Autism and Sex

The Transcript of an Interview with Dr. Rachel Loftin

Aspergers Autism Episode number 57.

Hello, and welcome to another edition of the try with Aspergers Autism Podcast. It’s my goal to provide the inspirational interviews and education you need to better connect with yourself and with the world around you. I am going to encourage you before I get started to please go to my aspergers.net/57, episode number 57 to get the post show notes and links for this episode. I know you find them helpful. Today, I am talking about Autism and sexuality with Dr. Rachel Loftin, director of the the autism assessment research treatment and services center at Rush University Medical center in Chicago. Sexuality is a big subject. In this episode, we will be covering a topic of Sex, Autism and Sex Education. You have to pardon my audio quality because I did this interview via phone after our Skype, our skype plug ins were giving us some issues. So, it will sound a little bit less quality than regular microphone interview. But I hope you will enjoy it. This show is brought to you by the Private Aspergers Autism Community. Just text me and at google voice number 847-250-7842. Text “join” along with your email address and I will send you a link to join the group. I will also add you to my free weekly newsletter where I keep you up to date and my blog and my podcast. You can also go to my contact page at my aspergers.net /contact and sign up there. Check your facebook settings to see which email you signed up with and that’s the email address that you need to send to me. And now onto our show.

Steve Borgman: I am very happy to have Dr. Rachel Loftin here today. In case you wouldn’t connect with  from our discussion on Adult Autism by [Inaudible]. Dr. Loftin is a clinical agent, assistant professor at ASRTS University school of medicine. Also a clinical director and associate professor at the ASRTS center at Rush University medical center and that stands for the Autism assessment research treatment and services department at Rush University?

Dr. Rachel Loftin: Rush University Medical center, yes.

Steve Borgman: Rush University Medical center. So Dr. Loftin, thank you so much coming and one of your expertise among many is in the area of sexuality, sex education, sexual health as it relates to Autism Spectrum and I had pulled up an article that you had written back in 2015, I think it was Dr. Ann Hartlage?

Dr. Rachel Loftin: That’s right.

Steve Borgman: It was regarding sex education. Now sex education in general is an important topic and Can you speak a little bit about, I know it’s pretty basic to a lot of us, but there’s many people who get the education, who don’t get really good sex education and they get mainly from whatever they happen to find in the media and they can often give us wrong idea about sex. May be I think we can start off with just a broad overview of what sex education is and why is it so important?

Dr. Rachel Loftin: Sure. Absolutely, exactly why people try to speak together sex education __ information they gather from media, [Inaudible] wherever it is. They are not getting complete education and they may also be getting a lot of misinformation. For example, one upsetting trends that [Inaudible] all types of people increase in the calamity to get sex education. So, in the absence of comprehensive course or other sort of information [Inaudible]. A lot of people are going to internet and [inaudible] and accepting [Inaudible] from the fact instruction based content and unfortunately [Inaudible], it’s same as the content [Inaudible] but it doesn’t necessarily says what that typically looks like. Sex education in contrast is sexually based information, comprehensive information, they get people what they guide vs what choices they want to make on picking very decisions about health, decisions about relationships decisions about, decisions about their [Inaudible] aspect for sexuality. All of these different components, they come under Sexuality but [Inaudible] so that they can make decisions for themselves.

Steve Borgman: Thank you so much for defining that and in specific, I am speaking to those listening audience who are on the Autism spectrum but also it includes [Inaudible] educators and professionals that we got quite a mix in the audience and [Inaudible] is that Artistic adults and young people can really put sex in the proper context and avoid a lot of difficulties by having or being well informed about sexual education and specifically from someone like you, who is an expert in the area of the intersection between Autism spectrum and sexuality, maybe I am using the wrong terms when I say sexuality, sex education probably better term. But when we think about Autism Spectrum, how does that intersect with sex education and what are some of the benefits and also challenges of being in Autism spectrum when it comes to the topic of sex?

