in a one-to-one instructional format (Leaf et al., 2010), a

group instructional format (Dotson et al., 2010), compared to Social Stories
(Leaf et al., 2012), improving social skills (Kassardjian et al., 2013),
improving conversational skills (Dotson et al., 2010). The teaching inter-
action procedure can be used to teach any sexual educational skill, as it
allows the learner to hear didactic information, watch a demonstration of
the targeted skill, and practice the targeted behavior with the therapist. The
procedure is collaborative, positive, and scaffolded. It is well-suited to teach
the nuanced skills associated with pursuing relationships and expressing
sexuality. Teaching interaction procedure is beneficial to teach skills related
to dating; asking someone out on a date, making plans, or what to do when
you get there. It may be used to work on skills related to recognizing
consent or lack thereof, or how to demonstrate consent (or lack thereof). It
can be used to teach these, and more, skills in broad way, but also in a
nuanced way focusing on intent and nuance. The role-play component of
TiP makes it an ideal teaching methodology for skills that focus on
nonverbal components, body language, tone of voice, and gesture.
Behavioral skills training

A variation of the teaching interaction procedure that can also be used in
sexual education is behavioral skills training (Sarokoff & Sturmey, 2004).
The difference between the two procedures is that in behavioral skills
training there is no provision of a rationale and that there is only an
appropriate demonstration of the targeted behavior (i.e., no inappropriate
demonstration of the targeted behavior). Otherwise, the implementation of
behavioral skills training is identical to the teaching interaction procedure.
Behavioral skills training has also been implemented for over 40 years to
individuals with and without a diagnosis of autism spectrum disorder.
Further, behavioral skills training has been one of the most evaluated
procedures in the behavior analytic research. This procedure has been used
to teach pedestrian safety skills (Harriage et al., 2016), social skills (Dogan
et al., 2017), gun safety skills (Miltenberger et al., 2009), and language skills
(Nuernberger et al., 2013). Behavioral skills training can be used to teach
any sexual educational skill as it allows the learner to hear didactic infor-
mation, watch a demonstration of the targeted skill, and practice the tar-
geted behavior with the therapist. This procedure may be best for
individuals who are confused by rationales or who perseverate on the
demonstrations of errors. In either case (BST or TIP), there is a focus on
Interventions 29
systematically approaching complex skills with modeling, practice, and

feedback.
Video modeling
Another procedure that can be used in sexual education for autistic/in-
dividuals diagnosed with ASD is video modeling (Charlop et al., 2010),
sometimes referred to as video-based instruction (Cihak et al., 2012;
Grosberg & Charlop, 2014; Gutierrez et al., 2016; LeBlanc et al., 2003;
MacDonald et al., 2005; MacManus et al., 2015; Nikopoulous & Keenan,
2004; Plavnick et al., 2013; Travers & Tincani, 2010). In video modeling,
the learner watches a video of how they should display the target behavior.
Video modeling is beneficial for learners who have good attending skills
and generalized imitation (McCoy & Hermansen, 2007). The practitioner
should set up the video ahead of time and ensure that the video captures the
correct demonstration of the targeted skill, preferably in the learner’s natural
environment. For example, if the targeted skill was breaking up with your
significant other, the video should target this behavior in the environment
where this is most likely to happen.
The practitioner has multiple choices in how to create the video. First,
the practitioner needs to choose if the video is going to include actors or if
the video will include the learner themselves. Second, the practitioner
selects if they are going to film the targeted behavior like a movie or if they
are going to film it from the point of view of the learner. Third, the
practitioner decides what the focus of the scene is. Finally, the practitioner
can determine how many different variations the video model will consist
of. Additional variations can aid in the generality of the skill, and can also
ensure that the individual does not learn one, unchanging script in the
context of practice.
During video modeling the instructor tells the learner that they are
going to watch a movie of the targeted behavior. Next, the learner watches
the video in its entirety. Finally, the practitioner either asks comprehension
questions at the end of the video or role-plays the behavior with the
learner. The practitioner could also pause the movie at any time to high-
light certain important aspects to the learner or to answer any questions the
learner may have.
Video modeling has been used since the 1980s both in clinical practice
and in research. Researchers have demonstrated it can be effective for
teaching perspective skills (LeBlanc et al., 2003), requesting (Cihak et al.,
2012), novel play statements (MacManus et al., 2015), peer engagement

(Grosberg & Charlop, 2014; Plavnick et al., 2013), play (MacDonald et al.,
2005), and sexual education (Travers & Tincani, 2010). The improvements
in technology have made video modeling easy to implement as it is easier to
capture short videos in the moment. This procedure is great to teach a
variety of sexual education skills. It should be noted, however, that we are
not encouraging practitioners to show video models of how to engage in
the act of sex (i.e., pornography) as there would be ethical, moral, and legal
concerns. Instead, this is an additional procedure that has utility for prac-
ticing difficult conversations or behaviors associated with expressing interest
or navigating conflict in dating. One of the benefits of video modeling is,
especially when filmed like a movie, the video can show outcomes or
reactions from all participants. For example, if using an interaction of people
flirting, this allows the practitioner to show the body language, postures,
language, and affect of both parties. This may help the learner identify what
cues they can look for in their partner in future situations.
The general availability of smartphones has made video modeling
incredibly accessible and easy to create. This allows for quick and very
relevant models to be created, increasing the likelihood of their utility as a
teaching tool.
Parent coaching
Despite the plethora of teaching procedures available, the content of some
parts of sex education are, quite simply, not appropriate to be taught to an
individual by a professional. The intimate and personal nature of much of
the content of sex education makes it inaccessible and inappropriate to be
taught directly by a professional. ABA has demonstrated much success using
parent coaching models. This may be done using many of the same
techniques outlined above. Parents can be trained to use methods like Cool
versus Not Cool, or Behavioral Skills Training. Parent coaching may be as
simple as demonstrating teaching with similar skills and explaining how
parents would adapt that to a particular target (i.e., showing parents how
they would model washing their torso, arms, legs, etc.), then explaining
how to teach using similar strategies how to teach washing genitals to their
child.
As well as using parent coaching to teach new skills, parents should be
coached on the maintenance of skills being taught in other settings. For
example, when teaching a functional “no” response, it is important that the
rationale for this is explained to parents, and parents are also taught how to
Interventions 31
prompt and reinforce this skill in natural settings at home, as well as under
what conditions they should and shouldn’t teach the skill.
For some parents teaching sexuality skills is uncomfortable. Overall
coaching should be given to parents in how to talk about and teach in a
direct, clear way, as well as how to access further resources if needed to help
with their content knowledge if required.
Social skills groups

The final intervention that can be used to teach autistic/individuals diag-
nosed with ASD about sexual behavior is social skills groups. Social skills
groups are opportunities for three or more individuals to come together and
work on a variety of behaviors simultaneously. Within social skills groups
the practitioner can implement, and should implement, different behavioral
analytic interventions including: discrete trial teaching, video modeling,
script fading, the teaching interaction procedure, behavioral skills training,
and the Cool versus Not Cool procedure. Further, the practitioner can
teach a variety of different curricular programs. Implementing sexual ed-
ucation in a social skills group setting has many advantages for the learner.
First, it puts learners in proximity to each other, which may increase the
likelihood of friendship development and generalization of skills taught.
Second, it is an efficient form of instruction as it allows for multiple learners
to be taught simultaneously. Third, it allows for the opportunity to learn
incidentally or through observational learning. Finally, it has been found to
be highly effective in both clinical practice and with empirical studies
(Akers et al., 2018; Garfinkle & Schwartz, 2002; Leaf, Leaf, McEachin,
et al., 2016; Kassardjian et al., 2013; Leaf et al., 2010; Palmen et al., 2008;
Wolfberg & Schuler, 1993). Social skills groups allow the practitioner to
teach sexual educational goals as the practitioner can implement a variety of
teaching procedures based upon the needs and strengths of the learners.
Many skills related to sexuality are amenable to group teaching, and many
of the above teaching strategies can be implemented in a group setting.
Targets can include practicing both initiating and responding to various
types of social initiations (conversations, sharing contact information,
making plans), practicing socially appropriate distance, recognizing consent
(in nonsexual situations), even working on online safety and online in-
teractions. However, it is important that practitioners ensure that all
members are comfortable talking about the topics in the group, that they
have a way to leave the group at any time, and that members can be
separated based upon certain topics.
Conclusion
This chapter provided you with a brief overview of different procedures
that can be implemented to teach sexual education to autistic/individuals
diagnosed with ASD. The interventions that are listed are not a compre-
hensive list as there are other procedures that can be used as well. These
procedures can include script fading (Krantz & McClannahan, 1993), video
prompting (Bennett et al., 2013), fluency instruction (Weiss, 2001), and
pivotal response training (Koegel et al., 2014). Finally, within the curric-
ulum portion of this book we will state what procedures are the most
appropriate to teach the different sexual educational skills that are provided
in the book. We encourage practitioners to use only those procedures that
have empirical support, are considered to be evidence-based procedures,
and are conceptually systematic with behavior analysis. As a final note,
please remember the importance of assessing and planning for safety con-
siderations in this area of instruction, and remember that mastery of skills
depends entirely on transfer to naturally occurring contexts.
PART TWO
Curriculum
33
CHAPTER 4
Age ranges
Abstract
Throughout the curriculum portion of the book, each skill has suggested target ages
to teach. Age ranges are unrelated to whether the individual is in school currently,
rather refer to an age range. Appropriateness and need for skill will vary by individual
and as such, these age recommendations should be regarded as guidelines.
Keywords: Adolescence; Adult; Age ranges; Early adolescence; Preschool; School age.
Throughout the curriculum portion of the book, each skill has suggested
target ages to teach. Age ranges are unrelated to whether the individual is in school
currently, rather refer to an age range. Appropriateness and need for skill will vary by
individual and as such, these age recommendations should be regarded as guidelines.
The following are the age ranges outlined throughout.
Description Ages
Preschool 3e5
School age 6e10
Early adolescence 11e14
Adolescence 15e20
Adult 21þ

CHAPTER 5
Body parts
Abstract
This domain will target knowledge of body parts. Knowing and using the correct
terminology for body parts is important to aid in communication to trusted adults and
healthcare professionals; being able to talk about body parts that hurt or are otherwise
unwell is essential. Additionally, being able to refer to body parts correctly is important
as it pertains to being able to report inappropriate interactions as related to safety and
abuse prevention.
Understanding and using slang for body parts also has importance; slang is used in
most social interactions and without understanding this terminology the individual
will be unable to participate in the interaction. It also means that if the individual
doesn’t understand the slang and the body part to which it refers, they will not be able
to understand the terminology being used. As such, it is important to understand the
stimulus equivalence of the correct terminology to any slang used in the individual’s
family or social communities.
Finally, an understanding of what type of language to use in what communicative
settings is important to maintain appropriate and effective interactions.
Keywords: Autism; Body parts; Slang; Terminology.

https://doi.org/10.1016/B978-0-323-95743-4.00014-X All rights reserved. 37
Overall goal • Using scientific/medically correct terminology, the

individual can:
• If female, the individual can label the following
parts on themselves and in pictures: breasts,
buttocks, vagina, vulva, clitoris, and anus
• If female, the individual can label the following male
body parts in pictures: penis, scrotum, anus, buttocks
• If male, the individual can label the following body
parts on themselves and in pictures: penis, scrotum,
anus, buttocks
• If male, the individual can label the following
female body parts in picture: breasts, buttocks,
vagina, vulva, clitoris, anus
• The individual can demonstrate an understanding of
culturally and contextually equivalent appropriate
slang for breasts, vagina, penis, testicles, and buttocks
Teaching Discrete Trial Teaching, Parent Coaching
methodologies
Cross-referenced Health and hygiene
skills
Special Age and situation-appropriate slang changes will vary
considerations based on culture and social situations. Make sure that the
informants for slang choices are within the population in
which the learner will use the slang (i.e., ask teenagers
what teenagers say, don’t try to guess).
While identification of body parts may often be included in many

teaching programs, typically they are either targeted too broadly and ac-
curate labels for genitals are glossed over or may be avoided all together.
Alternatively in traditional sex education programs all parts of the repro-
ductive system may be targeted which may be overwhelming and not well
maintained. The goal in this approach is a focus on functionality and
meaningfulness for the learner. As such, it is important for learners to be
able to use scientific and medically correct terminology to label body parts
on themselves and in pictures. This may be used in conversation with
parents, doctors, and other medical professionals, and others. Additionally,
it is equally important that learners are familiar with culture, family, and
socially used slang. Slang words for body parts are used differently within
families, but also within different social settings. Understanding and using
the correct slang in the correct contexts is important for social
interactionsdmost kids and adolescents use slang and other casual language
when talking about anything related to sexuality. As much as this is a social
skill, it is also a safety skilldif there is a disconnect or misunderstanding
related to the body part that is being spoken to, it can create confusion or
Body parts 39
even result in people being put in situations they were not expecting or
understanding. Alternately, only using slang proficiently may result in poor,
disjointed, or even offensive communication to parents, medical pro-
fessionals, or other trusted adults.
When teaching slang, as with any other aspect of sexuality, even the
best-intentioned parents and professionals may not be the best reference
point. It is important to talk directly to the family members to find out if
there are casual or other special names that they use when discussing body
parts. Likewise, adults are, sadly, usually out of touch with the slang being
used by children and teens; ensuring that the slang being taught is the
terminology that is likely to actually be used by the learner is important.
Finally, slang changes over time. Preschool aged children may use words
like “pee pee” to mean “penis,” whereas adolescents may be more likely to
use something common like “dick” or even more silly like “hairy canary”
or “love muscle.” Ensuring that these are revisited and retaught over time
and context changes is important.
Teaching body parts may typically be done using Discrete Trial Teaching.
See Chapter 3 for further description of discrete trial teaching. Additionally,
particular targets pertaining to identifying body parts on oneself should be
taught by a parent or caregiver, not by a therapist of other professional. Being
aware of the secondary skills that are being taught throughout is incredibly
important; having a therapist or other professional in a private space teaching a
label of one’s penis on themselves may teach the learner to label their penis,
but inadvertently may also teach the learner that it is acceptable to be in a
private space with an unfamiliar adult. Using parent coaching strategies
outlined in Chapter 3 can help guide clinicians in ways to work with parents
so that parents can be the ones teaching their children to label their own
genitals. Modeling how to teach other body parts or using a Behavioral Skills
Training technique will help parents understand how to teach more private
body parts effectively. Clinicians must address this with parents/caregivers
though and not assume that parents/caregivers will teach these parts, also
ensuring that both “family” slang and correct terminology is taught.
At all ages, both the scientifically correct terminology and the age-
appropriate slang should be taught. Additionally at older ages, if slang has
changed for targets previously learned, teaching should update to this as
well.
Using as realistic and accurate photos as possible is important for
teaching, as well as multiple exemplars of each body part. Remember that
body parts look different on different people and should be representative
of as many samples as possible; genitals with and without pubic hair,

circumcised and uncircumcised penises, etc.
Finally, the temptation may be there to teach a lot of nuanced parts of
the reproductive system (remember grade 7 health class worksheets!). This
will be addressed further in the chapter on reproduction, but the guiding
principle should be on functionality for the learner. What skills do the
learner require to be safe, to be happy, to engage in social interactions?
Those should be targeted first and only if and when those are acquired skills
should one move on to teach less directly impactful ones. Its more
important to be able to label your own penis and scrotum, than it is to label
the vas deferens on a diagram.
By preschool age individuals should be learning to:
o Identify on themselves (biologically female) using technical language
and slang
⁃ Vagina
⁃ Bum
o Identify on themselves (biologically male) using technical language and
slang
⁃ Penis
⁃ Scrotum
⁃ Bum
By school age individuals should be learning to:
and slang
⁃ Breasts
By early adolescence individuals should be learning to:
and slang
⁃ Vulva
⁃ Clitoris
⁃ Buttocks
⁃ Anus
o Identify in pictures (all) using technical language and slang
⁃ Penis
⁃ Scrotum
⁃ Breasts
⁃ Vagina
⁃ Vulva
⁃ Clitoris
Body partsdbio
Skill one The biologically female individual can Preschool

receptively and expressively identify the
following body parts on themself and in
pictures using clinically correct names:
o Vagina
o Bum
Skill two The biologically male individual can Preschool
o Penis
o Scrotum
o Bum
Skill three The biologically female individual can School age
o Breasts
Skill four The biologically female individual can Early
receptively and expressively identify the adolescence
o Vulva
o Clitoris
o Buttocks
o Anus
The biologically female individual can identify the following
body parts in pictures:
o Penis
o Scrotum
The biologically male individual can identify the following
body parts on themselves and in pictures:
o Buttocks
The biologically male individual can label the following
female body parts in pictures:
o Breasts
o Buttocks
o Vagina
o Vulva
o Clitoris
o Anus
Teaching DTT
format
Special Accurate photos should be used as often as possible in
considerations teaching (as opposed to drawings or sketches of body
parts). Ensure that multiple exemplars are used of each part
as necessary (e.g., circumcised and uncircumcised penis,
genitals with and without pubic hair).
Body partsdslang
Skill one The biologically female individual can Preschool

following body parts on themself and in a
picture using age-appropriate slang body
parts names:
o Vagina
o Bum
Skill two The biologically male individual can Preschool
pictures using age-appropriate slang body
part names:
o Penis
o Scrotum
o Bum
Skill three The biologically female individual can School age
pictures using age-appropriate slang body
parts names:
o Breasts
Skill four The biologically female individual can
following body parts on themself and in a
picture using age-appropriate slang body
parts names:
o Vulva
o Clitoris
o Buttocks
o Anus
The biologically female individual can identify the following
body parts in pictures:
o Penis
o Scrotum
The biologically male individual can identify the following
body parts on themselves and in pictures:
o buttocks
The male individual can label the following female body parts
in picture: breasts, buttocks, vagina, vulva, clitoris, and anus
Early
adolescence
Teaching DTT
format
Special Slang should be age-referenced to peers within this
considerations specified age group. Additionally, slang should include any
slang that the family uses or is common within the
learner’s culture.
CHAPTER 6
Menstrual care
Abstract
This domain will target skills related to effective menstrual care. Skills in this domain
should be targeted early, as in some cases, tolerating menstrual products may take
some time. Independence should be prioritized and, as such, great individualization
may be required. Adaptations may include teaching to change menstrual products on
a time-based interval as opposed to teaching the discrimination of when a product
should be changed, using period underwear instead of other products, and using
visual supports.
Keywords: Autism; Menstrual care; Menstrual cups; Pantyliners; Period; Sanitary

supplies; Tampons.
Overall goal • The individual identifies the onset of her period

• The individual uses appropriate products at
appropriate times within their cycle (e.g., extra-absorbent
for heavy days, tampons if swimming, etc.)
• The individual can independently select, change, and
dispose of sanitary pads, pantyliners, menstrual cups,
and/or tampons in private
• The individual carries pads, tampons, and pantyliners
on them when they will be needed
• The individual monitors their stock of sanitary
supplies, and purchases or requests more in advance
of needing them
• The individual tracks their menstrual cycle
Teaching Discrete Trial Teaching, Video Modeling, Parent
methodologies Coaching
Special Ongoing considerations for independence should be
considerations prioritized here. It is important that teaching in this
area begin far in advance for menses as tolerance to
sanitary materials can sometimes be lengthy.
Cross-referenced This domain closely aligns with health and hygiene, as
skills well as preferences.

