Child Study Center Grand Rounds 04.19.2022

May 18, 2022

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Let's talk about sex, Doc: Video-based examples of sexual health conversations to help CAPs help kids

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00:19To talk about.
00:23We will.
00:35I love you.
00:38Pretty much.
00:41Thank you we finally.
00:51We literally wouldn't.
00:54Well, I think it's too late.
01:30OK.
01:32Good afternoon and Kyle.
01:34Can I ask you one more favor?
01:36Could we put Lindas first? Slide on.
01:41Thank you. I don't know if
01:44people know who Kyle is,
01:46but Kyle is the most important person
01:49in grand rounds and I want you to
01:51appreciate and hug him and love him.
01:56And for those of you who didn't know,
01:57let me embarrass him in public.
01:59He is a Superman suit,
02:01not Superman, Star Wars, konwiser,
02:04reenactor, all sorts of things.
02:07So if you want to know,
02:08maybe we'll have him give Brian runs
02:10one of these days because he knows,
02:12like we tell psychiatrists and
02:13psychologists and mental health,
02:15he knows that play is a tool of healing.
02:18Whatever you need to heal play,
02:20he's a good player.
02:21OK, someone else who plays
02:23really well is today's speaker,
02:25and I'm just so delighted before that.
02:28Next week, Nathan Fox,
02:30am I remembering, right?
02:31I'm sorry, yes.
02:33So next week,
02:34just a heads up is going to be the first
02:37of the two parts series this year of
02:40the Viola Bernard Lecture which Tara
02:42Davila and others are putting together.
02:45But I'm really grateful to Tara for finding.
02:48Carolyn Roberts,
02:50Roberton Roberts,
02:52who will be our speaker for
02:54both parts and Doctor Roberts.
02:56I hope it's Robertson.
02:58Robertson,
02:58apologies if I bungled that she is a
03:02professor here at Yale and if I recall,
03:06Department of African American
03:07Studies her work is going to be very,
03:10very relevant to all the many efforts
03:13and initiatives about diversity,
03:15equity and inclusion.
03:16I'm really excited about it and.
03:19Again, it's going to be a two part series,
03:20so stay tuned for that and
03:22how it's going to be divided.
03:24Today I have the great
03:26pleasure of introducing my dear
03:28friend and recent graduates.
03:30Maybe maybe three years ago
03:32you graduated 2 years ago.
03:34Very recent graduate Linda Drozdowicz.
03:37I have had the the joy and
03:38the pleasure of knowing.
03:39Knowing Linda,
03:40I think since her first year in
03:42medical school or second year when
03:44she was at the Mayo Clinic and Linda
03:47was part of the Klingenstein Third
03:49Generation Foundation network which
03:51we started here in Yale in 2000.
03:54Two on network named after
03:56the late Donald Cohen.
03:58Our former former former director.
04:00If I get that right and he passed
04:02in 2001 and by 2002 the network
04:05was funded by the claimants teen
04:07Third Generation Foundation,
04:09they were so pleased with what we did
04:11here at Yale that the next year or
04:13two they funded the current 13 programs,
04:16the Mayo Clinic being one of them.
04:18So anyway,
04:18Linda was there one of her many talents
04:21making my point that plays a tool of healing.
04:24Is that she was and known as a ukulele girl.
04:28Right,
04:28and I didn't say girl,
04:30that's how she was known in her pre MD days.
04:33Not not ukulele miss but ukulele
04:35girl because what she did is that
04:37she would plant herself at one of
04:40the main fires or entries of this
04:42magnificent Mayo Clinic playing the ukulele.
04:46Welcoming people into the Mayo Clinic
04:49and in some of the pediatric units.
04:52And that's just amazing.
04:53That's, you know, the power of play.
04:56She played for our kids and
04:57winning one when she was here.
04:59And I see Sarah Kowalski when
05:02one of our nurses
05:04are associated. Yeah, patient,
05:06the manager which is like I
05:08never get their wording right,
05:10but our nursing Director Co.
05:13Director and she is smiling because she
05:15remembers as we all remember fondly.
05:17That reminds me of my Angelou,
05:20who we all know said you'll forget
05:22everything you are taught, but you will
05:25never forget how you're made to feel.
05:27So I'm sure that those kids have forgotten
05:30everything about what we taught them about.
05:32You know everything, but I'm sure
05:34they haven't forgotten your ukulele.
05:36Now, Linda has another great
05:41superpower that I discovered.
05:43Just by coincidence,
05:45one day I was telling confessing to Linda.
05:47I said, Linda, I'm I'm such a prude.
05:50That I don't know how to say
05:52body parts without blushing,
05:53and I'm an MD who has been
05:55practiced for 20 years.
05:56I have no I, I just get like really anxious.
05:59And you know, I say well euphemism,
06:02euphemism.
06:02And she starts naming 1 by 1 all
06:05the body parts in great detail.
06:08And I'm like damn how did you do that?
06:11And I saw that it was not just her
06:14natural ease which you will learn
06:16about in the second in a millisecond.
06:19But it was her intentionality.
06:21About this.
06:21Linda is,
06:22I think,
06:22one of one or two or three Charles
06:26psychiatrists in the country who also has.
06:29Training and sexual health.
06:30She will tell us exactly the
06:32name of her degree,
06:33but she pursued this and she knows
06:35a lot about this and she's going
06:37to be talking about many things,
06:39including a paper that I'll have her
06:42talk about but with great pride.
06:44Dorothy Stubby and I can tell you
06:46that the paper she's going to talk
06:48about with just published last
06:50year won the award from Adword,
06:52which is the Association of Directors
06:55of Residency Training in Psychiatry.
06:57She won the award for the best.
06:59Paper published by a trainee that year
07:02and we're incredibly proud of that.
07:04And I'm just so delighted to
07:06have played well with others,
07:07including Linda.
07:08So Linda Drozdowicz coming up.
07:16Something really quick. Sorry about this.
07:23Please hold for technical difficulties
07:25all right, thank you for having me.
07:27Andres has adjusted the screen so
07:29that I can be seen on the screen
07:31because I'm vertically challenged.
07:33Thank you for coming to this talk
07:34and this is a talk about sex,
07:36which is a topic that we don't talk about
07:38too openly or too often in child psychiatry.
07:40I think not as often as
07:42we should as you'll see,
07:43so the title is video based.
07:44Examples of sexual health
07:46conversations to help child,
07:47adolescent psychiatrists and practitioners
07:49in general help kids and synchronize.
07:52Multi site video conferencing
07:53works and there's a little I don't
07:55know what that thing is called.
