Psychosexual Problems in Individuals with ASD: Prevalence, Predictors and Developmental Course

Background: Adolescence is marked by many physical, psychological and social changes, including the development of intimate relations and sexuality. A healthy psychosexual development requires a variety of social skills. Important skills are the ability to be sensitive to the signals, needs and boundaries of others. It is precisely these skills that many people with ASD have difficulties with. Since the physical development of individuals with ASD is usually within the normal range, this discrepancy between psychosocial and physical development can be potential risk for difficulties regarding psychosexual development. Despite the fact that these difficulties are highly recognized in clinical practice, until recently, research on this topic has been scarce.

Objectives: In a sample of 142 individuals with ASD, we investigated 1) the prevalence of sexual problem behaviour during childhood, 2) the association between ASD severity and sexual problems during childhood, and 3) whether sexual problems during childhood were predictive of more severe psychosexual problems during adolescence.

Methods: Psychosexual development and potential sexual problems were assessed using the Child Behavior Checklist (CBCL at T1 and T2) and the Teen Transitions Screen (at T2), a newly developed instrument to assess psychosexual development and identify putative problems. Overall ASD severity was assessed during childhood (T1) and adolescence (T2) using the Autism Diagnostic Observation Schedule (ADOS).

Results: The prevalence of sexual problem behavior in children with ASD at T1 was 43% and at T2 30%. No cross-sectional or longitudinal associations between ASD severity and sexual problems were found. Individuals with sexual problems at T1 showed more severe sexual problems at T2 (p=.02).

Conclusions: Sexual problems are prevalent among individuals with ASD in childhood as well as in adolescence. These problems are however not related to the severity of ASD symptoms. Children with sexual problems are at risk for developing more severe sexual problem behavior later in life.