"Straight Sex is Complicated Enough!": The Lived Experiences of Autistics Who are Gay, Lesbian, Bisexual, Asexual, or Other Sexual Orientations

Self-reported masking in sexual minority and heterosexual autistic adults

Masking can include suppressing or concealing certain behaviors to appear "non-autistic" and is one response to the excess social stressors of being a neurominority in a neurotypical-majority society. It is important to understand how persons who are multiply marginalized (e.g. an autistic person assigned female sex at birth who is bisexual), who experience multiple layers of excess social stressors, may face additional pressures to conceal their authentic selves. Autistic persons may be more likely than neurotypical persons to identify with a sexual minority orientation, such as asexual, bisexual, gay or pansexual. To advance our understanding of how marginalized identities may be associated with masking, we examined self-reported masking using the Camouflaging Autistic Traits Questionnaire in a sample of autistic adults (N = 462). After matching participants for assigned sex at birth and age, and after controlling for these effects in modeling, we found that sexual minority autistic adults reported significantly higher levels of masking relative to heterosexual autistic adults. We situate these findings within literatures on masking, minority stress, and stigma.Lay AbstractMasking can include hiding certain behaviors to appear "non-autistic." Masking is one response to the stress of being autistic in a non-autistic world. Being autistic is only one part of someone's identity, though. Other parts of a person's identity include things like a person's sexual orientation. Autistic people are more likely than non-autistic people to have a sexual orientation other than heterosexual, like asexual, bisexual, gay, or pansexual. People who are both autistic and a sexual minority may experience social stress because of different pressures from society. These different pressures may mean sexual minority autistic adults feel pressured to social camouflage more than heterosexual autistic adults. Thus, we compared masking in sexual minority autistic and heterosexual autistic adults. In the statistical models, we controlled for two other factors that may impact masking: sex assigned at birth and age. We found that sexual minority autistic adults reported significantly higher levels of masking relative to heterosexual autistic adults. We discuss how these findings fit within previous research on masking and minority stress.

From Sex Education to Sexualities Education: Navigating the Intersectionality of Queer Communities in Italy and the Netherlands

This study aimed to explore the experiences, needs, and interests of queer people who are also neurodivergent, or live with a chronic illness or disability (i.e. IMMI: individuals with multi-minority identities) in Italy and the Netherlands. Five focus groups were conducted in Italy with 22 queer IMMI to identify their most relevant topics regarding and experiences with sex education. Building on the discussion topics of the focus groups, a survey in Italian and English was distributed via snowball sampling. The survey was created to explore the experiences related to sex education in the two countries. The final sample of respondents included 138 (97 Italian, 41 Dutch) queer IMMI. Results indicated that sex education received in both formal (e.g. school) and informal (e.g. family) contexts failed to include information that was sensitive and supportive of queer community's experiences. Participants reported the need to explore more topics addressing the specific needs of different identity intersections. Cross-cultural differences related to the experiences of Italian and Dutch participants were found. Overall, current sex education in Italy and the Netherlands is far from meeting the sexual health needs of queer people living with different intersections. Practical implications are discussed.

Autism and Employment Challenges: The Double Empathy Problem and Perceptions of an Autistic Employee in the Workplace

Background

High unemployment rates are found among autistic adults. Difficulties with social functioning in non-autistic workplaces can be significant barriers to employment success. Autistic social functioning challenges in non-autistic spaces have traditionally been attributed to assumed impairments in Theory of Mind (ToM). Alternatively, the Double Empathy Problem (DEP) posits that autistic social challenges arise not from assumed impairments within the autistic person but instead from mutual misunderstandings in the autistic/non-autistic social interaction. The purpose of this study was to compare the ToM impairments explanation of autistic social functioning with the DEP, within the context of autistic employee social functioning in a non-autistic workplace.