Menstruation is an unavoidable part of adulthood for women, and this is

not different for women on the autism spectrum. Menstruation can affect
women in many ways, including the impact of hormonal shifts on mood,
behavior, and even appetite and sleep patterns. Like most areas of sexuality
instruction, it is important to begin teaching in this area early, long before
the onset of menses. In some cases, tolerance to wearing a pantyliner or pad
may be lengthy to establish. For others, teaching independent management
of sanitary materials may take some time. Targeting these skills in advance
of when they are needed will mean a smoother transition to independence
once the individual begins menses.
Independence in this area is vital. Hopefully by this point in life, the
learner is already consistently independent in toileting and washroom skills.
If we do not teach menstrual care to independence then we sacrifice prior
teaching in washroom independence; requiring assistance with menstrual
care means the individual is still in a vulnerable position with an adult in the
washroom with them on a regular basis. As such, independence in men-
strual care is a safety skill. Throughout this chapter, independence in skill
should be prioritized over complexity of skill. As such, the goal should be to
teach the skill at as complex or advanced level possible while maintaining
independence in responding. Some learners will be able to try different
types of menstrual products (e.g., pads, tampons, menstrual cup, etc.),
choose which they like best, and independently acquire and use these. For
others, tolerating a sanitary pad or learning how to use a tampon may be an
insurmountable challenge. It may be preferable in these cases to teach the
learner to wear period underwear instead.
When considering to what degree the individual can manage their own
menstrual care we need to consider skills like monitoring when to change
their pad/tampon/menstrual cup, choosing between preferred items, and
monitoring their stock of sanitary supplies, procuring more in advance of
need. Trying different types of menstrual products overlaps here with
preferences and helps individuals decide what type and brand of product
they like best.
Finally, it is also important that the individual is able to accurately track
their period, and report this to appropriate individuals (e.g., caregiver,
doctor) as needed.
Menstrual care can be taught using Discrete Trial Teaching, Video
Modeling, and Parent Coaching. As always, teaching should be individu-
alized per learner. See Chapter 3 for further description of teaching
procedures.
Menstrual care 45

- Tolerate wearing a pantyliner or pad
- Independently change and dispose of pantyliner or pad as needed. If not
able to tolerate pad or pantyliner, OR is not independently able to
manage changing a pad or pantyliner after reasonable instructional at-
tempts period underwear could be considered as an alternative. Period
underwear may also be considered for use while teaching.
- Carry pad, pantyliner, and or tampons with them for when they will be
needed.
- Identify the onset of her period
- Track her period using a calendar, electronic, or other methods
By adolescence individuals should be learning to:
- Independently and privately change and dispose of tampons as needed
- Independently change and clean menstrual cups as needed
- Monitor their stock of sanitary supplies and purchase or request more in
advance of needing them
- Use appropriate products at appropriate times within their cycle
- Identify the onset of PMS symptoms and how to manage them
- Recognize and demonstrate understanding of health concerns related to
missed or irregular periods and can report to the appropriate person
Management of sanitary materials
Skill one The individual tolerates wearing Early

pantyliner or pad adolescence
Skill two The individual independently changes and Early
disposes of pantyliner, and pad as needed adolescence
Skill one and If the individual is not able to tolerate Early
two alternative (after reasonable instructional attempts) adolescence
pad or pantyliner, OR is unable to
independently manage changing a pad or
pantyliner consider the use of period
underwear (i.e.,. knix, Thinx, etc.).
Period underwear can also be used if
insufficient time was allocated to teaching
tolerance of a particular product(s), while
the learner is working to acquire the skill.
Skill three The individual carries pads, pantyliners, Early
and/or tampons with them when they adolescence
will be needed (note: discrimination of
when needed is not required for this
skill).
Skill four The individual independently and Adolescence
(optional) privately changes and disposes of tampons
as needed.
Skill five The individual independently changes and Adolescence
(optional) cleans menstrual cups as needed.
Skill six The individual monitors their stock of Adolescence
sanitary supplies and purchases or requests
more in advance of needing them.
Skill seven The individual uses appropriate products Adolescence
at appropriate times within their cycle
(e.g., extra absorbent for heavy days, etc.).
Teaching Video modeling, parent coaching, DTT
format
Special Skills one and twodthis could take a varying amount of
considerations time depending on the learner. Starting this process
should begin no later than the earliest signs of puberty.
Menstrual care 47
Tracking of cycle
Skill one The individual identifies the onset of her Early
period. adolescence
Skill two The individual tracks her period using a Early
calendar, electronic or other method. adolescence
Skill three The individual identifies the onset of PMS Adolescence
symptoms and how to manage them.
Skill four The individual recognizes and demonstrates Adolescence
understanding of health concerns (pregnancy,
other health issues) related to missed or irregular
periods and can report to the appropriate
person
Teaching Video modeling, parent coaching, DTT
format
CHAPTER 7
Reproduction and birth control
Abstract
This domain covers skills related to reproduction and birth control. An understanding
of reproduction and birth control is important to help protect against Sexually
Transmitted Infections (STIs) and unwanted pregnancy, as well as understanding how
to get pregnant should this be desired. Skills in this area include an understanding of
the process of reproduction, identification and use of different forms of birth control,
and the purchasing and storage of birth control.
Keywords: Autism; Birth control; Contraceptive; Reproduction; Sexually transmitted

infections.
Overall goal • The individual can describe the process of

reproduction including a demonstrated understanding
of the following processes: ovulation, intercourse,
ejaculation
• The individual can identify and use different forms of
birth control, as relevant for protection against
unwanted pregnancy and/or STI/STDs.
• The individual can purchase and safely store birth
control to have available when needed (if necessary)
Teaching Discrete Trial Teaching, Teaching Interaction
methodologies Procedure, Behavioral Skills Training, Parent Coaching
Cross reference Sexual acts, body parts, health and hygiene
Special Maintaining personal autonomy and preference needs
considerations to be prioritized throughout this teaching.
This closely aligns with body parts, preferences, sexual
acts, and health and hygiene domains.
While including a domain on reproduction and birth control in a

curriculum about sexuality is probably obvious, the way in which it should
be taught is again slightly different to other approaches. Like teaching about
body parts and puberty, teaching about reproduction and birth control

should take a learner-centered, applied approach. Those skills that are

directly relevant to the learner should be the focus. When learning about
the reproductive system, a functional applied approach should be taken,
ensuring that the learner is able to label and describe parts that are most
needed in their life at the time to mastery before moving on in teaching to
those that are more complex.
Understanding reproduction and many skills related to birth control are
skills that support safety of the individual by preventing STI’s and unwanted
pregnancy, but also the autonomy of the individual by teaching about
different types of birth control and helping to establish preference.
This is also a domain with close cross-reference to Individual Prefer-
ences. Understanding types of birth control, what each type does (and does
not do) helps individuals make informed choices about what type they want
to use. Choice is an important part of autonomy and thus needs to be a
consideration in all parts of teaching.
Reproduction and Birth Control can be taught using Discrete Trial
Teaching, Teaching Interaction Procedure, Behavioral Skills Training, and
Parent Coaching. For further description of these please see Chapter 3 and
as always individualize per learner. As is the case with many skills, skills
related to birth control use should be taught in advance of the individual
becoming sexually active to allow time for acquisition of skill.
- Identify and label parts of the reproductive system in picture/diagram.
- Describe the reproductive system in terms of sequence of events, and
function of each component.
- Identify and describe different forms of birth control.
- Describe what each type of birth control protects against (e.g., STD,
pregnancy).
- Describe or demonstrate on a prop where applicable how to use various
forms of birth control.
- Purchase or otherwise procure preferred forms of birth control.
- Safely store birth control and ensure they have adequate supply
available.
- Manage the logistic components of birth control (e.g., renewing pre-
scriptions, checking expiry dates).
- Carry needed birth control to use when needed.
- Discuss birth control with sexual partner as needed and appropriate.
Reproduction and birth control 51
Reproductive system
Skill one The individual can identify and label parts School age
of the reproductive system in picture/
diagram
Skill two The individual can describe the Early
reproductive system in terms of sequence of adolescence
events, and function of each component
Teaching DTT
format
Special Skills one and twodthis could take a varying amount of
considerations time depending on the learner. Instruction should begin no
later than the earliest signs of puberty
Birth control
Skill one The individual can identify and describe Early

different forms of birth control Adolescence
Skill two The individual describes what each type of Early
birth control protects against (STD, adolescence
pregnancy, etc.)
Skill three The individual can describe or demonstrate Early
on a prop (where appropriate) how to use adolescence
various forms of birth control
Skill four The individual can purchase or otherwise Adolescence
procure preferred forms of birth control
Skill five The individual can safely store birth control Adolescence
and ensure they have adequate supply
available
Skill six The individual can manage the logistic Adolescence
components of birth control (e.g., checking
expiry dates, taking pill regularly, renewing
prescription)
Skill seven The individual carries needed birth control Adolescence
(including a barrier method if currently
using a pill) to use when needed
Skill eight The individual discusses birth control with Adolescence
sexual partners as needed and appropriate
Teaching DTT, TIP, BST
format
Special The age ranges for these skills are guidelines/suggestions
considerations only. Many of these skills are relevant once an individual is
sexually active which varies. It is important that the skills are
taught in advance of this with sufficient time allowance to
learn the skills
CHAPTER 8
Health and hygiene
Abstract
Health and hygiene are important as sexuality domain, both for personal safety and for
an individual’s overall dignity and quality of life. From a safety lens, the more inde-
pendent an individual is in self-care, the lower the need will be for any paid assistance.
As such, independence in this domain should be targeted early.
In terms of personal health management, it is important that individuals develop a
sense of autonomy to the greatest extent possible. The private nature of a person’s
sexuality means that it is important for the individual to recognize normal or abnormal
changes in their body or in individual health patterns, and to take the correct steps to
remedy it (even if those steps are only telling a trusted adult).
Keywords: Autism; Health; Hygiene; Monitors health; Puberty; Signs of puberty;

Tolerates medical procedures.
Overall goal • The individual can maintain appropriate hygiene

including washing self and keeping genitals clean
• The individual regularly checks for, and can monitor
warning signs of any health concerns and can report
these to an appropriate person (i.e., makes doctor
appointment, tells caregiver, conducts self-
assessments, etc.)
• The individual is tolerant of medical exams including
(as appropriate): breast exams, pap tests or other
gynecological exams, exams of penis and scrotum,
blood draws
Teaching Discrete Trial Teaching, Cool vs. Not Cool, Teaching
methodologies Interaction Procedure, Behavioral Skills Training,
Video Modeling, Parent Coaching
Cross-referenced This area cross-references with social skills, body parts,
skills and menstrual care
Special Independence in this area should be highlighted as a
considerations priority. High levels of independence in these skills
enhances dignity and reduces the likelihood of
victimization

At first, considerations regarding health and hygiene may not seem to be

a sexuality skill. Independence throughout health and hygiene routines
serves as a safety skill, helping protect individuals against potentially abusive
situations. Individuals that can complete hygiene routines independently
require less assistance from unfamiliar people or paid staff members in
vulnerable situations; if you can shower independently, you don’t require
an adult in the bathroom with you while you are naked. Independence
throughout personal care routines is also important to promote and
maintain dignity of individuals with autism. As individuals are interested in
dating and relationships, hygiene may also contribute to social interactions.
Finally, a consideration of optional hygiene skills (e.g., hair removal if
desired) is included.
It is important for individuals with autism to manage medical routines
well and calmly. We recognize that many of the sexual health practices are
invasive, intrusive, and can also cause physical discomfort. While these
practises are often challenging to create teaching opportunities around, it is
important that individuals are not experiencing them for the first time as
adults, in unfamiliar settings, or in those occasioned by trauma.
Puberty is important to be targeted with individuals on the spectrum,
but with a self-centered focus. While it is optimal for everyone to un-
derstand all the components of puberty in people of both sexes, the most
important thing is for one to understand what is happening to their own
body. Focusing on this first and ensuring understanding of these changes
happening to themselves will help ensure safety, and anxiety about their
body. Only at this point should puberty in others be introduced.
Finally, this domain includes monitoring oneself. As individuals further
develop independence in self-care, other adults will have less time moni-
toring their bodies and as such are more likely to miss signs of abnormality.
Reporting signs of abnormality, as well as feelings of unwellness should be
targets.
This domain can be taught using Discrete Trial Teaching, Cool versus
Not Cool, Teaching Interaction Procedures, Behavioral Skills Training,
Video Modeling, or Parent Coaching. See Chapter 3 for further description
of these.
Finally, skills in this domain should be taught with an emphasis on
independence and individual comfort. When teaching skills about health, it
is most important to emphasize completion independently over perfection.
This may be accounted for by being adaptive in mastery; for instance, a
“good enough” shower every day can be complemented with a thorough
Health and hygiene 55
shower with assistance from a trusted caregiver once weekly. In terms of

tolerance to health procedures, teaching these gradually, systematically, and
in such a way that the individual remains calm and continues to assent to
procedures is of utmost importance. In some cases this means that teaching
progresses slowly and thus these should begin early. As well, while all of
these skills are important, some of them occur at a very low frequency. This
may mean maintenance of skills is challenging for some learners, which
should be considered.
At preschool age individuals should be learning to:
- Tolerate a bath or shower including a parent/guardian-assisted washing
of all body parts
At school age individuals should be learning to:
- Tolerate a bath and a shower including parent/guardian-assisted
washing of all body parts.
- Wash (with prompting) their:
o Hair
o Face
o Body
o Armpits
o Penis/vagina
o Buttocks and anus
o Legs and feet
- Brush their hair independently
- Brush their teeth independently
- Tolerate routine doctor visits including:
o Doctor touching their body
o Doctor measuring their height and weight
o Doctor listening to their chest
o Doctor looking at eyes, ears, and throat
- Recognize what their own body parts usually look like and can report
small abnormalities like scratches or insect bites
- Report feeling unwell and give specifics regarding body parts that hurt
or feel uncomfortable
At early adolescence individuals should be learning to:
- Complete all steps of a shower or bathing routine independently
including turning the water on/running a bath at appropriate tempera-
ture and washing all body parts independently.
- Safely engage in appropriate hair removal techniques as desired.
- Be tolerant of blood draws
- Be tolerant of various medical settings including clinics and hospitals

- Be tolerant of pap tests, gynecological exams and breast exams (females),
and exams of the penis and scrotum (males).
- Recognize irregularities in menstrual cycles and any abnormalities in
genitals or discharge
- Recognize the following signs of puberty in themselves:
o Females:
⁃ Breast development
⁃ Hair in underarms and genitals
⁃ Vaginal discharge and menstruation
o Males
⁃ Hair growth on face, underarms, and genitals
⁃ Growth of testicles and penis
⁃ Voice changes
At adolescence individuals should be learning to:
- Monitor, make, and attend regular health check up appointments
- Conduct regular breast exams (female)
- Conduct regular testicular exams (male)
Hygiene
Skill one The individual can tolerate a bath or Preschool

shower including parent/guardian-assisted
washing of all body parts
Skill two The individual can tolerate a bath and a School age
shower including parent/guardian-assisted
washing of all body parts. The individual
may prefer a bath or a shower, but is able
to tolerate either if necessary
Skill three The individual can wash the following body School age
parts (with prompting):
o Hair
o Face
o Body
o Armpits
o Penis/Vagina
o Buttocks and anus
o Legs and feet
Skill four The individual can brush their hair School age
independently
Skill five The individual can brush their teeth School age
independently
Skill six The individual can complete all steps of Early
shower or bathing routine independently adolescence
including turning the water on/running a
bath at appropriate temperature, and
washing all body parts independently
Skill seven The individual can safely engage in Early
appropriate hair removal techniques (i.e., adolescence
shaving, waxing, cream, etc.) as desired.
Teaching Parent coaching, DTT, TIP, BST, Cool not Cool
format
Special Independent skill consideration: Independence in hygiene
considerations skills is a safety skill. For clients that are unable to complete
washing all body parts sufficiently consider the following:
- Prioritize washing armpits, genitals, and anus over the
rest of the body
- Teaching client to independently wash “good enough”
most days, with a trusted adult assisting once a week
Tolerates medical procedures
Skill one The individual can tolerate routine doctor School age
visits including:
o Doctor touching their body
o Doctor measuring height and weight
o Doctor listening to chest
o Doctor looking at eyes, ears, throat
Skill two The individual is tolerant of the following Early
medical procedures: adolescence
o Blood draw
Skill three The individual is tolerant of various medical Early
settings including clinics and hospitals adolescence
Skill four Female: Early
o The individual is tolerant of pap test and adolescence
other gynecological exams
o The individual is tolerant of breast exams
Male:
o The individual is tolerant of exams of the
penis and scrotum
Teaching Parent coaching, DTT, BST, TIP, Cool not Cool
format
Special Tolerance skills may require ongoing assessment teaching
considerations to maintain. For many skills, the frequency of required
demonstration based on medical need may be insufficient
to ensure maintenance of skill. This will vary by learner
and by skill and should be assessed for each individual.
Tolerance may look different for all learners, but is defined
here as: the individual remains in the presence of the
medical professional throughout the procedure, does not
attempt to leave the medical setting throughout the
procedure, and refrains from engaging in any behavior that
interferes with the practitioner’s ability to complete the
procedure.
Monitors health
Skill one The individual can recognize what their School age
own body parts usually look like and can
report small abnormalitiesdi.e., dirt, insect
bites, small scratches, etc.
Skill two The individual can report feeling unwell, School age
and give specifics regarding body parts that
hurt or feel uncomfortable
Skill three The individual can recognize irregularities Early
in menstrual cycles, and any abnormalities adolescence
in their genitals (i.e., lumps), or discharge
Skill four The individual monitors, makes, and Adolescence
attends regular health check-up
appointments
Skill five The individual (female) conducts regular Adolescence
breast exams
Skill six The individual (male) conducts regular Adolescence
testicular exams
Teaching Parent coaching, DTT, BST, TIP
format
Special Prioritization of independence in these areas may require
considerations the use of tools (i.e., teaching tools for menstruation
trackingdcalendar or app), or adaptation (i.e., attending
doctor appointments for physical check-ups is more
important than making them independently).
Puberty
Skill one The individual can recognize the signs of Early

puberty in themselves as applicable adolescence
including:
o Females:
⁃ Breast development
⁃ Hair in underarms and genitals
⁃ Vaginal discharge and menstruation
o Males:
⁃ Hair growth on face, underarms, and
genitals
⁃ Growth of testicles and penis
⁃ Voice changes
format
Special While it is important to be aware of changes due to
considerations puberty in the opposite sex as well as their own, priority
should be placed on changes to their own body first before
those of others
CHAPTER 9
Sexuality and the law
Abstract
This domain covers skills pertaining to the law. For good reason, laws related to sexual
acts are strict. This domain covers skills relating to awareness of, and obeying laws
related to age of consent, pornography, public sexual acts, and assault. It is important
to note that laws vary by jurisdiction and those teaching them should be aware of the
law in the geographic settings relevant to their learner.
Keywords: Autism; Jurisdiction; Law; Pornography; Public sexual acts.
Overall goal The individual is:

