Prevalence and Frequency of Online Sexual Activity by Adults With Autism Spectrum Disorder

Abstract

We examined the prevalence and frequency with which cognitively able adults (141 men, 190 women) with autism spectrum disorder (CA-ASD) engaged in a range of online sexual activities (OSAs). Participants completed an online survey that assessed their recent involvement in nonarousal (Information Seeking, Chatting), solitary-arousal (S-OSA), and partnered-arousal (P-OSA) online sexual activities. Almost two thirds had engaged in one or more OSA but, on average, had done so infrequently. There were only a few differences based on sex, age, and sexual identity. Significantly more men than women had engaged in Information Seeking and S-OSA and had done so more frequently. Individuals in their 20s were significantly more likely to have engaged in Information Seeking. Sexual-minority individuals were more likely to report engaging in P-OSA than were heterosexual individuals. These results are discussed in terms of their implications for sexuality education aimed at assisting adults with CA-ASD to establish a healthy and meaningful sexuality.

Keywords

adult age autism spectrum disorders sexuality online sexual activity sex education

Cognitively able (average or higher IQ) adults with autism spectrum disorder (CA-ASD) are interested in having romantic and sexual relationships (Hellemans, Colson, Verbraeken, Vermeiren, & Deboutte, 2007; Hénault, 2005; Renty & Roeyers, 2007). The results of recent research assessing a broad range of aspects of the sexual well-being of adults with CA-ASD paint an overall positive picture, for both individuals in and not in a relationship, but also identify some challenges (Brown-Lavoie, Viecili, & Weiss, 2014; Byers, Nichols, & Voyer, 2013; Byers, Nichols, Voyer, & Reilly, 2013; Gilmour, Schalomon, & Smith, 2012). Individuals with ASD, even CA-ASD, experience challenges in social functioning and communication that are important for developing and maintaining romantic and sexual relationships (American Psychiatric Association, 2013; Orsmond, Krauss, & Seltzer, 2004; Renty & Roeyers, 2007). Thus, they may be most comfortable expressing their sexuality through online sexual activities (OSAs) because these activities do not require in-person, real-time interactions. In keeping with this view, Roth and Gillis (2015) found, in their sample of adults with CA-ASD (ages 19–50 years), that many identified avoiding the anxiety associated with face-to-face situations, having fewer nonverbal communication cues to interpret, and having more time to process information as benefits of online dating. Therefore, it is important to determine the extent to which men and women with CA-ASD engage in a range of OSAs.

Prevalence and Frequency of OSA

OSA refers to the use of the Internet for activities of a sexual nature (Cooper & Griffin-Shelley, 2002). These activities can be meaningfully divided into three categories: nonarousal OSA, solitary-arousal OSA, and partnered-arousal OSA (Shaughnessy, Byers, & Walsh, 2011). Nonarousal OSAs (N-OSA) are sexually related activities that involve educational and relational experiences (e.g., visiting educational websites, chatting on dating websites). Solitary-arousal OSAs (S-OSA) are arousal-oriented activities that do not involve another person (e.g., viewing or posting sexual explicit pictures or videos). Partnered-arousal OSAs (P-OSA) are arousal-oriented activities that are interactive and require the participation of at least two people (e.g., online conversations about desired or fantasized sexual acts with another person).

There has been considerable research on OSA in neurotypical populations. In general, these researchers have found that N-OSA, S-OSA, and P-OSA are common but not frequent in the general population (Daneback, Cooper, & Månsson, 2005; Daneback, Månsson, Ross, & Markham, 2012). For example, Byers and Shaughnessy (2014) found that the lifetime prevalence of these activities was 99%, 88%, and 67%, respectively; the prevalence of current OSA involvement is likely lower, however. In terms of frequency, Shaughnessy, Byers, Clowater, and Kalinowski (2014) found that, across a range of activities, on average individuals had engaged in S-OSA and P-OSA only once or twice or a few times in the previous 3 months. The authors did not report the frequency of N-OSA.

In contrast, there has been little research on the OSA of individuals with CA-ASD. Indeed, a review of the literature revealed only two such studies (Byers et al., 2013; Dewinter, Vermeiren, Vanwesenbeeck, Lobbestael, & van Nieuwenhuizen, 2014). Dewinter and colleagues (2014) assessed the sexual behaviors (including a range of OSAs), interests, and attitudes of 50 adolescent boys (ages 15–18 years) with CA-ASD. They found that 76% of their sample reported that they had viewed pornography online, 46% had talked about sex on the Internet, and 12% had engaged in “cybersex” (not defined). Furthermore, the adolescent boys with ASD did not differ from a neurotypical control group in their likelihood of having experienced OSA. The extent to which these results are generalizable to adults, particularly women, is not known. Furthermore, the authors did not assess the frequency of these behaviors. Unpublished data from Mazurek’s study of social media use among adults with ASD (Mazurek, 2013) revealed that participants typically spent 4.4 hr per day browsing or surfing the Internet (range = 0–18 hr; Mazurek, personal communication). Thus, it is possible that, while online, adults with CA-ASD frequently engage in OSA and spend significant time doing so. However, Mazurek did not assess involvement in OSA specifically. M. O. Muzarek (personal communication, November 1, 2015), using a subsample of participants in the current study, found that, on average and across a range of activities, participants with CA-ASD (ages 21–73 years) had engaged in arousal-oriented OSA (i.e., S-OSA and/or P-OSA) infrequently—between never and once in the previous month. However, these figures included individuals who had never engaged in OSA and thus underestimate the frequency with which OSA users engaged in these activities. The authors also did not report the frequency of N-OSA, S-OSA, and P-OSA separately. Thus, research is needed on the extent to which individuals with CA-ASD engage in a range of OSAs.