07:56The circle, the timing,
07:58your QR code which will give you
08:00access to the paper that was written
08:02about this project as well to the
08:04full sexual health didactic and
08:05I'll show this again at the end so
08:07don't worry if you don't get it now.
08:09So my goal is today are for you to
08:11learn the importance of discussing
08:12sexual development and sexual health
08:14in neurotypical and neurodiverse
08:16kids and their families.
08:17To see examples of videos used
08:19for teaching these skills and to
08:20learn the utility of synchronized.
08:22Multi site video conferencing for
08:24teaching niche content to a lot of people.
08:27So you might be thinking this
08:29seems like a really niche topic,
08:31or for those who know me, why Linda why, so?
08:33I would argue that this is not a niche
08:36topic at all, and I'll tell you why.
08:39As Andre saluted to when I was in residency
08:41at Mount Sinai Hospital in the city,
08:43I had the pleasure of actually
08:46going downtown to NYU to do the
08:48training program and human sexuality,
08:50which is a sex therapy training program.
08:53When I mentioned this to my mother,
08:54she said you did,
08:55what, and but.
08:56What is sex therapy?
08:58So sex therapy is where you help individuals
09:01and couples with any sexual difficulties.
09:03It is traditionally a
09:05purely behavioral therapy,
09:07but those of us who have ever done
09:08psychotherapy with anyone knows
09:10that relationships are everything.
09:11So usually you're covering both
09:12to help people feel better as
09:14individuals and as couples.
09:15So I had that background before
09:17I came to child psychiatry,
09:20but again, you know,
09:20what about when I got to child fellowship?
09:23Well, in month one I was on Winchester
09:25one or inpatient unit and we admitted.
09:28A 13 year old boy with autism,
09:30mild intellectual disability and I think
09:32he was admitted for aggression or some,
09:34you know,
09:35common reason that kids are admitted.
09:36And as an aside,
09:38his mother came in beside herself
09:40and told us that she had caught
09:42him ************ while looking at
09:43his sister and she was convinced
09:45that he was a sexual deviant.
09:46That he was disgusting.
09:47She was really really really disturbed
09:49by this and it felt wrong to me.
09:51I knew that there was something not
09:53sitting right but I didn't really
09:54know how to counsel her and it
09:56turned out she had not
09:57talked to him about puberty.
09:59About sexual development.
10:00About ************.
10:01But again I really didn't know
10:03what to tell her and that's what
10:05really prompted this project.
10:07So I got in touch with Andres
10:09and I got in touch with one of
10:11the sex therapists and NYU doctor
10:13Elizabeth Horden and together
10:14we we created this project.
10:16So you need to be able to talk
10:18to kids and their families
10:19about the birds and the bees.
10:20That's where we have this.
10:21This lovely picture and sexual
10:23health and mental health are
10:24actually bidirectionally influential.
10:26So if you're having sexual dysfunction,
10:28you're two to three times more likely
10:30to develop major depressive disorder.
10:32And if you've got depression,
10:34you're much more likely to
10:35experience sexual dysfunction,
10:36so this is directly relevant to the
10:38population that we treat medical.
10:40Sexual health education is also
10:42imperative because if providers
10:43are not bringing up the subject,
10:45if we're placing the burden on patients.
10:47For their parents to bring it up,
10:48we're contributing to stigma
10:49and when we're making it sort of
10:51the the elephant in the room,
10:52we don't go there unless you
10:53are bold enough to bring it up.
10:55We need to bring it up so that that's
10:57another reason this is so important.
10:58And finally,
10:59sexual health education is often
11:01not as openly available to
11:03neurodiverse kids and adults,
11:05but there's a tendency to infantilize people
11:07with any level of perceived disability,
11:09and these kids have just as
11:10much of an interest in you know,
11:12sex, partnership, romance,
11:14whatever it is,
11:15and so we need to make the information.
11:18Equally available to them in whatever modes
11:20of information transmission are going to be.
11:23You know,
11:24most identical.
11:25And this is not as niche as you think it is.
11:29So just in the last couple of
11:31years on Netflix there have been
11:32two shows about autism and sex.
11:34One is called a typical that's
11:36a scripted show.
11:37It's wonderful and one is
11:38called love on the spectrum,
11:39which is a reality TV show about
11:41people on the spectrum dating and
11:42I'm going to show a very brief clip
11:44from a typical you should watch it
11:46if you haven't. How is your
11:49session with your therapist today?
11:50She thinks that I should put.
11:52And find someone to have sex with.
11:55She didn't say the sex part. I added that.
11:59I'm a weirdo. That's what everyone
12:01says sometimes I don't know what
12:03people mean when they say things Sam.
12:05People on the spectrum date, you know, girls
12:07don't really notice me at all.
12:08And I'm not great at picking
12:09up signals. She's
12:10smiling right at you.
12:12You need to turn that
12:13down like 70%. Casey, all
12:18right. So wonderful show
12:19if you haven't seen it,
12:20check it out, but that's atypical.
12:22So this is actually in the media.
12:23People are talking about
12:25neurodiverse kids and sexuality.
12:28OK, So what did we do with this
12:30project myself and Doctor Gordon
12:31created a didactic on sexual
12:33health issues relevant to child
12:35and adolescent psychiatrists.
12:37This included discussing sexual
12:38health and development in
12:40neurotypical and neurodiverse kids.
12:42This included what to do when
12:43the psychiatrist is the problem,
12:45AKA sexual side effects of medications.
12:49And special considerations
12:50for kids on the spectrum.
12:52We got together with Andres,
12:55who's the director of the Center
12:57for simulated participants,
12:58which used to be called the
13:00standardized patients here at Yale,
13:01where he is professional actors
13:02who can act out these scenarios to
13:04help teach trainees what to do.
13:06And so we wrote scripts for them,
13:08recorded videos of ourselves as experts,
13:10talking with the simulated participants,
13:12and then created these videos.
13:15Our plan was to present this to,
13:17you know,
13:1812 John Adolescent Psychiatry fellows
13:20here at Yale and then COVID hit
13:22and our plan went up in flames so
13:24we had to pivot and this was back
13:27before Zoom was familiar to all of
13:29us and thanks mostly to Andres.
13:31We set up the synchronized video
13:33conferencing to 16 child and
13:35adolescent psychiatry programs
13:37across the country with 125 trainees,
13:39so this was kind of a silver lining
13:42of COVID where our audience actually blew up.
13:44In a good way when our plans blew
13:47up in a bad way.
13:48But I want to again give a special
13:50thanks to Doctor Martin and to Doctor Gordon.
13:52OK,
13:53so why you standardized patients?
13:55Because showing people is better
13:57than telling them when it comes to
14:00learning and I hope you're going
14:01to understand that today when
14:03you see these videos.