• Aware of and follows laws related to age of consent
(both in themselves and in partners)
• Aware of and follows laws related to production,
possession, and distribution of pornographic material
• Aware of and follows laws related to public sexual
acts
• Aware of and follows laws related to assault
including the perspective of the perpetrator and the
victim
Teaching Discrete Trial Teaching, Teaching Interaction
methodologies Procedure, Behavioral Skills Training, Parent Coaching
Special Specific laws will vary by jurisdiction. Clinicians and
considerations educators should be familiar with the laws in their
specific location and any other locations in which the
learner may spend time
Cross-referenced This area is closely aligned with consent, sexual abuse
skills prevention and reporting; and online activity
An important aspect of teaching about sexuality is the prevelance and

impact of errors. In almost all other aspects of teaching, some error is
allowable in learning, and sometimes even within masterydwe don’t al-
ways perform every skill in our repertoire with 100% accuracy all the time.
In terms of sexuality however, the law is very clear and sexual misconduct is
(rightfully) punishable by law. It is important to understand this often black

and white nature of the law and ensure that teaching this relality is included
for learners with autism.
While not exhaustive, teaching about the law should cover areas of age
of consent; laws related to production, possession, and distribution of
pornography; public sexual acts, and assault. It is extremely important that
learners are aware of the law, and understand what falls in and outside of
each type of law. Ignorance of the law is rarely an excuse that holds up, and
it is extremely important that learners understand which laws apply to them
and in what ways.
To further complicate, laws may vary across jurisdiction; it is important
that those teaching people with ASD are aware of the laws in the juris-
diction that the learner currently resides, as well as any the learner is likely
to encounter. If moving to or visiting within another jurisdiction it is
important to update teaching on the laws that apply.
It is important that the severity of consequences is highlighted to
learners, and that every effort is taken to ensure understanding of the
magnitude and severity of consequences of breaking the law.
This domain can be taught using Discrete Trial Teaching, Parent
Coaching. Teaching Interaction Procedure, Behavioral Skills Training. For
further description of these, please see Chapter 3. As always, individuali-
zation of teaching per learner is required.
- State the age of consent for engaging in sexual acts, including any vari-
ability across types of sexual act
- Identify if they are within the age of consent
- Describe the types and variations of acts that are included in consent
laws from the perspective of the victim
- Identify when familiar people are above the age of consent
- Can provide a reasonable description of the types and variations of such
acts that are included under consent laws from the perspective of the
perpetrator
- Demonstrate an understanding of the laws related to possession of
pornography (including pornography that includes minors)
- Demonstrate an understanding of the laws regarding ownership and/or
distribution of pornography
- Demonstrate an understanding of the laws related to acquisition of
pornography including all media forms
- Demonstrate an understanding of the laws related to sexual acts in pub-
lic places
Sexuality and the law 63
- Demonstrate an understanding of the laws governing unwanted

behavior or interactions (e.g., exposing oneself, stalking, etc.)
- Demonstrate an understanding of outdated laws that may be rarely
enforced.
Laws as a victim
Skill one The individual can state the age of consent Adolescence
for engaging in sexual acts, including any
variability across types of sexual act
Skill two The individual can identify if they are in Adolescence
the age of consent
Skill three The individual can describe the types and Adolescence
variations of acts that are included under
consent laws from the perspective of the
victim
Teaching Parent coaching, DTT
format
Special Age of consent varies based on jurisdiction. Additionally, it
considerations is important to teach to various sexual acts, even if the
client is not currently demonstrating interest in particular
acts
Laws as a Perpetrator
Skill one The individual can state the age of consent Adolescence
for engaging in sexual acts, including any
variability across acts
Skill two The individual can identify when familiar Adolescence
people are above the age of consent
Skill three The individual can provide a reasonable Adolescence
description of the types, and variations, of
such acts that are included under consent
laws from the perspective of the
perpetrator
format
Special Age of consent varies based on jurisdiction. Additionally, it
considerations is important to teach to various sexual acts, even if the
client is not currently demonstrating interest in particular
acts
Laws related to pornography
Skill one The individual demonstrates an Adolescence

understanding of the laws regarding
possession of pornography (including
pornography that includes minors)
Skill two The individual demonstrates an Adolescence
understanding of the laws regarding
ownership and/or distribution of
pornography
Skill three The individual demonstrates an Adolescence
understanding of laws related to acquisition
of pornography including all media forms
format
Special It is important that this area covers acquisition of
considerations pornography in various forms/ways to access. It is also
important that all aspects of pornography are covered in
this domain (including sharing of photos of known people)
Laws related to public acts
Skill one The individual demonstrates an Adolescence

understanding of the laws regarding sexual
acts in public places
Special
considerations
CHAPTER 10
Online activity
Abstract
This domain covers skills related to safety when engaging in online activity. The
prevalence of online activity continues to increase and is obviously not going away
anytime soon. Teaching safe online activity early is important. This section addresses
skills in navigation and safe use of apps and websites, and safe sharing of personal
information (textual and photos). This domain includes skills on safe and legal
streaming and downloading of content online, as well as skills related to unwanted
solicitations from others.
Keywords: Autism; Internet safety; Online activity; Online navigation; Privacy; School
interactions.
Overall goal • The individual can navigate and safely use dating
apps/websites
• The individual can demonstrate safe and legal
streaming and downloading of sexual content
• The individual demonstrates understanding of safe
sharing of personal information including texting and
photo sharing including recognition of solicitation of
sexual imagery and information.
• The individual can recognize when they are being
sent inappropriate sexual solicitations or unwanted
photos and blocks the sender
methodologies Interaction Procedure, and Behavioral Skills Training
Special Online safety includes practice with age and socially
considerations appropriate online activity. It is important to teach these
in consultation with peer groups in regard to what similar
aged peers are actually playing. Additionally, families may
have rules and restrictions around online access which
should be addressed and honored where applicable
Cross-referenced This domain closely aligns with law and social skills.
skills Victimization is common for autistic individuals, and it
is essential that they are educated about self-protection

Accessing information on the internet is a fast changing, and scary

domain! While it is tempting to lean on parental controls and website/app
restrictions to manage behavior in this area, this usually proves unsuccessful.
Many children and adolescents are more adept with parental controls and
their workarounds than the adults who set the controls so can often find
ways to circumvent restrictions. Alternatively, they may encounter com-
puters/phones/tablets in other settings where these restrictions are not in
place. The fact is, internet is the most accessible it has ever been, and
accessibiliy is likely to expand. As such, the safer approach is to teach in-
dividuals skills about safe and appropriate internet use.
Internet safety should be taught in website use, apps, and online gaming.
All of these formats work a little bit differently and safety risks may be
slightly different in each. It is likely that individuals will access all of these at
some point and so all should be taught. As well, both the available apps/
games/website activity changes over time, as will the individual’s interest.
Safety risks in used formats should be revisited regularly.
Safety risks may include (but are not limited to) accessing illegal con-
tent, solicitations of sexual content (e.g., requests to send photos), un-
wanted photos of others being sent, requests for personal information
including credit card numbers. It can be challenging to discern some of
these risks when engaging in interactions online, and puts people with
autism at particular risk for victimization. While these risks may seem high
and overwhelming, it is important to balance these with the fact that online
activity provides important social opportunities. Many people use online
means for social interactions and communication, leisure, and dating apps,
and it is virtually impossible to avoid the benefits of online activity. For
people on the autism spectrum who may not have the same access to peer
groups and friends as others, this community is often found online. This
can provide such important opportunities for social interaction, and
shouldn’t be avoided. Navigation and use of many different types of apps,
games, and online sites should be included in teaching from a young age to
help develop skills needed to access these sources of potential social
interactions.
Online activity can be taught using Discrete Trial Teaching, Teaching
Interaction Procedure, Behavioral Skills Training, and Cool versus Not
Cool. See Chapter 3 for a further description of these teaching procedures,
and always ensure teaching is individualized to the learner.
- Demonstrate basic privacy rules while on an electronic device including:
Online activity 67
o Being clothed while using device

o Refraining from taking device into the bathroom
- Refrain from sharing personal information with strangers online
- Demonstrate an understanding of, and use appropriately location ser-
vices in apps
- Refrain from sharing photos of his/herself online
- Refrain from sharing photos of others online without their permission
- Understand that when photos are shared with permission that photos
need to be appropriate
- Recognize unwanted or inappropriate solicitations for sexual imagery,
conversations, and information
- Demonstrate functional and effective protest to unwanted or inappro-
priate solicitations for sexual imagery, conversations, and information
- Connect with known peers in games/apps including sharing contact
information
- Use appropriate language in online chat forums
- Refrain from bullying when participating in online forums
- Create, use, and safely store appropriate usernames and passwords for
online accounts
- Independently access and use email
- Proficiently and safely use age-appropriate social media
- Proficiently and safely uses age-appropriate online games
- Select appropriate apps, social media, and games and reflect their own
interest and comfort
- Initiate and respond to online flirting behavior (e.g., photos) from
known individuals as desired and appropriate. This includes selection
of photos that may be flirty or risqué without being pornographic or
incongruent with the situation
- Initiate and respond to online flirting behavior (e.g., verbal) from
known individuals as appropriate and desired. This includes flirting mes-
sages that match the situation
- Demonstrate an understanding of the various privacy and sharing set-
tings on each app/site they use
- Demonstrate an understanding of navigation within various apps (e.g.,
swiping to respond)
- Demonstrate an understanding of the risks of downloading from various
sites (e.g., costs, virus risk, distribution of personal information)
Privacy
Skill one The individual demonstrates basic privacy School age

rules while on an electronic device
including:
- Being clothed while using device
- Refraining from taking device into
bathroom
Skill two The individual refrains from sharing Early
personal info (full name, address, school) adolescence
with strangers online
Skill three The individual demonstrates an Early
understanding, and uses appropriately, adolescence
location services in apps
Skill four The individual refrains from sharing photos Early
of his or herself online adolescence
Skill five The individual refrains from sharing photos Early
of friends online without their permission adolescence
Skill six The individual understands that when Early
photos are shared (with permission), that adolescence
the photos need to be appropriate (no
nudity, no private places, etc.)
The individual recognizes unwanted or Early
inappropriate solicitations for sexual adolescence
imagery, conversations, and information
Skill seven The individual demonstrates functional and Early
effective protest to unwanted or adolescence
inappropriate solicitations for sexual
imagery, conversations, and information
Teaching DTT, Cool versus Not Cool
format
Special Privacy needs can change over time so this should be
considerations addressed on an ongoing basis. External privacy controls
(e.g., internet blockers) can be used when needed to help
ensure individual safety, but should not be used in place of
teaching skills. It is sometimes the tendency of those
providing sex education to lean too heavily on external
controls in place of teaching safety skills. While this may be
beneficial until skills are mastered, the need to provide least
restrictive environments, respect the individual’s right to
autonomy, and personal habilitation means that teaching
skills related to privacy and safety must be prioritized
Online activity 69
Social interactions
Skill one The individual connects with known peers Early

in games/apps including sharing contact adolescence
information (i.e., username)
Skill two The individual uses appropriate language in Early
online chat forums (e.g., meets language adolescence
level used in group, matches teasing level,
uses similar tone and slang, etc.)
Skill three The individual refrains from bullying when Early
participating in online forums adolescence
Skill four The individual selects appropriate apps, Adolescence
social media, and games that reflect their
own interest and comfort
Skill five The individual initiates and responds to Adolescence
online flirting behavior (e.g., photos) from
known individuals as desired and
appropriate. This includes selection of
photos that may be flirty or risqué without
being pornographic or incongruent with
the situation
Skill six The individual initiates and responds to Adolescence
online flirting behavior (verbal) from
known individuals as appropriate and
desired. This includes flirting messages that
match the situation
Teaching DTT, Cool vs. Not Cool, TIP, BST
format
Special It is important that the frame of reference for social
considerations interactions in online forums matches that of peers that use
the same forum, as such targets should be drawn from this
peer environment (i.e., not adult assumptions of
appropriate social behavior).
Online navigation
Skill one The individual creates, uses, and safely stores Early
appropriate usernames and passwords for online adolescence
accounts
Skill two The individual independently accesses and Early
uses email adolescence
Skill three The individual proficiently and safely uses Early
age-appropriate social media adolescence
Skill four The individual proficiently and safely uses Early
age-appropriate online games adolescence
Skill five The individual demonstrates an understanding Adolescence
of the various privacy and sharing settings on
each app/site they use
Skill six The individual demonstrates an understanding Adolescence
of navigation within various apps (e.g., swiping
to respond, etc.)
Skill The individual demonstrates an understanding Adolescence
seven of the risks of downloading from various sites
(e.g., costs, virus risk, distribution of personal
information)
format
CHAPTER 11
Sexual acts
Abstract
This domain covers sexual acts. An understanding of sexual acts and the formal and
casual language used to describe them is important, even if the individual has not
demonstrated interest in the particular act. Understanding vocabulary is important as it
pertains to the ability to give consent, and safety skills. Additionally, sexual acts may be
discussed in nonsexual social situations, observed in TV, movies, and other media, or
otherwise shared with the individual learner. Understanding the terminology and
scope of the acts is a vital component to these situations. Finally, an understanding of
various sexual acts will help inform an individual of their own interest (or disinterest) in
engaging in them, leading to overall satisfaction within their own sexual life. As with
masturbation, these skills should be targeted in consultation with the learner and the
learner’s family to ensure congruence with individual and family values and beliefs.
Keywords: Autism; Consent; Oral sex; Sexual acts; Sexual intercourse; Sexual Slang.
Overall goal • The individual demonstrates an understanding of the

following sexual acts: sexual intercourse, anal sex,
oral sex
• The individual can demonstrate an understanding
and usage of common slang terms for sexual
intercourse, anal sex, oral sex, and any others
relevant to their setting, culture, and social situations
Teaching Discrete Trial Teaching, Video Modeling, Parent
methodologies Coaching
Cross-referenced Body parts, preferences, abuse prevention and reporting
Special Even if individuals have not expressed an interest in
considerations engaging in any of these sexual acts, it is important for
them to be able to recognize these acts as both a safety
and social skill.
Additionally similarly to social skills and body parts, the
selection of slang should be based on same-age and
same-community peer input.
It is essential that such skills are taught as a continuum
of acts that they or others may elect to experience or
to not experience. Issues of consent and assent should
be embedded into every teaching context.
Clinician’s Guide to Sexuality and Autism

An understanding of sexual acts, as well as the formal and casual lan-

guage used in their discussion is important, even when an individual has not
demonstrated an interest in a particular act. Understanding vernacular
around sexual acts is a safety skill and helps ensure an understanding of what
is being discussed, suggested, or offered. Sometimes it is thought that dis-
cussing a sexual act will evoke an interest in that act. It is unlikely that this is
what will happen, but is more likely to function to help keep that indi-
vidual safe.
Additionally, there are many social situations that include demonstra-
tions of sexual acts, or language and innuendo surrounding them. Watching
TV or movies, listening to music and others often includes sexual innuendo
and not understanding this might hinder one’s understanding of the social
interactions surrounding such situations. Not understanding the context of
the show, etc., may limit one’s ability to participate in the social situation
surrounding it.
Understanding sexual acts is important if learners are to make informed
decisions about whether they they are, or might be, interested in, that
particular act. It is important to understand different sexual acts in order to
be able to discuss them with partners. Understanding and using vocabulary
that goes with particular sexual acts means that individuals can report these
to appropriate persons if needed in acts of abuse.
As with other domains that include discussion of vocabulary, it is
important that individuals are taught all words that might be used to refer to
sexual acts. This includes formal names for acts to be used in discussion with
doctors, caregivers, other trusted adults, but also casual terminology or slang
that may be used with peers, on media outlets, and with sexual partners.
Ensuring that these are taught with a degree of stimulus equivalence will
help make sure this is understood. Selection of slang to be targeted should
be drawn from the individual’s immediate social and peer community.
Sexual acts are an area of teaching that should be approached with
sensitivity. Consultation with family is important to ensure targets are
congruent with individual and family values and beliefs. Additionally, issues
of consent and assent should be emphasized in all aspects of teaching in this
domain. Consent and assent are incredibly important in all parts of sexu-
ality, and every opportunity to emphasize it should be taken.
This domain can be taught using Discrete Trial Teaching, Video
Modeling, and Parent Coaching. These teaching strategies are outlined in
Chapter 3 and should be implemented with individualization to each
learner. Not all skills are appropriate to observe in-situ or by video, some
are more appropriate to description only. Please use discretion and adjust
Sexual acts 73
per your learner. Be aware of laws surrounding depiction of sexual acts in

video and picture, and that many of these fall into the category of
pornography and should not be used as a teaching tool. Video models are
only applicable to early sexual acts.
- Recognize in pictures, video, and in-situ, and describe the following
interactions:
o Hugging
o Kissing on the cheek
o Quick kissing on the lips
o Cuddling
o Holding hands
- Recognize in pictures, in video, in situ and describe (where appropriate)
o Kissing with tongue
o Over clothes touching of buttocks, breasts, genitals
- Label and describe the following interactions using proper terminology:
o Hugging
o Cuddling
o Holding hands
- Label and describe the following interactions using slang (if applicable)
o Hugging
o Cuddling
o Holding hands
- Label and describe the following interactions using slang (if applicable)
- Recognize in pictures, in video, in situ, and describe (where appropriate):
o Undressing another person
o Under clothes touching of buttocks, breasts, genitals
o Oral sex acts (to a male)
o Oral sex acts (to a female)
o Vaginal penetration by finger

o Vaginal penetration by penis
o Vaginal penetration by other object (sex toy)
o Anal penetration by finger
o Anal penetration by penis
o Anal penetration by other object (sex toy)
o Masturbation
o Masturbation
- Label and describe the following interactions using slang if applicable:
o Masturbation
By adolescence the individual should be learning to:
- Demonstrate an understanding of the existence of various sexual acts
including:
o Fetish
o Multiple partner sex acts
o Role-play and dress up
o Other relevant preferences
- Use appropriate terminology with appropriate audiences/settings
Sexual acts
Skill one The individual can recognize in pictures, in School age