Gender, Age, and Sexual Identity Differences in OSA Experience

It is likely that the sex, age, and sexual identity of individuals with CA-ASD influence their use of OSA. With respect to sex, society, in general, is more permissive toward male than toward female sexual expression; as such, gender roles prescribe greater interest in and motivation toward sexual arousal and expression for men then for women (Byers, 1996; Wiederman, 2005). The results of Pecora, Mesibov, and Stokes’s (2016) study comparing the sexual functioning of men and women with CA-ASD are consistent with these gender role expectations—for example, the men reported higher sexual arousability, greater sexual desire, more sexual thoughts, and more frequent solitary sexual activity. Based on gender role socialization and research with neurotypical populations (Albright, 2008; Daneback, Ross, & Månsson, 2008; Döring, 2009; Kubicek, Carpineto, McDavitt, Weiss, & Kipke, 2011), it is likely that, compared with women with CA-ASD, men with CA-ASD are more likely to engage in OSA that involves sexual arousal and is linked to sexual pleasure (i.e., S-OSA and P-OSA) and to do so more frequently; however, gender role socialization would not be expected to affect sexual activities that do not involve pleasure and arousal (i.e., N-OSA).

The age of individuals with CA-ASD likely influences the extent to which they engage in OSA. The Internet has become an important part of the lives of most young people and young people are more likely to adopt new technologies than are older people (Hoffman, Novak, & Venkatesh, 2004; McMillan & Morrison, 2006). Thus, it is likely that individuals in their 20s and 30s are more inclined than are older individuals to turn to the Internet to obtain sexuality information and to chat on dating sites (i.e., N-OSA) to address unmet learning needs from school-based or physician-offered sexual health education (Hannah & Stagg, 2016; Hatton & Tector, 2010; Hénault, 2005; Holmes et al., 2014; Nichols & Blakeley-Smith, 2010). In addition, younger adults with CA-ASD are less likely to be in a romantic relationship than are their neurotypical peers (D’Entremont, Voyer, Nichols, & Byers, 2014) and so would be more likely to engage in arousal-oriented OSAs (i.e., S-OSA and P-OSA) to fill this gap.

Finally, individuals’ sexual identity may influence the extent to which they engage in OSA. In general, individuals who identify as a sexual minority tend to have more positive attitudes toward OSA than those who identify as heterosexual (Banks, 2010; Heinz, Gu, Inuzuka, & Zender, 2002; Moor, Heuvelman, & Verleur, 2010). This may be because the anonymity and safety of the Internet can be a source of information and social support while protecting them from the stresses associated with their sexual-minority status including rejection, prejudice, and discrimination (Banks, 2010; Heinz et al., 2002; Moor et al., 2010). Thus, it is likely that, compared with heterosexual individuals with CA-ASD, sexual minority individuals with CA-ASD have more OSA experience.

The Current Study

There has been little research on use of the Internet to engage in sexuality-related activities by individuals with ASD. Therefore, the goal of the current study was to enhance understanding of current experiences of OSA in a community sample of adults with CA-ASD. Information about the OSA of individual with CA-ASD is important because it informs development of education and intervention modalities, materials, and content to assist adults with ASD in establishing healthy and meaningful sexuality. We posed the following research questions:

Research Question 1 (RQ1): What is the prevalence of recent experience with N-OSA, S-OSA, and/or P-OSA?

Research Question 2 (RQ2): For those with these OSA experiences, how frequently do they engage in OSA?

Research Question 3 (RQ3): For those with these OSA experiences, how many hours do they spend engaging in OSA?

Research Question 4 (RQ4): How prevalent is possible problematic OSA?

Based on the gender role expectations and research with neurotypical individuals, we also predicted three hypotheses:

Hypothesis 1 (H1): Compared with women, men would be more likely to have recently engaged in S-OSA and P-OSA and those who had, would have done so more frequently, and spent more time doing so. We did not expect to find a sex difference in N-OSA.

Hypothesis 2 (H2): Compared with older age groups, adults in their twenties and thirties would be more likely to have recently engaged in N-OSA, S-OSA, and P-OSA and those who had, would have done so more frequently and spent more time doing so.

Hypothesis 3 (H3): Compared with individuals who identify as heterosexual, individuals who identify as a sexual minority would be more likely to have recently engaged in N-OSA, S-OSA, and P-OSA and those who had, would have done so more frequently, and spent more time doing so.

Method

Participants

Participants were recruited for an internet study of Sexual Well-Being of High-Functioning Adults With Autism Spectrum Disorders. Inclusion criteria were being 21 years of age or older and scoring above the cutoff score (26 or greater) for ASD on the Autism Spectrum Quotient (AQ) recommended by Woodbury-Smith, Robinson, Wheelwright, and Baron-Cohen (2005). In total, 511 individuals started the survey. Of these, 180 were dropped from the sample: 24 did not indicate their age or were younger than 21 years; seven did not indicate their sex or identified as transgender (to be able to analyze for sex differences); 90 scored below 26 on the AQ; and 59 failed to finish the survey.