14:04All right,
14:05this is a picture that brings
14:07up all sorts of feelings.
14:08This is when we're filming our videos,
14:11and this was probably about a
14:13week before everything shut down,
14:15which was the last time we were
14:17in person together before COVID
14:18so little did we know that this
14:20would be the end,
14:20but we luckily did our recording
14:23before everything got rough.
14:26OK,
14:26so when I ask you to think about talking
14:29to parents and kids about sexuality,
14:32including kids on the spectrum,
14:34how does that make you feel?
14:37Right,
14:37we asked this to participants in the project.
14:39The people participating in the
14:40detected and they had some thoughts.
14:43OK, so the biggest word, awkward, right,
14:46awkward, uncomfortable, difficult,
14:47but also words like necessary.
14:49Important safety, privacy right?
14:51So this was recognized as an important topic,
14:54but one that kind of tends to
14:56give people the the shakes.
14:57And you know what's the the cure for fear,
15:00knowledge, right knowledge and practice.
15:02So we delivered the didactic.
15:06All right,
15:07So what content did we specifically cover?
15:10Basic sexual health and development
15:12in childhood talking about sexual
15:14development and younger kids with autism.
15:16Normal sexual development in
15:19adolescence and ***********.
15:21Management of medication induced
15:23sexual dysfunction and then special
15:25considerations and adolescents
15:26with autism and sexuality.
15:30So I just want to show this.
15:31You don't need to read all the words,
15:32but I want to show you that children
15:35are sexual fetuses are sexual.
15:37It is actually not uncommon for
15:39ultrasonographers to have to
15:40quickly move the wand when they're
15:42doing a scan during pregnancy.
15:43And the little girl or the
15:45little boys touching themselves
15:46fetuses self stimulate baby self,
15:48stimulate young children self stimulate.
15:50It feels good.
15:51Whether you want to call it
15:52overtly sexual versus for comfort.
15:54You know kids are in touch
15:56with their sexual parts.
15:57So in children under four it
15:59is normal to touch themselves.
16:00The public or in private.
16:01They have no idea,
16:02and they don't really care.
16:04They're interested in private parts.
16:05They might be interested in women's breasts.
16:07They might want to be naked,
16:08talk about bodily functions,
16:10peeing and pooping, and this and that.
16:13So I don't know if it's happened to you,
16:14but it's certainly happened to me
16:16that parents come in concerned about
16:17these sorts of behaviors and wondering
16:19if there's something wrong with their child.
16:20No,
16:21there's usually nothing wrong with the child.
16:24In four to six year olds,
16:26things develop a little bit.
16:27They might actually start to masturbate,
16:29so purposefully touching
16:30themselves for pleasure.
16:31Parents blush at this.
16:32There's often a lot of kind of shaming,
16:34automatic reactions.
16:35You know that.
16:36Don't do that over here.
16:37Don't ever do that.
16:38They might talk about private parts
16:40using naughty words without even
16:41really knowing what they're saying,
16:43but they picked up that it's naughty.
16:45And then you know,
16:46games like playing Doctor.
16:47I'll show you mine if you show me yours.
16:49These are, you know,
16:50normal aspects in four to six year olds
16:52with their sexual behavioral development.
16:55Then in school aged children,
16:56you know they typically do masturbate,
16:58usually in private.
16:59If they're not doing it in private,
17:00that is a time for,
17:01you know, redirection.
17:02You know kind of gentle but firm redirection.
17:05They'll play more sexually
17:06oriented games like Truth or Dare,
17:08so a little bit different
17:10than playing Doctor.
17:11They're going to view and listen
17:12to sexual content in the media.
17:13It's everywhere.
17:14It's completely unavoidable.
17:15And typically in this same range.
17:17Actually,
17:17at some point they'll be exposed to
17:18**** which makes everybody nervous.
17:20But I'm going to tell you and show you
17:22why it doesn't have to make you as nervous,
17:23because, again,
17:24knowledge is power.
17:25And at this age they want more privacy
17:27and they become more reluctant about
17:29talking about these issues with their
17:30parents and adults in their lives.
17:32And they begin to become actually
17:33sexually attractive to peers.
17:34So they're leaving latency.
17:37All right, so let me show you.
17:51This is going to be slow.
17:53Give me a second. I can
17:54feel Andre's blood pressure rising.
17:58Hi Stephanie, it's so good to see you.
18:00I still hang out in the waiting room.
18:04I'm just getting so big.
18:06How are you doing?
18:07Oh, we're great, we're great.
18:09You know things are finally, stabling out.
18:11I am a little concerned
18:12about having the talk soon.
18:14You know she'll be hitting
18:16puberty in a few years and
18:18she might have questions and.
18:19I'm maybe not, you know,
18:22maybe it's too early to talk about this.
18:24No, actually, it's never too early.
18:26She's 8, almost nine and puberty isn't
18:28far off and research really supports
18:30that talking to children sooner
18:32rather than later and starting age
18:34appropriate sex Ed can support healthy
18:36sexual development later in life so
18:38that they relate to their sexuality
18:40in a happy and healthy manner. And
18:42I think having a talk would be very helpful.
18:44OK, why is it coming up now?
18:46So Hannah came home from school
18:49the other day and she said that.
18:50Someone was talking about
18:52screwing and she asked
18:53me what it meant.
18:54I didn't know what to say,
18:56so I told her it was a bad word
18:59and not to say it again. But
19:01at that moment I kind of thought I
19:03should have said something about sex,
19:05but I didn't know what to say.
19:08So that's really normal.
19:09At this age they start expressing
19:11curiosity and ideally what you want
19:13to do is talk to her about it in an
19:16open way and be nonjudgmental so
19:18that she doesn't feel ashamed or
19:20embarrassed because the most important
19:22component at this point is making sure
19:24the door is open so she continues
19:26to talk to you as she develops.
19:27So I'm happy to go over some information
19:29with you about how she can develop sexually.
19:31Would that be helpful?
19:32What have you talked to her about so far?
19:35Well, actually I haven't shared much, I mean.
19:37She knows that she has private parts like
19:40a vagina. She knows that she's not to
19:43share those parts with anyone she knows.
19:46The boys and girls have different
19:48private parts and she knows that
19:50babies come from Mommy's bellies
19:52and since she was adopted,
19:53she knows that belly wasn't mine.
19:55And other than that I mean.
19:58I think that's about it. Actually,
20:00that's great. You've provided her
20:02with some good basic information.
20:05You know my parents never really talked to
20:08me about this stuff and she's just so young
20:12but. You know now that I think
20:14about it, she used to touch
20:16herself when she was much younger
20:18and we told her that that wasn't
20:20nice and that she should stop it.
