**14. Conclusion**

portant article emphasizes particular skills that are often amiss for individuals with disa‐ bilities, Abilities, especially the ability to make eye contact, develop appropriate greetings, recognize personal space, and interpret nonverbal communication, that apply to individu‐

Based on previous studies, and addressing the gap in identified interventions specific to the sexual development of individuals with ASD, a current intervention program called Growing Up Aware is in the process of being developed at Columbia University [14]. The first research component attempted to better understand how parents teach their children with ASD about sexuality. Results of the study showed that the majority of pa‐ rents indicated a strong interest in learning how to better communicate with their chil‐ dren about sexual and reproductive health [14]. This is met currently by insufficient availability of materials for parents. Many clinical providers appear under-equipped, with normative knowledge and skills themselves about how to address questions of pa‐ rents regarding their child's changing sexual development based on parental perception. Clinicians need to become better equipped to help families with unusual or inappropri‐

Medication side effects that were not troubling to a child with ASD may cause signifi‐ cant distress in an adult with ASD by decreasing sexual desire or interfering with sexual potency [56]. Self-injury may result if appropriate instruction about masturbation is not provided. Medications such as fluoxetine or sertraline (selective serotonin reuptake inhib‐ itors) are frequently prescribed for persons with ASD to help with anxiety or repetitive behaviors. This group of medications can cause a decrease in sexual desire or make it much more difficult to attain an orgasm. Since masturbation is one of the most frequent sexual behaviors within the ASD population, unintentional self-injury may result from prolonged attempts to reach orgasm. Appropriate instruction in masturbatory behaviors may be necessary in order to prevent self-injury [46]. Alternately, a medication with sex‐ ual side effects may be beneficial for a patient who has anxiety and/or excessive inappro‐ priate sexual behaviors by decreasing sexual desire [57] and enhancing the effectiveness

There are many important reasons for promoting sexuality education for those with ASD in‐ cluding the following: 1) prevention of sexual abuse, 2) preventing inappropriate sexual be‐ havior toward others, 3) promoting health and hygiene and preventing sexually transmitted disease and pregnancy, 4) facilitating the development of intimate relationships, and 5) pre‐

als with ASD [39].

444 Recent Advances in Autism Spectrum Disorders - Volume I

ate sexual development.

**12. Medication concerns**

of behavioral interventions.

**13. Public intervention**

In summary, our literature review and ample experiences of the families in our clinical practice show that, while every person has the innate basis for developing sexuality in a multitude of expressions and experiences, individuals with disabilities (and especially in‐ dividuals with an Autism Spectrum Disorder) most often require additional education and help to become able to express their sexuality in a socially appropriate way. While most neurotypically developing peers form intimate relationships beginning in adoles‐ cence and into adulthood, along a variety of experiences from dating to partnering in committed relationships, many individuals with an Autism Spectrum Disorder remain living with their family of origin into their adulthood and have significant difficulty nav‐ igating the social expectations surrounding relationships. Their difficulty may pertain to recognizing their own needs and wants, as well as to recognizing their partner's wishes coupled with more inexperience than their peers in this arena. Individuals with ASD and their parents and caregivers frequently identify this difficulty when directly asked about it. Sexuality education in a supportive format that includes the individual's family and their particular values and background will be most effective. Interventions need to be individualized with a long-range goal that matches the cognitive, social, and emotional developmental level of the person with ASD. As the prevalence of persons with ASD in‐ creases in our society, we are more than ever called to support their ability to mature in‐ to adults capable of functioning in all areas of life, including sexuality and intimacy.

### **Author details**

Maria R. Urbano, Kathrin Hartmann, Stephen I. Deutsch, Gina M. Bondi Polychronopoulos and Vanessa Dorbin

\*Address all correspondence to: urbanomr@evms.edu

Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Nor‐ folk, Virginia, USA

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**Chapter 20**

**Clinical Implications of a Link Between Fetal Alcohol**

**Spectrum Disorders (FASD) and Autism or Asperger's**

**Disorder – A Neurodevelopmental Frame for Helping**

The teratogenic effect of alcohol was first observed by paediatrician Paul Lemoine in Nantes, France in 1968, when he linked facial dysmorphic and growth features with maternal use of alcohol (wine) in pregnancy. His initial series was 127 infants. Subsequently the syndrome Fetal Alcohol Syndrome was defined in 2 classic papers in 1973 by David smith and Ken Jones in Seattle. Their initial case series were 8 patients. The recognition that prenatal alcohol exposure did not just cause dysmorphic facial features and growth delay was made by Sterling Clarren in Seattle in 1978 with the introduction of the term Fetal Alcohol Effect ( FAE) to describe children with alcohol exposure but no facial features. This descriptive clinical term was changed to Alcohol Related Neurodevelopmental Disorder (ARND) by the Institute of

**2. A conceptual understanding of the spectrum of effects of prenatal alcohol**

In the same vein as Autistic Spectrum Disorders, Fetal Alcohol Spectrum Disorders (FASD,) initially described by Streissguth & O'Malley in 2000 is an umbrella term to describe the continuum of complex neuropsychiatric, cognitive, behavioral, social, language, communica‐ tion and other multi-sensory deficits. There are, however, two conditions within this spectrum which describe the range of conditions caused by prenatal alcohol exposure. They are Fetal

and reproduction in any medium, provided the original work is properly cited.

© 2013 O'Malley and Rich; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

**Understanding and Management**

Additional information is available at the end of the chapter

Kieran D. O'Malley and Susan D. Rich

http://dx.doi.org/10.5772/54924

**1. Introduction**

Medicine in 1996.

**exposure**