The final sample consisted of 141 men and 190 women. Participants ranged in age from 21 to 73 years (M = 37.8, SD = 11.1). They largely identified as White/Caucasian/European (90%) and were highly educated (57% had completed an undergraduate or graduate degree). Almost half were living in the United States (57%) with the remainder living in Australia/New Zealand (21%), United Kingdom (11%), Europe (9%), or Canada (6%). On average, they reported that religion was moderately important in their daily life (M = 4.8, SD = 2.3 on a 7-point scale). About half (53%) were currently in a romantic relationship. Most identified as heterosexual (69%) with the remainder identifying with other sexual-minority designations. Participants reported substantial autism-related symptomatology (M on the AQ = 37.6, SD = 5.4) but only about half (53%) reported that they had received a professional diagnosis.

Measures

The Background Information Form was used to gather demographic information including gender, race/ethnicity, age, education, religiosity (not at all important [1] to very important [7]), country of residence, sexual identity (heterosexual gay, lesbian, bisexual, unlabeled, unsure), and relationship status (in a relationship, not in a relationship). It also included a question about the source of their ASD diagnosis. To examine age differences in OSA experience, we divided participants into 10-year age groups ( 21–30 [n = 87], 31–40 [n = 105], 41–50 [n = 82], and over 50 [n = 57]).

The AQ (Woodbury-Smith et al., 2005) is a 50-item self-report questionnaire assessing autistic traits in adults with average intelligence. It consists of 10 items in each of five domains: social skills, attention to detail, communication, imagination, and attention switching. Responses are given on a 4-point Likert-type scale, dichotomized to indicate presence or absence of the symptom, and then summed to yield possible scores ranging from 0 to 50. Higher scores indicate greater symptomatology. The authors have provided evidence for the reliability and validity of the AQ as a screening tool for adult ASD (α = .74 in the current study).

The Online Sexual Experience Questionnaire (Shaughnessy et al., 2011) was used to assess nonarousal (two items), solitary-arousal (four items), and partnered-arousal (three items) OSA experience (see Table 1 for the items). Participants rated the frequency with which they had engaged in each behavior during the previous month on a 6-point scale ranging from never (0) to once a day or more (6). Responses were used in two ways. First, they were dichotomized to create three scores indicating whether individuals had any N-OSA, S-OSA, or P-OSA experience in the previous month. Individuals who indicated never to all of the items in a subscale were assigned to the No Experience Group for that subscale; those who indicated experience with one or more of the activities were assigned to the Experience Group for that subscale (N-OSA Experience, S-OSA Experience, P-OSA Experience). Second, for those individuals in the Experience Group on each subscale, the mean frequency of activity was determined by averaging the frequency of the subscale items (N-OSA Frequency, S-OSA Frequency, P-OSA Frequency). Internal consistency for the N-OSA, S-OSA, and P-OSA subscales score were α = .23, .74, and .91, respectively. Due to the low internal consistency of the N-OSA scale, the two items were analyzed separately (Information Seeking, Chatting).

Table 1.

Percentage of Men and Women Who Had Engaged in Each Online Sexual Activity in the Previous Month.

OSA	Men	Women	Total
OSA	n (%)	n (%)	N (%)
Nonarousal OSA experience
Visited an educational website on sexuality	37 (26)	32 (17)	69 (21)
Chatted on a dating website	22 (16)	19 (10)	41 (13)
Solitary-arousal OSA experience
Watched sexual explicit videos/photos	111 (79)	46 (24)	157 (48)
Masturbated while watching sexually explicit videos	84 (60)	33 (18)	117 (36)
Masturbated while viewing a stranger via web cam	8 (6)	3 (2)	11 (3)
Read erotic material	58 (41)	47 (25)	105 (32)
Partnered-arousal OSA experience
Engaged in a conversation sharing sexual fantasies	12 (9)	19 (10)	31 (10)
Engaged in private discussions about sexual fantasies with the same person while masturbating	9 (6)	15 (8)	24 (7)
Maintained a sexual relationship	8 (6)	16 (9)	24 (7)
Any OSA experience	121 (87)	82 (45)	203 (63)

Note. N = 141 men and 190 women. OSA = online sexual activity.

In separate questions, participants who indicated that they had engaged in each of the N-OSA activities indicated the number of hours a week they spent in that activity. Participants who indicated that they had engaged in any of the S-OSA and/or P-OSA activities responded to a question about the number of hours per week they spent engaging in sexual activity online (i.e., watched sexually explicit videos or read erotic material, shared sexual fantasies with a stranger, maintained a sexual relationship online). We used this information to determine the duration of OSA. We also defined possible problematic OSA use as spending more than 10 hr per week engaging in OSA.

Procedure

Following ethical review in Canada and the United States, we contacted 192 national and international autism organizations selected based on the following criteria: (a) providing a specialty service/resource for adults with ASD; and/or (b) having a reputation as credible by direct experience or recommendation by another expert. Information about the study was provided to each organization or professional (including flyers for clients). The flyer directed potential participants to the study website, where they read an informed consent page describing the purpose of the study, procedures, potential benefits and risks, confidentiality, and how to contact the researchers with any questions about the study before accessing the survey. After completing the survey, participants were presented with a debriefing page that explained the purpose of the study and provided further resources on sexuality with suggested websites and books.

Data Analysis

We used chi-square analyses to examine sex, age, and sexual identity differences in the percentage of men and women who had engaged in Information Seeking, Chatting, S-OSA, and P-OSA. We used one-way analyses of variance to examine sex, age group, and sexual identity differences in Information Seeking Frequency, Chatting Frequency, S-OSA Frequency, P-OSA Frequency, and duration of Information Seeking, duration of chatting, and duration of arousal-oriented OSAs for those individuals who had engaged in these activities.