video, and in situ, and describe the
following interactions:
- Hugging
- Kissing on the cheek
- Quick kissing on the lips
- Cuddling
- Holding hands
Skill two The individual can recognize in pictures, in School age
video, in situ, and describe (where
appropriate):
- Kissing with tongue
- Over clothes touching of buttocks,
breasts, genitals
Skill three The individual can recognize in pictures, in Early
video, in situ, and describe (where adolescence
appropriate):
- Undressing another person
- Under clothes touching of buttocks,
breasts, genitals
- Oral sex acts (to a male)
- Oral sex acts (to a female)
- Vaginal penetration by finger
- Vaginal penetration by penis
- Vaginal penetration by other object (sex
toy)
- Anal penetration by finger
- Anal penetration by penis
- Anal penetration by other object (sex
toy)
- Masturbation
Skill four Demonstrates an understanding of the Adolescence
existence of various sexual acts including:
- Fetish
- Multiple partner sex acts
- Role-play and dress updother relevant
preferences
format
Special Not all skills are appropriate to observe in-situ or by video,
considerations some are more appropriate to description only. Please use
discretion and adjust per your learner. Be aware of laws
surrounding depiction of sexual acts in video and picture,
and that many of these fall into the category of
pornography and should not be used as a teaching tool.
Video models are only applicable to early sexual acts. Also
consider issues of safety and victimization in all discussions.
Vocabulary
Skill one The individual can label and describe the School age
following interactions using proper
terminology:
- Hugging
- Cuddling
- Holding hands
Skill two The individual can label and describe using School age
slang (if applicable) the following
interactions:
- Hugging
- Cuddling
- Holding hands
Skill three The individual can label and describe the School age
following interactions using proper
terminology:
breasts, genitals
Skill four The individual can label and describe the School age
following interactions (if applicable) using
slang terminology:
breasts, genitals
Skill five The individual can label and describe the Early
following interactions using proper adolescence
terminology
breasts, genitals
toy)
- Anal penetration by other object (sex toy)
- Masturbation
(Continued)
Sexual acts 77
Skill six The individual can label and describe the Early
following interactions (if applicable) using adolescence
slang terminology
breasts, genitals
toy)
- Anal penetration by other object (sex toy)
- Masturbation
Skill seven The individual uses appropriate terminology Adolescence
with appropriate audiences/in appropriate
settings
Teaching Parent coaching, DTT, TIP, BST
format
Special Age and situation-appropriate slang changes and will vary
considerations based on culture and social situations. Make sure that the
informants for slang choices are within the population that
the learner will use the slang (i.e., ask teenagers what
teenagers say, don’t try to guess). Different acts may have
more than one appropriate slang worddteach as many as
currently appropriate.
CHAPTER 12
Consent
Abstract
Skills in this domain are related to how to provide or obtain consent and assent in a
variety of overt and covert sexual situations. Additionally, this domain covers skills
related to appropriately responding when consent and assent are given, and when
withdrawn. This domain also contains skills related to understanding of breaches of
consent as abuse and appropriate steps. This domain is so important. Demonstration
of, and recognition of, consent and assent in others is a skill that relies both on vocal
communication as well as nonverbal cues, which may be challenging for learners on
the autism spectrum. Teaching these skills early and often is vital.
Keywords: Assent; Autism spectrum; Consent; Nonverbal cues; Sexual behavior.
Overall • The individual can demonstrate an understanding of consent

goal and assent as a form of permission to engage, or participate
in, a variety of overt and covert sexual situations
• The individual can demonstrate consent and assent to sexual
acts broadly, in isolation, and under identified circumstances.
• The individual can recognize and respond appropriately to
consent and assent, or lack thereof, given by another
individual
• The individual can discern and respond appropriately to
situations where a partner has denied consent or assent.
• The individual can describe breaches of consent as abuse
and follow appropriate reporting
methodologies Interaction Procedure, Behavior Skills Training, Video
Modeling
Cross This area overlaps significantly with abuse identification,
referenced prevention and reporting, as well as understanding of the law.
skills
Special This area is challenging to teach within and especially
considerations important for both safety concerns and relationships.
Discussions must take place in the context of assent/
consent and victimization.

Chapter 1 outlines some of the risks for people on the autism spectrum
as pertaining to a need sexuality education. Skills related to effectively
giving consent when desired as well as withholding consent when needed
are both incredibly important, and may be particularly challenging for
people on the autism spectrum. Effectively communicating desires is
important, and this requires both recognition of one’s own likes and dis-
likes, as well as effective communication of these. For some people with
ASD, they may never have been allowed to refuse a physical greeting, or
taught how to. If one is going to be able to give consent, they must first be
able to recognize and discuss actions, items, and interactions that they like
and do not like. They must have opportunity to practice giving and
withdrawing consent and assent in various situations, as well as refusing to
give consent at all. Historically, teaching about assent and honoring signs of
assent from individuals with ASD has been inexcusably underemphasized.
Effectively and confidently giving and withdrawing assent is extremely
important in preventing victimization, especially within sexual interactions.
Equally importantly, individuals must be able to recognize both overt
and subtle signs of giving and withdrawal of consent by others. While some
indices of consent and assent are loud, overt, and clear, others are subtle and
rely on interpretation of body language, tone of voice, and other nonverbal
cues. A pull away, a pause before saying “yes,” and a questioning tone in a
vocal agreement can all indicate a withdrawal of assent in an interaction and
must be honored as such. For people on the autism spectrum, such cues,
especially those that are at all nuanced, may be difficult to interpret
correctly, or sometimes to even notice at all. It becomes incredibly
important to teach these overtly and to a high degree of fluency.
Skills in the consent domain are closely related to those in both “abuse
prevention and reporting” and the law. The overlap is intentional as these
skills are of paramount importance for those with ASD.
Skills in the consent domain can be taught using a variety of teaching
methodologies including Discrete Trial Teaching, Cool versus Not Cool,
Teaching Interaction Procedure, Behavioral Skills Training, and Video
Modeling. All teaching strategies are outlined in Chapter 3 and as always
should be selected and individualized based on the learner.
Throughout this chapter, we use the terms “primary sexual experi-
ences” and “early sexual experiences” to denote the types of interactions or
experiences one might have early in relationshipsdholding hands, kisses,
hugs, and cuddles. It is important that the skills listed above apply to these
early experiences as well as those that are more complex. As well it is
Consent 81
important to teach giving and recognizing consent and withdrawal in overt

ways as well as more subtle behaviors.
Finally, when teaching about consent, the transient or momentary
nature of consent should be considered. Consenting to something that
someone wants applies in that moment only, and they may change their
mind at a later time. This can be a challenging concept for people with
ASD, who may have interests that are more rigid and stable, and thus is
important to be emphasized within teaching as well.
- Clearly accept physical contact from others (like hugs from family
members).
- Identify and clearly protest any unwanted physical contact from others.
By school age, individuals should be learning to:
- Ask before physically engaging with someone in casual physical contact
(e.g., a hug) and refrain from engaging in it if the person says no.
- Ask before physically helping someone and refrain from helping if the
person says no
- Answer yes/no questions about items/activities they like (e.g., “do you
like juice? Do you like roller coasters?”)
- Answer yes/no to offers of physical help
- Assert independence by refusing offers or attempts to provide physical
help.
- Tell others “I don’t like that” and/or move away in response to un-
wanted physical contact in casual interactions (e.g., someone standing
too close, pulling their arm to go somewhere, etc.)
- Answer yes or no to requests for casual physical contact from others
(e.g., “can I sit next to you?”)
By early adolescence, individuals should be learning to:
- Ask overt questions before physical engaging with others in primary
sexual behavior (e.g., “can I hold your hand?”)
- Recognize positive or negative body language toward primary sexual
behavior and terminate the sexual behavior in response to negative
body language from their partner (e.g., turning their face away from a
kiss)
- Ask partners what type of primary sexual behavior they like, do not like,
or are interested in and they refrain for persistently asking their partner
to engage in behaviors their partner has said they do not like
- Ask overt questions before physically engaging with others in all sexual
behavior (e.g., “can I kiss you?”)
- Recognize positive or negative body language toward all sexual

behavior and terminate the behavior in response to negative body
language
- Clarify consent for a partner if they are unsure whether consent or assent
has been provided.
- Answer yes or no to overt requests for physical contact associated with
primary sexual behavior (e.g., can I hold your hand?)
- Nonvocal-verbally agree to primary sexual behavior or can move away
from unwanted behavior (e.g., holding the hand of someone who
reached for theirs)
- Identify early sexual experiences that they liked, did not like, or are not
sure about
- Knowledgeably answer yes or no to overt requests for physical contact
for all sexual experiences.
By adolescence, individuals should be learning to:
- Talk about sexual acts with their partner or potential partner in terms of
things they like, do not like, and might like to try but have not expe-
rienced yet in advance of these happening with a partner
- Tell a partner about aspects of a sexual act they enjoy and the parts they
did not enjoy prior to engaging in it, during the act, or following the act
- Demonstrate understanding of when sexual acts have occurred without
their consent; recognize this as an act of abuse and behave accordingly.
Consent 83
Demonstrating consent
Skill one The individual can clearly accept physical Preschool

contact from others (e.g., hugs from
family)
Skill two The individual can identify and clearly Preschool
protest unwanted physical contact from
others
Skill three The individual answers yes or no to School age
questions about items/activities they like
(e.g., do you like roller coasters? Juice?
etc.)
Skill four The individual can answer “yes” or “no” School age
to offers of physical help
Skill five The individual can tell others “I don’t like School age
that” and/or move away in response to
unwanted physical contact in casual
interactions (e.g., someone standing too
close, pulling their arm to go somewhere,
etc.)
Skill six The individual can answer “yes” or “no” School age
to requests for casual physical contact from
others (e.g., can I shake your hand? Give
you a hug? Sit next to you? etc.)
Skill seven The individual can assert independence by School age
refusing offers of, or attempts to provide,
physical help (e.g., someone attempting to
adjust their clothing, etc.)
Skill eight The individual can answer yes or no to Early
overt requests for physical contact adolescence
associated with primary sexual behavior
(e.g., can I hold your hand? Kiss you?
Hug you? etc.)
Skill nine The individual can nonvocal-verbally Early
agree to primary sexual behavior or can adolescence
move away from unwanted behavior (e.g.,
holding hand of someone who reached for
theirs, kissing back, etc.)
Skill ten The individual can identify early sexual Early
experiences that they liked, did not like, adolescence
and are not sure about
(Continued)
Skill eleven The individual can knowledgeably answer Early

yes or no to overt requests for physical adolescence
contact for all sexual behavior
Skill twelve The individual can identify early sexual Early
experiences they liked, did not like, or are adolescence
undecided about
Skill thirteen The individual can talk about sexual acts Adolescence
with their partner or potential partner in
terms of things they like, do not like, and
might like to try but have not experienced
yet in advance of these happening with a
partner
Skill fourteen The individual can tell a partner the Adolescence
aspects of a sexual act that they enjoy and
the parts that they do not enjoy either
prior to engaging in the act, during the
act, or follow the act occurring.
Skill fifteen The individual demonstrates understanding Adolescence
of when sexual acts have occurred without
their consent, recognizes this as an act of
abuse, and behaves accordingly (see abuse
prevention and recording)
Teaching Parent Coaching, DTT, BST/TIP, Cool not Cool
format
Special There is much overlap in the skills in this domain with
Considerations many in sexual abuse prevention and reporting, as well as
several within social skills. Please ensure complementary
skills are being taught together.
Consent 85
Consent and assent recognition
Skill one The individual asks before physically School age

engaging with someone in casual physical
contact (e.g., can I give you a hug?) and
refrains from engaging if the person says
“No.”
Skill two The individual asks before physically School age
helping someone and refrains from
helping if the person says no
Skill three The individual asks overt questions before Early
physically engaging with others in adolescence
primary sexual behavior (e.g., “can I hold
your hand?”)
Skill four The individual recognizes positive or Early
negative body language toward primary adolescence
sexual behavior and terminates the sexual
behavior in response to negative body
language from their partner (e.g., turning
face away from a kiss, letting go of their
hand, etc.)
Skill five The individual can ask partners about Early
what types of primary sexual behavior adolescence
that they like, do not like, or are
interested in and refrains from persistently
asking their partner to engage in
behaviors that their partner has said they
do not like
Skill six The individual asks overt questions before Early
physically engaging with others in all adolescence
sexual behavior (e.g., Can I kiss you?)
Skill seven The individual recognizes positive or Early
negative body language toward all sexual adolescence
behavior and terminates the behavior in
response to negative body language (i.e.,
turning face away from a kiss, letting go
of their hand, etc.)
Skill eight The individual clarifies consent from a Early
partner if the individual is unsure whether adolescence
consent or assent has been provided.
Teaching Parent Coaching, DTT, BST, TIP, Cool not Cool
format
CHAPTER 13
Social skills
Abstract
This domain covers social skills that are particularly applicable to sexuality. Social skills
are an integral part of the human experience and as such are complex and may
require specified teaching. This is not an exhaustive list of social skills, rather those that
are especially relevant in the area of sexuality. Social skills are often specific to the
immediate social environment and community and as such these need to be carefully
considered. There is strong overlap between this domain and that of relationships as
well as individual preference.
Keywords: Autism; Behavior; Compliments; Relationships; Sexuality; Social skills.

Overall goal Social skills:

• The individual can distinguish between types of
relationships by description and in their own life
including acquaintances, friends, romantic
relationships, and sexual relationships
• The individual can distinguish between flirting,
teasing, stalking, and bullying
• The individual initiates appropriately as desired and
responds appropriately to various types of physical
interactions (hugging, kissing, sexual acts, etc.) (see
consent)
• The individual can communicate physical “triggers”
to physical or emotional discomfort that need to be
avoided
• The individual can make social plans that both parties
enjoy and follow through with social plans.
• The individual can compromise within reason on all
parts of a social relationship
Teaching Discrete Trial Teaching, Cool vs. Not Cool, Behavioral
methodologies Skills Training, Teaching Interaction Procedure, Video
Modeling
Cross- This area closely aligns with relationships and
referenced preferences
skills
Special Social skills are often highly specific to the immediate
considerations social environment/community. Skills like slang, social
media use, places people hang out, social activities peer
groups engage in, etc., tend to vary from community to
community. As such, the social skills targeted as those
that reflect the community in which they will be used.
Whenever possible, consider using peers to determine
what skills should be taught and in what order.
Social skills are complex and are relevant across all aspects of an in-
dividual’s life. While this domain will only cover those that are directly
relevant to sexuality, there is significant overlap between these and social
skills that apply to other parts of an individual’s life.
The desire for social interaction is variable across people, and sometimes
clinicians make the mistake of waiting for an individual to demonstrate
particular social interest to begin teaching social skills. This is a mistake, as it
discounts the need to have social skills in order to access many of these
social environments. The social skills covered in this domain are necessary
for comfortable, positive sexual relationships.
Social skills 89
Social skills are often highly specific to the immediate social environ-
ment/community. Skills like particular slang used, types and amount of
social media use, places people hang out, social activities peer groups engage
in, etc., tend to vary from community to community. As such, the social
skills targeted to be taught should be those that reflect the community in
which they will be used. Whenever possible, consider using peers to
determine what skills should be taught and in what order.
This domain is closely related to types of relationships and these should
be taught in conjunction with each other. Socials skills are interactive,
meaning what the learner is expected or required to do is often in response
to someone else’s social behavior, which may vary greatly across people.
Teaching loosely and using a lot of examples will help ensure demonstra-
tion of the skills when needed.
Distinguishing between types of interactions as positive (joking, flirting)
and negative (bullying) can sometimes be challenging and should be tar-
geted in this area. As well, social interactions require a careful balance of
both compromise so that friends and partners get to have plans and activities
that they enjoy, as well as standing up for oneself.
There is literature and research available on teaching social skills and
individualization of teaching should be utilized with all learners. Social skills
can be taught using Discrete Trial Teaching, Cool versus Not Cool,
Behavioral Skills Training, Teaching Interaction Procedure, and Video
Modeling. See Chapter 3 for further description of these procedures.
- The individual can determine between “mean” and “nice” things to say
to other same-age peers
- Determines “nice” and “mean” things same age peers say
- Recognize and describe interactions that do not include themselves (i.e.,
people giving compliments, playful teasing, mean teasing)
- Demonstrate use of compliments playful teasing, and mean teasing in
various situations
- Recognize when directed to them by others compliments [playful
teasing, mean teasing]
- Respond to compliments and playful teasing either reciprocally (giving a
compliment or teasing back) ort in another way that is matched to the
interaction (e.g., saying “thank you” to a compliment)
- Recognize mean teasing as an act of bullying and can respond by alert-
ing a parent or teacher.
- Initiate greetings with others
- Initiate friendly interactions, questions, or conversations with preferred

others
- Initiate requests to add someone new on some variety of social media
(both in person and by e-request within the app/system)
- Initiates requests to spend time with others outside of their usual social
settings (i.e., hang out outside of school)
- Respond appropriately to greetings from others
- Respond to friendly comments, questions, or conversations as desired
- Respond to requests for adding someone else on carious social media
(both in person and within the app/system)
- Responds appropriately to requests to spend time with others outside of
the usual setting (i.e., hang out outside of school)
- Communicate to others things they like and dislike when referring to
concrete objects, i.e., flavors of chips, types of candy
- Recognize when others communicate preferences that are different
than their own
- Respond respectfully to preferences of others that are different from
their own (refrains from making disparaging comments about others’
preferences)
- Initiate requests to exchange contact information with others
- Plan time with others including location, activity, time, transportation
- Respond to requests to exchange contact information with safe others
- Accept invitations to plans made by others
- Exchange contact information with friends/peers including online
gaming contacts, phone number, social media contact, and email address
- Store contact information safely
- Not share other people’s contact information unless requested or
permitted by that person
- Advocate for their own interests and preferences when making plans
with others
- Acknowledge and consider the interests and preferences of others when
making plans
- Communicate to others things they like and dislike in terms of less con-
crete items and activities (i.e., types of music, activities, TV shows)
- Consider known information about peer’s like and dislikes when mak-
ing plans (e.g., brings peer’s preferred snack)
- Advocate for their own preference when making plans with peers
Social skills 91
- Recognize flirting when seen in interactions that do not involve them

(i.e., people in public, TV shows)
- Differentiate physical acts as friendly or sexual in nature even when they
are acts that share topography with friendly ones (types of hugs, kiss on
the cheek)
- Demonstrate appropriate responses when someone is flirting with them
and when the person doing the flirting is a preferred person (i.e., flirting
back, smiling)
- Can demonstrate appropriate responses when someone is flirting with
them and they want them to stop (i.e., telling them to stop, walking
away)
- Initiate appropriate flirting when interested in someone
- Recognize when the person with whom they are flirting wants them to
stop and they stop
- Demonstrate an understanding of stalking and recognize when someone
is engaging in stalking behavior directed toward them and knows the
most appropriate steps to take
- Demonstrates a recognitions of when he or she is engaging in stalking
behavior and stops stalking either on their own or when asked
- Organize and make plans with others
- When necessary, cancel plans in a respectful manner
Type of interactions
Skill one The individual can determine between School age

