Abstract

Despite the difficulties in living their sexualities, the sexual education of autistic people is often neglected. In this sense, this research aims to identify autistic people’s demands on their sexualities, in line with the neurodiversity paradigm. This qualitative research was carried out from September 2017 to October 2018, with 14 autistic children aged 15 to 17 enrolled in regular schools. Data were collected by semi-structured interviews and analyzed according to the thematic content analysis. Two analytical categories were identified: “discursive processes and the ‘blue angel’ imagery”; and “diversity in diversity: the sexuality of autistic people as singular processes”. The results show that, while autistic people grow physically and sexually according to the typical development stages, some singularities should not be ignored. However, the construction of false beliefs encourages the denial of autistic people’s sexuality. We can conclude that the establishment of effective actions of sexual education and support to the sexuality of the autistic person requires a paradigmatic change anchored in the social model of disability.

Key words:
Sexual education; Sexuality; Autism

Introduction

Despite the growing interest of the scientific literature, autism is still a contentious field permeated by divergences and controversies¹1 Rios C, Ortega F, Zorzanelli R, Nascimento RL. Da invisibilidade à epidemia: a construção narrativa do autismo na mídia impressa brasileira. Interface [periódico na Internet], 2015 [cited 2019 May 22]; 19(53):325-336. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-32832015000200325&lng=en&nrm=iso
http://www.scielo.br/scielo.php?script=s... . Starting from different paradigms, some researchers have explored the psychosexual sphere of autism and stressing the need to analyze it not only from an external perspective (of parents, caregivers, or specialists) but mainly at a personal level²2 Parchomiuk M. Sexuality of Persons with Autistic Spectrum Disorders (ASD). Sex Disabil [serial on the Internet], 2019 [cited 2019 May 10]; 37:259-274. Avaiable from: https://link.springer.com/article/10.1007/s11195-018-9534-z?shared-article-renderer
https://link.springer.com/article/10.100... . In this context, it is salutary to expand research that analyzes the sexuality of this population based on subjective experiences²2 Parchomiuk M. Sexuality of Persons with Autistic Spectrum Disorders (ASD). Sex Disabil [serial on the Internet], 2019 [cited 2019 May 10]; 37:259-274. Avaiable from: https://link.springer.com/article/10.1007/s11195-018-9534-z?shared-article-renderer
https://link.springer.com/article/10.100... ^,33 Den Houting J. Neurodiversity: An insider's perspective, Autism [serial on the Internet], 2019 [cited 2020 Apr 10]; 23(2):271-273. Available from: https://journals.sagepub.com/doi/full/10.1177/1362361318820762?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
https://journals.sagepub.com/doi/full/10... . It is particularly interesting to increase scientific production based on a paradigm coined within the autistic community, as is the case with Neurodiversity³3 Den Houting J. Neurodiversity: An insider's perspective, Autism [serial on the Internet], 2019 [cited 2020 Apr 10]; 23(2):271-273. Available from: https://journals.sagepub.com/doi/full/10.1177/1362361318820762?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
https://journals.sagepub.com/doi/full/10... .

The shift from the classic psychoanalytic paradigm initiated by Leo Kanner and the advancement of neurosciences culminated in the emergence of multiple autism interpretation models and, consequently, in several therapeutic approaches. Although they are different in their theoretical bases, most approaches are based on behavioral and psychopharmacological therapies, searching for a cure or control of autistic characteristics, including the so-called “inappropriate sexual behaviors”²2 Parchomiuk M. Sexuality of Persons with Autistic Spectrum Disorders (ASD). Sex Disabil [serial on the Internet], 2019 [cited 2019 May 10]; 37:259-274. Avaiable from: https://link.springer.com/article/10.1007/s11195-018-9534-z?shared-article-renderer
https://link.springer.com/article/10.100... ^,44 Beddows N, Brooks R. Inappropriate sexual behavior in adolescents with autism spectrum disorder: what education is recommended and why. Early Interv Psychiatry [serial on the Internet], 2016 [cited 2019 May 24]; 10(4):282-289. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26265030
https://www.ncbi.nlm.nih.gov/pubmed/2626... .