Results

Preliminary Analyses

We conducted a number of preliminary analyses to examine possible group differences. We used a one-way multivariate analysis of variance to determine whether the individuals who did not complete the survey differed from those who did in their AQ scores, demographic characteristics (age, sex, religiosity, sexual identity [heterosexual/sexual minority], or relationship status [in a relationship/not in a relationship]). It was not significant, F_mult(6, 486) = 0.36, p = .91. Similarly, those with and without a professional diagnosis did not differ in these characteristics, F_mult(6, 310) = 1.25, p = .28. However, there were significant sex differences, F_mult(5, 311) = 7.49, p < .001, $η_{p}^{2}$ = .107. The men were significantly older (40 vs. 36 years on average) and likely to identify as heterosexual (80% vs. 66%), more religious (5.2 vs. 4.6), and less likely to be in a romantic relationship (47% vs. 60%). The men and women did not differ in the extent of their autism symptoms.

Prevalence, Frequency, and Duration of OSA

Table 1 provides the percentages of participants who had engaged in each OSA in the previous month (RQ1). Almost two thirds had engaged in one or more of these activities. The most common reported activities were watching sexually explicit videos online (48%), masturbating while doing so (36%), and reading erotic material online (32%). Just over a fifth of the sample (21%) had visited an educational website about sexuality in the previous month; about one tenth (13%) had chatted on a dating website; about half (54%) had engaged in at least one S-OSA activity; and about one tenth (12%) had engaged in at least one P-OSA activity.

The average frequencies of engaging in each type of OSA in the previous month are presented in Table 2 (RQ2). On average, the 69 participants with Information Seeking Experience had done so 2 or 3 times; the 41 participants with Chatting Experience had done so between 2 and 4 times; the 175 participants with S-OSA Experience had done so between 1 and 3 times; and the 39 participants with P-OSA Experience had done so between 1 and 3 times. In terms of the amount of time spent engaging in OSA (RQ3), these individuals indicated that they had spent, on average, about 1 hr per week visiting educational websites (range = <1 hr–10 hr), 4 hr per week chatting on dating websites (range = <1 hr–20 hr), and 4 hr per week engaging in arousal-oriented OSA (S-OSA and/or P-OSA) activities (range = <1 hr–30 hr). As an indicator of possible problematic OSA use, we determined the number of participants who had spent more than 10 hr per week engaging in each of these activities (RQ4). Seventeen individuals (10 men, seven women; 5%) reported spending 10 or more hours engaging in one or more of these activities: one seeking sexual information, three on a dating website, and 13 engaging in S-OSA and/or P-OSA.

Table 2.

Average Frequency and Duration of Online Sexual Activities.

Frequency & duration	Information seeking^a	Chatting^b	Solitary online sexual activities^c	Partnered online sexual activities^d
Frequency & duration	M (SD)	M (SD)	M (SD)	M (SD)
Frequency	1.97 (1.18)	2.56 (1.25)	1.63 (1.03)	1.71 (1.43)
No. of hours	1.16 (1.69)	3.85 (4.52)	3.61 (4.96)^e

Note. Means are based on only individuals with the corresponding type of OSA experience (see Table 1). Frequency: 0 = not at all; 1 = once; 2 = 2 or 3 times; 3 = once a week; 4 = 2 or 3 times a week; 5 = once a day; 6 = more than once a day. OSA = online sexual activity.

n = 69. ^bn = 41. ^cn = 175. ^dn = 39. ^eParticipants provided the number of hours engaging in either solitary or partnered online sexual activities.

Sex, Age, and Sexual Identity Differences in OSA

In terms of sex differences (H1; see Table 3), significantly more of the men than of the women had Information Seeking and S-OSA Experience; however, the men and women did not differ in their likelihood of Chatting or P-OSA Experience. The men also reported engaging in Information Seeking and S-OSA significantly more frequently than did the women. The men and women did not differ in the number of hours per week spent engaging in Information Seeking, Chatting, or arousal-oriented OSA (S-OSA and/or P-OSA).

Table 3.

Gender Differences in Information Seeking, Chatting, S-OSA, and P-OSA Experience and Frequency.

Activity	OSA experience				OSA frequency
	Men	Women	χ²	$η_{p}^{2}$	Men	Women	F	$η_{p}^{2}$
	n (%)	n (%)	χ²	$η_{p}^{2}$	M	M	F	$η_{p}^{2}$
Information seeking	37 (26)	32 (17)	4.38*	.115	2.24	1.66	4.50*	.063
Chatting	22 (16)	19 (10)	2.36	.085	2.77	2.32	1.38	.034
Solitary-OSA	114 (81)	61 (33)	75.29***	.481	1.88	1.16	22.03***	.113
Partnered-OSA	16 (12)	23 (12)	0.06	.014	1.44	1.90	0.98	.026

Note. N = 141 men and 190 women for the analysis of OSA Experience. Means for the analysis of OSA frequency are based on only individuals with the corresponding type of OSA experience (see Table 1). S-OSA = solitary-arousal–online sexual activity; P-OSA = partnered-arousal–online sexual activity.

p < .05. ***p < .001.

In terms of age differences, individuals in the four age groups differed significantly on Information Seeking Experience, χ² = 11.88, p = .008. Individuals in their twenties were significantly more likely to have engaged in Information Seeking (34%) than were those in the other three age groups (14%, 18%, and 18%, respectively). The age groups did not differ significantly on Chatting, S-OSA, or P-OSA Experience. The age groups also did not differ in the frequency of or number of hours spent engaging in any of the types of activities.