“mean” and “nice” things to say to other
same-age peers
Skill two The individual can determine “nice” and School age
“mean” things that same age peers say to
them
Skill three The individual can recognize and describe School age
interactions that do not include themselves,
i.e., people giving compliments, playful
teasing, and mean teasing/making fun of
Skill four The individual can demonstrate use of School age
compliments, playful teasing, and mean
teasing in various situations
Skill five The individual can recognize when School age
directed to them by others compliments,
playful teasing, and mean teasing
Skill six The individual can respond to compliments School age
and playful teasing either reciprocally
(giving a compliment or teasing back), or
in another way that is matched to the
interaction (i.e., saying “thank you” to a
complement)
Skill seven The individual can recognize mean teasing School age
as an act of bullying and can respond by
alerting a parent, teacher, etc.
Skill eight The individual can recognize flirting when Adolescence
seen in interactions that do not involve
themdi.e., people in public, TV shows,
etc.
Skill nine The individual differentiates physical acts as Adolescence
friendly or sexual in nature, even when
they are acts that share topography with
friendly ones (types of hugs, holding hands,
kiss on the cheek, etc.)
Skill ten The individual can demonstrate appropriate Adolescence
responses when someone is flirting with
them and when the person doing the
flirting is a preferred person (i.e., flirting
back, smiling, etc.)
Skill eleven The individual can demonstrate appropriate Adolescence
responses when someone is flirting with
them and they want them to stop (i.e.,
telling them to stop, walking away, etc.)
(Continued)
Social skills 93
Skill twelve The individual can initiate appropriate Adolescence

flirting when interested in someone.
Skill thirteen The individual can recognize when the Adolescence
person with whom they are flirting wants
them to stop, and they stop
Skill fourteen The individual demonstrates an Adolescence
understanding of stalking and recognizes
when someone is engaging in stalking
behavior directed toward them and knows
the most appropriate steps to take. (These
will vary and may include telling a parent,
teacher, or law enforcement personnel
based on the severity of the individual’s
behavior, frequency, past attempts to stop
it, etc.)
Skill fifteen The individual demonstrates a recognition Adolescence
of when he or she is engaged in stalking
behavior and stops stalking either on their
own or when asked.
format
Special There is a significant overlap in the skills in this domain
considerations with many in relationships, as well as several within
consent. Please ensure complimentary skills are being
taught together.
Initiation of interactions
Skill one The individual initiates greetings with others School age
Skill two The individual initiates friendly interactions, School age
questions, or conversations with preferred others
Skill three The individual initiates requests to add someone School age
new on some variety of social media (both in
person and by e-request within the app/system)
Skill four The individual initiates requests to spend time School age
with others outside of their usual social setting
(i.e., hang out outside of school)
Skill five The individual initiates requests to exchange Early
contact information with safe others (phone adolescence
number, email address, etc.)
Skill six The individual plans time with others including Early
location, activity, time, transportation, etc. adolescence
Responding to interactions
Skill one The individual responds appropriately to School age

greetings from others
Skill two The individual responds to friendly School age
comments, questions, or conversations as
desired
Skill three The individual responds to requests for School age
adding someone else on various social
media, (both in person and by e-request
within the app/system)
Skill four The individual responds appropriately to School age
requests to spend time with others outside
of the usual setting (i.e., hang out outside of
school)
Skill five The individual responds to requests to Early
exchange contact information with safe adolescence
others (phone number, email address, etc.)
Skill six The individual accepts invitations to plans Early
made by others that include location, adolescence
activity, times, transportation, etc.
format
considerations many in relationships, as well as several within consent.
Please ensure complimentary skills are being taught
together.
Social skills 95
Making plans
Skill one The individual exchanges contact Early

information with friends/peers including adolescence
online gaming contacts, phone number,
social media contact, email address, etc.
Skill two The individual stores contact information Early
safely adolescence
Skill three The individual does not share other Early
people’s contact info unless requested or adolescence
permitted by that person
Skill four The individual can advocate for their own Early
interests and preferences when making adolescence
plans with others
Skill five The individual can acknowledge and Early
consider the interests and preferences of adolescence
others when making plans
Skill six The individual can organize and make Adolescence
plans with others
Skill seven When necessary, the individual cancels Adolescence
plans in a respectful manner
Teaching Parent Coaching, DTT, BST/TIP, Cool not Cool
format
together.
Communicating preferences
Skill one The individual can communicate to others School age

things they like and dislike when referring
to concrete objects (i.e., flavors of chips,
types of candy, games)
Skill two The individual recognizes when others School age
communicate preferences that are different
than their own.
Skill three The individual responds respectfully to School age
preferences of others that are different than
their own (i.e., refrains from making
disparaging comments about others’
preferences)
Skill four The individual communicates to others Early
things they like and dislike in terms of less adolescence
concrete items and activities (e.g., types of
music, activities, television shows)
Skill five The individual considers known Early
information about peer’s likes and dislikes adolescence
when making plans (e.g., brings the peer’s
preferred snack)
Skill six The individual advocates for their own Early
preferences when making plans with peers adolescence
format
together.
CHAPTER 14
Sexual abuse prevention and

reporting
Abstract
This domain covers skills related to sexual abuse prevention and reporting. With the
unfortunate reality that prevalence of abuse of people with autism spectrum disorders
remains disproportionately high, this domain is of the utmost importance. It includes
teaching skills related to recognition of acts that are abusive as well as precursors to
these acts from both the point of view of the recipient of the act, and the perpetrator
of the act. It also includes skills related to evaluating the safety of a situation in advance
of being in the situation. One of the most important skills to teach is a functional
protest, and several ways to teach this are outlined in this domain.
Finally, while avoiding abusive situations is obviously ideal, it is important that in-
dividuals with autism can report unsafe or risky events to a safe person, and accurately
recall the events. Skills that cover these areas are included as well.
Keywords: Autism spectrum; Consent; Protest; Self reporting; Sexual abuse; Sexual
acts.

Overall goals • The individual can recognize acts that are abusive
from the point of view of the recipient of the acts
• The individual can recognize acts that are potential
precursors to abusive acts from the point of view of
the recipient of the acts
• The individual can recognize acts that are abusive
from the point of view of the perpetrator of the acts.
• The individual can recognize acts that are potential
precursors to abusive acts from the point of view of
the perpetrator of the acts
• The individual can describe and demonstrate various
appropriate strategies for evaluating the safety of a
situation in advance of being in the situation
• The individual can functionally protest (protest in a
way that is effective per situation and makes the
listener stop)
• The individual can accurately recall events that have
transpired
• The individual can accurately discriminate events
that pose a safety risk
• The individual can identify a safe person and share
unsafe or risky events that transpired with them
Cross reference Consent, sexual acts, law, preferences
methodologies Ineteraction Procedure, Behavioral Skills Training
Special While much of this is written for vocal-verbal
considerations communicators, many areas can be adapted to PECS,
voice output, or other augmentative users.
Possibly the most terrifying thoughts for parents and caregivers related
to sexuality and their children with autism pertain to sexual abuse. This is
with good reason. As outlined in Chapter 1, individuals on the autism
spectrum are at high risk of victimization, and must be taught skills to help
avoid sexually unsafe situations. This is a completely unacceptable situation,
and one that requires immediate societal attention and change. It is
imperative, however, to also teach skills related to sexual abuse prevention
to those on the autism spectrum.
The first steps in abuse prevention are recognizing acts that are abusive,
and also recognizing potential precursors to abusive acts. While some de-
terminations about abuse classification are easy to discern, others can be
very difficult. For example, sometimes abuse is committed by a trusted
adult. Sometimes the victim in an abusive situation doesn’t feel unsafe and
Sexual abuse prevention and reporting 99
may even feel special or important. This makes it challenging to recognize

in the moment that an act may actually be abusive. As such, when teaching
this skill it is important that a focus on what makes an act abusive is
prioritized, instead of a focus on the person committing abuse. Abuse can
be committed by anyone, including those that are trusted caregivers or
others in care positions. We must be careful that we are not teaching people
with autism that all caregivers or “close” people are safe, and rather focus on
the types of behavior that are appropriate from various people in their life.
Arguably the most important skill that can be taught to people with
autism is a functional protest. Functional protest means a protest in the form
that it will stop or prevent the undesired action. In some cases, a protest is
quiet and polite (e.g., “no thanks” to an offer of food). Other times it must
be loud, clear, and forceful as is the case when someone is put in an unsafe
situation. Protest should be taught early, across a variety of settings and
situations, using a variety of listeners. If we are going to teach people to
protest, it means we must also honor their protest and continue to show
learners that their protest works.
We also need to teach individuals with autism to evaluate situations for
safety before being in the situation, and when a particular situation may
become unsafe. Once able to determine the safety or potential risks in a
situation we can teach individuals to generate both long- and short-term
risk and benefit analyses. These skills will help individuals avoid poten-
tially dangerous situations, and develop skills to help them get out of
dangerous situations as they arise.
Finally, while significant efforts should be taken to protect autistic in-
dividuals from overtly unsafe situations, they also need to be taught to recall
of information and report to correct people. Should an individual with
autism be in an unsafe situation, or be a victim of sexual abuse it is
extremely important that they are able to report this. This needs to include
skills like recalling events up to a prolonged time period passing, determine
who is the correct person to share information with, and answer questions
related to the information.
As discussed in Chapter 1, not only are people with ASD more likely to
be victims of sexual abuse, they are also at risk of committing sexual offenses
themselves. This chapter outlines skills related to recognition of acts that are
abusive, and precursors to abuse from the perspective of the perpetrator.
This will help serve as a safety skill for all parties involved.
This chapter is written with a vocal-verbal learner perspective. With a
good understanding of your learner and some creativity, these skills can be
adapted well to an augmentative communication user. For example,

teaching recall by having a learner take photos on their phone of places they
go in a day, people they worked with etc., and use those to answer
questions about what they did may be one way to adapt.
Skills in this chapter can be taught using Discrete Trial Teaching, Cool
versus Not Cool, Teaching Interaction Procedure, and Behavioral Skills
Training. These teaching procedures are outlined in Chapter 3 and as al-
ways, should include individualization to the learner.
- Make a choice between a preferred and nonpreferred item
- Protest using a single work to items or activities they do not want
- Say “stop” to ongoing activities they do not want
- Use “no” and “stop” with a variety of adults and peers in various
situations
- Recognize by name and description close immediate family members
(parent caregiver, siblings, grandparent)
- Demonstrate appropriate interactions with close family members and
refrain from them with nonclose family members as desired and
appropriate.
- Label current or ongoing physical pain in themselves
- Protest in advance of an activity (e.g., “I don’t want to go there”)
- Protest nonpreferred touching by another person under “regular” situ-
ations (e.g., I don’t want to give that person a hug, I can put on my own
sunscreen)
- Protest with follow-up request (I don’t want to do that, I want to do
this instead)
- Protest using a variety of topographies (i.e., “no!,” “no thank you,”
“STOP,” “I don’t want to,” “leave me alone”)
- Adjust their protest to the severity of the situation for themselves (e.g.,
“no thank you” in response to “Do you want some juice?” vs., “STOP”
in response to something more aversive or immediate)
- Protest in a persistent manner (e.g., if the first “stop” didn’t result in the
person stopping they can repeat it more forcibly)
- Protest using vocabulary and with clear articulation such that they will
be understood by their listener.
- Select from an array an item recently (within past 3 min) shown or
manipulated.
- Select from an array which item was NOT recently (within past 3 min)
shown or manipulated
- Answer questions regarding an even that occurred within that day
including questions about people, location, what happened, etc.
- Describe events by generating information regarding setting, people,
and other information from events that occurred within that day.
- Answer yes/no and “I don’t know” questions about an event they
described
- Recognize by name and description extended family members (cousins,
aunts/uncles)
- Demonstrate appropriate interactions with extended family members
and refrain from them with nonfamily members (i.e., giving hugs) as
desired and where appropriate
- Determine what events are noteworthy or out of the ordinary
throughout their day (i.e., tell their parents they had a fire drill at school
but not that they ate lunch)
- Differentiate between strangers and community helpers.
- Label situations as safe/unsafe when depicted in video and pictures based
on their outcomes (e.g., “the ladder was unsafe. I know because the girls
fell”)
- Label situations as safe/unsafe when depicted in video based on poten-
tial for poor outcome (i.e., “the boy COULD fall out of the tree”)
- Label current or ongoing physical pain and discomfort in themselvesd
body part specific if relevant
- Label behavioral indicators of physical pain and discomfort in others.
- Recall information about an event, item, or activity that occurred
within the past 48 h
- Answer questions about an event, item, or activity that occurred within
the past 48 h
- Correct another person’s incorrect account of an event, item, or activity
that occurred within the past 48 h.
- Name or recognize a variety of trusted people in their lives.
- Recognize people in various positions of authority throughout their life
and the limits to their authority
- Make fluent in-the-moment decisions and choices about preferred and
neutral activities
- Generate possible precautions that could be put in place to minimize
safety risk
- Describe the risks and rewards associated with various decisions

throughout their life
- Demonstrate behavior that takes appropriate precautions when entering
risky situations
- Report physical pain or discomfort that is not ongoing but occurred
recently
- Describe and report sources of nonphysical pain or discomfort in them-
selves (i.e., bullying, harassment)
- Recognize when they are engaging in behavior resulting in nonphysical
sources of pain or discomfort for others.
Functional protest
Skill one The individual can make a choice between a Preschool

preferred and nonpreferred item
Skill two The individual can protest using single word Preschool
to items or activities they do not want
Skill three The individual can say “stop” to ongoing Preschool
activities that they do not want
Skill four The individual can use “no” and “stop” with Preschool
a variety of adults and peers in various
situations
Skill five The individual can protest in advance of an School
activity (e.g., “I don’t want to do that, I don’t age
want to go there”)
Skill six The individual can protest nonpreferred School
touching by another person under “regular” age
situations (e.g., I don’t want to give that
person a hug, I can put on my own
sunscreen, etc.)
Skill seven The individual can protest with follow-up School
request (e.g., I don’t want to do that, I want age
this instead)
Skill eight The individual can protest using a variety of School
topographies (i.e., “no!,” “no thank you,” age
“STOP!,” “I don’t want to,” “leave me
alone”
Skill nine The individual can adjust their protest to the School
severity of the situation for themselves (e.g., age
“no thank you” in response to “do you want
some juice” vs. “STOP!” in response to
something more aversive or immediate)
Skill ten The individual can protest in a persistent School
manner (e.g., if the first “stop” didn’t result in age
the other person stopping they repeat it more
forcefully)
Skill eleven The individual can protest using vocabulary School
and with clear articulation such that they will age
be understood by their listener
format
Special This skill is arguably the most important skill to teach. To
considerations be functional, the protest must work for the learner. This
skill must be generalized and practiced often, in a variety of
settings, with a variety of peers and adults regularly.
This section was written for vocal-verbal communicators.
For those learners that use an augmentative form of
communication, or do not yet have an established form of
communication, this is still an incredibly important skill
and must be targeted within the individual’s current form
of communication.
Recall events
Skill one The individual can select from an array an School Age
item recently (within past 3 min) shown or
manipulated
Skill two The individual can select from an array School age
which item was NOT recently (within past
3 min) shown or manipulated
Skill three The individual can answer questions School age
regarding an event that occurred within that
day including questions about people,
location, what happened, etc.
Skill four The individual can describe events by School age
generating information regarding setting,
people, and other information from events
that occurred within that day
Skill five The individual can answer yes/no and “I School age
don’t know” questions about an event they
described
Skill six The individual can recall information about Early
an event, item, or activity that occurred adolescence
Skill seven The individual can answer questions about Early
an event, item, or activity that occurred adolescence
Skill eight The individual can correct another person’s Early
incorrect account of an event, item, or adolescence
activity that occurred within the past 48 h
Teaching DTT
format
Special Caution needs to be utilized to avoid suggestibility when
considerations teaching recall. As well, attention to saliency of
eventsdincreased saliency or preference within events may
skew objective recall and an aspect of the skill that needs
to be considered while teaching
Discrimination of people and events
Skill one The individual can recognize by name and Preschool

description close immediate family members
(parent/caregiver, siblings, grandparent)
Skill two The individual can demonstrate appropriate Preschool
interactions with close family members and
refrain from them with nonclose family
members (i.e., giving hugs) as desired and
appropriate
Skill three The individual can recognize by name and School age
description extended family members
(cousins, aunts/uncles)
Skill four The individual can demonstrate appropriate School age
interactions with extended family members
and refrain from them with nonfamily
members (i.e., giving hugs) as desired and
appropriate
Skill five The individual can determine what events School age
are noteworthy or out of the ordinary
throughout their day (i.e., they tell their
parents they had a fire drill at school, not
that they ate lunch)
Skill six The individual can differentiate between School age
friends, acquaintances, and strangers in their
life
Skill seven The individual can differentiate between School age
strangers and community helpers
Skill eight The individual can name or recognize a Early
variety of trusted people in their lives adolescence
Skill nine The individual can recognize people in Early
various positions of authority throughout adolescence
their life, and the limits to their authority
Teaching Parent coaching, DTT, BST, TIP
format
Special Interactions will vary by family rules and cultural values.
considerations Additionally, the skills in this area are a moving
targetdrelationships will continue to change over time and
this will continually need to be revisited.
Safety assessment
Skill one The individual can label situations as safe/ School age
unsafe when depicted in video and pictures
based on their outcome (e.g., “the ladder
was unsafe. I know because the girls fell”)
Skill two The individual can label situations as safe/ School age
unsafe when depicted in video and pictures
based on potential for poor outcome (e.g.,
“the boy COULD fall out of the tree”)
Skill three The individual can make fluent in-the- Early
moment decisions and choices about adolescence
preferred and neutral activities
Skill four The individual can generate possible Early
precautions that could be put in place to adolescence
minimize safety risk
Skill five The individual is able to describe the risks Early
and rewards associated with various adolescence
decisions throughout their life
Skill six The individual demonstrates behavior that Early
takes appropriate precautions when entering adolescence
risky situations
Special Assessment of risk is ongoing and changes based on
considerations individual circumstance. The learner should be able to use
problem-solving and decision-making skills as opposed to
learning rote risk assessment.
Abuse
Skill one The individual can label current or ongoing Preschool

physical pain in themselves (not body parte
specific)
Skill two The individual can label current or ongoing School age
physical pain and discomfort in
themselvesd body partespecific if relevant
Skill three The individual can label behavioral School age
indicators of physical pain and discomfort in
others
Skill four The individual can report physical pain or Early
discomfort that is not ongoing but occurred adolescence
recently
Skill five The individual can describe and report Early
sources of nonphysical pain or discomfort in adolescence
themselves (i.e., bullying, harassment, etc.)
Skill six The individual can recognize when they are Early
engaging in behavior resulting in adolescence
nonphysical sources of pain or discomfort
for others
Teaching Parent consultation, DTT
format
Special For many learners prompting labeling of pain and
considerations discomfort in naturally occurring situations may be
insufficient frequency for the learner to become fluent in
this skill. Care should be taken to contrive teaching
opportunities for discomfort where possible.
CHAPTER 15
Masturbation
Abstract
This domain covers skills related to masturbation. These skills should be targeted with
both male and female learners and should be addressed early. It is much easier to
teach guidelines around masturbation before they are necessary than to address these
skills once masturbation in problematic locations or harmful habits have already
developed. These skills should be targeted in consultation with the learner and the
learner’s family to ensure congruence with family values and beliefs. Care should be
taken to teach guidelines for masturbation with long-term application in mind; a
bathroom may be a private place in one’s home, but is not as private in a public gym
changeroom. As such, consideration to discrimination and generalization needs of the
learner is important.
Keywords: Autism; Masturbation; Privacy; Sexuality.
Overall goal • The individual can maintain privacy while

masturbating or engaging in genital play.
• The individual can masturbate safely and effectively
(to orgasm).
The individual can masturbate safely and effectively
(to orgasm) using lubricant and appropriate aids/toys
as necessary
• The individual cleans their environment after
masturbating including cleaning any aids/toys used,
semen, other bodily fluids, etc.
• The individual can access legal pornography or other
sexual material as desired and can maintain
appropriate responsibility of such material (i.e.,
storing it in a private location)
Teaching Discrete Trial Teaching, Video modeling, Cool versus
methodologies Not Cool, Chaining/Task Analysis Teaching, Parent
Coaching
Cross-referenced Sexual acts, preferences, law
Special Video modeling can be used when legal and
considerations appropriate.