The neurodiversity movement emerges, contrasting this perspective. Contrary to what some critics claim, this paradigm recognizes autism as a disability, although it also considers it a neurodiverse condition³3 Den Houting J. Neurodiversity: An insider's perspective, Autism [serial on the Internet], 2019 [cited 2020 Apr 10]; 23(2):271-273. Available from: https://journals.sagepub.com/doi/full/10.1177/1362361318820762?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
https://journals.sagepub.com/doi/full/10... . In line with the social model of disability, Neurodiversity’s principal assumption is that all forms of neurological diversity must be respected³3 Den Houting J. Neurodiversity: An insider's perspective, Autism [serial on the Internet], 2019 [cited 2020 Apr 10]; 23(2):271-273. Available from: https://journals.sagepub.com/doi/full/10.1177/1362361318820762?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
https://journals.sagepub.com/doi/full/10... ^,55 Kapp SK, Steward R, Crane L, Elliott D, Elphick C, Pellicano E, Russell G. 'People should be allowed to do what they like': Autistic adults' views and experiences of stimming. Autism serial on the Internet], 2019 [cited 2020 Apr 12]; 23(7):1782-1792. Available from: https://journals.sagepub.com/doi/full/10.1177/1362361319829628?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
https://journals.sagepub.com/doi/full/10... . Thus, therapies should not seek a cure but focus on maximizing skills, providing socio-emotional support, and promoting strategies in the face of individual and environmental demands⁶6 Silberman S. Neurotribes: The legacy of autism and the future of neurodiversity. New York: Penguim Random House; 2015.^,77 Pantazakos T. Treatment for whom? Towards a phenomenological resolution of controversy within autism treatment. Stud Hist Philos Biol Biomed Sci [serial on the Internet]. 2019 [cited 2019 May 22]; 77:101176. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1369848618301018?via%3Dihub
https://www.sciencedirect.com/science/ar... . In this context, one of the permanent claims among Neurodiversity activists refers to the autistic people’s right over their body and sexuality³3 Den Houting J. Neurodiversity: An insider's perspective, Autism [serial on the Internet], 2019 [cited 2020 Apr 10]; 23(2):271-273. Available from: https://journals.sagepub.com/doi/full/10.1177/1362361318820762?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
https://journals.sagepub.com/doi/full/10... ^,88 Sala G, Pecora L, Hooley M, Stokes MA. As Diverse as the Spectrum Itself: Trends in Sexuality, Gender and Autism. Curr Dev Disord Rep [serial on the Internet], 2020 [cited 2020 Apr 13]; 10.1007/s40474-020-00190-1. Avaiable from: https://doi.org/10.1007/s40474-020-00190-1
https://doi.org/10.1007/s40474-020-00190... , regardless of the level of limitations, refuting the belief that autistic people are asexual or “eternal children”⁵5 Kapp SK, Steward R, Crane L, Elliott D, Elphick C, Pellicano E, Russell G. 'People should be allowed to do what they like': Autistic adults' views and experiences of stimming. Autism serial on the Internet], 2019 [cited 2020 Apr 12]; 23(7):1782-1792. Available from: https://journals.sagepub.com/doi/full/10.1177/1362361319829628?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
https://journals.sagepub.com/doi/full/10... .

However, regardless of the paradigm, the literature is scarce in research on autistic people’s needs concerning the sexual sphere⁸8 Sala G, Pecora L, Hooley M, Stokes MA. As Diverse as the Spectrum Itself: Trends in Sexuality, Gender and Autism. Curr Dev Disord Rep [serial on the Internet], 2020 [cited 2020 Apr 13]; 10.1007/s40474-020-00190-1. Avaiable from: https://doi.org/10.1007/s40474-020-00190-1
https://doi.org/10.1007/s40474-020-00190... . To a large extent, this vacuum is associated with the understanding of disability as incapacity²2 Parchomiuk M. Sexuality of Persons with Autistic Spectrum Disorders (ASD). Sex Disabil [serial on the Internet], 2019 [cited 2019 May 10]; 37:259-274. Avaiable from: https://link.springer.com/article/10.1007/s11195-018-9534-z?shared-article-renderer
https://link.springer.com/article/10.100... ^,66 Silberman S. Neurotribes: The legacy of autism and the future of neurodiversity. New York: Penguim Random House; 2015. and the silencing and disqualification of the autistic people’s statements⁴4 Beddows N, Brooks R. Inappropriate sexual behavior in adolescents with autism spectrum disorder: what education is recommended and why. Early Interv Psychiatry [serial on the Internet], 2016 [cited 2019 May 24]; 10(4):282-289. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26265030
https://www.ncbi.nlm.nih.gov/pubmed/2626... ^,88 Sala G, Pecora L, Hooley M, Stokes MA. As Diverse as the Spectrum Itself: Trends in Sexuality, Gender and Autism. Curr Dev Disord Rep [serial on the Internet], 2020 [cited 2020 Apr 13]; 10.1007/s40474-020-00190-1. Avaiable from: https://doi.org/10.1007/s40474-020-00190-1
https://doi.org/10.1007/s40474-020-00190... ^,99 O'Reilly M, Lester JN. Social Constructionism, Autism Spectrum Disorder, and the Discursive Approaches. In: O'Reilly M, Lester J, Muskett T, editors. A Practical Guide to Social Interaction Research in Autism Spectrum Disorders. The Language of Mental Health. London: Palgrave Macmillan; 2017. p. 61-85.. In this sense, this paper aims to analyze the demands of autistic people on their sexuality, in line with the neurodiversity paradigm.