Finally, with respect to sexual identity, individuals who identified as heterosexual were less likely than those who identified as a sexual minority to report P-OSA Experience (10% vs. 19%), χ² = 4.58, p = .032, $η_{p}^{2}$ = .029. Heterosexual and sexual-minority individuals did not differ significantly on Information Seeking, Chatting, S-OSA, or P-OSA Experience. Heterosexual and sexual minority individuals also did not differ in the frequency of or number of hours spent engaging in any of the types of activities.

Discussion

A number of recent studies have demonstrated that adults with CA-ASD are interested in sexual activity and engage in a range of sexual behaviors, both alone and with a partner (Gilmour et al., 2012; Kellaher, 2015; Mehzabin & Stokes, 2011). The present study extends this research by showing that, as with the general population (Albright, 2008; Daneback et al., 2012; Döring et al., 2015; Shaughnessy et al., 2017), OSA is a common albeit not a frequent part of the lives of adults with CA-ASD. That is, for most adults with CA-ASD, OSA appears to be a nonproblematic form of sexual expression.

Recent Prevalence and Frequency of OSA

We assessed recent OSA experience (the previous month) to determine the extent to which various OSAs (seeking information, chatting on dating websites, solitary online sexual activities, and partnered online sexual activities) are an ongoing part of the lives of individuals with CA-ASD. We found that almost two thirds of our participants had recently engaged in at least one OSA—that is, only about one third had not engaged in any OSA in the previous month. This indicates that OSA is part of the lives of many adults with CA-ASD.

There were, however, differences in the prevalence of various OSA activities. About a fifth of our participants had used the Internet to gain desired sexuality information in the previous month. This may be because they have difficulty obtaining this information from social sources due to challenges and impairments in social functioning and communication (American Psychiatric Association, 2013; Roth & Gillis, 2015; Tarnai & Wolfe, 2008) and/or because they are most comfortable with and generally prefer the Internet as a modality for seeking information (Brown-Lavoie et al., 2014; Gillespie-Lynch, Kapp, Shane-Simpson, Smith, & Hutman, 2014). Furthermore, 13% of our participants had chatted on a dating website. It is likely that others had visited dating websites but had not “chatted,” something we did not ask about. This is in keeping with Mazurek’s (2013) finding that many adults with ASD use social networking sites for social connection and suggests that they also use them for romantic connection.

It is instructive to compare our prevalence findings to previous research. Shaughnessy, Fudge, and Byers (2017) found in their sample of undergraduate students that the recent prevalence (previous 3 months) of S-OSA experience (77%) and P-OSA experience (67%) were similar. However, we found that in the previous month, 54% of our sample had engaged in S-OSA but only 13% had chatted on a dating website and 12% had engaged in P-OSA—activities that involve engagement with another person. The higher prevalences reported by Shaughnessy and colleagues, particularly for P-OSA, may reflect the social challenges associated with ASD. However, it may also reflect differences in the two samples (undergraduate students versus a community sample). Some previous research has investigated the lifetime but not the recent prevalence of these activities in individuals with ASD. For example, Roth and Gillis (2015) found that half of their small sample (N = 17) of adults with CA-ASD had tried online dating. DeWinter et al. (2014) reported that 76% of their sample of adolescents with ASD had viewed pornography online (a S-OSA activity), 46% had talked about sex on the Internet (a P-OSA activity), and 12% had engaged in cybersex (a P-OSA activity). The differences between the lifetime prevalence reported by Roth and Gillis and DeWinter et al. and the current data suggest that although many individuals with CA-ASD have used the Internet to engage in OSA, they do not do so regularly.

Furthermore, our findings on the frequency of these activities suggest that even those adults with CA-ASD who do engage in OSA, do so infrequently. That is, similar to findings with neurotypical populations (Döring et al., 2015), the mean frequencies corresponded to less than once a week for each of these activities for an average duration of 4 hr or less. M. O. Mazurek (personal communication, November 1, 2015), as an unpublished part of his 2013 study, found that adults with ASD typically spent 4.4 hr per day browsing or surfing the Internet. Although we did not ask about Internet use generally, Mazurek’s findings coupled with our own suggest that most of the time that adults with CA-ASD spend on the Internet is not sexually related. Indeed, in our study only a small number of individuals (17) reported spending 10 or more hours per week engaging in OSA. Thus, even though there is some evidence that autism traits are associated with greater problematic Internet use in general (Romano, Osborne, Truzoli, & Reed, 2013; Romano, Truzoli, Osborne, & Reed, 2014), we found little evidence that problematic OSA use is common among individuals with CA-ASD, at least in terms of the amount of time being devoted to these activities.

Sex, Age, and Sexual Identity Differences in OSA

Overall, in contrast to findings with neurotypical populations (Daneback et al., 2008; Döring, 2009; Kubicek et al., 2011), we did not find pervasive differences in the OSA of adults with CA-ASD based on sex, age, or sexual identity. Nonetheless, there were significant and meaningful group differences in the prevalence or frequency of some OSAs. First, more of the men than women had recently engaged in S-OSA, sought information online, and had done so more frequently. The former finding is in keeping with research that has shown that men with CA-ASD report greater desire for solitary sexual activity and engaging in such activities more frequently than do women with CA-ASD (Byers et al., 2013a & b). The latter finding is inconsistent with research with neurotypical samples that has not found gender differences in N-OSA (Shaughnessy et al., 2011). The fact that the men in our sample were less likely than were the women to be in a relationship may have made them more likely to seek sexual information online. Alternately, it may be that the women were more able to obtain the sexuality-related information they needed from social sources such as friends, family members, or health care providers.

