1051068

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ISCXXX10.1177/10534512211051068Intervention in School and ClinicDavies et al.

Global Perspectives
Elizabeth Walton, Associate Editor
Intervention in School and Clinic 1­–6
© Hammill Institute on Disabilities 2021

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DOI: 10.1177/10534512211051068
https://doi.org/10.1177/10534512211051068
isc.sagepub.com

Sexuality Education for Children and Youth With

Autism Spectrum Disorder in Canada

Adam W. J. Davies, PhD1, Alice-Simone Balter, PhD1, Tricia van Rhijn, PhD1 ,
Jennifer Spracklin, DHS2, Kimberly Maich, PhD3, and Rsha Soud, BSc1

Abstract
With no standardized approach to sexuality education among Canada’s 13 provinces and territories and the various
curricula focusing on neurotypical and non-disabled children, educators have insufficient instruction and lack appropriate
training on how to address sexuality education for children and youth with disabilities, particularly children and youth
with autism spectrum disorder (ASD). This article provides the current context of sexuality education for children and
youth with ASD in Canadian schools and guidance for more inclusive approaches with attention to three important
areas: puberty, relationships, and gender and sexual diversity. Recommendations are offered to support more inclusive
approaches to sexuality education acknowledging that a one-size-fits-all approach is insufficient for children and youth
with ASD. The recommendations focus on three goals: (a) moving beyond simple knowledge-based approaches to include
skill-building; (b) including parents, autistic voices, and advocates in planning and ongoing conversations; and (c) providing
supports for educators.

Keywords
special education, autism, inclusion practices, teacher education/training/preparation, sexuality

Comprehensive sexuality education describes cognitive, experience of ASD is diverse and the range of expressions
social, emotional, and physical development in a holistic varies widely between individuals, an individualized
manner that values bodily autonomy, diversity, evidence- approach tailored to the specific needs of children and youth
based instruction, reproductive health, and respect for dif- is warranted that also considers the various sociocultural
ferences (Bialystok, 2019). Sexuality education prevents barriers that affect individuals with ASD. Although access
negative health outcomes, creates safe learning environ- to sexuality education for those with disabilities is a human
ments, and gives children and youth necessary knowledge rights issue (Davies & Kenneally, 2020) enshrined in the
and skills to nurture healthy relationships that enhance United Nations Convention on the Rights of Persons with
well-being, preparation for adult life, and life expectancy Disabilities (UN General Assembly, 2007), sexuality educa-
(Action Canada for Sexual Health and Rights, 2020). tion for individuals with ASD is often neglected in school
Yet, in Canada, sexuality education remains highly con-
tested and unstandardized, with provinces and territories
1
each featuring unique curricula designed by their ministries University of Guelph, Guelph, Ontario, Canada
2
of education. In addition, curricula focus on neurotypical Eastern Health, St. John’s, Newfoundland and Labrador, Canada
3
Memorial University of Newfoundland, St. John’s, Newfoundland and
children and children without disabilities, leaving little to Labrador, Canada
no explicit instruction for educators on how to address
sexuality education for children and youth with disabilities Corresponding Author:
Adam W. J. Davies, Department of Family Relations and Applied
or in special education programming (Davies & Kenneally, Nutrition, University of Guelph, 50 Stone Road East, Guelph, Ontario,
2020), particularly children and youth with autism spec- Canada N1G 2W1.
trum disorder (ASD) in dedicated school settings. As the Email: adam.davies@uoguelph.ca
2 Intervention in School and Clinic 00(0)