Dr. Rachel Loftin: Right, It is great question. A complicated, this question. When I talk about sexuality, what I would also like to tell audience is that when you think about the complexity of the social interaction that we have in our lives, the social interaction that are required in [Inaudible] are some of the most complicated. And some of the most [Inaudible], if you messed up a sexual approach [inaudible] it can work like a [Inaudible] behavior, it can look like stuck. It can look like a fault. So, it’s really complicated and difficult sometimes to know how to manage the [inaudible] flirting for people. some of these much more complicated social behaviors. So, that’s one aspect when I think sexuality is unique in Autism, it’s socially complicated behavior for people who struggled a lot with understanding other people’s view or who struggle a little read on people’s t-shirt [Inaudible] and understand the unspoken aspects of the communication and that’s really far of challenges. And,[Inaudible] that individuals with Autism are much likely to have that intimate relationship [Inaudible] and typical populations and so,  is that more like to be not finding the partnership they want, and there is scope that can help people to gain insight that can give them in particular people that education can help them about relationships. I think it’s really important to do that.

Steve Borgman: So, what I think saying is that as much as sexuality, it’s the most complex and most intimate of social relationships and if you are struggling understanding some of the social nuances,  particularly if you are artistic and the person you are writing to is non-artistic, I think [Inaudible] some of the challenges and the problems of reason why it’s important to for us as mentors, friends to offer the social skills training that would help them with that.

Dr. Rachel Loftin: Absolutely, and of course, there are people with Autism who don’t desire sexual relationships [Inaudible] typical people who don’t. It’s not something that I see necessary somebody to do. But if it is something that [Inaudible] something the girl like to have [Inaudible] opportunity to get. You might also ask about what are some of the strainful challenges that are associated with Autism except related to sexuality, I hadn’t answered that piece yet and I answered the difficult piece, but I didn’t answer the first piece, very important, [Inaudible] One idea that a lot of scholars are speaking about is what  people with Autism, many people with Autism may be a little more open minded to sex or little less influenced by social, so what you may see Autism, we don’t have great numbers to prove this yet. But actually this is kind of debated area, but what we might see is people with Autism are much more likely to be positive if they have any sexual cohesion or interest, I think they are open about who they are attracted to and that may also give people with Autism who are not open to [Inaudible] different things or other sexual behavior that may be outside of the mainstream and in my opinion that’s the opportunity to be enjoyable, help them with people who interest or whatever think that are important to note

Steve Borgman: And also, I think [inaudible] important for us to distinguish I think, because I have met clients who sometimes, they are open and are fine with different expressions of sexuality but then there are some who are distressed by which they proceed to be could be outside the norm, how do you work with, how would you say to the people who are distressed by the differences vs there are those who are pretty much okay with that?

Dr. Rachel Loftin: Yeah, that’s a great point. We don’t want to overdo so much [Inaudible] but everybody of human, you are exactly right there are some people who I have really struggled [Inaudible] at the social and then they strived to really follow that at the social roles, only had sexuality [Inaudible] or whatever those concerns might be. It may be hard to distinguish that, I think it is something you would need to do few things, one would be disappoint that person, so they feel comfortable expecting who they are. But also, respecting whatever their boundaries are, whatever [Inaudible] not for themselves. So I think it’s important for people to think the actions that are out there [Inaudible] making decisions for themselves, what I also think is important that we get people [Inaudible] decisions they can make.

Steve Borgman: And when I ask, kind of, I guess I am going into some challenges I have heard, from leaders, sometimes it’s apparent, sometimes it’s relative of someone who, on the spectrum who may have thought our behavior was okay, but I see sometimes thing that aren’t legal, how do we as friends or may be even as young people on the spectrum, what is the way to know what is legal, what’s not legal and how do we protect ourselves from choosing behavior that may get us in trouble, because I know that you also help and consult with courts and helping people understand what’s legal and not legal, you educate both sides, you educate the course of our spectrum but I am sure you also educate people in spectrum about on what’s legal and not. This is a roundabout question but I guess, I hope I had made myself someway clearer with that.

