Autism and intellectual disability: a systematic review of sexuality and relationship education

Individuals with neurodevelopmental disorders, including Autism (ASD) and intellectual disability (ID), have a right and need for appropriate sexuality and relationship education (SRE). These individuals often have the same desires as typically-developing people to express their sexuality and form intimate relationships; and may have an increased risk of sexual exploitation and abuse. While there are various materials recommended for teaching SRE to these groups, there is a lack of empirical evaluation of such. A systematic review was carried out on peer-reviewed articles published in English between 1980 and March 2018 to identify what SRE programs have been evaluated empirically, highlighting their content, methods of delivery, efficacy in changing knowledge and behavioural outcomes, and limitations. Thirty-three studies were retained for inclusion which quantitatively evaluated SRE interventions delivered to individuals diagnosed with ID (approximately 63%) and ASD. Most of the studies evaluated stand-alone programs derived from mixed sources within the broader SRE literature. They focused more on biological content (e.g., anatomy, puberty, reproduction) and self-awareness/safety (e.g., boundaries, assertiveness, privacy) than personal sexuality (e.g., sexual orientation, masturbation) and relationships (e.g., dating, emotions, parenting). Most programs improved outcomes, however the overall quality of included studies was poor. Limitations included scant description of theoretical and ethical paradigms within programs and use of non-validated outcome measures. Recommendations for future research and clinical implications are discussed.