settings. Individuals with ASD have been found not to completed in January 2021. Some provinces have more
receive any formal sexuality education in school settings recently updated curriculum (i.e., British Columbia, 2016;
due to being in special education placements (Barnett & Ontario, 2019; Quebec, 2018) introducing topics regarding
Maticka-Tyndale, 2015). Deconstructing the stigmatization gender and sexual diversity and identities, internet safety,
of children and youth with disabilities related to sexuality body image, and consent. Other areas lag with curriculum
education is important for creating more supportive and for some grades dating to 1995 (i.e., Newfoundland and
inclusive environments for addressing sexuality for all chil- Labrador, Northwest Territories). Unlike any other content
dren (Davies & Kenneally, 2020; Gougeon, 2009). As such, area, instruction is not always mandatory, with parents hav-
this column provides the current context of sexuality educa- ing the right to exempt their children in Alberta and Ontario
tion for children and youth with ASD in Canadian school up to Grades 9 and 8, respectively. Despite wide variation,
settings and guidance toward more inclusive approaches. correct anatomical names, body characteristics, hygiene,
puberty, family structures, and healthy relationships are
commonly taught during the elementary grades (K–6).
Autism Spectrum Disorder in the
Reproduction, sexual assault, and sexual health are com-
Canadian Context mon in grades 7 to 12. Unfortunately, “there is no single
The Public Health Agency of Canada (2018) reports that province or territory which covers all of the topics neces-
prevalence rates in Canada are about 1 in 66 children with sary to bring their sex-ed in line with those international
ASD diagnoses (aged 5–17), with boys more often diag- standards or the Canadian Guidelines” (Action Canada for
nosed than girls (1 in 42 vs. 1 in 165, respectively) and more Sexual Health and Rights, 2020, p. 14). Finally, children
than half diagnosed either before school entry or by around and youth with disabilities are mostly overlooked. The
age 8 (see Note 1). Although there is strong advocacy for Ontario curriculum is an exception, noting the importance
the creation of a national autism strategy in Canada of making appropriate accommodations for students with
(Canadian Autism Spectrum Disorder Alliance, 2021) and a intellectual and physical disabilities (see Ontario Ministry
coast-to-coast autism assessment occurring to support its of Education, 2019, p. 68); yet, practical advice and/or dif-
creation (Canadian Academy of Health Sciences, 2021), ferentiated curriculum expectations for children with vari-
families of children with ASD must navigate services that ous disabilities are not provided. More effort is required to
differ among the 13 Canadian provinces and territories. provide information about how to address sexuality educa-
Despite generally positive attitudes, full inclusion for all tion with children and youth with ASD to all educators
students with exceptionalities is still not guaranteed in (Davies, 2020).
Canada (Maich & Sider, 2019). Students with ASD may
look to peers to model effective and appropriate skills; how- Sexuality Education for Children and
ever, social isolation can hinder learning essential social
skills—including skills related to relationships and sexual-
Youth: What Is Needed?
ity (Gougeon, 2009). Moreover, receiving formal training Children and youth with ASD require the same general sex-
for students with intellectual disabilities, as well as teach- uality education content as their peers with recognition that
ers’ beliefs and attitudes, can affect how sexuality education distinct attributes of ASD require explicit approaches and
is addressed in special education settings (Doyle, 2021). instruction (Gougeon, 2009; Hartman, 2014). In addition,
individuals with ASD are often seen as asexual—not hold-
ing any sexual desires or feelings toward others—or their
School-Based Sexuality Education in Canada
sexuality is problematized because “the sexual rights of
Although the effectiveness of comprehensive school-based individuals with autism are often curtailed under the guise
sexuality education is widely recognized (Action Canada of protection” (Gougeon, 2010, p. 352), resulting in harm-
for Sexual Health and Rights, 2020), there is no unified ful inaction. The following sections address important focal
approach in Canada, with provinces and territories respon- areas for sexuality education for children and youth with
sible independently for the formulation of their own formal ASD including puberty, relationships, and gender and sex-
curricula. Furthermore, although 85% of Canadian parents ual diversity.
support teaching sexuality education in schools (Wood
et al., 2021), attempts to update curriculum often receive
Puberty
public pushback (e.g., Bialystok, 2019), with tensions
between parents’ desires to control the content and chil- Puberty is a critical aspect of sexuality education for indi-
dren’s right to access information about sexual health and viduals with ASD as they experience the same physical
development (Bialystok, 2018; Davies & Kenneally, 2020). changes as all students (Curtiss, 2013). For some individu-
To contextualize Canadian sexuality education, a review als with ASD, pubertal changes may prompt increases in
of the 10 provincial and three territorial curricula was certain symptomologies (e.g., seizures, depression, anxiety,
Davies et al. 3