Methods

This study compared autistic and non-autistic participants' ability to accurately interpret the behaviors of an autistic employee at work. A sample of 254 participants (173 non-autistic and 81 autistic) read a vignette about a hypothetical autistic employee having difficulty coping in the workplace. Participants answered open-ended questions regarding their interpretation of the employee's behavior and emotional state.

Results

A significantly greater proportion of autistic participants (50.7%) accurately interpreted the behavior of the employee compared with non-autistic participants (31.2%) (χ 2 = 8.65, p = 0.003). Autistic participants with the highest behavior interpretation scores had significantly higher mean self-reported autism traits scores (M = 26.8) compared with autistic participants who scored lowest on behavior interpretation (M = 19.3, p < 0.001). The opposite relationship was found for non-autistic participants.

Conclusions

Results from this study contribute to evidence supporting the DEP, shifting the paradigm of autistic social functioning away from a deficit model and toward addressing mutual misunderstandings in the autistic/non-autistic social interaction. The pattern of findings between neurotype groups by behavior interpretation abilities on an autism traits measure points to mutual misunderstandings as a clash of neurologically different social cultures. Addressing the DEP in the workplace would contribute to removing barriers to successful employment for autistic adults.

Perspectives of autistic adolescent girls and women on the determinants of their mental health and social and emotional well-being: A systematic review and thematic synthesis of lived experience

LAY ABSTRACT

Difficulties with mental health and low levels of well-being are more common among autistic girls and women than non-autistic people, but we do not fully understand why. Research does not focus enough on what autistic girls and women could tell us about this. This review aims to summarise the studies where autistic girls and women explain things that affect their mental health and well-being to help us understand how to prevent these difficulties from developing. Three research databases were searched to find possibly relevant studies. There were 877 studies found, which two researchers screened according to particular criteria. They found 52 studies that could be included in this review. One researcher evaluated the quality of these studies and extracted the key information from them. This review summarises the views of 973 autistic girls and women aged between 13 and 70+. The findings from the 52 studies were analysed, and we found many factors that affect the mental health and well-being of autistic girls and women. These factors fall into two categories: (1) difficulties living in a world not designed for autistic people and (2) the impact of stigma due to being autistic.

Health Care Disparities Among Autistic LGBTQ+ People

Background

Lesbian, gay, bisexual, transgender, or queer (LGBTQ+) people and disabled people experience disparities in access to health care compared with others. However, we have yet to understand how health care disparities may be further exacerbated at the intersection of disability and LGBTQ+ identity, particularly among autistic people.

Objectives

The primary goals of this study were to (1) examine differences in unmet health care needs and health status between LGBTQ+ autistic people and straight/cisgender autistic people and (2) explore how state policies and demographics predict the unmet health care needs of the autistic LGBTQ+ people.

Methods

We conducted a cross-sectional analysis using data from the 2019 National Survey on Health and Disability that included a subsample of autistic participants, with 62 LGBTQ+ adults and 58 straight/cisgender adults. To address our first study goal, we used an independent samples t-test, and to address our second study goal, we used Poisson regression.

Results

The LGBTQ+ group reported significantly more days of poor physical and mental health, more co-occurring diagnoses, and more unmet health care needs than the straight/cisgender group. For LGBTQ+ people, protective state health care laws and a lower income resulted in significantly more health care needs being met.

Conclusions

Findings from this study suggest that the intersection of an LGBTQ+ identity and autism is associated with greater disparities in physical and mental health as well as unmet health care needs; however, state policies prohibiting discrimination of LGBTQ+ people may act as a protective factor and result in fewer unmet health care needs. Future research should examine additional structural factors that may mitigate health inequities for autistic LGBTQ+ people.

Understanding the Self-identification of Autism in Adults: a Scoping Review

Adults are increasingly self-identifying as autistic, and reporting problems being referred for an autism diagnostic assessment. This scoping review aims to ascertain: (1) what research has been conducted on the self-identification process of autism in adults, who do and do not have a formal diagnosis of autism, and (2) which aspects of the self-identification process could be used to improve the referral and the diagnostic process of an adult autism assessment. The main themes identified were: the diagnostic process from a client´s perspective; the process of self-identifying as autistic from a lifespan perspective; an autistic identity; sexual identity and experiences, and the perception of autism as a difference or a disability. These themes could positively enhance the referral and diagnostic process.