Methods

This qualitative research was conducted with autistic people from September 2017 to October 2018, whose preliminary data were presented at the Eighth Ibero-American Congress on Qualitative Research (CIAIQ)¹⁰10 Lopes SVMU, Vilar NBS, Pouchaim AJMV, Sucupira LCG, Nóbrega LRM, Brilhante AVM. Transtorno do Espectro Austista e Sexualidade. Atas CIAIQ 2018; 2:1175-1180.. Participants were recruited by a public call on social media that gathers autistic people and relatives. Participation in the research was voluntary.

The inclusion criteria were being oralized autistic or using an alternative communication technique that would allow answering the interview. Adolescents under the age of 18 without authorization from those responsible and those with autism who did not have the communication tools to enable the interview were excluded. Fourteen oralized autists, aged between 15 and 17, attended the invitation; eight were male, five were female, and one participant identified himself as neutral gender. It is noteworthy that all were enrolled in regular schools. While oralized, one of the participants eventually used augmentative and alternative communication technologies through a cell phone application, due to selective mutism episodes. This technology was not needed in this research. Nine participants lived in Fortaleza, three in Maracanaú, one in Caucaia, and one in Eusébio, all municipalities in Ceará, Brazil.

Data was collected through semi-structured interviews that addressed the constraints faced by autistic people in experiencing their sexuality and their sexual education demands. The interviews were conducted by the same researcher who, while being the mother of an autistic child, has features that characterize her as part of the Broader Autism Phenotype (BAP)¹¹11 Endres RG. O Fenótipo Ampliado do Autismo em genitores de crianças com Transtorno do Espectro Autista - TEA [Internet]. Psic Teor e Pesq [periódico da Internet]. 2015 [acessado 2019 Maio 23]; 31(3):285-292. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-37722015000300285&lng=en&nrm=iso
http://www.scielo.br/scielo.php?script=s... . This particularity contributed to the establishment of rapport and is a facilitator in the interview process.

Data were analyzed according to thematic content analysis¹²12 Minayo MCS. O Desafio do conhecimento: pesquisa qualitativa em saúde. São Paulo: Hucitec; 2014.^,1313 Bardin L. Análise de conteúdo. São Paulo: Edições 70; 2016 based on neurodiversity as a theoretical benchmark. The informants were identified by pseudonyms chosen by them to maintain anonymity. The research project was approved by the Research Ethics Committee of the University of Fortaleza.

Results

Two analytical categories were identified: discursive processes and the “blue angel” imagery, and diversity in diversity: the sexuality of autistic people as singular processes.

Discursive processes and the “blue angel” imagery

The difficulty of parents and teachers in recognizing autistic people as sexed people was recurrent in the statements. Informants believe that this resistance is fostered by the introjection of false beliefs about autism. The fallacy that autistic children are eternal children is contested by Elric (16 years):

Elric, whose girlfriend is also autistic, considers himself to be a person with limited autonomy: he reports restrictions on leaving home without support, difficulties in school adaptation, and sensory processing disorder, which compromise activities of daily living. In bringing up these questions, Elric states:

Sakura (17 years) confirms Elric’s criticism of the mental age concept and the infantilization of autistic people, especially those with cognitive impairment:

Sakura states that there was never any intra-family dialogue on sexuality and that she was interrupted whenever she tried to approach the topic:

Autistic people’s stereotype of innocence and the denial of sexuality gains imagery based on a metaphorical construction. The expression “blue angel” is widely disseminated to characterize autistic people and acts as a discursive process, standardizing their infantilization and contributing to female autism’s invisibility, as illustrated by Jasmin’s (15 years) statement:

From the same perspective, Kalel (17 years) adds that the “blue angel” imagery contributes to the autistic people’s sexuality denial:

