Let's get one thing out of the way: no, I do not have a medical degree. If you read a book such as "Autism's False Prophets" by Paul A Offit, you'll understand that it's some people with medical degrees who have over time inflicted grievous harm on autistic people and their families. My first qualification for discussing this issue is that I've lived on the autism spectrum for 63 years. My other qualifications are that for seventeen of those years I've been speaking about autism. At conferences, large and small. To groups of professionals and special-ed teachers but above all to parents of autistic children. The number of parents' meetings I've spoken at must by now be well into the hundreds; in Australia, the US, the UK, The Netherlands, Poland, Germany and Ireland. Additionally, I've been working with autistic individuals for just as long; in camps, holiday programs, schools (both special and mainstream) and privately. I've come to know many autistic adults over a period of nearly 40 years. In this article, I distil my experience, try to answer many of the questions I've been asked over the years and hope that I've come up with something useful.
Some people will agree with me, some will vehemently disagree. It doesn't matter. It isn't possible to write a definitive treatise on this subject any more than it's possible to describe the "autistic experience". You need to keep this caveat in mind at all times. If you think you can do a better job, go for it. (This piece has been online for a couple of years and nobody so far has.) If I act as a catalyst for wider discussion, I'll be very satisfied. That's what I often do at parents' meetings.
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What all autistic people have in common is what's called "the triad of impairments". These are in communication, social interaction and imaginative thought. If these impairments are present, then the person is on the "autism spectrum"; if one or more are absent then this is not the case. It's simplistic to assume that people who have a marked intellectual disability are at one end of the spectrum while those with a gifted-level IQ are at the other. Autism is not related to intellectual functioning and autistic people with high IQs can often have quite profound impairments. However, the level of intellectual functioning in an autistic person makes a significant difference to the manner in which their sexuality can be expressed.
Late in 2006. during a parents' meeting at Ashwood School in Melbourne, Australia, I was asked this question: "Can you explain why so many autistic children reach puberty but do not appear to engage in any sexual activity for several years?" Answering questions at a public meeting demands an ability to think on one's feet and I believe that I've mastered it, although it always takes me at least a day before my energy levels return to normal. That person got his answer and additionally I've now had some time to thoroughly think it through, so my answer is this:
Autistic adolescents may not appear to engage in any sexual activity but of course it begins at the same time and with the same frequency as non-autistic adolescents. Autistic adolescents will generally go out of their way to avoid any exhibition or discussion of this activity, regarding it as extremely private. Any attempt to raise the subject may result in immediate anger and an absolute refusal to discuss it. In fact, if you want to be verbally abused, ask an autistic teenager about his or her sexual activity. So the question really relates to overt sexual behaviour. Think firstly about developmental delay and consider also what's involved in sexual activity with a partner. While the body of an autistic 13yo may be sexually mature, he or she may still be functioning mentally at an eight or nine year old level and therefore be quite unable to consider a sexual activity with a partner. And what is involved? Touching of the most intimate kind and a loss of absolute control over the activity.
To avoid harassment at school, some autistic adolescents will form strategic alliances with students of the opposite sex who face similar issues. Both parties may not be autistic, but both will be considered nerdy or weird, reputations that will abate somewhat if they can point to a person of the opposite sex and truthfully claim a special relationship. In fact, a lot of autistic adolescents eventually have their first sexual experience with a partner of their own age and sex, perhaps someone from their own class, not because (in most cases) they're homosexual but because it's a more comfortable thing to do. One's own sex is more of a known quantity and the chances of rejection are less because both parties will be pretty much in the same boat. I say this after talking to a great many autistic adults about this subject. Please note here that my experience derives from Australian society which is not, in general, either as restrictive or as punitive as in the US.
Many autistic adults do not have any relationship with another person until age 25 or even 35. It can take a great deal of time and maturation to build up sufficient confidence to initiate sexual activity with another, or not to freak if you happen to be autistic and someone initiates it with you. Even then, the activity will in all likelihood be no more than petting. It's pretty rare to find a person diagnosed as being on the autism spectrum who wants or is capable of the kind of relationship that goes with a marriage.
(I need to note here that a diagnosis of Asperger syndrome does not, in my opinion, necessarily place a person on the autism spectrum. Volkmar, Lord, Bailey, Schultz and Klin, writing in the Journal of Child Psychology and Psychiatry, pp 135-170, 2004, identify no less than seven different sets of criteria for "Asperger syndrome": DSM-IV; ICD-10; Ghazuiddin, Tsai & Ghazuiddin, 1992; Leekam, Libby, Wing, Gould & Gillberg, 2000; Klin & Volkmar, 1997; Wing, 1981; Szatmari, Bryson, Boyle, Streiner & Duku, 2003; Tsai, 1992. Volkmar et al go on to state: "These definitions are difficult to operationalize and probably have limited agreement with each other." This statement causes me to question whether there should be anything called "Asperger syndrome". In Australia and most other English-speaking countries, a diagnosis of "Asperger syndrome" must be made according to the criteria laid down in the DSM but no such requirement exists in the US. It's possible for literally any psychologist to diagnose it according to his or her own criteria. I prefer, and use exclusively, the old terminology; low, mid-range and high-functioning autism.)