Masturbation, like other domains, needs to be targeted early. Almost all

children will at some point discover touching their genitals, and frankly, that it
feels good. As such, there is “built in” reinforcement to this act, and behavior
patterns are developed quickly. Teaching the conditions under which
masturbation is ok is typically much easier when this is new to learners, and
conversely much more challenging to change long-existing behavior patterns.
This approach means really consider what the “rule” about masturbation will be
that can apply all the time without extra discrimination needed. For example, it
might be tempting to teach that a bathroom is a private space and one can
masturbate there. And, in some cases a bathroom might be a fully private space
(e.g., your bathroom at home). However, a bathroom in a recreation center
changing room or public pool is not a private space and engaging in mastur-
bation there is likely to get one in serious trouble. While these distinctions may
seem easy to some of us, for people on the autism spectrum distinctions like this
can sometimes be challenging. In most cases, it is best to set a conservative rule
(e.g., the ONLY place you can masturbate is in your bedroom at home) than try
to teach subtleties. Like some other aspects of sexual behavior, the room for
error is very small; masturbating in public domains is, in most places, a criminal
behavior, the consequences of which can be very serious and long lasting.
There are many other skills that are to be considered within mastur-
bation, including being able to masturbate safely (not using dangerous aids
or materials) and effectively (to orgasm). Ineffective masturbation can lead
to frustration and challenging behavior. In many cases, effective mastur-
bation is shaped naturally within the act; people continue to do things that
feel good. This is also a sensitive and challenging area to teach within and
may require the consultation of a sexuality professional should ineffective
masturbation become a pervasive problem.
It is also important to teach about hygiene. Masturbation that includes
aids or sex toys needs to include instruction on toy storage and cleaning.
The individual also needs to learn how to clean themself and any other
soiled areas following orgasm.
Access to pornography is also covered in other domains (online activity,
law, and individual preference) but the point cannot be overstated. Many
individuals that are not of legal age to access pornography are accessing
pornography. Many individuals who have parental controls or site locks on
their network at home are accessing pornography. The fact is that
pornography is accessed, and it is better to teach safe access and manage-
ment of pornography early and often than to wait until an individual
reaches legal age. A discussion of masturbation skills would be remiss to not
include this reminder.
Masturbation 111
Masturbation is challenging to teach. It can be awkward and uncom-

fortable to talk about, and also deeply personal and private. Masturbation
skills can be taught, with discretion, using Discrete Trial Teaching, Cool
versus Not Cool, Video modeling, Task Analysis/Chaining, and Parent
coaching. These teaching procedures are outlined in Chapter 3. Paying
close attention to the people who are teaching these skills and ensuring that
they are close, trusted adults, and the pool of teachers in this area is small is
important to maintaining safety and privacy.
Finally, autistic learners may often display masturbatory behavior before
parents, caregivers, and other adults expect them to do so. Planning ahead
and starting early is important to present clear boundaries and conditions
under which masturbation is both permitted and safe.
By preschool age, individuals should be learning to:
- Demonstrate an understanding of their own personal private space
(typically their bedroom)
- Demonstrate an understanding of their own belongings
By school age, individuals should be learning to:
- Demonstrate an understanding of other people’s private space and
appropriate rules around this (e.g., knocking on closed door)
- Demonstrate an understanding of other people’s belongings and refrain
from touching or taking them without permission
- Demonstrate an understanding of the limits of privacy in terms of sound
- Demonstrate an understanding of measures to improve privacy (e.g.,
playing music to mask sound, closing doors)
- Demonstrate respectful behavior of others’ privacy including knocking
on doors, refraining from searching computer history, and not scrolling
through other people’s phones
- Identify sex toys/aids and their appropriate use
- Store toys or other masturbation aids (e.g., lubricant) in a safe and pri-
vate location
- Use toys or other aids in a same manner and refrain from masturbating
with necessarily dangerous items (e.g., glass bottles)
- Clean self and any other needed areas following completion
- Access, manage, and store legal pornography in a safe and private loca-
tion if applicable
- Regularly check toys for wear and tear, replacing as needed
- Masturbate to orgasm as desired
By adulthood, individuals should be learning to:

- Shop for or otherwise appropriately obtain sex toys, pornography, or
other masturbation aids as desired
Privacy
Skill one The individual demonstrates understanding Preschool

of their own personal private space
(typically their own bedroom)
Skill two The individual demonstrates understanding Preschool
of their own belongings
Skill three The individual demonstrates understanding School
of other people’s private space and aged
appropriate rules around thisde.g.,
knocking on the closed door
Skill four The individual demonstrates an School
understanding of other people’s belongings aged
and refrains from touching or taking them
without permission.
Skill five The individual demonstrates an School
understanding of limits of privacy in terms aged
of sounds
Skill six The individual demonstrates an School
understanding of measures to improve aged
privacydplaying music to mask sound,
closing doors, etc.
Skill seven The individual demonstrates respectful Early
behavior of others’ privacy including adolescence
knocking on doors, refraining from
searching computer history, not scrolling
through other people’s phones, etc.
Teaching Parent coaching, DTT, Cool versus Not Cool
format
Special Pay close attention to ongoing privacydmany places that
considerations appear private (i.e., a public washroom) are still public in
terms of masturbation and other sexuality skills. Rules
around privacy may be different based on the act being
taughtde.g., changing clothes is acceptable in bedroom,
public washroom, store changing room, gym lockerroom,
etc. Masturbation is only acceptable in one’s own bedroom
and not the other places listed.
Toy and material management and hygiene
Skill one The individual identifies sex toys/aides and Early

their appropriate use adolescence
Skill two The individual stores toys or other Early
masturbation aids (e.g., lubricant) in a safe adolescence
and private location
Skill three The individual uses toys, or other aides in a Early
safe manner and refrains from masturbating adolescence
with necessarily dangerous items (e.g., glass
bottles)
Skill four The individual cleans toys immediately Early
after use adolescence
Skill five The individual cleans self and any other Early
needed areas following completion (i.e., adolescence
achieves orgasm)
Skill six The individual accesses, manages, and stores Adolescence
legal pornography in a safe and private
location
Skill seven The individual regularly checks toys for Adolescence
wear and tear, replacing as needed
Skill eight The individual shops for or otherwise Adult
appropriately obtains sex toys,
pornography, or other masturbation aids.
Teaching DTT
procedures
Special Individuals may require access to masturbation aids before
considerations they are able to acquire them themselves. It is important
that caregivers are aware of the safety risks of not providing
safe aids. Additionally, sex toys can become unsafe over
time, or with regular wear and tear. Ideally, an individual is
able to learn to discriminate this and replace toys
appropriately. If discrimination of this is challenging, an
individual may alternately be taught to replace toys on a
time-based rotation (i.e., every 12 months).
Effective masturbation
Skill one The individual is able to masturbate to Adolescence

orgasm as desired.
Teaching Task analysis, following a visual schedule
procedures
Special
considerations
CHAPTER 16
Sexual orientation
Abstract
Skills in this area are related to understanding of sexual identity in oneself and others.
Formal and slang vocabulary are included, as well as targets related to under what
conditions one should use each type of vocabulary and how to recognize and avoid
offensive language. This chapter has an additional section on identification of one’s
own sexual identity, and how and when to communicate that to others.
Keywords: Autism; Bisexual; Gay; Heterosexual; Homosexual; Lesbian; Sexual

orientation.
Overall Goal Sexual orientation:

• The individual can recognize their own sexual
orientation
• The individual can decide if they want to share their
sexual orientation and with whom and manage
coming out as per their own comfort level
• The individual can describe a continuum of sexual
orientations and be respectful of those in others
• The individual understands, and appropriately uses
slang terms related to their own sexual orientation,
and can differentiate between acceptable and
derogatory slang
Teaching Discrete Trial Teaching, Video Modeling, Cool vs. not
methodologies Cool
Cross-referenced Gender identity, preferences
Special For some, sexual orientation is very static throughout
considerations their lifetime. For others, this is fluid and may change at
different points. As such, some skills may need to be
revisited with individuals at later points in time. This is
a list of essential, yet discrete, skills and does not address
the potential need for individualized emotional support
or even therapy when desired by the individual in
question.

Like many aspects of human sexuality sexual orientation is incredibly

individualized. For some, their own sexual orientation is simple, straight-
forward, and static; they may identify consistently with one gender from
birth. For others, their orientation may be fluid throughout their lives.
While individualized programming is always important, this domain is
especially important to tailor to the experiences, feelings, and views of the
individual learner.
It is also important to consider that for some learners, working in the
domain of sexual identity can be extremely emotionally challenging. It is
important to include consultation or collaboration with other professionals
to help with emotional support as needed.
Modeling, Parent Coaching, or Cool versus Not Cool procedures. These
teaching procedures are outlined in Chapter 3. As always, teaching pro-
cedures should be individualized per learner.
Sexual orientation skills include three main target areas: recognition of
sexual orientation in themselves and others, disclosure of their own and
others’ sexual orientation, and vocabulary related to sexual orientation. All
parts are important to teach; however, it is important to realize that this may
change over time, and should be revisited regularly.
While we recommend most skills taught in this domain are targeted in
early adolescence onwards, if the learner is demonstrating interest or dis-
cussion in this area, teaching can begin earlier.
As in other domains teaching about vocabulary is tricky. It is important
when teaching slang that the language taught reflects that which will be
encountered in the individual’s setting. As such, peers, siblings, and other
community members should be consulted. As well, in terms of sexual
orientation some slang may be derogatory when used under certain con-
ditions but less so under others. These careful discriminations should be
taught, as well as skills related to “figuring it out” as new vocabulary is
encountered in the future. Similarly good natured teasing often occurs
within adolescents and adults. It is important to teach that all slang or
derogatory terminology is equivalent, and the ways that some may be more
hurtful than others.
Finally, understanding of sexual orientation is a growing area across
society. As our understanding of sexuality continues to evolve across time, it
is important to ensure that teaching keeps up with societal change.
Sexual orientation 117

- Define and describe various sexual orientations including but not
limited to:
o Heterosexual
o Homosexual
o Gay
o Lesbian
o Trans
o Bisexual
o Asexual
- Demonstrate appropriate understanding when the sexual orientation of
someone else is disclosed
- Demonstrate understanding of their own sexual orientation
- Demonstrate understanding that disclosure of sexual orientation is
sometimes a private discussion and does not share sexual orientation in-
formation about others unless given permission by that person.
- Decide for themselves when to share information about their own sex-
ual orientation
- Decide for themselves with whom to share information about their own
sexual orientation
- Share information about their own sexual orientation with appropriate
people (e.g., their friends and family, not their teacher at school)
- Demonstrate an understanding of common formal or technical terms
related to sexual orientation
- Demonstrate an understanding of common slang terms related to sexual
orientation
By now individuals should be learning to:
- Be aware of legislation or regulations that protect their own personal
privacy and control of their own disclosure (e.g., employers asking
about sexual orientation)
- Recognize potential sources of discrimination related to disclosure of
their sexual orientation
- Differentiate between acceptable terms related to sexual orientation and
those that are offensive to others
- Refrain from using slang that is discriminatory, derogatory, or otherwise
offensive to others
Recognition of sexual orientation
Skill one The individual defines and describes various Early

sexual orientations including but not limited adolescence
to heterosexual, homosexual, gay, lesbian,
trans, bisexual, and asexual
Skill two The individual demonstrates appropriate Early
understanding when the sexual orientation adolescence
of someone else (family member, friend,
acquaintance) is disclosed
understanding of their own sexual orientation adolescence
format
Special Recognition of sexual orientation is not the same as
considerations appropriate responses to sexual orientation, or other value-
based aspects of sexual orientation. These will be addressed
within value and preference domains
Disclosure of sexual orientation
Skill one The individual demonstrates understanding Early

that disclosure of sexual orientation is adolescence
sometimes a private decision and does not
share sexual orientation information about
others unless given permission by that person
Skill two The individual decides for themselves Early
when to share information about their own adolescence
sexual orientation
Skill three The individual decides for themselves with Early
whom to share information about their adolescence
own sexual orientation
Skill four The individual shares information about Early
their own sexual orientation with adolescence
appropriate people (e.g., their friends and
family members, not their teacher at school)
Skill five The individual is aware of legislation or Adolescence
regulations that protect their personal privacy
and control of their own disclosure (e.g.,
employers asking about sexual orientation)
Skill six The individual recognizes potential sources Adolescence
of discrimination related to disclosure of
their sexual orientation.
format
Special
considerations
Sexual orientation 119
Vocabulary related to sexual orientation
Skill one The individual demonstrates an Early

understanding of common formal or adolescence
technical terms related to sexual orientation
Skill two The individual demonstrates an Early
understanding of common slang terms adolescence
related to sexual orientation
Skill three The individual differentiates between Adolescence
acceptable terms related to sexual
orientation and those that are offensive to
others
Skill four The individual refrains from using slang Adolescence
that is discriminatory, derogatory, or
otherwise offensive to others
Teaching DTT, Cool versus not Cool
procedures
Special When teaching slang, it is important to consult common
considerations uses of slang in the individual’s community
CHAPTER 17
Gender identity
Abstract
Skills in this area are related to an understanding of gender with reference to oneself
and/or others. Formal and slang vocabulary are included in teaching, as well as targets
related to under what conditions one should use each type of vocabulary and how to
recognize and avoid offensive language. An additional section on identification of
one’s own gender identity, and how and when to communicate that to others is also
included.
Keywords: Autism; Binary gender; Gender dysphoria; Gender fluidity; Gender identity;
Sexual orientation.
Overall goal • The individual recognizes and describes their own

gender identity
• The individual can decide if they want to share their
own gender identity and with whom and manage
sharing this information as per their own comfort
level
• The individual can recognize and is respectful of
those with other identities including cis and trans
• The individual uses pronouns appropriately for self
and others
Teaching Discrete Trial Teaching, Video Modeling, Cool vs.
methodologies Not Cool
Cross-referenced Sexual orientation, preferences
Special For some, gender identity is very static throughout
considerations their lifetime. For others, this is fluid and may change
at different points. As such, some skills may need to be
revisited with individuals at later points in time. This is
a list of essential, yet discrete, skills and does not address
the potential need for individualized emotional support
or even therapy when desired by the individual in
question.

Like many aspects of human sexuality gender identity is incredibly

individualized. For some, their own gender identity is simple, straightfor-
ward, and static; they may identify consistently with one gender from birth.
For others, gender identity may be fluid throughout their lives. While
individualized programming is always important, this domain is especially
important to tailor to the experiences, feelings, and views of the individual
learner.
It is also important to consider that for some learners, working in the
domain of gender identity can be extremely emotionally challenging. It is
important to include consultation or collaboration with other professionals
to help with emotional support as needed.
Modeling, Parent Coaching, or Cool versus Not Cool procedures. These
teaching procedures are outlined in Chapter 3. As always, teaching pro-
cedures should be individualized per learner.
Gender identity skills include three main target areas: recognition of
gender identity in themselves and others, disclosure of gender identity, and
vocabulary related to gender identity. All parts are important to teach;
however, it is important to realize that this may change over time, and
should be revisited regularly.
While we recommend most skills taught in this domain are targeted in
early adolescence onwards, if the learner is demonstrating interest or dis-
cussion in this area, teaching can begin earlier.
As in other domains teaching about vocabulary is often tricky. It is
important when teaching slang that the language taught reflects that which
will be encountered in the individual’s setting. As such, peers, siblings, and
other community members should be consulted. As well, in terms of
gender identity some slang may be derogatory when used under certain
conditions but less so under others. These careful discriminations should be
taught, as well as skills related to “figuring it out” as new vocabulary is
encountered in the future. Similarly good-natured teasing often occurs
within adolescents and adults. It is important to teach that all slang or
derogatory terminology is equivalent, and the ways that some may be more
hurtful than others.
Finally, understanding of gender identity is a growing area across soci-
ety. As our understanding of gender continues to evolve across time, it is
important to ensure that teaching keeps up with societal change and sci-
entific understanding.
Gender identity 123

- Define and describe binary gender identity
- Define and describe gender fluidity, gender nonbinary, and gender
dysphoria
- Demonstrate empathy, understanding, or support when the gender
orientation of someone else is disclosed
- Demonstrate understanding of their own biological sex and their own
gender
- Demonstrate an understanding that the disclosure of gender identity is a
private decision and doesn’t share information about the gender identity
of others without permission
- Decide for themselves with whom to share information about their own
gender identity
- Only share information about their own gender identity with appro-
priate people
- Demonstrate understanding of formal or technical terms related to
gender identity
- Demonstrate understanding of common informal or slang terms related
to gender identity
- Demonstrate the ability to differentiate between acceptable terms
related to gender identity and those offensive to others
- Refrain from using slang that is discriminatory, derogatory, or otherwise
offensive to others.
- Be aware of legislation or regulations that protect the personal privacy
and control of their own disclosure (e.g., employers cannot ask about
sexual orientation or gender identity)
- Recognize potential sources of discrimination related to disclosure of
their gender identity
- Recognize when they have been the victim of discrimination and can
report this to the correct individual
Recognition of gender identity
Skill one The individual defines and describes binary Early

gender identity adolescence
Skill two The individual defines and describes gender Early
fluidity, gender nonbinary, and gender adolescence
dysphoria
Skill three The individual demonstrates empathy, Early
understanding or support when the gender adolescence
orientation of someone else (family
member, friend, acquaintance) is disclosed
Skill four The individual demonstrates understanding Early
of their own biological sex and their own adolescence
gender
format
Special Recognition of gender identity is not the same as
considerations appropriate responses to gender identity, or other value-
based aspects of gender. These will be addressed within
value and preference domains.
Gender identity 125
Disclosure of gender identity

that disclosure of gender identity is adolescence
generally a personal/private decision, and
so does not share information regarding the
gender identity of others unless given
permission
Skill two The individual decides for themselves Early
when to share information about their own adolescence
gender identity
Skill three The individual decides for themselves with Early
whom to share information about their adolescence
own gender identity
Skill four The individual shares information about Early
their own gender identity with appropriate adolescence
people (e.g., their friends, certain family
members but generally not the cashier at
the grocery story)
Skill five The individual is aware of legislation or Adolescence
regulations that protect their personal
privacy and control of their own disclosure
(e.g., employers may not ask about sexual
orientation, etc.)
Skill six The individual recognizes potential sources Adolescence
of discrimination related to disclosure of
their gender identity
Skill seven The individual recognizes when they have Adolescence
been the victim of discrimination and can
report this to the correct individual
format
Special
considerations
Vocabulary related to gender identity

of common formal or technical terms adolescence
related to gender identity
Skill two The individual demonstrates understanding Early
of common informal, or slang terms, related adolescence
to gender identity
Skill three The individual demonstrates the ability to Early
differentiate between acceptable terms adolescence
related to gender identity and those that are
offensive to others and under what
conditions
Skill four The individual refrains from using slang that Early
is discriminatory, derogatory, or otherwise adolescence
offensive to others
procedures
Special When teaching slang, it is important to consult common
considerations uses of slang in the individual’s community
CHAPTER 18
Individual preferences
Abstract
This domain covers skills related to individual’s preferences in terms of menstrual care
products, masturbation aids, sexual intimacy, dating activities, and birth control. The
identification of preference, as well as the ability to make and communicate choices
related to preferences is greatly important to autonomy, and overall quality of life.
Keywords: Birth control; Dating; Masturbation aids; Menstrual care products;

Pornography; STD.
Overall goal • The individual can recognize their own preferences in

the areas of:
o Menstrual care product
o Masturbation aids
o Sexual intimacy
o Dating activities and settings
o Birth control
• The individual can effectively communicate their
choice in the above areas.
• The individual can make choices among items in the
above areas
Teaching Discrete Trial Teaching, Behavioral Skills Training,
methodologies Teaching Interaction Procedure
Cross-referenced This area closely aligns with social skills
skills
Special It is important to remember that preferences are
considerations individual and change over time. Preferences may
change with circumstances, and may vary across
individuals (e.g., sexual acts that an individual prefers
with one person may be different with another).
Continued targeting of these areas over time is
recommended.