Dr. Rachel Loftin: Yeah, and I think it brings us back to a point from the beginning of our conversation about the role of media. I think unfortunately a lot of people faced with autism and they’ll be dumb, but a lot of people will follow the same process as media and try to behave like characters from a movie, characters from [inaudible], things like that. The difficulty comes with the behaviors that are portrayed in movies caused some worries. Again, fantasy world, in this infatuated world there are some things that you can’t do in real life. So when I give presentations, I like to talk in particular about where media comes in. I show pictures from number of different romantic kinds and talk about stalker training. Because so many romantic comedies, we need training people how to cross the line and become stalkers and maybe if some of them here have sexualized account, it looks like a very romantic thing to do, like a very fun thing to do. And then at the end the couple sticks together, so the guy always gets the girl with this approach.

Steve Borgman: I suppose the girl becomes interested but if you’re watching that from a little standpoint, you think that’s okay and then you go out and pursue someone after repeated no’s and it may proceed to a stalking behavior. Can stalking behavior be prosecuted?

Dr. Rachel Loftin: Absolutely. It’s one of the most common [inaudible] for people with autism.

Steve Borgman: That’s interesting. How does a person with autism know when they’re bordering on stalking and how can they present that?

Dr. Rachel Loftin: Yeah, I think that’s a great question, Steve. For those people who have a close friend or trusted person they can mend inside, I strongly suggest it. That’s what most typically developing people do, too. When you’re reporting for a date instead of talk to people that have a romantic [inaudible], before sending a text, when people can show it to a friend and they talk it through and then re-word it. In getting that kind of outside input can be extremely helpful. Sorry, go ahead.

Steve Borgman: I’m sorry. It just made me realize so much is on the media now, on the internet now, well, on the smartphone. You have teenagers now, everything is now over the smartphone. Everything is done via text and Instagram and Snapchat and there’s so very little that, of course I grew up in the dinosaur ages, you just spoke to each other in person. I guess that just makes your point so much more clearer that there need to be training even on social media aspect of it, right?

Dr. Rachel Loftin: Oh, absolutely. That’s a big part of what we do. Social media can be so great such that it connects you both, even not otherwise have connection. But on the other hand, once you make a social mistake in social media, you say the wrong thing, you have hurt someone, whatever you do, this is permanent record of it. And if you say it out loud in person, it might just go away. But if you texted someone or you put it on Facebook or you tweet about, it’s not just going to just go away. People can capture that image. They can keep it around. They can use it. They can come up later in court case if you do cross the line and you get a stalking charge or some other kind of charge. I would invite a lot of caution. I wouldn’t say to veer away completely from social media but I would be very cautious about seeing someone in social media and I would discuss that with a trusted person first. And if the trusted person isn’t available it is okay to give a little extra context in trying to reach out to someone in Facebook. For instance, you could say, “I’m not sure if you’re interested with me. This might be overstepping. But I feel attracted to you and I wanted to ask if you would be in person.” What a lot of people might do is skip that step of saying, “I’m not sure if this is okay. I hope I’m not making you uncomfortable,” or whatever it is to kind of let the person know you’re uncertain about what you’re doing. That can really help the communication, just to be more open and to explain kind of where you’re coming from and what you are speaking.

Steve Borgman: That’s a great script that I’ll make available for those who are listening. Thank you for sharing that. It’s good practice for everyone, particularly for those on the Spectrum.

Dr. Rachel Loftin: And that’s great at what you’re saying about, great, it’s good for everyone. It’s really important because I went to a sex education conference a few years ago. It was my first time presenting about this topic at a really autism world psychology conference. So I was surrounded by people who did sex education for a living. All of these things I’m just pointing out and talking about related to autism, they are coming back and saying, “That’s a problem for everybody that we see.” So if these aren’t unique to autism, it doesn’t mean that there’s something wrong sexually with a person with autism. It just means that these are things that everybody struggled with. And then if you already have social difficulties or communication difficulties, and you’re trying to cope with these difficult things on top of it. It just makes it that much harder.

Steve Borgman: I think that’s a good point. It just means that those on the spectrum just have an extra step to make sure that they include sex education in their social warming, that they do.

Dr. Rachel Loftin: Right, and a lot of people are in special education classes or have some kind of a different education schedule while they’re in school. Many of those students either get included, or I’m sorry, get excluded completely from the sex ed that’s offered in school or they ended going to the same sex ed classes [inaudible]. But the concepts aren’t broken down and explained fully a little bit because somebody might need to really understand what’s going on in any of these classes. For example, a sex ed class in high school might teach about anatomy, these section, and then you’ll see, they ain’t going to teach the social aspects of approaching people and they won’t teach how to ask for concern, to make sure that the activities are consensual and some of these other aspects in such a heavy social world.