20:23Now I'm thinking that that was
20:24probably the wrong thing to do.
20:26I mean, was I wrong
20:27with that? No, that's not wrong.
20:29It sounds as if you did set some very
20:31appropriate boundaries about what is
20:33public behavior versus private behavior,
20:35but I might recommend a timing adjustment to
20:38the approach overall so equally important
20:40to telling them what they can't do.
20:42Telling kids what they can't do
20:44is telling them what they can
20:45do and where they can do it.
20:47You want to try to create a positive
20:49approach from our perspective
20:50from a health perspective,
20:52************ is a normal and healthy part.
20:54Of development and it starts very early.
20:56Infants and kids masturbate and
20:58they do it because it's soothing
20:59and because it's pleasurable.
21:01They don't relate to it as a sexual
21:04activity the way that adults do,
21:06but a lot of adults have these concerns,
21:07so we can talk about how you and her
21:10father could talk to her and support
21:12her in her healthy sexual development.
21:14Because with your support,
21:15you could really ensure that
21:17she relates to her sexuality in
21:19a way that's healthy overall,
21:20and you know she's developing now and
21:22you want to help her through this.
21:25From the issue with ************ too,
21:27and I know it's really hard
21:28to think about right now,
21:29but her eventual future sex life.
21:31Ohh my gosh. Yeah I think more
21:34information would be helpful, great.
21:38OK.
21:43All right? So. The next topic
21:46we went over was discussing
21:48sexual development in kids with
21:49autism and the main takeaways.
21:51And I'm doing a very
21:53abridged version of the talk.
21:54So like I said, the full didactic
21:56is available through those codes,
21:57but kids with autism may require some extra
22:00specifics and sexual health education,
22:02so there's a lot of sex education that
22:05occurs socially in groups of kids.
22:06They pick things up from each other.
22:08What is OK? What is not OK and kids
22:10with autism may miss those cues,
22:12so you may have to be a little bit more
22:14or a lot more concrete in terms of.
22:15Explaining what is public,
22:17what is private, what can you say or do?
22:19To whom, with whom,
22:21when there are already great resources
22:23geared towards this population,
22:25so this is not a time to reinvent the wheel.
22:27And I'm going to show you some of these
22:30resources. All right, another video.
22:34Or we just.
22:40Well, that's
22:45really helpful.
22:48But I worry about Hannah because she's
22:51not like normal kids. You know, she can
22:53be quite persistent and repetitive.
22:55For example, we were at the mall
22:57the other day getting back to
22:59school clothes and she kept yelling.
23:01Screw Wayne, screw Wayne. Screw Wayne.
23:05And I mean everyone stared at us.
23:08Oh, that sounds like it was pretty difficult.
23:10What did that bring up for you?
23:12You know what?
23:13Never? I think about it. I'm just
23:14thinking she might be a bit too much.
23:16You know, one of those women.
23:19It's quite difficult with her autism.
23:23I just. I just really didn't think that she
23:25would be that interested in sex. You know?
23:28Well, it's a really challenging topic.
23:31Most people are not taught
23:33how to talk about sexuality,
23:34so we can go over some information and try
23:37to practice to make it easier to begin with.
23:40Can you tell me how you might expect Hannah
23:43to develop into sexuality and adulthood?
23:46You know, I really never
23:48gave it much thought. I just.
23:50I just kind of thought she
23:52would wait until marriage.
23:53I mean, that's what my parents told me.
23:55I mean, I mean, that's not what I did,
23:57but I just thought.
24:00We kind of work through it as
24:02she got older and definitely.
24:05Much older than I did because.
24:08I mean. Cheers, autism.
24:11And I just didn't think that
24:12she would be interested
24:14in any type of sexual encounters.
24:16I mean, you have to connect with someone
24:19to want to have sex with them, right?
24:21Well yes, but no, no no.
24:24This is really not an uncommon
24:26approach to sexuality.
24:27Teaching sexuality to children and
24:29most kids manage to figure it out.
24:32They piece it together from the media,
24:34their friends from the Internet,
24:35where if we're being honest,
24:37**** is pretty widely available.
24:39But where did you really learn
24:41your information? I guess
24:42it was my friends and you
24:44know I have an older sister.
24:46Well, that's pretty common.
24:47That's exactly where most people
24:49learn it. They're friends.
24:50So what did you learn from that?
24:54I guess I learned that if I liked a
24:57boy and I wanted him to go out with me,
24:59I would talk to him or flirt with him and.
25:03You know, maybe he would
25:05become my boyfriend and.
25:07That I shouldn't go all the way
25:09because I didn't want a baby and.
25:10Come to think of it, I never
25:13understood how the two were connected.
25:15OK, so The thing is though,
25:17that even the parts that you did understand,
25:19like flirting, involves some
25:21understanding of the social cues
25:23and the nuances and that can be more
25:26difficult for neurotypical children,
25:27particularly some of those with autism.
25:30So since Hannah has some difficulty
25:33with those nuances and those cues a
25:35more active and direct approach from
25:37you and her father could help support
25:40the healthy sexual development.
25:42The other component is unfortunately,
25:44the reality is the neuroatypical population
25:47is more vulnerable to exploitation or abuse.
25:50So if you and her father really
25:52tackle this directly,
25:53you could help protect her against
25:56that unfortunate consequence.
25:57So that makes sense.
25:58OK, so the most important place to start
26:00is to try to understand where Hannah's at.
26:03What does she think the word
26:06screwing actually means?
26:07From there you can see what she
26:09understands about puberty about sexuality.
26:11OK, so? Why don't we try it?
26:13We could role play,
26:14why don't you be Hannah?
26:15OK, OK, so Hannah,
26:17I want to talk to you about puberty.
26:19Do you know what that is?
26:22When I get my *****
26:23well, ***** are a part of it.
26:25Puberty is when the body changes
26:26from a kid to adult and it
26:28happens over a number of years.
26:30There are a lot of changes,
26:31some of it is that you get some hair and
26:33some places that you haven't had hair before.
26:35You grow a lot taller and there are changes
26:37to some other parts that are inside of you.
26:39Do you know what parts I'm talking about?
26:41Do you mean my vagina? Yeah well, yes.
26:44The vagina that's part of your
26:46private parts or genitals.
26:48But that's inside.
26:49There's an outside called
26:51the ***** and the *****.
26:52Is connected by the vagina to the uterus,
26:55which is where babies grow
26:57in an adult so Steph.
26:58This is the kind of information
27:01that we recommend including and
27:03in about this detail at this age.
27:05Do you think that you'd be comfortable
27:07talking to Hannah about this?
27:08I can also provide a lot of resources.
27:12But I would like those resources OK.