Occasionally I hear of two aspies being happily married and I'm always sceptical. I'm sure it happens, but I'm much more sure that the majority of people on the autism spectrum express their sexuality in something like the ways I'm describing in this article. The latest revision of the DSM may go so far as to eliminate Asperger syndrome and replace it with "high-functioning autism" in an attempt to restore some sanity to the diagnostic process. Sorry, Tony.
Higher functioning individuals will have a good understanding of society's rules and be aware of the consequences that are likely to flow from flouting them. That doesn't mean that they view themselves as part of that society; it could be that they will see themselves as individual islands in a sea of people which is collectively called "society". They may, therefore, not be especially impelled to obey those rules if they feel that they can get away with flouting them or if they can't imagine being caught simply because it hasn't yet happened to them.
I make a point of saying this because the age of consent can be a major trip point for those autistics who are prepared to engage in sexual activity with another. An autistic person aged 18, 19 or 20 needs to know categorically that it's not OK to choose a sexual partner aged 12, 13 or 14 even though the mental age of the autistic person is lower than his/her chronological age due to the developmental delay intrinsic to autism. It can also be the case that an autistic aged 12, 13 or 14 who has a gifted-level IQ will seek out an older individual because mentally they will function in so many ways at the older level. (This highlights the impossibility of writing a definitive treatise!) Higher-functioning autistic adolescents need to be made aware that courts, reflecting current social attitudes, will be merciless. It's a bleak truism that the life of an autistic person sentenced to jail just about anywhere is effectively over.
At about midpoint on the autism spectrum we encounter those individuals who, in degree of autism, are the so-called "classic autistics", the ones most people will be able to correctly identify without any prior experience as autistic. Their outcome in general will depend on their level of intellectual functioning. Donna Williams is a well-known example of someone with a moderate degree of autism who has been able, by force of intellect and personality, coupled with a good deal of experience, to overcome many of the more imprisoning aspects of her condition and move on to enjoy a fruitful life. She's the only person I know of who has come from mid-range and been able to publicly tell people about her experiences. Her development is by no means over.
However, Donna Williams is a one-off. The individuals at midpoint will know that society exists and understand in broad but blurred detail what that might mean for them. They may not give society any more than passing consideration. In most cases, at puberty, these individuals do nothing more than become intimately acquainted with one of their hands, a behaviour that's likely to persist for life. Occasionally, they may seek out another to do to them whatever they have been doing to themselves. The issue of reciprocity will not occur to them. This will only happen if they are reasonably sure that the other person will not explode in their face. The person propositioned could be a sibling, a parent, a carer or indeed anyone around them. Gender specificity does not seem to be important to them. The proposition itself is nearly always so brief as to be easily missed: a gentle brush on one's thigh or buttocks is common.
At a somewhat lower level of intellectual functioning, we encounter those boys who, at puberty or shortly thereafter, make overt attempts at contact with the females closest to them. And it's always females. I have never encountered a boy who, operating at this level, tried to make inappropriate physical contact with a father or brother, although these may simply not be reported or have been dealt with by slapping the autistic person away. These boys have no idea or are only dimly aware that there's such a thing as society. They don't care; they're simply obeying those hormonal impulses which tell them to mate. In all cases, these individuals need to enter a group home for the continuing safety of their family's female members. Once in a home, that's where they'll spend their lives. In a group home, sexuality takes on a different dynamic which in my experience involves the stronger ruling the weaker.
At the lowest level of intellectual functioning is the autistic individual who has no idea that there is such a thing as society, let alone that it has rules and expectations. Neither has such a person a concept of "mother" or of any other family member. To be sure, such a person will be familiar with these individuals, and may even like them reciprocally. Such a person will recognise the primary caregiver and perhaps smile or grin when (s)he appears. But there will be no love, for such a person cannot love anyone but him/her self. Every thought, every action is evaluated by its relevance to the autistic person. These individuals don't speak but they may have limited receptive language. Their sexuality is infantile and remains so throughout life. Once they reach puberty they can attempt to gratify themselves irrespective of their whereabouts. At night, when there is no-one to tell them not to, they might insert a finger into themselves even if they are male. Because these individuals tend to go to bed (or be put to bed) early, they often wake early and will lie in their soiled sheets and pyjamas until a carer gets them up for a shower, which is by far the best way to clean them.
Melbourne, Australia, December 2006
Abu Dhabi, UAE, May 2008