Children's Hospital Colorado

Working with LGBTQ Youth with Autism Spectrum Disorder and Developmental Disabilities

A close-up of two kids smiling and touching their foreheads and noses to each other.

Providers who regularly work with teens know how difficult it can be to talk about sexuality with their patients. Adolescence is a complex stage of development, in which youth grow a sense of social and relationship intimacy in tandem with their sense of personal identity.

Among adolescents navigating the already-tricky waters of adolescence, kids and teens with autism spectrum disorder (ASD) are unique — but that doesn’t make conversations about their sexuality any less critical.

In Colorado, suicide is the leading cause of death in people age 10 to 24. Lesbian, gay, bisexual, transgender, queer and questioning, or LGBTQ, youth are at significantly higher risk for suicidal ideation and attempts than their non-LGBTQ peers. Particularly for teens with developmental disabilities or ASD, risk factors such as victimization and rejection by family and peers can be magnifiers. Comorbid psychiatric diagnoses are common in children and teens with autism and developmental disabilities. It’s crucial for providers to routinely screen for mood disorders, anxiety and suicide risk.

Asking youth with developmental disabilities about sexuality

One of the most dangerous assumptions providers sometimes make about teens with developmental disabilities and ASD is that they are asexual or don’t understand romantic attraction or sexual activity. This misconception is especially common for youth with intellectual disabilities.

Medical providers sometimes mistakenly infantilize patients. In the process, they might forget that just as teens with developmental disabilities are developing physically, they’re emotionally dealing with the same questions of sexuality as their neurotypical peers, but often in unique ways. The reality is that all teens, regardless of the presence or absence of a developmental diagnosis, experience and explore sexuality differently. Discouraging or ignoring these experiences sends a confusing message to these youth. Worse yet, it can discourage healthy sexual development.

Like the term ‘spectrum’ suggests, every teen is unique and conversations about sexuality need to be tailored. When interviewing your patient, it helps to establish a baseline understanding of their interpretation of sexuality:

  • How do they see gender, both as it relates to biological sex and gender expression?
  • How do they see romantic attraction, sexual attraction and relationships?

If these questions are too abstract, tools like the Genderbread Person can offer a more concrete visual explanation. Some youth will be well-versed in terminology. Don’t be afraid to ask or clarify what something means to them — don’t make assumptions.

Using their definitions as a scaffold, ask about their gender identity and how they express it. Ask them who are they attracted to, both romantically and sexually. You can then target your education and interventions based on their responses.

Support for LGBTQ youth with developmental disabilities

Perhaps the most important component of teens’ sexual development is a solid support system inside and outside the home. Coming out as LGBTQ-identified is a daunting task for any teen. As they explore their sexual identity and seek acceptance in their communities, teens with ASD and intellectual disabilities could potentially put themselves at risk for victimization.

Ask your patients to identify and map out who they feel comfortable talking with about their sexuality and how supportive their family is. Conversations with families about sexuality can be difficult. Always be an advocate for your patient if they request your help and only when they’re ready. If you feel your patient is putting themselves at risk for victimization or harm to self and others, you may need to have these conversations sooner.

Outside the home, these teens may find support in school LGBTQ-friendly groups, local teen LGBTQ support groups and community resource centers. It’s also helpful to provide resources in case of crisis. The Trevor Project offers immediate help to LGBTQ teens and young adults who are in emotional distress or considering suicide through phone, online live-chat or text at 866-488-7386. This is an excellent resource for any LGBTQ youth, as they can provide immediate assistance regardless of location. The Suicide Prevention Lifeline also offers 24/7 assistance in times of distress and crisis at 800-273-TALK.

Regardless of their perceived level of functioning, youth with ASD and intellectual disabilities develop and express their sexuality in diverse ways. It’s the medical providers’ responsibility to recognize this and encourage healthy exploration among patients. Thoughtful and developmentally appropriate recommendations are critical for healthy sexual development and positive mental health outcomes.