Second, we found that individuals in their twenties were more likely to seek sexual information online than were individuals in the older age groups (although they did not do so more frequently). This may be because individuals with CA-ASD are delayed in their adaptive skills, and thus likely also reach developmental milestones such as forming romantic relationships later than their neurotypical peers (D’Entremont et al., 2014; Duncan & Bishop, 2015). If so, they may be just starting to identify informational needs related to sexuality.

Third, compared with participants who identified as heterosexual, participants who identified as a sexual minority were more likely to report having engaged in P-OSA—however, even among this group only a minority of individuals reported having had this experience in previous month. Thus, sexual identity does not appear to be an important factor in OSA use among adults with CA-ASD.

Study Limitations

The results of the current study need to be considered in light of some limitations and strengths. First, because many participants (47%) had never received a professional diagnosis, we cannot be sure that all participants met the criteria for a diagnosis of ASD. However, all participants had significant autism symptoms and the mean score on the AQ (a well-validated screening instrument for ASD) for the sample fell considerably above the recommended cutoff. Furthermore, the AQ scores of those with and without a professional diagnosis were comparable. As such, it is likely that our participants fell on the autism spectrum. Second, the sample was highly educated and largely identified as Caucasian/White/European. The extent to which these results are generalizable to adults with CA-ASD with other characteristics is not known. Furthermore, the sample was disproportionately female compared with estimates of the gender ratio of individuals with ASD of 4 males to 1 female (American Psychiatric Association, 2013). This may be a result of our recruitment from self-help groups in that men are less likely than are women to use the Internet to interact with similar others, seek self-help, and volunteer to participate in research (Addis & Mahalik, 2003; Sax, Gilmartin, & Bryant, 2003). Nevertheless, our approach of recruiting participants through ASD organizations and online communities, including individuals without a professional diagnosis, and administering the survey online likely resulted in a more representative sample than in many studies of individuals with ASD. Indeed, a strength of the study is that the sample was a community rather than a clinical sample that was diverse in terms of geographical location, age range, relationship status, and sexual identity.

Implications for Education and Practice

The results have implications for sexual health education and clinical practice aimed at assisting adolescents and adults with ASD experience their sexuality in a healthy and meaningful way and addressing their deficits in sexually related knowledge and skills (Pecora, Mesibov, & Stokes, 2016). We found that OSA was a common experience for our participants regardless of their age. This suggests that sexual health education for individuals with ASD of all ages (including those who are no longer in school) needs to include a discussion of OSA as a useful and engaging source of sexual health information and a viable form of sexual expression. It is important that such discussions emphasize the positive aspects of OSA but also provide information about how to identify reliable and unreliable informational websites as well as basic safety information related to online chatting and dating sites, partnered OSA, and arranging face-to-face meetings.

There are published curricula that target social development in teens and young adults, some of which are based on empirical research (e.g., the UCLA PEERS® Program; Laugeson, Gantman, Kapp, Orenski, & Ellingsen, 2015) and include lessons related to dating and sexuality. However, to our knowledge only one program has been specifically developed to address psychosexual development in teens with ASD. The Tackling Teenage Training (TTT) program is an 18-session individually based education-intervention program. The description of an ongoing waitlist, randomized control trial (RCT) with a large sample of teens (100 per group) was published in 2015, although results were not yet available (Visser et al., 2015). Of the 18 sessions, only Session 17 focused on safe Internet use. Thus, much more work is needed to better understand OSA as a viable, and perhaps desirable, form of sexual expression for many adults with ASD. Curricula need to be developed and evaluated that present OSA as a positive option for both heterosexual and sexual minority individuals, with an emphasis on safe use, and extensive opportunities for multisensory learning and practice.

We found that few participants reported OSA that might be problematic, at least in terms of amount of time spent online. In contrast, clinical and parental reports and anecdotal data as well as our own clinical experience working with adult clients who have found themselves in compromising and unsafe situations associated with their OSA suggest that there is a subgroup of individuals with ASD who are particularly vulnerable to problematic Internet use (Mazurek, Shattuck, Wagner, & Cooper, 2012). Thus, sexual health education should include information to help individuals distinguish between problematic and nonproblematic use including discussion of possible negative impacts on well-being and quality of life and education regarding accessing illegal materials, such as child pornography (Atwood, Henault, & Dubin, 2014).

Directions for Future Research

The current results extend our understanding of the OSA of individuals with CA-ASD. They also point to a number of areas for future research. First, we did not investigate the relationship context in which OSA occurred. Research is needed to determine the extent to which individuals in and not in a romantic relationship engage in OSA as well as the extent to which individuals engage in S-OSA and P-OSA alone or with a partner (Shaughnessy & Byers, 2014). Second, although we found little evidence that problematic OSA use is common among individuals with CA-ASD, research is needed to identify risk factors for problematic OSA in terms of time spent engaging in OSA, negative impact on well-being and quality of life, and accessing illegal materials. This information can then be used to develop Interventions and educational approaches. Third, although we found few group differences based on sex, age, or sexual identity, more research is needed to better understand characteristics of individuals with CA-ASD that make them more or less likely to engage in various types of OSA, and for whom OSA might contribute positively to their sexual well-being. Finally, the results suggest a need for research aimed at informing the development of education and intervention modalities, materials, and content to assist adults with ASD in navigating the Internet as a means to establish healthy and meaningful sexuality. In particular, researchers need to identify the specific types of information being sought to best meet the informational needs of individuals with CA-ASD in terms of both online resources and in-person sexual health education. Although research with neurotypical populations suggests that people experience more positive than negative outcomes from OSA (Shaughnessy et al., 2014), the extent and nature of positive and negative outcomes of various forms of OSA for adults with CA-ASD is not known. This is critical for identifying both the potential benefits of OSA as well as information about problematic use that should be included in sexual health education.