Steve Borgman: Yeah, now a lot of the work that you do at the AARTS center you said that that includes kind of sex education. What is an example of breaking a concept down so that it’s more easily understandable? Maybe you could just pick a specific aspect of that.

Dr. Rachel Loftin: Yes, well, one thing that I’ll mention, it’s not quite what you’re asking but I think it’s a helpful illustration of how specific it’s good to be. We have this really, where most our different sex acts and different sex anatomy and we have a proper term for the word that you use when you go to the doctor. But then you have a list of slang terms that are also widely used for that. I think what you find in most school-based sex education programs is you don’t often hear the slang term. It’s if you don’t have the group of terms and you do this to reviewing of a woman and actually that’s even dangerous. So I had a patient who was a teenage girl who was using a slang term for oral sex and she didn’t understand what it meant. When people overheard her saying that, it sounded like she wanted to go around giving people oral sex. So it [inaudible] doing, and that was a really difficult situation. So I think for many stages understanding the slang terms and using more casual language about sex, it’s a crucial thing to learn. And so that is one area where we really try to break it down to be specific.

Steve Borgman: That’s a great example. That actually does answer the question I asked about how specific you have to be and what an example of that is. Dr. Loftin, could you speak a little bit to the emotional and mental well-being in relation to sexuality? You mentioned in this paper how that has as adolescents, just where we are physically changed particularly related to sexuality. There you mentioned a development may not be quite in sync with how they’re changing physically. How is it that as parents and professionals we can be aware of that and how can we be helpful in helping them people with sometimes a lag between the physical and emotional?

Dr. Rachel Loftin: Yeah, that’s a great question. I’ll discuss first what that one looks like. Maybe these people can, yes they see it, and they can help recognize it a little bit. Social development is delayed in autism, basically like the [inaudible] of autism they use. So that they then lead to the same social interactions, make friendship, even if the same topics of interest are delayed so that you could have somebody, for instance, who is intellectually a 12-year old. He is a smart 12-year old kid who can do the academic of the other 12-year old kids, no problem. But when it comes to making friends, he’s making more like a six or seven-year old. Or when it comes to topics of interest, he may even be able to know that as Pokemon, he may make use of some power rangers. They stayed with the interest that are a little younger. Despite that spatial delay that I’m describing here, a typical nature issue shouldn’t be far off. You really expect it to be significantly different from here. So that same 12-year old is probably either already in puberty or starting to go to puberty just like their peers. What that may mean, you may have a kid who’s starting to get mustache who still wants to play Power Ranger action figures, who still wants to do things that younger kids are doing. So for parents, sometimes when you see a child playing in those ways, you assume that they’re childish across the board and you might not realize that curiosity about sex is developing, and an interest in sex is developing. And so this is what [inaudible] teenager who’s interested in Barney or something very childish, who’s going to show you interest in sex and masturbating or doing some of these things that shows sexuality and it’s very hard for parents to kind of reconcile these gaps between the physical development that seems to be right on track and the social development that shows signs of delay. The other difference of physical [inaudible] that this can cause is signs of confusion [inaudible] is sometimes we see teenagers and young adults to want to seek out other people who share their interest. Because if you are a 22-year old man who’s interested in child’s cartoon, you may end up talking to children and not talking to other adults. And that can lead to a lot of difficulties because even if you have only have pure intentions, you weren’t thinking about sex, it looks really bad to other people, if you’re talking to children. It looks like something sexual even if that’s not what you were saying. I have seen guys get themselves in a lot of trouble for friendships that start like that across the age range where adults are talking to children.

Steve Borgman: In those situations, how is it that you advise and help them to teach them on the right side of the legal side of things? For example, they might really have these interests that they enjoy, so maybe you might teach them to reach out to people with other interests that have kids, I guess. How can they really tell sometimes? Because I guess, [inaudible] can you always tell who’s the kid and who’s not.

