Some adults with autism traits reject conventional sexual labels

Adults who have characteristics of autism are about three times as likely as their peers to not identify themselves as heterosexual, homosexual or bisexual, according to a new study¹.

The study is based on surveys of more than 47,000 adults in Sweden. It shows that about one out of five individuals with autism traits does not believe she fits into any of these standard categories for sexual orientation.

The findings suggest that researchers and clinicians should be open-minded when discussing sexuality with people who have autism or its traits.

“These traditional categories are not working,” says lead investigator Kyriaki Kosidou, a researcher at the Karolinska Institute. “To address sexuality is important in clinical settings, but our findings show that we have to think out of the box; we have to think progressively.”

Several studies have hinted that minority sexual orientations are overrepresented among people with autism². This year, for example, scientists reported that nearly 70 percent of 309 individuals with autism reported being non-heterosexual, compared with 30 percent of typical adults³.

The new work is the first to look at the connection between sexual orientation and autism traits in the general population.

“This study provides further evidence of a link between neurodiversity and sexual-orientation diversity,” says John Strang, director of the gender and autism program at Children’s National Health System in Washington, D.C., who was not involved in the research. “Studies like this encourage more careful listening to autistic people about their experience of sexual orientation.”

None of the above:

Kosidou and her colleagues analyzed data from 47,356 Swedish adults who completed various public-health surveys between 2002 and 2014. Among the surveys was a 10-item questionnaire called the AQ-10 that screens for traits associated with autism, such as difficulties with social interaction and communication. Adults who scored above a certain threshold were classified as having autism traits.

Participants also answered a question asking whether they considered themselves heterosexual, homosexual, bisexual or “none of the above.”

More than 3,000 respondents, or about 7.5 percent of the sample, have traits associated with autism. Of these individuals, 77 percent reported being heterosexual, compared with 89.5 percent of those without autism traits. They were also especially likely to say that none of the given labels fit their sexual orientation: 19.1 percent selected “none of the above,” compared with 6.8 percent of adults without autism traits.

The respondents with autism traits are also slightly more likely to be bisexual: 2.5 percent of them reported being bisexual, compared with 2.1 percent of adults without autism traits. The findings appeared 30 October in the Journal of Autism and Developmental Disorders.

“[Clinicians] working with people on the spectrum should be encouraged to be open to different ways of describing sexual orientation and discussing sexuality,” Kosidou says.

Sexual stressors:

No one knows how autism features and sexual orientation might be linked. Biological factors could be at play. For instance, exposure to high levels of male sex hormones in utero could increase the odds of autism traits as well as particular sexual orientations.

It’s also possible that people with autism traits are less concerned with social norms surrounding sexual orientation than most people are. So they may be more likely to embrace or disclose non-standard sexual orientations.

“One might consider how that characteristic of direct and concrete honesty, which is so common among autistic people, might lead them to more honestly describe their sexuality as outside of established categories,” Strang says.

Minority sexual orientations may present additional challenges for people who have autism or features of the condition. Some of these individuals face stigma and discrimination for both their autism-related behaviors and their sexual orientation.

“It sometimes feels like you have to come out of the closet twice,” says Jeroen Dewinter, a clinical psychologist at the GGzE Centre for Child & Adolescent Psychiatry in the Netherlands, who was not involved in the research but often treats adolescents with autism.

The next step, Dewinter says, is to conduct qualitative research with adolescents and adults with autism to learn about how they experience and describe their own sexuality.