Diversity in diversity: the sexuality of autistic people as singular processes

Our collaborators’ statements show that the experiences and demands of autistic people regarding their sexuality are as diverse as the spectrum. Although Kalel (17 years) is considered a young man with high academic skills, he reports difficulties in socializing:

Kalel has a brother two years younger, also autistic with severe autonomy limitations and several associated conditions. Kalel tells us about his brother, who was diagnosed with “classic autism”:

Following the narrative line, Kalel reinforces that the right to sexuality of autistic people should be respected regardless of the autonomy level. However, what he observes in his daily life is, on the one hand, the brother’s infantilization, and on the other, the invisibility of his demands:

Kalel also points out that the experience of sexuality and the sexual education of non-oral autistic people are compromised by the lack of investment in augmentative and alternative forms of communication since childhood:

Luke (17 years old), like Kalel, has a brother with severely limited autonomy and cognitive impairment and corroborates the importance of preparing parents for these issues:

The greater need for support, including communication, should not be considered an obstacle for the sexual education of autistic people, as Violet (16 years) points out:

On the other hand, fewer communication hardships do not necessarily reduce sexuality’s demands. Naruto (15 years) has no difficulty in speaking. However, Naruto reports difficulties in understanding social norms, which culminated in stigmatization by his peers. Regarding this aspect, he narrated the following episode:

After discussing this episode in his therapy and talking to his parents, Naruto reports that he understood that:

Unlike Naruto, Sakura refers to the apparent ease of socialization, associated with her ability to perform:

The ability to “perform normality” - using her words - did not facilitate Sakura’s relational experience:

Besides the multiple demands and experiences, Noa (17 years old) brings up the diversity of sexual orientation and gender identity:

Noa says the departure from hegemonic social rules makes autistic people more likely to perceive themselves with non-normative gender characteristics than neurotypical ones:

Thanus (17 years) defines himself as heteroromantic asexual, for not feeling sexual attraction, but being able to fall in love with other people. He believes that there is a societal resistance to admit different forms of relational experience. However, when this experience is associated with autism, disqualification is justified by disability:

Discussion

Our results corroborate that, although autistic people develop physically and sexually according to the typical development stages, some singularities should not be ignored. The experiences and expressions of the sexuality of autistic people are as diverse as the spectrum¹⁴14 Sala G, Pecora L, Hooley M, Stokes MA. As Diverse as the Spectrum Itself: Trends in Sexuality, Gender and Autism. Curr Dev Disord Rep [serial on the Internet]. 2020 [cited 2020 Apr 13]. Avaiable from: https://doi.org/10.1007/s40474-020-00190-1
https://doi.org/10.1007/s40474-020-00190... , requiring an adaptive support structure that considers needs, desires, difficulties, and commitments²2 Parchomiuk M. Sexuality of Persons with Autistic Spectrum Disorders (ASD). Sex Disabil [serial on the Internet], 2019 [cited 2019 May 10]; 37:259-274. Avaiable from: https://link.springer.com/article/10.1007/s11195-018-9534-z?shared-article-renderer
https://link.springer.com/article/10.100... ^,1414 Sala G, Pecora L, Hooley M, Stokes MA. As Diverse as the Spectrum Itself: Trends in Sexuality, Gender and Autism. Curr Dev Disord Rep [serial on the Internet]. 2020 [cited 2020 Apr 13]. Avaiable from: https://doi.org/10.1007/s40474-020-00190-1
https://doi.org/10.1007/s40474-020-00190... .

However, the results of this research show that singularities are ignored, and autistic people’s sexuality is often silenced¹⁵15 Holmes LG, Strassberg DS, Himle MB. Family Sexuality Communication: Parent Report for Autistic Young Adults Versus a Comparison Group. J Autism Dev Disord [serial on the Internet]. 2020 [cited 2020 Apr 13]. Avaiable from: https://www.ncbi.nlm.nih.gov/pubmed/32056120
https://www.ncbi.nlm.nih.gov/pubmed/3205... . Literature attributes this attitude to low expectations regarding the possibility of romantic involvement and the fear of stimulating a sexual desire that would not develop spontaneously¹⁶16 Holmes LG, Himle MB, Strassberg DS. Parental romantic expectations and parent-child sexuality communication in autism spectrum disorders. Autism [serial on the Internet]. 2016 [cited 2019 May 23]; 20(6):687-699. Avaiable from: https://www.ncbi.nlm.nih.gov/pubmed/26408632
https://www.ncbi.nlm.nih.gov/pubmed/2640... . Paradoxically, expressions of sexuality are recognized in autistic people with more significant support needs, with a focus on their social inadequacy¹⁷17 Glidden D, Bouman WP, Jones BA, Arcelus J. Gender Dysphoria and Autism Spectrum Disorder: A Systematic Review of the Literature. Sex Med Rev [serial on the Internet]; 2016 [cited 2019 May 23]; 4(1):3-14. Avaiable from: https://www.sciencedirect.com/science/article/abs/pii/S2050052115000049
https://www.sciencedirect.com/science/ar... .