Footnotes

Acknowledgements

The authors thank Susan Voyer and Georgianna Reilly for their help with the study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

Addis

M. E.

Mahalik

J. R.

(2003). Men, masculinity, and the contexts of help seeking. American Psychologist, 58, 5–14.

Albright

J. M.

(2008). Sex in America online: An exploration of sex, marital status, and sexual identity in Internet sex seeking and its impacts. Journal of Sex Research, 45, 175–186.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Atwood

Henault

Dubin

(2014). The autism spectrum, sexuality and the law. London, England: Jessica Kingsley.

Banks

(2010). Regulating hate speech online. International Review of Law, Computers and Technology, 24, 233–239.

Brown-Lavoie

S. M.

Viecili

M. A.

Weiss

J. A.

(2014). Sexual knowledge and victimization in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44, 2185–2196.

Byers

E. S.

(1996). How well does the traditional sexual script explain sexual coercion? Review of a program of research. Journal of Psychology & Human Sexuality, 8, 7-25.

Byers

E. S.

Nichols

Voyer

S. D.

(2013). Challenging stereotypes: Sexual functioning of single adults with high functioning Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 43, 2617-2627.

Byers

E. S.

Nichols

Voyer

S. D.

Reilly

(2013). Sexual well-being of a community sample of high-functioning adults on the autism spectrum who have been in a romantic relationship. Autism, 17, 418-433.

10.

Byers

E. S.

Shaughnessy

(2014). Attitudes toward online sexual activities. Cyberpsychology: Journal of Psychosocial Research on Cyberspace, 8, article 10.

11.

Cooper

Griffin-Shelley

(2002). Introduction. The Internet: The next sexual revolution. In Cooper

(Ed.), Sex and the internet: A guidebook for clinicians (pp. 1–15). New York, NY: Brunner-Routledge.

12.

Daneback

Cooper

Månsson

S.-A.

(2005). An Internet study of cybersex participants. Archives of Sexual Behavior, 34, 321–328.

13.

Daneback

Månsson

S.-A.

Ross

M. W.

Markham

C. M.

(2012). The Internet as a source of information about sexuality. Sex Education: Sexuality, Society and Learning, 12, 583–598.

14.

Daneback

Ross

M. W.

Månsson

S.-A.

(2008). Bisexuality and sexually related activities on the Internet. Journal of Bisexuality, 8, 115–129.

15.

D’Entremont

Voyer

S. D.

Nichols

Byers

E. S.

(2014, May). Psychosocial outcomes of a community sample of high functioning individuals with Autism Spectrum Disorder. Presented at the International Meeting for Autism Research in Atlanta.

16.

Dewinter

Vermeiren

Vanwesenbeeck

Lobbestael

van Nieuwenhuizen

(2014). Sexuality in adolescent boys with autism spectrum disorder: Self-reported behaviours and attitudes. Journal of Autism and Development Disorders, 35, 731–741.

17.

Döring

(2009). The Internet’s impact on sexuality: A critical review of 15 years of research. Computers in Human Behavior, 25, 1089–1101.

18.

Döring

Daneback

Shaughnessy

Grov

Byers

E. S.

(2015). Online sexual activity experiences among college students: A four-country comparison. Archives of Sexual Behaviour, 1-12.

19.

Duncan

A. W.

Bishop

S. L.

(2015). Understanding the gap between cognitive abilities and daily living skills in adolescents with autism spectrum disorders with average intelligence. Autism, 19, 64–72.

20.

Gillespie-Lynch

Kapp

Shane-Simpson

Smith

D. S.

Hutman

(2014). Intersections between the Autism Spectrum and the Internet: Perceived benefits and preferred functions of computer-mediated communication. Intellectual and Developmental Disabilities, 52, 456–469.

21.

Gilmour

Schalomon

P. M.

Smith

(2012). Sexuality in a community based sample of adults with autism spectrum disorder. Research in Autism Spectrum Disorders, 6, 313–318.

22.

Hannah

L. A.

Stagg

S. D.

(2016). Experiences of sex education and sexual awareness in young adults with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 46, 3678–3687.

23.

Hatton

Tector

(2010). Sexuality and relationship education for young people with autistic spectrum disorder: Curriculum change and staff support. British Journal of Special Education, 37, 69–76.

24.

Heinz

Inuzuka

Zender

(2002). Under the rainbow flag: Webbing global gay identities. International Journal of Sexuality and Gender Studies, 7, 107–123.

25.

Hellemans

Colson

Verbraeken

Vermeiren

Deboutte

(2007). Sexual behavior in high-functioning male adolescents and young people with autism spectrum disorder. Journal of Autism and Developmental Disorders, 37, 260–269.

26.

Hénault

(2005). Asperger’s syndrome and sexuality: From adolescence through adulthood. London, England: Jessica Kingsley.

27.

Hoffman

D. L.

Novak

T. P.

Venkatesh

(2004). Has the Internet become indispensable? Communications of the ACM, 47, 37–42.