irritability, social withdrawal; Hartman, 2014) and decreases 2010). Finally, consent is a critical part of sexuality educa-
in others. Comprehensive education about puberty prior to tion, particularly for children and youth with ASD who can
its onset is important in building knowledge and skills to be more at risk for sexual abuse and assault (SIECCAN,
encourage self-confidence and esteem amid the physical, 2015). The concept of consent can be taught as early as the
cognitive, emotional, and social changes that occur. preschool years through age-appropriate lessons and teach-
Learning proper terminology for body parts not only gives able moments such as sharing toys, offering and accepting
children and youth a vehicle for accurate reporting of abuse hugs, and games like tickling. For consent education to be
or assault but is also a factor in continuing to develop their effective, it needs to be integrated throughout the curricu-
sense of self, in turn helping to shift the degree of perceived lum for all grades as students practice seeking and provid-
vulnerability (Sex Information and Education Council of ing consent. Consent education also includes learning the
Canada [SIECCAN], 2015). The concrete teaching of pub- difference between what types of touch are and are not
lic and private behaviors and settings encourages “appropri- acceptable. Children and youth with ASD who have experi-
ate sexual expression [and] not repression of sexual desires” enced abuse or assault may not recognize it as such, instead
helping to prevent engaging in sexual behaviors in public seeing it as complying with the request of an adult (Kenney
(Beddows & Brooks, 2016, p. 286), which can increase the et al., 2013). Including instruction and skill-building in sex-
risk for sexual victimization. uality education about social reciprocity, sensory issues,
and consent is essential to support children and youth with
ASD to develop healthy relationships.
Relationships
Individuals with ASD want social (Travers & Tincani, 2010)
Gender and Sexual Diversity
and romantic relationships (Hartman, 2014) but commonly
experience social barriers due to social isolation and stigma- It is often assumed that children and youth with ASD are
tization (Gougeon, 2009, 2010). Although youth and young asexual, do not have a sexual orientation, and do not experi-
adults with ASD desire intimate relationships, many were ence sexual desire (Gougeon, 2009); yet, like their peers,
“frustrated by their lack of knowledge of and skill on how to they develop gender and sexual identities, including some
develop and manage a romantic relationship” (Cheak- who identify as asexual. Furthermore, assumptions regard-
Zamora et al., 2019, p. 2611). Although not characteristic of ing sexual orientation can result in restricted access to
all individuals with ASD (N. Adams & Liang, 2020), unique important sexual health information regarding HIV trans-
needs that children and youth with ASD may experience mission and other sexually transmitted diseases (Chappell,
relative to navigating relationships are social reciprocity, 2014). Sala et al. (2020) noted how heterosexual assump-
sensory issues, and consent. Given that social reciprocity is tions are often carried forward into work with autistic com-
an important relationship skill, instruction focusing on munities on relationships, leading to serious ramifications
knowledge and skill-building around interactions with peers and increasing psychosocial distress for LGBTQ+ (i.e.,
and partners is imperative. This approach helps to make the lesbian, gay, bisexual, transgender, queer or questioning)
“implicit explicit” (Greiert, 2016, p. 136) and break down individuals with ASD who identify outside of heterosexual
how to initiate friendships, reading social cues, how to flirt, identities and/or binary notions of gender identity. Canadian
initiating and establishing boundaries within relationships, sexuality education curriculum that incorporates non-­
and discussions around sexual consent. heterosexual and non-cisgender approaches and identities
Touch is an important part of many relationships. Some are still being developed (Bialystok, 2018; Bialystok 2019).
individuals with ASD have increased sensitivity to physical Accordingly, the intersections of ASD, gender, and sexual-
sensations, commonly referred to as sensory issues (Greiert, ity are almost completely disregarded in current curricula
2016). Accordingly, sexuality education should “foster . . . (SIECCAN, 2015). Representation of LGBTQ+ individu-
an awareness of individual sensory needs and how they als with ASD and discussions of the intersections of gender
may differ from the sensory needs of a partner, and provide and sexual identity—particularly related to understandings
strategies for how to communicate and manage sensory of social cues and neurodiversity—can mitigate against
differences” (Greiert, 2016, p. 144). In addition, students their erasure and discrimination experiences (McGuire &
learn about sexuality and relationships through their social Zener, 2019).
engagements with peers outside of core teaching time, yet Sexuality education can be an avenue for both decon-
children and youth with ASD may have fewer opportunities structing cisgender and heterosexual assumptions about gen-
to interact with peers outside of dedicated instructional set- der and sexuality (i.e., that relationships always involve one
tings (Gougeon, 2009). These experiences can contribute to man and one woman, that individuals must always desire
the social othering and exclusion of children and youth with long-term romantic relationships, and that gender identity
ASD, thereby impacting the development of social and sex- and expression must align with assigned sex at birth) while
ual relationships (Davies 2020; Gougeon 2009; Gougeon also allowing for more space to deconstruct gendered norms
4 Intervention in School and Clinic 00(0)

Table 1.  Recommendations for Goal 1.

Goal: Ensuring That Sexuality Education Goes Beyond Increasing Knowledge to Include Skill-Building.
Children and youth with ASD who receive this education will: Practice recommendations:
• Develop social skills and understanding of social norms before • Use social narratives as teaching strategies for where
more technical aspects of sex education are taught (i.e., teach social cues, common norms, and socially acceptable
how to act in social situations rather than what shouldn’t be behaviors are focused on that children and youth
done) (Beddows & Brooks, 2016); with ASD can practice in their daily lives (Davies,
• Develop reciprocity skills related to friendships, flirting, and 2020; Tarnai & Wolfe, 2008).
romantic relationships (Greiert, 2016); • Focus on including concrete and visual materials
• Increase skills in managing physical (e.g., menstruation care, (e.g., checklists, task schedules) to support
nocturnal emissions) and emotional (e.g., movement, exercise) instruction.
changes resulting from puberty; • Allow ample opportunities for repetition and review
• Increase their capacity to practice consent in different areas of (e.g., instructional videos).
the curriculum; and • Include video modeling or video self-modeling of
• Increase their ability to disclose sexual assault by engaging developmentally appropriate sexuality-related skills
in comprehensive sexuality education (Curtiss, 2018) that and understanding.
includes personal safety skills.