27:14Anyway, this is nearly this is not
27:18nearly close to what my friends from
27:20our support group have to deal with.
27:22The ones with teenage boys.
27:24They say that there's
27:25literally semen everywhere. Oh,
27:27that's kind of a common problem.
27:29A lot of parents have this issue and you
27:33know I would like you to let them know
27:34they could talk to somebody like me.
27:36And there are a lot of really
27:37great resources online.
27:37I'm also happy to share with you,
27:39but mainly the idea is to talk openly.
27:41And very concretely,
27:43about how to handle ************.
27:44You want to tell the kids where they
27:46can masturbate and where they can.
27:47And as I said, be concrete.
27:50For example,
27:50if you just tell a child they
27:52should masturbate in the bathroom,
27:54that doesn't necessarily say you
27:55don't masturbate in the school or
27:57the mall bathroom and you want
27:59to use very accurate terminology
28:00and provide the child with words
28:02so that they can communicate.
28:03And this is definitely important
28:05for girls too.
28:06But with boys there's another
28:08issue with the mechanics.
28:09Where should they ejaculate?
28:11How do they? Clean up.
28:12And while this might seem like
28:15an uncomfortable topic.
28:16As I said,
28:17there are a lot of resources we
28:18can help guide you through it,
28:20and it's a really important topic
28:21to tackle to make sure that the
28:24children are happy and are safe.
28:25Sounds good, great.
28:29So these are conversations that come up.
28:34All right, So what are some of the resources?
28:37These are two nice books that
28:38you can recommend to families
28:40of kids on the spectrum.
28:41The growing up book for boys
28:43and what's happening to Ellie.
28:44These are gendered books,
28:45so they may not be a good fit for everybody,
28:47but it's you know it's a starting point and
28:50they can tackle most things in puberty.
28:52Menstrual hygiene,
28:53************ for both sides.
28:55And you know they're
28:57they're helpful resources.
28:58This is an example of teaching
29:00materials that can be helpful for
29:01kids you know on the spectrum.
29:03Is with intellectual disability or
29:05other developmental differences.
29:06You know something that seems simple,
29:08like how to use a menstrual
29:09pad might not be that simple.
29:11And in teaching it you might
29:12think you can quickly show it,
29:13but there are visual guides that
29:14exist that you can actually
29:15give the kid a print out.
29:17Let them try,
29:17walk them through it and they can
29:19have a reminder of how to do these
29:20really important things that feel
29:22embarrassing to talk about and to ask
29:23about after the fact.
29:26The Vanderbilt Kennedy Center
29:28has a lot of great materials.
29:30This is one example.
29:31The healthy bodies toolkit.
29:32Again, these are gendered but healthy
29:34bodies for boys and for girls.
29:36Again, going through puberty,
29:38hygiene growing up with a lot of good,
29:42you know, images, social stories,
29:43etcetera in there that parents can use,
29:45and they can print them
29:46for free off the Internet.
29:47They're available in multiple languages.
29:51All right and then most of us who
29:52work with kids on the spectrum
29:54have heard of social stories.
29:55Social stories are a good way to teach,
29:57you know, social skills and ways of relating.
30:00So there are social stories about public
30:02and private behaviors and this is critical.
30:05How are kids going to get in trouble when
30:06they do a private thing in public right?
30:08And so this is an example of one for boys
30:10about ************ or touching their
30:12genitals about where you can do it,
30:13when to do it,
30:15what to do afterwards etcetera.
30:17So again, these resources already exist
30:19and I'm not big into fear mongering.
30:21But fear is part of this and kids on
30:23the spectrum are at higher risk of being
30:26registered as sex offenders because of
30:28a misunderstandings of public versus
30:31private misunderstandings about boundaries.
30:32So the sexual health information
30:34is is really critical.
30:35It's not all about safety,
30:37they deserve pleasure and to
30:39actually have fun, love lives.
30:40But safety is part of this right and
30:43more so than a neurotypical kids.
30:45So again, talk about it.
30:46Talk about it. Talk about it.
30:48We talked about normal sexual
30:51development and adolescence and
30:53*********** so adolescent sexual health
30:55education is preventive medicine.
30:57High quality sex education is associated
30:59with lower rates of pregnancy and STI,
31:02lower risk taking behavior.
31:03It increases the use of protection and
31:05increases sexual pleasure which no
31:07one wants to hear about in teenagers.
31:09But that is another good thing that
31:10comes out of it. So this is important.
31:14This is what we all want to do right always,
31:16especially when **** comes up.
31:17Don't don't even get into *********** right?
31:19Don't be an ostrich.
31:20Don't put your head in the sand there.
31:22There's resources for helping.
31:25OK. And this is a fun one,
31:27and this was with a simulated
31:29participant who was was he the first
31:31underage actor in in the center?
31:34So so Andres got all sorts of rules
31:37adjusted for Connor, who's who's
31:39excellent and who's now in acting school.
31:42Let's see here. Guide for parents.
31:45OK, here we go. Good to see you Bobby.
31:47How's the anxiety?
31:51Doing ohh I'm I mean I've I've been OK,
31:54he's been doing OK but but
31:56I've got a concern, sure.
31:58I found him looking at **** online.
32:01And I looked at the history on
32:03the computer and you know a lot
32:05of a lot of **** sites came up.
32:08I mean, I get it in 16 years
32:10old and wants to see this stuff.
32:12But I mean there were a lot of
32:14sites and and so I'm just not
32:17sure if that behavior is is normal
32:20and and well how I should react.
32:23Come on, Dad,
32:24it's OK. I know this can
32:26be an embarrassing subject,
32:27but poor news is actually
32:28incredibly common in teenagers.
32:30Studies actually show that in the US.
32:32The first viewing of **** is
32:34as young as eight years old. On
32:35that 18 boys. That is young, yeah,
32:38and if you think about it,
32:41it can sound scary,
32:41but you used to have to go to
32:43the store to get a magazine.
32:44And these days, as you know,
32:45kids have access to the Internet
32:46so they can see these things.
32:48Younger and younger.
32:49It doesn't have to be scary
32:50and it actually like to share
32:51some information with you guys.
32:52If that's OK with you,
32:53is that right, Bobby?
32:57Yeah, I'd like to like to hear about.
32:58I mean, I just I.
33:00Because I never really thought that
33:02about Bobby being that age now,
33:04and I certainly didn't realize that you know,
33:07all the boys were looking at **** online.
33:09I mean, when I was that age we just had
33:13my father's Playboys dad come on, it's
33:16it's OK. Poor news is
33:18actually incredibly common.
33:19Many, many people use it,
33:20and there's nothing inherently bad about it.
33:23I want to talk to you about something
33:25called **** literacy, which basically
33:26means what to know and think about.