Dr. Rachel Loftin: Yeah, well, one thing, these things are so situation-dependent. But one thing I have found on a few guys, is to just directly ask when nobody sees. And if the persons says, yes, and so you have other evidence. You’re safe, kind of moving forward talking to that person. If that person says anything else, the conversation’s over.

Steve Borgman: Good point.

Dr. Rachel Loftin: That’s pretty straightforward. It’s even gotten a little messier or a little more dangerous. Sometimes they use special software, the parent-controlled software. Even if the parents are involved, it’s software that kind of help put some [inaudible] on these. If you have a pre-occupied interest, or a special interest, something that really [inaudible] you and energizes you, you’ll want to go back to that website. If you’ve really heard the stories [inaudible]. So there are people and programs that could maybe just keep you out of a chat room or kind of block whatever it is that’s potentially going to cause you a lot of trouble.

Steve Borgman: And in the last topic, I wanted to just maybe, and it’s really hard to generalize but this is more for adults on the spectrum, and to give our adults in relationships, have you talked to many adults and some of those struggles when they are in a digital relationship? In general, like communicating sexually, that kind of thing.

Dr. Rachel Loftin: Yeah, absolutely. We’ve got a number of those, either couples who are already been married a long time and they realize something’s wrong or some of them even more often re-evaluate a child. And if we’re doing a child evaluation one of the parents starts to realize that he or she is in this spectrum [inaudible] come back and kind of adjust some of the difficulties. It feels like the biggest concern that become exposed to us is about some issues in communication and the partner with autism must be able to read things to the partner who doesn’t have autism. It’s really focused on teaching the non-autistic partner has to be better to express themselves verbally and will clearly state what they need and not try to rely on the person with autism communicating non-verbally. It’s just a matter of almost psychoeducation, just kind of teaching what I could be and how I could be impacting the relationship and what are some ways that both partners need to adjust in order to better communicate. So much like I was saying earlier these are issues that are unique to autism you can find [inaudible] typical couples who are addressing some of these communication issues. But they can never be heightened enough. The partner who doesn’t have autism can sometimes show [inaudible] and they struggle to understand how to better communicate and learn to get their needs met. Because most people with autism are capable of being [inaudible] they’re just not going to understand each other, what they are, if they demand clear respect. So have working on your communication and thinking is one of the main things that comes up.

Steve Borgman: Have you found some of the couple resources that are helpful for married people on the spectrum and learning how to communicate their needs and how to break down that communication?

Dr. Rachel Loftin: Absolutely. Yeah, there are a couple of really good books that are written by people who have either been on a relationship with someone with autism or they’re written by the person with autism. And I think reading and understanding each other’s perspective can be incredibly helpful. I can give you a couple of those, if needs to.

Steve Borgman: That would be great. Well, thank you so much Dr. Loftin. I know we covered this area, sex education in the Autism spectrum and a great [inaudible] and I really thank you for your time and as questions come up, maybe this will form the basis for more specific question and answer regarding sex, and the autism spectrum. But thank you so much for your time and I really appreciate everything that you’re doing for the autism community and for benefiting my audience so much.

Dr. Rachel Loftin: Oh, thanks so much for asking me. I really appreciate it.

Steve Borgman: Well, that’s it for today’s show. Please don’t forget to go to myaspergers.net/57 to get all the show notes and resources related to this episode. Thanks for listening. I really appreciate it. Could you also do me a favor and subscribe to the podcast if you haven’t already, or give us a review on iTunes. That’s how word gets out to make autism known to the world at large via this podcast. I wanted to share an interesting study that I read about today in sciencedaily.com. It says, girls are better at masking autism than boys. I don’t know if this is necessarily new news but they documented it a little bit more straightforward really, I guess. What they did is they showed that girls are better at mimicking social skills maybe because that’s the way they socialize. But they seem to have the same difficulty, they’re very good at picking up emotions in other people but they don’t always know why people are having those emotions and I think that’s the cognitive aspect of empathy that can be a struggle for boys and girls on the spectrum. So I thought that was an interesting. I’ll put that in the show notes. Until next time. Thank you for listening and have a great week.

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