Problem Solving in Sexuality Education

Background:

There is an urgent need to teach people with ASD about the social aspects, not simply the basic facts, of sexuality. Most people with ASD desire an intimate relationship (Healy et al, 2009; Koegel et al, 2014), but relatively few are able to form the partnership they desire (Hancock, Pecora, Mesibov, & Stokes, 2017). It appears that the social difficulties inherent in ASD are directly related to social isolation and loneliness (White & Roberson-Nay, 2009) experienced when relationships fail. An intervention was developed to address both sexuality education and social problem solving – the application of knowledge in real-world social situations,. The proposed presentation assessed use of a manual for sexuality education that was developed by ASD specialists and a consultant from Planned Parenthood and coupled sexuality education with social problem solving instruction.

 

Objectives:

This presentation will outline the outcomes from a pilot investigation of sexuality education with social problem solving.

 

Methods:

Ten young men with ASD (confirmed with ADOS2 administration and expert clinician diagnosis) completed a 14-week sexuality education course. The intervention was implemented by educators and/or master’s level clinicians with training in ASD. The manual was based on a published curriculum (Davies & Dubie, 2012). Planned Parenthood’s standards, adapted from the federal standards for sexuality education, were used as a framework for editing of the Davies and Dubie manual. Supplementary lessons were created for additional areas of need that were not fully addressed: legality/illegality of pornography and consent. In each session, instructors led participants through at least one example of problem solving following the standard 5-step model of social problem solving (D'Zurilla & Goldfried, 1971). Examples were tied to each week’s content.

All participants participated in pre- and post-testing that included measures of social validity, knowledge questionnaires and vignettes of situations to assess social problem solving. Feedback from participants, course leaders and parents was collected to assess acceptability of the intervention.

 

Results:

Participants demonstrated knowledge acquisition in most areas; learning in some discrete topics was mixed. Surprisingly, knowledge of HIV went down, while knowledge of anatomy, male sexual function, and social-sexual boundaries increased. In response to the social problem solving vignettes, improvements in identifying the problem and offering realistic alternatives to solve the problem of were apparent in eight of ten participants, while two participants demonstrated no change. Acceptability among attendees was good, and feasibility of the intervention was high.

 

Conclusions:

There is a need for comprehensive sexuality instruction for people with ASD. Instruction in social problem solving is an important component to promote healthy outcomes and prevent problem behaviors. It appears that including a social problem-solving component in the regular instruction may improve problem solving, at least in testing situations. Additional study is needed to confirm that problem solving carries over to the natural setting. Given what we understand about autism, generalization deficits, and social problem solving challenges, however, it is likely that social problem solving instruction specific to sexual topics will be a valuable component of sexuality education curricula for this population.