33:28If you're going to use it the same way,
33:31you wouldn't learn how to drive from
33:32playing Grand Theft Auto, right?
33:34It's completely made up.
33:35**** is the same way,
33:36and so it's important to remember
33:37that **** is not the same as real
33:40relationships or sexual encounters.
33:41Plenty of professionals who work
33:43with people with sexual issues
33:44agree that **** can be a very
33:46healthy part of a normal sex life.
33:47The issue comes up if there's a
33:49blurring of that boundary and you
33:50start to expect real relationships and
33:52real sexual encounters to look like
33:54****. Yeah, I guess that makes sense and
33:58I know it's hard to talk about this stuff.
34:00We don't have to belabor the point,
34:02but I can give you guys some materials
34:04and resources that you can look at
34:05on your own to help educate you.
34:07Yeah, I'd like to see that.
34:09Of course, I have to tell my wife I
34:11am reading it, that's just gross. It's
34:14OK if you don't have any other
34:16questions for now. Why don't Bobby
34:17and I do our usual check in?
34:23OK, all right. So oh The thing is
34:28what corn is like Grand Theft Auto.
34:30So in these videos we tried to give
34:32people good take away lines right?
34:34You're not going to remember every
34:35single thing said in the teaching
34:36videos but **** is like Grand Theft
34:38Auto **** literacy prevents kids
34:40from crashing in real Life OK?
34:42Let me see here.
34:44Yeah, so one example of an
34:46excellent resource is amaze.org.
34:48You can send teenagers there.
34:49You can send families there
34:50you can see all use the mouse.
34:52You know one of the first videos
34:53here is **** is not sex Ed.
34:56So again, adults tend to have the
34:58automatic reaction not wanting to talk
35:00about it where we're not going there,
35:02but **** is everywhere.
35:03So so you might as well.
35:04Do you know, harm reduction?
35:06Not that **** is inherently harmful,
35:07but it can be harmful if kids
35:08don't know what they're looking
35:10at and how to contextualize it.
35:11Similar to to movies.
35:12R rated movie.
35:13You might be able to prepare your
35:14kid as long as you discuss first that
35:16we don't shoot people in real life,
35:17right?
35:18So point is the same way and amazed.org
35:21has resources on all sorts of things
35:23relevant to adolescent sexual development,
35:24including **** use.
35:27OK,
35:27So what about when your psychiatrist
35:29is the problem?
35:30So medication induced sexual side effects.
35:37OK.
35:50Difficult to talk about. That's right,
35:53Bobby's having a moment. Oh
35:55come on, this is going to be
35:56our our technical difficulty.
35:57It was working before.
36:03Fundrise forgive me, I hate
36:06talking about that stuff.
36:06Within there he and my mom were
36:08so worried that I watched ****.
36:10Well it didn't even work.
36:12I can't finish.
36:15Sorry I. I didn't mean to
36:17talk about that stuff.
36:18Bobby, it's good that you brought it up.
36:20Your sexual health is just as important
36:22as the rest of your health and it actually
36:24connects to the rest of your health.
36:26I'm wondering what you mean by you can't
36:28finish when we talk about sexual function.
36:31It can be helpful to think of
36:33it in sort of three categories.
36:34The first category is sort
36:36of like the electrical.
36:38Can you still get aroused when
36:39you look at these images?
36:40Like do you feel desire like you always have?
36:42Yeah, OK, all right. So that's intact.
36:45The next category is the mechanical.
36:47Are you able to get the.
36:48Even sort of erection that
36:49you've always gotten.
36:52And then the last category is the hydraulics,
36:55and there's a lot of different words
36:57you can use. But can you finish?
36:58Can you come?
36:59Can you ejaculate and achieve orgasm?
37:02I think it's mechanics and hydraulics.
37:06Takes a very long time for me
37:08to finish, and sometimes I can
37:09at all. Even with **** it's frustrating. Was
37:13it always this way or is it different
37:15since you started your antidepressant?
37:19Now that you mentioned it,
37:20it did change early this year.
37:22I used to finish very quickly
37:24when I did that, but now it takes
37:29forever and I'm just frustrated.
37:31But it's not like I'll even
37:33get a girlfriend or anything.
37:35I mean, regardless,
37:36this isn't unusual and it's
37:37good that you brought it up.
37:39The medication you're taking can
37:41actually impact sexual function
37:42by making it harder to orgasm.
37:44And if it's bugging you,
37:45there's things we can do to address it.
37:47Yeah, actually I am kind of worried
37:50for if I do get a girlfriend,
37:53so I've totally avoided Molly's
37:55texts because. Aye, I thought
37:58I was crazy.
37:59You're not crazy. Thank you. OK.
38:07All right, So what do you do if our
38:10medications are causing a problem? The
38:12first thing you want to do that a lot
38:14of us don't do is track the symptoms.
38:16So my favorite skill is the CSF Q, the
38:19changes in sexual functioning questionnaire.
38:21It goes in terrible detail into
38:24every single aspect of sexuality
38:25and you can track it over time.
38:28It's very helpful for seeing small
38:30changes for the better or for the worse.
38:32And what do you do with the medication?
38:34So sometimes people don't want
38:36to change the Med at all.
38:38I've run into that more times than
38:40I would expect to, or someone says,
38:41well, you know.
38:42Recipro has changed my life and if
38:44the trade off is that I have no sex
38:46drive I don't care so I've had that
38:48conversation a lot of times but I
38:50always recommend making an adjustment
38:51since if your sex life is suffering,
38:53that's a pretty big quality of life impact.
38:56So adjustments you can make are making
38:58a decrease in the dose of medication.
39:00Go to the next lowest dose,
39:01see if the person still gets
39:03a therapeutic effect,
39:03but there might be less of a
39:05sexual side effect.
39:06You can switch if it's an SSRI,
39:08you can switch to a different SSRI,
39:09and sometimes that resolves the problem.
39:12I've had that.
39:13Happen,
39:13you can either add or switch to Wellbutrin,
39:16which tends to counteract SSRI
39:18induced sexual dysfunction.
39:20A lot of times people don't want
39:21to be on more than one medicine
39:22at the time at a time,
39:23but you can offer it and do a
39:25switch if it's more of a depression
39:27than an anxiety issue.
39:28You can augment with buspar and I
39:30always like to make a shout out.
39:35One second. If you can give women Viagra,
39:39you can give men Viagra.
39:40You can also give women Viagra.
39:42So there's a small but existent literature
39:44on using Viagra in women for SSRI induced
39:47sexual dysfunction and it can work.
39:49I have successfully used it with two of my.
39:53Early 20s patients who had
39:55sexual dysfunction from an SSRI.