28.

Holmes

L. G.

Himle

M. B.

Sewell

K. K.

Carbone

P. S.

Strassberg

D. S.

Murphy

N. A.

(2014). Addressing sexuality in youth with autism spectrum disorders: Current pediatric practices and barriers. Journal of Developmental and Behavioral Pediatrics, 35, 172–178.

29.

Kellaher

C. D.

(2015). Sexual behavior and autism spectrum disorders: An update and discussion. Current Psychiatry Reports, 17, 41–48. doi:10.1007/s11920-015-0562-4

30.

Kubicek

Carpineto

McDavitt

Weiss

Kipke

M. D.

(2011). Use and perceptions of the Internet for sexual information and partners: A study of young men who have sex with men. Archives of Sexual Behavior, 40, 803–816.

31.

Laugeson

E. A.

Gantman

Kapp

S. K.

Orenski

Ellingsen

(2015). A randomized controlled trial to improve social skills in young adults with Autism Spectrum Disorder: The UCLA PEERS® Program. Journal of Autism and Developmental Disorders, 45, 3978–3989.

32.

Mazurek

M. O.

(2013). Social media use among adults with autism spectrum disorder. Computers in Human Behavior, 29, 1709–1714.

33.

Mazurek

M. O.

Shattuck

P. T.

Wagner

Cooper

B. P.

(2012). Prevalence and correlates of screen-based media use among youths with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 1757–1767.

34.

McMillan

S. J.

Morrison

(2006). Coming of age with the Internet: A qualitative exploration of how the internet has become an integral part of young people’s lives. New Media & Society, 8, 73–95.

35.

Mehzabin

Stokes

M. A.

(2011). Self-assessed sexuality in young adults with High-Functioning Autism. Research in Autism Spectrum Disorders, 5, 614–621.

36.

Moor

P. J.

Heuvelman

Verleur

(2010). Flaming on YouTube. Computers in Human Behavior, 26, 1536–1546.

37.

Nichols

Blakeley-Smith

(2010). “I’m not sure we’re ready for this . . . ”: Working with families toward facilitating healthy sexuality for individuals with autism spectrum disorders. Social Work in Mental Health, 8, 72–91.

38.

Orsmond

G. I.

Krauss

M. W.

Seltzer

M. M.

(2004). Peer relationships and social and recreational activities among adolescents and adults with autism. Journal of Autism and Developmental Disorders, 34, 245–256.

39.

Pecora

L. A.

Mesibov

G. B.

Stokes

M. A.

(2016). Sexuality in high-functioning autism: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders, 46, 3519–3556.

40.

Renty

Roeyers

(2007). Individual and marital adaptation in men with autism spectrum disorder and their spouses: The role of social support and coping strategies. Journal of Autism and Developmental Disorders, 37, 1247–1255.

41.

Romano

Osborne

L. A.

Truzoli

Reed

(2013). Differential psychological impact of internet exposure on internet addicts. PLoS ONE, 8(2), e55162. doi:10.1371/journal.pone.0055162

42.

Romano

Truzoli

Osborne

L. A.

Reed

(2014). The relationship between autism quotient, anxiety, and internet addiction. Research in Autism Spectrum Disorders, 8, 1521–1526.

43.

Roth

M. E.

Gillis

J. M.

(2015). “Convenience with the click of a mouse”: A survey of adults with autism spectrum disorder on online dating. Sexuality and Disability, 33, 133–150.

44.

Sax

L. J.

Gilmartin

S. K.

Bryant

A. N.

(2003). Assessing response rates and nonresponse bias in web and paper surveys. Research in Higher Education, 44, 409–432.

45.

Shaughnessy

Byers

E. S.

(2014). Contextualizing cybersex experience: Heterosexually identified men and women’s desire for experiences with cybersex with three types of partners. Computers in Human Behavior, 32, 178-185.

46.

Shaughnessy

Byers

E. S.

Clowater

S. L.

Kalinowski

(2014). Self-appraisals of arousal-oriented online sexual activities in university and community samples. Archives of Sexual Behaviour, 43, 1187-1197.

47.

Shaughnessy

Byers

E. S.

Walsh

(2011). Online sexual activity experience of heterosexual students: Gender similarities and differences. Archives of Sexual Behavior, 40, 419-427.

48.

Shaughnessy

Fudge

Byers

E. S.

(2017). An exploration of prevalence, variety, and frequency data to quantify online sexual activity experience. The Canadian Journal of Human Sexuality, 26, 60-75.

49.

Tarnai

Wolfe

P. S.

(2008). Social stories for sexuality education for persons with autism/pervasive developmental disorder. Sexuality and Disability, 26, 29–36.

50.

Visser

Greaves-Lord

Tick

N. T.

Verhulst

F. C.

Maras

van der Vegt

E. J. M.

(2015). Study protocol: A randomized controlled trial investigating the effects of a psychosexual training program for adolescents with autism spectrum disorder. BMC Psychiatry, 15, Article 207. doi:10.1186/s12888-015-0586-7

51.

Wiederman

M. W.

(2005). The gendered nature of sexual scripts. The Family Journal: Counseling and Therapy for Couples and Families, 13, 496–502.

52.

Woodbury-Smith

M. R.

Robinson

Wheelwright

Baron-Cohen

(2005). Screening adults for Asperger syndrome using the AQ: A preliminary study of its diagnostic validity in clinical practice. Journal of Autism and Developmental Disorders, 35, 331–335.