Sexual behaviors in autism: Problems of definition and management

Surveys of sexual behavior in autism suggest a variety of behavioral expres sion. However, the course of sexual development in autism is unplotted, lea ving questions about the normalcy of specific behaviors. Even less is known about deviations of sexual development and the incidence of paraphilias in this population. We explore the problems of definition of sexual behaviors and describe a case report that highlights the difficulties of management. An application of a testosterone-suppressing medication and its effect on sexual behavior are reported. After failure of behavioral and educational p rograms, leuprolide, an injectable antiandrogen, resulted in suppression of behaviors and retention of the participants' community placement. Follow-u p for almost 3 years shows no abnormal physical effects. Dosage has been ta pered over that period to a low but effective dose. Directions for research are discussed.