It is worth highlighting how the discursive processes are organized to build a unique meaning for the autistic person’s sexuality. The “blue angel” metaphor, criticized by our informants, creates a narrative congruence between a pathologizing disability model and the normative disciplinary society⁹9 O'Reilly M, Lester JN. Social Constructionism, Autism Spectrum Disorder, and the Discursive Approaches. In: O'Reilly M, Lester J, Muskett T, editors. A Practical Guide to Social Interaction Research in Autism Spectrum Disorders. The Language of Mental Health. London: Palgrave Macmillan; 2017. p. 61-85.. In this way, the infantilization of autistic people with the greatest need for support legitimizes the pathologization of their sexualities⁶6 Silberman S. Neurotribes: The legacy of autism and the future of neurodiversity. New York: Penguim Random House; 2015.^,99 O'Reilly M, Lester JN. Social Constructionism, Autism Spectrum Disorder, and the Discursive Approaches. In: O'Reilly M, Lester J, Muskett T, editors. A Practical Guide to Social Interaction Research in Autism Spectrum Disorders. The Language of Mental Health. London: Palgrave Macmillan; 2017. p. 61-85.. Insofar as the limitation attributed exclusively to the condition of disability, one starts with the presumed incapacity, culminating in a limitation of investments⁶6 Silberman S. Neurotribes: The legacy of autism and the future of neurodiversity. New York: Penguim Random House; 2015.. In contrast, divestment fosters limitation, arresting the person in a vicious circle³3 Den Houting J. Neurodiversity: An insider's perspective, Autism [serial on the Internet], 2019 [cited 2020 Apr 10]; 23(2):271-273. Available from: https://journals.sagepub.com/doi/full/10.1177/1362361318820762?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
https://journals.sagepub.com/doi/full/10... ^,66 Silberman S. Neurotribes: The legacy of autism and the future of neurodiversity. New York: Penguim Random House; 2015..

The disqualification of non-normative sexual and gender expressions also appears in the results, in Noa and Thanus reports. However, their stories are not exceptions, and there is growing evidence that autistic people have greater sexual and gender diversity than neurotypical people¹⁷17 Glidden D, Bouman WP, Jones BA, Arcelus J. Gender Dysphoria and Autism Spectrum Disorder: A Systematic Review of the Literature. Sex Med Rev [serial on the Internet]; 2016 [cited 2019 May 23]; 4(1):3-14. Avaiable from: https://www.sciencedirect.com/science/article/abs/pii/S2050052115000049
https://www.sciencedirect.com/science/ar... ^,1818 Strang JF, Janssen A, Tishelman A, Leibowitz SF, Kenworthy L, McGuire JK, Edwards-Leeper L, Mazefsky CA, Rofey D, Bascom J, Caplan R, Gomez-Lobo V, Berg D, Zaks Z, Wallace GL, Wimms H, Pine-Twaddell E, Shumer D, Register-Brown K, Sadikova E, Anthony LG. Revisiting the Link: Evidence of the Rates of Autism in Studies of Gender Diverse Individuals. J Am Acad Child Adolesc Psychiatry [serial on the Internet], 2018 [cited 2019 May 23]; 57(11):885-887. Avaiable from: https://www.ncbi.nlm.nih.gov/pubmed/30392631
https://www.ncbi.nlm.nih.gov/pubmed/3039... . Silencing these issues, both in academia and in media elements, at a time when autism gained prominence in television series and programs, corroborates the role of discourses - and silences - in the construction of autism’s social imagery⁹9 O'Reilly M, Lester JN. Social Constructionism, Autism Spectrum Disorder, and the Discursive Approaches. In: O'Reilly M, Lester J, Muskett T, editors. A Practical Guide to Social Interaction Research in Autism Spectrum Disorders. The Language of Mental Health. London: Palgrave Macmillan; 2017. p. 61-85..