39:57The dose is 50 milligrams.
39:58For those who have never prescribed
39:59it because I had to look into this,
40:00there are almost no contraindications
40:03which surprised me.
40:04But I guess half the country takes it.
40:05There's almost no contraindications and
40:07you can prescribe it, and it can work.
40:09And what I told girls or women
40:11rather is that women have just
40:13as much erectile tissue as men,
40:15but most of ours is internal,
40:16so erectile dysfunction is
40:18always used to talk about men.
40:21But in fetuses, it's the same.
40:22Kind of.
40:23Apparatus that turns into you know vagina,
40:26******** ***** versus penis.
40:28We have internal erectile tissue
40:29and we get erectile dysfunction
40:31and so taking a medication that
40:33increases blood flow can help.
40:35It's not as much of a switch As for
40:37men right men can be on or off but for
40:39women it really can actually do the trick.
40:41So I want to you know put that out there.
40:43You psychiatrist can prescribe
40:44Viagra or ask the PCP to do it if
40:48you're not comfortable to help with
40:50SSRI induced sexual dysfunction.
40:52We also talked about adolescents and
40:54sexuality in kids and teens with autism,
40:57so again,
40:57the sexual health needs of kids on
40:59the spectrum should not be discounted.
41:01OK,
41:02they have the same needs as everyone else.
41:03You may need to have an expanded focus
41:06on the social ropes of you know,
41:08romance, dating, sex, etcetera.
41:12You know,
41:12an example might be that if you have
41:14a son who wants to ask a girl or a
41:16boy out and you can tell them you
41:18know you may ask the kid out once.
41:20If they say they're busy or they
41:22say no on another day,
41:23you may ask them out one more time
41:25and if they say they're busy again,
41:27you may not ask them out again.
41:28So kind of really going through
41:30step-by-step what that would look like.
41:32These are really nuanced conversations
41:34and it it may not go well.
41:36And you also want to do again.
41:37I don't like doing the the fear
41:39mongering but more education around
41:40safety because kids on the spectrum
41:42and kids with differences in general
41:43are at higher risk of being victimized,
41:45coerced.
41:45So you want to talk to them in
41:48great detail about how there are
41:49never secrets from parents.
41:51And you know, even if it feels embarrassing,
41:53you know to talk to a trusted
41:55adult if anything is going on.
41:58You also want to make
41:59sure to cover sexual orientation
42:00and gender variance because the
42:02rates of non heterosexuality and of
42:04gender variance in the neurodiverse.
42:06Population are higher than in
42:07the neurotypical population,
42:08so it's even more relevant to
42:11this group of kids. All right,
42:12let's look at one final video.
42:26Having sex and.
42:29One second OK, give it a second.
42:34It has to brace itself for
42:36this conversation. Oh no.
42:44I I could not wait for this appointment.
42:47I know it's been a while, but.
42:48I wanted to get in here to
42:50see you to tell you that
42:53Hanna's having sex and she's only 16.
42:56OK, well, we can definitely talk about this,
42:59so tell me what's going on.
43:01We had your sex Ed talk and we
43:03went over all the recommendations
43:05and we thought that she would.
43:08Wait till marriage or wait till even
43:09later we thought that she understood
43:11everything we talked about. But
43:13obviously she didn't because
43:15now she's having sex and.
43:17I'm just at a loss. I don't.
43:19I don't know what to do.
43:20You sound really upset so tell
43:23me what happened if you would.
43:26Well, she met this boy through
43:27her dungeons and Dragons.
43:28Meet up now we were excited
43:31that she had some normal
43:33friends to hang out with and.
43:36They started
43:37talking and they're obsessed with the
43:39game, so that's all they talked
43:40about. We never thought in
43:42a million years that sex would
43:43be a part of this equation
43:45and. Now she's having sex.
43:49We were happy that she had
43:51a neurotypical friend,
43:52but not if this is the cause.
43:54Look, are you concerned that she's
43:56being pushed to do something
43:58that she doesn't want to do?
44:00No, no, I mean she acts like she's
44:03really proud that she has a boyfriend.
44:06OK? I mean we were having brunch
44:08with friends and she went on and
44:10on about having a boyfriend
44:12and what she's doing with him?
44:13Well what was going on
44:15that she brought this up?
44:16Absolutely nothing, we just asked.
44:18Hey, how's your weekend
44:20dungeons and Dragons going?
44:22And then she went on and on about
44:25having this boyfriend and what
44:26they're doing with each other.
44:27I mean we were floored.
44:29It sounds like it was a
44:30lot to have sprung on you,
44:31especially with your friends there.
44:33Oh
44:33my goodness, a lot is an understatement.
44:36You know, it sounds like you
44:38were understandably upset but
44:40like to throw in that from a
44:41health professional standpoint,
44:43there's at least a couple
44:44positives in there, one at least.
44:46East Hawking to you and Pew.
44:48It sounds like it was consensual,
44:50which we always worry about.
44:51And with an age appropriate partner,
44:53and she's having some pleasure.
44:54But but I totally understand that
44:57your point is broader than that,
44:58and that you're really worried that
45:00she's not sticking with your family
45:01values so we can talk about this,
45:03and I can help you find some ways
45:05to address your concerns with her.
45:07You know, I get
45:08that she's talking to us, and you know,
45:10I get that no one's ****** her.
45:12She's not being raped,
45:13and she may even enjoy it, but
45:15she's just too young to have sex.
45:17Well, as her parents you definitely
45:19have the right to explain that to
45:21her and the right to provide some
45:23rules and some boundaries that might
45:25help decrease her opportunity to
45:27engage in sexual behaviors such as
45:29an open door policy in the home.
45:31But really importantly is talking
45:33to her and explaining it to her and
45:36doing it in a very concrete way.
45:38The way that you addressed sexuality
45:40and puberty, because again using that
45:43concrete mechanism can help when she
45:45doesn't understand some of these nuances.
45:47But also, you know it's really
45:49important to have the conversation
45:50more than once to keep having the
45:53conversation along the way so that
45:55she can incorporate this information
45:57and really use it to help inform
45:59some of her own value system as she
46:01grows and becomes more of an adult
46:04as she goes through adolescence and
46:06creates her own value system as
46:08adolescence ultimately need to do.
46:10That makes sense, yeah,
46:12this also brings up though.
46:13The knee to remind Hannah of the
46:16difference between public information.
46:17And private information doing so
46:20can help avoid things like this
46:23embarrassment that you felt,
46:24but it also very importantly can
46:26help keep her safe.