Note. ASD = autism spectrum disorder.

Table 2.  Recommendations for Goal 2.

Goal: Creating More Inclusive Approaches That Include Parents, Autistic Voices, and Advocates in Conversations and Planning.
Sexuality education curriculum designers and educators will: Practice recommendations:
• Encourage parents to ask questions and learn about • Include educators, parents, and students with ASD as
the content of sexuality education curriculum so they participants in curriculum development workshops with a focus
can continue and extend learning from school to on lived experience.
home to contribute to their children/youth’s healthy • Provide regular parent–teacher communication about sexuality
sexuality; education content (e.g., information nights, sharing resources).
• Include autistic voices and advocates in the further • Make frequently asked questions and other myth-busting lists
development of sexuality education curricula for those available.
with ASD, especially LGBTQ+ individuals and those • Provide opportunities for honest conversation in a safe
who are transgender and gender nonbinary (N. Adams setting and invite knowledgeable guest speakers in to lead the
& Liang, 2020); and conversation.
• Develop curricula and teaching accommodations in a • Provide a list of terminology so that parents can use the same
co-constructive fashion by involving children and youth language at home.
with ASD to address their specific needs rather than • Provide a script to help parents open the conversation at
exclusively focusing on parental perspectives. home.

Note. ASD = autism spectrum disorder; LGBTQ = lesbian, gay, bisexual, transgender, queer.

and how such norms affect children and youth with ASD. In Recommendations
addition, those who do not fit binary identity criteria might
face internalized stigma and miss opportunities for diagnosis The following recommendations are offered to support
and forms of social support (Pearson & Rose, 2021). the provision of more inclusive approaches to sexuality
Confidentiality must be respected for individuals with ASD education for students with ASD. These recommenda-
while providing a safe space to discuss gender and sexual tions acknowledge that a one-size-fits-all approach will
diversity without outing any student to their parents (McGuire never be sufficient for children and youth with ASD and
& Zener, 2019). Moreover, challenging stereotypes of what it require specific teaching strategies. Therefore, the goals
might mean to be visibly LGBTQ+ is important for students focus on: moving beyond simple approaches that aim to
with ASD who could identify as non-heterosexual and non- increase knowledge to include skill-building (see Table 1);
cisgender but not conform to normative ideas of LGBTQ+, the need to include parents, autistic voices, and advocates
heterosexual, or cisgender individuals (McGuire & Zener, in ongoing conversations (see Table 2); and providing
2019). Curriculum that breaks down stereotypes, respects supports for educators (see Table 3). Each table provides
confidentiality, and promotes self-identification can address learning outcomes and specific strategies to support
the needs of all students, not just those with ASD. implementation of these recommendations in practice.
Davies et al. 5

Table 3.  Recommendations for Goal 3.

Goal: Providing Educators With Professional Development Opportunities and Supportive Curriculum (Doyle, 2021).
Educators delivering sexuality education curriculum will: Practice recommendations:
• Have regular opportunities to participate in professional • Use a self-assessment to check values and beliefs that
development specific to teaching sexuality education; could influence approaches to sexuality education (e.g.,
• Utilize the sexuality curriculum and their professional TeachingSexualHealth.ca, 2020).
development learning to ensure classroom lessons are • Seek out and share opportunities to engage in webinars,
not unintentionally presented with personal biases; and podcasts, or other professional learning opportunities from
• Deliver sexuality education as an explicit and essential trusted sources.
part of the curriculum from school entry to graduation, • Receive funding to purchase practical programs and tools
not limited to years around the onset of puberty. that teach concrete social boundaries skills (e.g., Circles®;
James Stanfield Inc, 2016).

Conclusion ORCID iD
Despite some recent updates to sexual health curricula, Tricia van Rhijn https://orcid.org/0000-0001-8570-3888
there is still a lack of focus on the sexual health and well-
being of children and youth with ASD in Canadian school Note
settings (Davies, 2020). This exclusion perpetuates the 1. The authors acknowledge that these data rely on the gender
societal stigmatization of ASD and the relegation of chil- binary; data have yet to be collected for nonbinary identify-
dren and youth with ASD to the margins of society: further- ing individuals.
more, “if these negative attitudes and perceptions are not
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