These discursive processes culminate in an essential paradox: the uniformity of neglect through a dichotomous construction. While recognizing that some autistic people need more educational and therapeutic support than others, Neurodiversity refutes the binary that dichotomizes them in high or low functioning³3 Den Houting J. Neurodiversity: An insider's perspective, Autism [serial on the Internet], 2019 [cited 2020 Apr 10]; 23(2):271-273. Available from: https://journals.sagepub.com/doi/full/10.1177/1362361318820762?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
https://journals.sagepub.com/doi/full/10... . It is not ignored that some behaviors can expose autistic people to critical situations, making them both victims and potential perpetrators²2 Parchomiuk M. Sexuality of Persons with Autistic Spectrum Disorders (ASD). Sex Disabil [serial on the Internet], 2019 [cited 2019 May 10]; 37:259-274. Avaiable from: https://link.springer.com/article/10.1007/s11195-018-9534-z?shared-article-renderer
https://link.springer.com/article/10.100... ^,99 O'Reilly M, Lester JN. Social Constructionism, Autism Spectrum Disorder, and the Discursive Approaches. In: O'Reilly M, Lester J, Muskett T, editors. A Practical Guide to Social Interaction Research in Autism Spectrum Disorders. The Language of Mental Health. London: Palgrave Macmillan; 2017. p. 61-85., nor does the Neurodiversity paradigm presuppose the absence of therapeutic support. However, it is assumed that the limitations derive from a mix between subjective and environmental issues³3 Den Houting J. Neurodiversity: An insider's perspective, Autism [serial on the Internet], 2019 [cited 2020 Apr 10]; 23(2):271-273. Available from: https://journals.sagepub.com/doi/full/10.1177/1362361318820762?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
https://journals.sagepub.com/doi/full/10... . Thus, therapies must be individualized and based on educational strategies, so that each subject develops the necessary skills to know, control, and explore his/her body⁶6 Silberman S. Neurotribes: The legacy of autism and the future of neurodiversity. New York: Penguim Random House; 2015.^,88 Sala G, Pecora L, Hooley M, Stokes MA. As Diverse as the Spectrum Itself: Trends in Sexuality, Gender and Autism. Curr Dev Disord Rep [serial on the Internet], 2020 [cited 2020 Apr 13]; 10.1007/s40474-020-00190-1. Avaiable from: https://doi.org/10.1007/s40474-020-00190-1
https://doi.org/10.1007/s40474-020-00190... .

On the other hand, even autistic individuals with more subtle deficits may experience socializing difficulties and require support, including adaptive sexual education²2 Parchomiuk M. Sexuality of Persons with Autistic Spectrum Disorders (ASD). Sex Disabil [serial on the Internet], 2019 [cited 2019 May 10]; 37:259-274. Avaiable from: https://link.springer.com/article/10.1007/s11195-018-9534-z?shared-article-renderer
https://link.springer.com/article/10.100... ^,33 Den Houting J. Neurodiversity: An insider's perspective, Autism [serial on the Internet], 2019 [cited 2020 Apr 10]; 23(2):271-273. Available from: https://journals.sagepub.com/doi/full/10.1177/1362361318820762?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
https://journals.sagepub.com/doi/full/10... ^,1919 Barnett JP, Maticka-Tyndale E. Qualitative Exploration of Sexual Experiences Among Adults on the Autism Spectrum: Implications for Sex Education. Perspect Sex Reprod Health [serial on the Internet], 2015 [cited 2019 May 23]; 47(4):171-179. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26418175
https://www.ncbi.nlm.nih.gov/pubmed/2641... . However, the dichotomy between low and high functioning often culminates in neglecting the specific needs of people in this group³3 Den Houting J. Neurodiversity: An insider's perspective, Autism [serial on the Internet], 2019 [cited 2020 Apr 10]; 23(2):271-273. Available from: https://journals.sagepub.com/doi/full/10.1177/1362361318820762?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
https://journals.sagepub.com/doi/full/10... .

It is noteworthy that, although our informants had different levels of support needs, this paper shows, as a limitation, the absence of non-oral autistic patients, evidencing a gap to be filled by future studies.

Final considerations

Discussing the hegemonic metaphorical framework of autism allows us to rethink how these symbolic constructions guide educational and therapeutic actions, in a dichotomous sense of pathologization or neglect.

However, as the expressions of the sexuality of autistic people are diverse and singular, they demand an adaptive support structure that considers their particularities. However, these measures require a paradigmatic change, at the risk of changing the form and not the structure.

References

Publication Dates

History