Honoring individual preferences is important to everyone. When our

choices and options are restricted, it can be extremely frustrating. This is
true especially within the realm of sexuality, and equally true for those on
the autism spectrum. Having preferences respected and honored is
important for autonomy in decisions and overall quality of life.
Preference comes on many levels. When considering, for example,
preference for menstrual products one has to have experienced types of
products (how do you know if you even like tampons without trying
them?). Then within the type of product there is such broad availability of
brand, size, and type. These preferences, both broad and specific, are really
important to most people. They may be static (I always prefer one brand
over another) or may change over time. As such, they are some important
considerations when teaching preferences within the realm of sexuality.
The first consideration, which may feel obvious, but is often overlooked
when working with individuals with ASD, is that in order for someone to
determine whether an item is preferred or not they must be exposed to the
item. As such, it is important to ensure we are offering a variety of items; for
example, when teaching menstrual care, we need to ensure we are offering
different styles, types, and brands of products. Often, we teach skills in
sexuality domains without a lot of consideration to these aspects.
Preference also includes being able to effectively communicate prefer-
ences to others both spontaneously (as in, “would you like to go to a movie
tonight?” or as a choice, “should we go see movie A or movie B?”), and as
articulation of the preferred choice and the not preferred one.
When considering preferences, there are complicating factors that play
into each area. Sometimes preferences are related to long-term effects, i.e.,
one brand of birth control pill has fewer side effects than the other. This can
be difficult to discern sometimes, and teaching may need to help bring
attention to these variables. Additionally, some preferences are idiosyn-
cratic, i.e., some sexual activities are better with some people than others.
This means that recognizing and communicating preference can be situa-
tional and complicated. Finally, preferences change over time. This means
that reviewing preferences often is important.
Teaching about preferences can be done using Discrete Trial Teaching,
Behavioral Skills Training, and Teaching Interaction Procedure. See
Chapter 3 for more detailed explanations of these teaching procedures, and
as always teaching should be individualised per learner.
Individual preferences 129

- Identify their own likes and dislikes in terms of items and activities (e.g.,
the types of movies they like to watch, type of food they like)
- Be respectful and acknowledge the preferences of others even if they are
different than their own
- Recognize their preferred masturbation aids (e.g., vibrators, lotion, etc.)
- Make choices between available masturbation aids
- Plan dates that consider their partner’s preferences
- Advocate for their own preferences in making plans with partners
- Make considerations to safety and overall comfort when planning for
dating activities (i.e., plans to meet new people in public places)
- Recognize that sexual preferences are generally individualized and sub-
jective as they pertain to both self and others (e.g., being a “bad kisser” is
related to individual preferences in style, and not an objective assessment
of one’s ability)
- Try different styles of menstrual products (e.g., pad, tampon) if desired
- Try different brands of menstrual products within regularly used types
- Select preferred or currently desired menstrual product from available
choices
- Indicate a preferred or currently desired menstrual care product sponta-
neously to a known person
- Demonstrate an understanding of the various types of birth control and
the risks and benefits associated with each
- Communicate their preference for birth control type with their partner
as needed
- Take into consideration their partner’s preference for birth control type
as appropriate
- Within a type of birth control select their preferred type considering a
variety of related factors (e.g., protection against pregnancy, protection
against STI/STD, ability to remember to take their pill every day)
- Within a type of birth control demonstrate and communicate prefer-
ence for brand if applicable
- If unhappy with a type of birth control the individual will communicate
their displeasure and reasons why with the appropriate person (e.g.,
informing doctor of unpleasant side effects)
- Within legal limits the individual recognizes preferred categories of
pornography
- Within legal limits the individual requests of otherwise obtains preferred

categories of pornography
- When needed or appropriate the individual communicates their prefer-
ence in pornography to a sexual partner
- The individual recognizes their own enjoyment, pleasure, or discomfort
in the moment while engaging in any level of sexual act either verbally
(e.g., saying “I like that” or “that’s a little too much”) or with body lan-
guage (smiling, leaning in, pulling away)
- Communicate information about sexual acts they have enjoyed or ones
they have not enjoyed in the past to current/future partners
- Use past sexual experiences to assess whether they might enjoy some-
thing they haven’t experienced and communicate this to a partner
Menstrual care
Skill one The individual tries different styles of Adolescence

menstrual products (e.g., pad, tampon,
menstrual cup, period underwear) if desired
Skill two The individual tries different brands of Adolescence
menstrual products within regularly used
types (this is generally advisable to review
and practice prior to onset of menstruation)
Skill three The individual selects preferred or currently Adolescence
desired product from available choices
Skill four The individual indicates preferred or Adolescence
currently desired product spontaneously to
a known person
Teaching DTT
format
Special Menstrual care product preference may change based on
considerations timing within the individual’s cycle, and activities in which
the individual is engaging. For individuals who
demonstrate a strong preference to type or brand of
product, ensuring some flexibility in accepting less
preferred items is recommended to ensure acceptance of
alternative products in unexpected or uncontrollable
circumstances where the most preferred product is
unavailable.
Birth control
Skill The individual demonstrates understanding of Adolescence

one various types of birth control and the benefits and
risks associated with each
Skill The individual communicates their preference for Adolescence
two birth control type (e.g., birth control pill, condom)
with their partner as needed
Skill The individual takes into consideration their Adolescence
three partner’s preference for birth control type as
appropriate
Skill Within a type of birth control, the individual selects Adolescence
four their preferred type, considering a variety of related
factors (e.g., protection against pregnancy,
protection against STI/STD, ability to remember to
take their pill every day)
Skill Within a type of birth control the individual Adolescence
five demonstrates and communicates preference for
brand if applicable.
Skill If unhappy with a type of birth control, the Adolescence
six individual communicates their displeasure and
reasons why with appropriate person (e.g.,
informing her doctor of uncomfortable side effects
of current birth control pill)
Masturbation aids
Skill one The individual recognizes preferred Early

masturbation aids (e.g., vibrators, lotion, adolescence
fleshlight)
Skill two The individual makes choices between Early
available masturbation aids adolescence
Skill three The individual spontaneously requests or Early
otherwise obtains (e.g., purchase online, at adolescence
an adult store, or other vendor) preferred
masturbation aids
Skill four Within legal limits, the individual Adolescence
recognizes preferred categories of
pornography
Skill five Within legal limits, the individual requests Adolescence
or otherwise obtains preferred categories of
pornography
Skill six When needed or appropriate, the Adolescence
individual communicates their preference
in types of pornography to a sexual partner
Teaching DTT
format
Special In terms of preferences with pornography, while legal age
considerations limits exist to accessing pornography, it is reasonable to
assume in many cases that the individual may be accessing
pornography before the legal age. It is important to address
preferences in pornographic content in terms of legal rules,
even with individuals who may not yet meet the legal age
to procure pornography. Instruction in what pornography
is illegal (e.g., child pornography, “snuff” films) or would
generally be considered problematic (e.g., depictions of
rape or incest) should be considered essential.
Dating activities
Skill one The individual identifies their own likes and School age
dislikes in terms of items and activities (e.g.,
types of movies they like to watch, food
they like)
Skill two The individual is respectful and School age
acknowledges the preferences of others,
even if different than their own
Skill three The individual plans dates that consider Early
their partner’s preferences adolescence
Skill four The individual advocates for their own Early
preferences in making plans with partners adolescence
Skill five The individual makes considerations to Early
safety and overall comfort when planning adolescence
for dating activities (i.e., plans to meet new
people in public places, plans for safe
transportation to dates)
format
Special There is much overlap here with social skills domainsdbe
considerations sure to cross-reference and target both.
Sexual acts
Skill one The individual recognizes and demonstrates Early

an understanding that sexual preferences adolescence
are generally individualized and subjective
as they pertain to both self and others (e.g.,
being a “bad kisser” is related to individual
preferences in style, not an objective
assessment of their ability)
Skill two The individual recognizes their own Adolescence
enjoyment, pleasure, or discomfort in the
moment while engaging in any level of
sexual act
Skill three The individual demonstrates/communicates Adolescence
their own enjoyment or discomfort in the
moment while engaging in any level of
sexual act either verbally (e.g., saying “I
like that” or “that’s a little too much”), or
with body language (e.g., smiling, leaning
into someone pulling away)
Skill four The individual communicates information Adolescence
about sexual acts they have enjoyed, or
ones they have not enjoyed in the past, to
current or future partners
Skill five The individual will use past sexual Adolescence
experiences to assess whether they might
enjoy something they haven’t experienced
and communicate this to a partner
Teaching BST, TIP, Cool not Cool
format
Special Careful consideration of teaching strategies is important in
considerations this domain. Using parallels to other successful methods in
teaching preference may be beneficial. Consider carefully
the instructor and the relationship they have with the
learner, being mindful of maintaining boundaries of
professional relationships. Focus on teaching ways to
communicate preferences in sexual acts using BST/TIP
CHAPTER 19
Types of relationships
Abstract
This domain covers skills related to different types of relationships. It is sometimes
challenging to have clear definitions of the type of relationship one finds themselves
in, particularly if they desire to be in a different type of relationship. This domain covers
skills related to understanding different types of relationships and the behaviors
common within them. Skills also include demonstrating understanding of the fluent
and transient nature of relationships, and a recognition and management of rela-
tionship change.
Keywords: Autism; Consent; Physical interactions; Potential for abuse; Relationship;

Trusted adult.
Overall goal • The individual demonstrates an understanding of

various types of relationships as they pertain to
themselves and others
• The individual demonstrates an understanding of
appropriate or expected behavior common in various
types of relationships
• The individual demonstrates an understanding of
fluent or transient nature of relationships, and
recognizes signs of relationships changing
methodologies Teaching Interaction Procedure, Cool vs. Not Cool
Cross-referenced This area closely aligns with social skills, preferences,
skills consent, and abuse prevention
Special This area is somewhat nuanced; it is important to teach
considerations and assess regularly
It can sometimes be difficult to discern what type of relationship one is

in with someone else, especially in early days of dating or sexual re-
lationships. Relationships with people change, and can move from
friendship to romantic partner and sometimes back again. Each type of

relationship comes with different expectations and understandings of pa-

rameters for how each person should act. These extend to physical in-
teractions, the way that each partner speaks to each other, methods of
contact, what type of personal information they share, and what other types
of personal interactions can be expected. Some of these relationship types
are straightforward, clear, and easy to define. Others however may be more
nuanced, fluid, and unclear. These relationships have potential for serious
implications if the “rules” of the relationship are not clearly understood by
all parties. Potential for abuse, issues related to consent, and even legal issues
can arise if the type and parameters of the relationship are not clearly
understood.
The changing nature of relationships may be challenging for people
with autism to understand, and as such should, early on be the focus of
teaching. Interpersonal cues and other ways to understand what type of
relationship one is in with a person should be taught, as opposed to teaching
that particular people are in specific types of relationships. The exception to
this can include close family members (parents, siblings). As types of re-
lationships change over time, these skills should be reviewed regularly.
This area has nuances that vary across individual circumstances. For
example, some families are physically close and may cuddle on the couch,
hug often, even cosleep. Others may be very physically distant. It is
important to ensure that learners are being taught parameters for re-
lationships with consideration to these individualized circumstances.
Skills in this domain can be taught using Discrete Trial Teaching,
Behavior Skills Training, Teaching Interaction Procedure, and Cool versus
not Cool. See Chapter 3 for a full description of these teaching methods
and individualize per learner.
- Demonstrate understanding of the differences between relationship
types including:
o Close family
o Extended family
o Acquaintance
o Friend
o Close friend
o Peer/classmate
o Trusted adult (known)
o Trust adult (community person)
o Romantic/sexual interest
o Romantic/sexual interestdcasual
o Romantic/sexual interestdserious
o Ex-romantic/sexual partner
o Any additional types of relationships that might be relevant for that
individual’s life/culture
- Demonstrate understanding of fluiditydthat people may not necessarily
be in one type of relationship only (e.g., may move from friend to
romantic interest)
- Demonstrate understanding that people may be in different categories of
relationship at the same time (e.g., classmate and romantic interest)
- Demonstrate an understanding of expected behavior by people in
various types of relationships including:
o Physical interactions
o Types of language used
o Methods of contact
o Personal information sharing
o Other personal interactions (sharing food, loaning money)
- Demonstrate understanding of how people in various relationships act
toward one another. This includes:
- Demonstrate an understanding of how they should/can act with others
in various types of relationships. This includes:
- Demonstrates an understanding of when someone is acting to them in a

way that is unexpected or inappropriate for their relationship status
including
- Communicate with relevant persons if someone is acting in a harmful or
dangerous way for their relationship type (e.g., a family member being
abusive)
- Discriminate between relationships based on external factors (e.g.,
related to family, trusted adult community)
- Discriminate between relationships that exist based on interactions (e.g.,
a close friend is someone you trust a lot, tell important things to, does
nice things for you)
- Describe indicators of a relationship that has moved from one type to
another
- Place known and relevant people in their life into various relationship
categories.
Types of relationships

of differences between relationship types adolescence
including:
- Close family
- Extended family
- Acquaintance
- Friend
- Close friend
- Peer/classmate
- Trusted adult (known)
- Trusted adult (community person)
- Romantic/sexual interest
- Romantic/sexual partnerdcasual
- Romantic/sexual partnerdserious
- Ex-romantic/sexual partner
* Any additional types of relationship
that may be relevant in that
individual’s life/culture
Skill two The individual demonstrates understanding Early
of fluidity dthat people may not adolescence
necessarily be in one type of relationship
only (e.g., may move from friend to
romantic interest)
Skill three The individual demonstrates understanding Early
that people may be in different categories adolescence
of relationship at the same time (e.g.,
classmate and romantic interest)
Skill four The individual is able to discriminate Adolescence
between relationships based on external
factors (e.g., related to family, trusted
adultdcommunity is someone who works
in doctor office, etc.)
Skill five The individual is able to discriminate Adolescence
between relationships that exist based on
interactions (e.g., a close friend is someone
that you trust a lot, tell important things
to, does nice things for you)
Skill six The individual can describe indicators of a Adolescence
relationship that has moved from one type
to another. This will vary based on relevant
types of relationships in the individual’s life
at the time.
(Continued)
Skill seven The individual can place known and Adolescence

relevant people in their life into various
relationship categories (i.e., they can
identify a their own neighbor as an
acquaintance, their aunt as a family
member, etc.)
Teaching DTT
format
Special Some types of relationships apply more at different parts of
considerations someone’s life than others. As well, some individual
circumstances may apply (e.g., a friend’s parent may be a
trusted adult, while other friend’s parents may be just
acquaintances).
Expectations of relationships
Skill one The individual demonstrates an Early

understanding of expected behavior by adolescence
people in various types of relationships
including:
- Physical interactions
- Types of language used
- Methods of contact
- Personal information sharing
- Other personal interactions (sharing items,
sharing food, lending money, etc.)
Skill two The individual demonstrates an Early
understanding of how people in various adolescence
relationships act toward one another. This
includes:
understanding of how they should/can act adolescence
with others in various types of relationships.
This includes:
Skill four The individual demonstrates an Early
understanding of when someone is acting to adolescence
them in a way that is unexpected or
inappropriate for their relationship status.
This includes:
(Continued)
Skill five The individual communicates with relevant Early

persons if someone is acting in a harmful or adolescence
dangerous way for their relationship type
(e.g., a family member being abusive)
Teaching DTT, BST, TIP, parent coaching, Cool Not Cool
format
Special Some rules of relationships are very clear and
considerations nonnegotiable, particularly those relating to legal issues,
consent, and potential for abuse. Others however, may
vary based on individual circumstances (e.g., some families
are physically very close, others are not). Ensure that both
broad and individual circumstances are addressed.
CHAPTER 20
Problem solving and critical

thinking
Abstract
This domain covers skills related to problem solving and critical thinking which are
important to short-term decision making (i.e., planning where to go on a date), longer-
term problem solving (i.e., how to deal with conflict with a partner in a respectful way),
and remaining safe (i.e., what should I do if I feel unsafe? Where can I find resources
about abuse?). Skills in this domain will cover teaching in-the-moment problem
solving, skills related to finding and procuring resources, and planning skills.
Keywords: Autism; In-the-moment decisions; Planning; Problem-solving and critical

thinking.
Overall goal • The individual demonstrates in-the-moment problem

solving
• The individual demonstrates ability to find resources
in various places
• The individual demonstrates planning ahead skills
within safety and social priorities
methodologies Teaching Ineteraction Procedure, Cool vs. Not Cool,
Parent Coaching
Cross- referenced This area closely aligns with abuse prevention
skills
Special The goal of this domain is to teach overall problem-
considerations solving skills, not simply the solutions to a variety of
problems they may encounter. As such, teaching
broadly, loosely, and with many exemplars is important.
Problem-solving and critical thinking skills extend far beyond sexuality

skills. Problem-solving skills are important in many aspects of life and they
have direct implications within sexuality teaching. The goal of this domain
is to teach overall problem-solving skills, not simply the solution to
problems. It is impossible to teach all problematic situations an individual

may encounter; behavior and life are complex and the situations individuals
encounter across their life are often novel and include complicated main-
taining contingencies. While teaching direct skills is important, it is also
important to teach individuals skills related to critical thinking.
Critical thinking skills involve both planning ahead, considering possible
concerns, variable outcomes, and anticipating “changes in plans.” As in
other domains, these skills can be targeted in younger children without
including sexuality-specific targets. These skills should be developed early,
and targeted often. Teach children to plan ahead; consider the situation
they will be in, apply their learning of past experiences, and consider
alterative plausible needs of future situations. Teach individuals to be
responsible for their own materials and possessions; this will help not only
with responsibility but also increase awareness of their environment which
is an important safety skill.
Critical thinking also includes making quick in-the-moment decisions.
Sometimes we have a long time to think out problems, but sometimes
situations require a quick decision and being able to make decisions quickly
without panicking is important.
Finally, identifying resources for different topics and parts of life is
important. Understanding who to ask for what is important, both for
getting the accurate answer to your question and, once again, as a safety
skill.
Problem-solving and critical thinking skills can be taught using Discrete
Trial Teaching, Behavior Skills Training, Teaching Interaction Procedures,
and Parent Coaching. Further description of these can be found in Chapter
3. As always, individualization per learner is important. While teaching
broadly and loosely and with lots of exemplars is important in all teaching,
in this domain this will help lead to acquisition of problem-solving skills,
not just an answer to specific questions.
- Collect and manage their own needed items when leaving for an activ-
ity immediately (e.g., getting bathing suit and towel to go swimming;
hat and mitts when told its cold out)
- Collect and manage their own items for future events (e.g., packs an
overnight bag)
- Find contact information if needed for social plans.
- Recognize possible outcomes or things that could happen next in
contrived situations
Problem solving and critical thinking 145
- Recognize and describe several possible “next step” in the moment