Telling Disabled and Autistic Sexuality Stories: Reflecting upon the Current Research Landscape and Possible Future Developments

Developments in the study of sexuality in the lives of disabled people have been relatively slow, as the spectre of a medicalised model continues to dominate most debates and invalidate any form of sexual identity. The social model of disability has enabled the amplification of voices that have been previously silenced; however, progress has stalled. Within autism studies, however, the rise of neurodiversity studies coupled with intersectionality, has presented an opportunity to explore sexualities in terms of difference rather than deficiency, therefore bypassing deficit models which have dominated any study of non-heterosexual lives. Such deficit models have focussed upon discovering what it is about autism that leads autistic people to think they are non-heterosexual, often resulting in a lack of support for young LGBT+ people as sexuality is dismissed as a result of autism. Reflecting upon findings from my own ongoing work alongside emerging social research, this article explores important developments and potential future directions. This will highlight the progress made and the barriers remaining. Using a sociological approach and a framework inspired by Plummer, which focusses upon the importance of sexual stories, the article will show that much needs to be done. The diversity of goals and multiplicity of stories means that disabled and autistic sexuality stories have not been accepted into the public consciousness.

Sex and Sexuality in Autism Spectrum Disorders: A Scoping Review on a Neglected but Fundamental Issue

ASD consists of a set of permanent neurodevelopmental conditions, which are studded with social and communication differences, limited interests, and repetitive behaviors. Individuals with ASD have difficulty reading eye gestures and expressions, and may also have stereotyped or repetitive language, excessive adherence to routines, fixed interests, and rigid thinking. However, sexuality in adolescents and young adults with ASD is still a poorly studied and neglected issue. This review aims to evaluate sexual function and behavior in individuals with ASD to foster a greater understanding of this important, although often overlooked, issue. This review was conducted by searching peer-reviewed articles published between 01 June 2000 and 31 May 2022 using the following databases: PubMed, Embase, Cochrane Database, and Web of Science. A comprehensive search was conducted using the terms: "Autism" OR "ASD" AND "Sexuality" OR "Romantic relation" OR "sexual behavior" AND/OR "sexual awareness". After an accurate revision of 214 full manuscripts, 11 articles satisfied the inclusion/exclusion criteria. This review found that, although individuals with ASD may have sexual functioning, their sexuality is characterized by higher prevalence rates of gender dysphoria and inappropriate sexual behavior. Furthermore, sexual awareness is reduced in this patient population, and the prevalence of other variants of sexual orientation (i.e., homosexuality, asexuality, bisexuality, etc.) is higher in adolescents with ASD than in non-autistic peers. Sexual health and education should be included in the care path of patients with ASD in order to improve their quality of life and avoid/reduce inappropriate and risky behaviors.

Are Autism Spectrum Disorder and Asexuality Connected?

Asexuality is a lack of sexual attraction to any gender. There is some evidence to suggest that many self-identified asexuals have a formal diagnosis of autism spectrum disorder which is characterized by deficits in social interaction and communication, as well as by restricted and repetitive interests and behaviors. Additionally, the literature shows that asexuality and lack of sexual attraction or low sexual interest is overrepresented in people with autism spectrum disorder compared with neurotypical samples. Nevertheless, no studies have been conducted to investigate the relationship between autism and asexuality in depth. We conducted a systematic review of the literature to examine whether asexuality and autism spectrum disorder are connected. We conclude that asexuality and autism share various aspects, such as a possible role of prenatal factors, reference to romantic dimensions of sexual attraction and sexual orientation, and non-partner-oriented sexual desire, but future research should explore and clarify this link.