ASD and addiction / porn - advice? consult?

[singasongofjoy]

I don't have training in addiction and certainly not in addiction to porn and masturbating but I'm supervising a case that is, well, exactly that - and to the extent it's landed the client in the hospital (teaching an adult male how to masturbate without causing injury is not something I imagined I'd ever need to do in the course of a day's work, but that's why I like this field, I suppose).

Anyone with expertise in ASD and addiction, or anyone with expertise in porn / masturbation / related topics - interested in sending me some reading, resources, up for a phone call, anything? TIA!

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[PsyDr]

1) Amazon sells a 55 gallon barrel of personal lubricant, which might reduce harm.
2) Addiction stuff is often treated with medications that limit reward (e.g., topiramate or naltrexone)
3) Many SSRIs induce low libido and erectile dysfunction (e.g., paroxetine, citalopram).

 

[thebalmofhurtminds]

Have you noticed whether this seems to fall under a version of a compulsive behavior? If so, you can borrow from that new name for Habit Reversal Training with a focus on competing responses.

 

[Sanman]

What age client are we talking about? I would think limiting triggers, such as computer time, might be more effective than reducing libido in this instance. Lubricant would certainly not be a bad idea. I would wonder about treating this as an addictive behavior rather than a compensatory one given the ASD and social difficulties. Would working more on the core ASD issues and not allowing the individual to retreat into the computer/digital world be more effective than only addressing the masturbation? Perhaps limited time with the computer can be used as a reward for the person engaging in healthy, but more difficult pro-social behaviors. Just spitballing as I don't know the age or severity of the concerns.

 

[borne_before]

(1) What is the cognitive functioning/IQ of the individual?

(2) What type of autism are we looking at?

(3) Have you attempted an informal FBA? Could they be masturbating for other reasons then automatic? Like access to something or escape?

(4) You may want to consult a BCBA...

 

[cara susanna]

Take this with a huuuge grain of salt as I am not competent in ASD, but I wonder if it makes more sense to use other language than addiction regarding this behavior. For instance, non-suicidal self-injury is something you see in this population but I don't see it described as an addiction.

 

[R. Matey]

What's the goal here? Is it to reduce or eliminate the pornography use? The latter might be very difficult to achieve, but you might have better luck conceptualizing it as a form of OCD-like symptoms rather than an "addiction" and treating it with some MI and exposure with response prevention. SSRIs would also help, but may not be a long term solution.

Also, how do we know this person has an ASD?

 

[bcliff]

Sounds like an interesting case -- My interest was sparked, so here are a few relevant papers I came across:

A Systematic Review of Interventions for Inappropriate Sexual Behavior of Children and Adolescents with Developmental Disabilities - Review Journal of Autism and Developmental Disorders

This review provides a systematic analysis of studies that evaluated interventions for inappropriate sexual behavior(s) of children and adolescents with developmental disabilities. Searches of databases, reference lists, and journals yielded 12 studies that met the predetermined inclusion...

link.springer.com

Sexuality in autism: hypersexual and paraphilic behavior in women and men with high-functioning autism spectrum disorder

Like nonaffected adults, individuals with autism spectrum disorders (ASDs) show the entire range of sexual behaviors. However, due to the core symptoms of the disorder spectrum, including deficits in social skills, sensory hypo- and hypersensitivities, ...

www.ncbi.nlm.nih.gov

https://link.springer.com/content/pdf/10.1007/s11195-006-9016-6.pdf

https://link.springer.com/content/pdf/10.1023/A:1023088526314.pdf

https://www.liebertpub.com/doi/pdfplus/10.1089/cap.2008.020?casa_token=MY_xY6ycplgAAAAA:YWm1KVqSHK90jzd8j6GeYH3zW8pceOdEmwCBoAN7GntlALyvrzxB4V-8Oyre6bZF_26BqHDOqzw

https://link.springer.com/content/pdf/10.1007/s40617-015-0062-3.pdf

Looks like there's been a lot written on this topic, including specific recommendations re: pharmacologic and non-pharm interventions. I think all the links should work, but feel free to PM if any are paywalled.

I also agree that consultation with a BCBA may be appropriate/useful.

 

[futureapppsy2]

Take this with a huuuge grain of salt as I am not competent in ASD, but I wonder if it makes more sense to use other language than addiction regarding this behavior. For instance, non-suicidal self-injury is something you see in this population but I don't see it described as an addiction.

I agree with this bx not being an "addiction," but I think self-injurious behavior in this population and NSSI in other populations tend to be different concepts (though neither are addictions).