(e.g., If my marker isn’t working I can ask a teacher for a new one
OR use a different color)
- Ask clarifying questions about information presented to them about a
variety of topics
- Identify relevant “experts” in their life and their topics (e.g., my friend
plays guitar, he might know the answer to this music question)
- Carry, keep charged, and maintain responsibility for their own phone
- Recognize and discuss potential safety concerns when making plans
- Plan alternative or add safeguards to unsafe situations
- Make excuses or change plans in the moment when needed
- Manage plans being changed with short notice and make decisions
about whether to participate
- Discriminate and identify appropriate people to ask questions related to
sexuality topics (i.e., a parent may be an appropriate person to ask about
menstrual care, but an older sibling may be an appropriate person to ask
about online activity)
- Search internet resources safely and with a critical view to accuracy of
information
- Have an exit plan for unsafe or uncomfortable situations and can
demonstrate (at least in practice)
- List and understand how to access various additional health resources
(i.e., school nurse, family doctor, planned parenthood resources)
- Access and use emergency resources if needed
Planning ahead
Skill one The individual collects and manages their School age
own items needed when leaving for an
activity immediately (e.g., “its time to go
swimming, get your things”dthey collect
their bathing suit, towel, etc., or “its cold
outside today”dgets hat and mitts)
Skill two The individual collects and manages own School age
items for future event (e.g., packs overnight
bag)
Skill three The individual finds contact information if School age
needed for social plans (address, phone
number of other people)
Skill four The individual carries, keeps charged, and Early
maintains responsibility for their own phone adolescence
Skill five The individual recognizes and discusses Early
potential safety concerns when making plans adolescence
Skill six The individual plans alternatives or adds Early
safeguards to unsafe situations adolescence
format
Special There is much overlap here with abuse prevention.
considerations
In-the-moment decisions
Skill one In contrived situations the individual can School age

recognize possible outcomes or “things that
could happen next”
Skill two In the moment the individual can School age
recognize and describe several possible
“next steps” (e.g., if my marker isn’t
working I can find a teacher and ask for a
new one, OR use a different color)
Skill three The individual can make excuses or change Early
plans in the moment when needed adolescence
Skill four The individual can manage plans being Early
changed with short notice and make adolescence
decisions about whether to participate
Skill five The individual has an exit plan for unsafe Adolescence
or uncomfortable situations and can
demonstrate (at least in practice)
format
Special
considerations
Problem solving and critical thinking 147
Resources
Skill one The individual is able to ask clarifying School age

questions about information presented to
them about a variety of topics
Skill two The individual is able to identify relevant School age
“experts” in their life and their topics (e.g.,
“my friend plays guitar, he might know
the answer to this music question”)
Skill three The individual is able to discriminate and Early
identify appropriate people to ask questions adolescence
related to sexuality topics (i.e., their parent
may be an appropriate person to ask about
menstrual care, their older sibling may be
an appropriate person to ask about online
activity)
Skill four The individual can search internet resources Early
safely and with a critical view to accuracy adolescence
of information
Skill five The individual is able to list, and Adolescence
understand how to access various additional
health resources (i.e., school nurse, family
doctor, planned parenthood resources)
Skill six The individual is able to access and use Adolescence
(if needed) emergency resources (i.e., help
phone numbers)
format
Special This area overlaps with relationships and abuse prevention.
considerations Resources will vary by areas, it is important to ensure
accuracy in available resources for the area in which
individuals access services and live.
Appendix
149
CHAPTER 21
Resources
Abstract
This chapter includes resources for various components of teaching about sexuality for
people on the autism spectrum.
Keywords: Autism; Puberty; Resources; Sex education.
Online resources
https://researchautism.org/self-advocates/sex-ed-for-self-advocates/
Includes information related to:
- Puberty
- Consent
- Relationships and dating
- Sexual orientation
- ASD specific
www.kidshealth.org
- Puberty
- Reproduction
www.plannedparenthood.org
- Includes information related to:
o Birth control
o Abortion
o Gender and sexual orientation
o Terminology
o ASD-specific information
o reproduction
Www.urbandictionary.com
- Current and common slang definitions
www.medlineplu.gov
- Puberty
- Menstruation
www.aboutkidshealth.ca
- Reproduction
- Puberty
www.npr.org
- Gender identity and terminology
www.genderspectrum.org
- gender identity
www.bpl.org
hotline for LGBTQA þ related concerns
www.youthline.ca
- gender identity
- sexual orientation
www.pflag.org
- gender identity
- sexual orientation
Teaching social skills

The Autism Partnership Social Skills Group by Justin B. Leaf,
Ph.D., BCBA-D, Christine M. Milne, Ph.D., BCBA-D, Jeremy A.
Leaf., M.A., BCBA, Jonathan M. Rafuse, M.S., BCBA, Joseph H.
Cihon, Ph.D., BCBA-D, Julia L. Ferguson, M.S., BCBA, Misty L.
Oppenheim-Leaf, M.A., BCBA, Ronald Leaf, Ph.D., John
McEachin, Ph.D, Toby Mountjoy, M.A., BCBA.
PEERS for Young Adults: Social Skills Training for Adults with
Autism Spectrum Disorder and Other Social Challenges.
By Elizabeth Laugeson.
Crafting Connections Contemporary applied behavior analysis (ABA)
for enriching the social lives of persons with Autism Spectrum Disorder by
Mitchell Taubman, Ph.D., Ron Leaf, Ph.D., and John McEachin, Ph.D.
The Science of Making Friends: Helping Socially Challenged
Teens and Young Adults by Elizabeth Laugeson.
Books about sex

Guide to getting it on by Paul Joannides.
The Book of Happy, Positive, and Confident Sex for Adults on
the Autism Spectrum . and Beyond! By Michael John Carley.
Resources 153
Books about puberty

The Care and Keeping of You (Revised): The Body Book for
Younger Girls by Valorie Schaefer and Josee Masse.
The Care and Keeping of You 2: The Body Book for Older Girls
by Dr. Cara Natterson and Josee Masse.
The Girls Body Book (Fifth Edition): Everything Girls Need to
Know for Growing Up! (Puberty Guide, Girl Body Changes,
Health Education Book, Parenting Topics, Social Skills, Books for
Growing Up) by Kelli Dunham RN, BSN.
The Boys Body Book (Fifth Edition): Everything You Need to
Know for Growing Up! (Puberty Guide, Health Education, Books
for Growing Up) by Kelli Dunham RN, BSN.
CHAPTER 22
Concluding thoughts
Abstract
This book has taken us through a number of topics relevant to sexuality and sexual
safety for autistic individuals. The goal of this book was to openly discuss and outline
the issues requiring our collective attention, with the hope that the sexual needs of
autistic individuals can be more widely acknowledged and consistently supported.
Keywords: Autism; Sexual health; Sexual safety; Sexuality education; Sexuality.
This book has taken us through a number of topics relevant to sexuality and
sexual safety for autistic individuals. The goal of this book was to openly
discuss and outline the issues requiring our collective attention, with the
hope that the sexual needs of autistic individuals can be more widely
acknowledged and consistently supported.
The state of sexuality education is woeful, for those who are neuro-
typical, and even more alarmingly, for those with disabilities. The topic
itself is controversial, which leads some families, teachers, and other care-
givers to avoid the topics. The world is unforgiving, however, and a lack of
information and education can have dire consequences. Autistic individuals
are more likely than others to have negative sexual experiences, to be
sexually abused, and to be exploited in other ways. It is essential that ed-
ucators and caregivers provide them with the information, skills, and
compassion they need to navigate their sexuality, claim their gender and
sexual identities, and secure their sexual health.
We have reviewed a wide variety of instructional methods that are well-
suited to delivering both content knowledge and social navigation skills.
The effective instructional methods that have been used to teach many
other skills are relevant in this context as well. It may be especially helpful
to examine some of the procedures noted for their utility in teaching
complex aspects of sexual health.
Including content in the areas associated with sexuality is part of a
comprehensive curriculum, and is necessary. We have provided a curricular

outline to guide instruction in a number of areas. While some of the

instructional areas are clear and noncontroversial, others are more complex.
In many ways, the first part of the book covers the aspects of sexuality we
are most comfortable with and which may already be included in education
plans, but which may also still lack nuanced instruction. In the body parts
progression, goals include understanding the language used to refer to body
parts, both in a scientifically accurate manner and in typical slang terms used
in their region/community. While the knowledge of the appropriate terms
may be helpful in health and legal contexts (as in the case of an abuse
investigation), it is also important to expose the individual to terms
commonly used in informal social circumstances. Goals for menstrual care
focus on hygiene and on independence. While both of these skills have
been represented in curricular approaches, it is important to look at the
components emphasized here, and how they are linked to independence
and safety.
There is also a substantial focus on health, represented in the repro-
duction and birth control progression and in the health and hygiene skills.
Indeed, the special knowledge and care of reproductive health is preven-
tative, and can also help the individual to identify and report problems that
should be assessed.
Much of the other content focuses on areas that are often underrep-
resented and ignored. The identification of goals in law and in online safety
is related to the data on the increased vulnerability of autistic people to
sexual violence and exploitation. The focus on sexual acts; on sexual abuse
prevention and reporting; and on social skills helps to ensure that the in-
dividual learns about and understands sexual behavior and recognizes vio-
lations of behavioral norms in sexual contexts. This is extremely important,
especially since an uninformed individual is both at risk for victimization
and for being identified as a perpetrator. The understanding of laws gov-
erning sexual behavior and sexual content, and of what behaviors are
acceptable and unacceptable, is vital and can prevent a host of problems.
The inclusion of material about instruction in masturbation, sexual
orientation, and gender identity may be the content that readers found
most difficult or challenging. Indeed, parents, teachers, and caregivers often
struggle to discuss these topics with children and students who do not have
disabilities. This is further complicated by society’s lack of acknowledgment
of autistic individuals as sexual beings. It is easy to ignore this dimension of
their experience in the world, and there may not be much initiation of the
topic from them. Furthermore, these are topics that are conversational
Concluding thoughts 157
lightning rods, often separating individuals based on strong opinions, deeply

held beliefs, or religiously influenced practices. Nevertheless, it is clear that
individuals with autism have sexual dimensions to their lives, sexual needs,
and sexual preferences. It is also clear that autistic individuals tend to
identify as nonbinary at a higher rate than neurotypical individuals. Helping
the autistic individual to understand, navigate, and explore these essential
parts of their identity is key to providing them with comprehensive care.
Appropriate intervention should always focus on choice making, pref-
erences, and empowerment of the individual to determine every aspect of
their life. In sexuality, this is perhaps even more salient and necessary. The
curricular targets here are designed to ensure a broad sampling of the topics
where choice and preference are relevant. Please note the emphasis on the
dynamic nature of these preferences, as individuals are free to explore and
change preferences throughout their lives.
It is our hope that this book will support autistic individuals’ sexual
knowledge and safety by providing a framework for instruction, and by
helping caregivers to acknowledge the importance of recognizing autistic
people as sexual beings. It is also our hope that this book may demystify
some of the instruction needed, and provide targets for review, instruction,
discussion, and exposure. We sincerely hope that this book can help de-
stigmatize conversations around sexuality, sexual health, and personal safety,
and provide sound instruction and compassionate support for autistic in-
dividuals in identifying their needs, preferences, and identities. We also
sincerely hope that the use of this book helps to increase positive outcomes
and reduce negative experiences in the lives of autistic people.
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Leaf, J. A., Leaf, J. B., Milne, C., Townley-Cochran, Oppenheim-Leaf, M. L., Cihon, J. H.,
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Index
A H
Age ranges, 35 Human sexuality, 3
Applied behavior analysis (ABA), 152 gender identity, 122
Autism spectrum disorder (ASD), 3e4, Hygiene, 57
80
Autistic individuals, 155 I
Individual preferences
B birth control, 131
Behavioral skills training, 28e29 dating activities, 133
Birth control, 51e52, 131 masturbation aids, 132
Body parts menstrual care, 130
bio, 41 sexual acts, 134
slang, 42 Ineffective masturbation, 110
Intellectual Disability (ID), 6
C Internet safety, 66
Consent In-the-moment decisions, 146
and assent recognition, 85
demonstrating, 83e84 L
Conversation skills, teaching, 21e22 Laws
as perpetrator, 63
D related to pornography, 64
Dating activities, 133 related to public acts, 64
Discrete trial teaching, 20e22 as victim, 63
E M
“Early sexual experiences”, 80e81 Masturbation, 111
Effective instructional methods, 155 aids, 132
Effective masturbation, 113 effective, 113
Effective teaching strategies, 11 privacy, 112
Ethics Code for Behavior Analysts, 18 toy and material management and
Extraordinarily complex multidimen- hygiene, 113
sional matrix, 3e4 Menstrual care, 11, 44, 130
management of sanitary
G materials, 46
Gender identity tracking of cycle, 47
disclosure of, 125 Monitors health, 59
recognition of, 124
skills, 122 N
vocabulary related to, 126 Neurodiversity, 4
Goal selection process, 14 Nonvocal communicator, 15
167
168 Index
O Sexual acts, 75, 134

Online activity vocabulary, 76e77
online navigation, 70 Sexual behaviors, 23e24
privacy, 68 Sexual education skills, 25
social interactions, 69 Sexuality, 155
Online navigation, 70 Sexuality Education, and Information
Online resources, 151e152 Council of the United States, 4
Sexuality-related skills, 9
P Sexual orientation
Parent coaching, 30e31 disclosure of, 118
Parent/guardian consent, 12 recognition of, 118
People and events, discrimination of, skills, 116
105 vocabulary related to, 119
Pornography, 62, 110, 127e130 Sexual relationships, 135e136
Potential for abuse, 135e136 Sexual rights and pleasure, 6e7
“Primary sexual experiences”, 80e81 Sexual safety, 155
Privacy, 68, 112 Sexual victimization, 6
Problem-solving and critical thinking, Sexual violence and exploitation, 156
143e144 Social interactions, 69
in-the-moment decisions, 146 Social skills, 88
planning, 146 communicating preferences, 96
resources, 147 groups, 31
Puberty, 60 initiation of interactions, 93
Public transportation, 27 making plans, 95
responding to interactions, 94
R teaching, 152
Relationships type of interactions, 92e93
expectations of, 141e142
sexual, 135e136 T
types of, 139e140 Teaching interaction procedure (TIP),
Reproductive system, 51 25e28
Resources Tolerates medical procedures, 58
books about sex, 152 Toy and material management and
online, 151e152 hygiene, 113
problem-solving and critical thinking, Tracking of cycle, 47
147 Traditional sex education programs,
teaching social skills, 152 38e39
S V
Safety assessment, 106 Victimization, 5e6
Sanitary materials, management of, 46 Video modeling, 29e30, 72e73
Sex education, 9e10, 13 Violence, 5e6
Sexual abuse, 5e6, 98 Vocabulary
prevention and reporting, 98e99, gender identity, 126
101e102 sexual acts, 76e77
Sexual activities, 128 sexual orientation, 119

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Clinician’s Guide to

MARY JANE WEISS

No part of this publication may be reproduced or transmitted in any form or by any

For information on all Academic Press publications visit our

Publisher: Nikki P. Levi

Typeset by TNQ Technologies

PART ONE Introduction and foundational material

1. Why is this book necessary? 3

2. How to use this book 9

PART TWO Curriculum

7. Reproduction and birth control 49

8. Health and hygiene 53

9. Sexuality and the law 61

10. Online activity 65

11. Sexual acts 71

13. Social skills 87

14. Sexual abuse prevention and reporting 97

15. Masturbation 109

16. Sexual orientation 115

17. Gender identity 121

18. Individual preferences 127

19. Types of relationships 135

20. Problem solving and critical thinking 143

21. Resources 151

22. Concluding thoughts 155

Why is this book necessary?

Keywords: ABA; Autism; Sex education; Sexuality.

and signiﬁcant social awareness. And it includes individuals who display

Sexual abuse, violence, and victimization

any, in the way of such instruction (Barnard-Brak, et al., 2014). Further,

Sexual rights and pleasure

arguably, there is no acceptable level of abuse or victimization). While

How to use this book

Keywords: ABA; Autism spectrum disorders; Caregiver; Clinician; Sex education;

When to start teaching sex education?

Who should teach these skills?

Consent and assent

Where should sex education be taught?

Who should receive sex education?

The use of peers

of instructional methods; safety and risk must be embedded into every

Values and preference

to content are included, and practitioners are recommended to familiarize

Be ﬂexible in instruction. Finally, sexuality and all its components are

versus arrest for indecent exposure. Professionally we are ethically required to

practitioner should seek out additional training or mentorship. These

behavior. Discrete trial teaching is often used to teach conditional dis-

Cool versus Not Cool

An optional component of the cool versus not cool procedure is having

of romantic relationships. It is an appropriate procedure for any discrimi-

The teaching interaction procedure (TIP)

the procedure in a one-to-one instructional format (Leaf et al., 2010), a

Behavioral skills training

systematically approaching complex skills with modeling, practice, and

2012), novel play statements (MacManus et al., 2015), peer engagement

Social skills groups

Clinician's Guide to Sexuality and Autism

Keywords: Autism; Body parts; Slang; Terminology.

Clinician's Guide to Sexuality and Autism