46:28Yeah, I definitely want don't want
46:30anything like this to happen again,
46:32and I don't want her to feel
46:34ostracized or even worse because of
46:36it. Yeah, and The thing is though,
46:39that as much as you talk to her
46:41even while you're reinforcing the
46:43family values and wanting her to wait
46:45and helping support that behavior,
46:48it's still going to be very important
46:50to continue to talk to Hannah
46:52about healthy sexual development,
46:54because ultimately,
46:54if she is going to have sex again soon, or.
46:58Hopefully wait as you would like her to do.
47:02She will have hopefully a healthy sex
47:04life and you can help determine that that
47:07will be a happy and healthy sex life.
47:10Of like well,
47:12you know you mentioned you went over
47:13the resources on puberty and sexuality
47:15with her and would help to do so again.
47:18Is there anything else I should be adding?
47:20Absolutely I really recommend
47:22that with Hannah.
47:23You cover some of the social topics
47:25such as dating and rejection and the
47:27rituals around social interaction
47:28with him and with having some of the
47:31trouble picking up on the nuances
47:33it can be really helpful to support
47:35her in this so you know when you
47:38help then she could have potential
47:40to navigate those waters.
47:42You also want to make sure that
47:43you're covering the positives for
47:45right to pleasure and her right
47:46to feel cherished and an intimate
47:48relationship as well as some of the
47:50negatives you want to make sure
47:52she understands what consent is,
47:53what it looks like to be a victim,
47:55and where she could go,
47:56or whom she could talk to if
47:58she feels unsafe.
47:59And then as well,
48:00you want to talk to her
48:01about safer sex measures.
48:03This is what we call measures such as
48:06contraceptive and barrier methods,
48:08because no sex is absolutely safe.
48:10But with these safer X measures,
48:12she could reduce her risk for
48:14unwanted pregnancy and for
48:16sexually transmitted infections.
48:18So these are the topics that we
48:19suggest that you touch base on and I'm
48:21happy to go over it with you and to
48:23provide you with a bunch of resources.
48:25I'd love the resources.
48:27This is so
48:27much information it's
48:28making my head spin well,
48:30it can definitely feel
48:31like a challenging topic and a
48:33lot of parents feel this way,
48:35but potentially a helpful reframe
48:36is that this when you break it
48:38down is no more difficult than
48:40all of the other really difficult.
48:42Topics that you're already handling
48:44really successfully with Hannah.
48:46OK, well thank
48:47you of course.
48:52OK. So one resource that I
48:56want you to know about aside
48:58from these videos that we made is a
49:01resource called sex Ed for self advocates
49:03by an autism organization online.
49:06They have videos on everything
49:09relevant to dating, intimacy,
49:11etcetera made by people on the
49:13spectrum for people on the spectrum.
49:15It's wonderful and I want
49:16to leave time for questions,
49:17so I'm not going to show one of those videos,
49:19but sex Ed for self advocates is the name,
49:22and that's for older adolescents and
49:23their parents to take a look at.
49:25And they have wonderful videos.
49:26So with this product product project,
49:30we created a paper.
49:32We did a study and we found that two weeks
49:35after the session in the 125 learners,
49:38there were statistically significant
49:39improvements in skills and knowledge
49:41as well as positive attitudes
49:43towards talking to kids and families
49:45about sex and sexual health.
49:47We also found that using the multi
49:49site synchronous videos for teaching
49:51increased knowledge across programs and
49:53across providers and also increased.
49:55Equity,
49:55it's it's not fair or not right that
49:57if there's a couple of experts in one
49:59spot that you know 10 providers know
50:01something that the rest don't know,
50:03so doing these sort of synchronous
50:05video conferencing events can be a
50:07good way to disseminate the more niche
50:09areas of knowledge to a lot of people.
50:13Again, don't reinvent the wheel.
50:14There's lots of resources for these topics,
50:16so don't be scared.
50:17You can look them up.
50:18You can ask me this didactic is available,
50:20including all the resources in it.
50:22It's available publicly.
50:24And you can use it and thank you.
50:26This is my family,
50:28my husband,
50:28my son,
50:29my daughter and thanks to Andres and
50:30Dorothy and Elizabeth Jordan thanks.
50:40No sex was involved in the
50:41making of those children.
50:45Thank you.
50:47Thank you Linda questions please and Kyle,
50:51would you mind just changing
50:52the view so that we can see?
50:55Yes, I see Doctor Cardones hand raised
50:57there. So Doctor Cardone go ahead.
51:01Sure, are there opportunities for your
51:04participants to have booster sessions
51:06so that they can keep learning?
51:08I I did a qualitative study on when he won,
51:11introducing CBT to all our glorious
51:14staff and I learned quickly that one
51:17time is not enough in terms of didactic,
51:19particularly in sensitive new
51:21areas of learning.
51:22And so I'm wondering if if you have
51:24thought about the one year booster
51:26session or write to me Doctor
51:27Drozdowicz about your dilemma,
51:29because I think adult learners
51:30need that opportunity.
51:32For continuous reflection on new content.
51:36Absolutely. And can I answer into this thing?
51:39OK, all right? I have not thought
51:41about that until right now,
51:43so I think that's a good idea.
51:44And people can certainly contact me,
51:46but I think the idea of a
51:47booster session is good,
51:48or maybe even sending out the videos again at
51:51certain intervals as a reminder to refresh.
51:53But yeah, it is specialized material,
51:55so that's that's a good thought,
51:56and we shouldn't.
51:57We should think of it.
51:59Next question
52:01question again comes from Sarah Kowalski,
52:03who is her wonderful nurse and when he won.
52:06Hi Doctor Dee, thanks for being here.
52:10Would love to bring this to our staff.
52:12I'm sure Carol can shake
52:13her head too. This would
52:14be a great little
52:17session for our staff to see
52:18you and here we often do get
52:21children on the unit that we hear,
52:23you know have come in with acting out
52:26sexually and there's kind of that
52:28like let's put them in a single room.
52:30Let's put them at a single
52:31table and they can't.
52:32So this would be a really great session
52:34for us to have to just feel more
52:37normal about understanding children.
52:39My question.
52:40Now it is for women when you
52:43prescribed Viagra to women
52:45is it covered by insurance?
52:47So great question.
52:48I didn't hear that it wasn't and for
52:50any medication if there's an issue
52:52with coverage, I always recommend
52:54referring people to Good RX,
52:56which which often you can buy things
52:58without insurance over the counter
52:59somewhere with a coupon for almost no money.
53:02So I didn't hear of any issues
53:03with the coverage and if there was
53:05an issue I might call the company
53:07and show them that paper and say.
53:09This is needed, you know.
53:13Well, someone in addition to your mom
53:15who's very proud of you and I know
53:16your mom and I know she's very proud
53:18of you even though she has Linda.
53:20What are you thinking about today?
53:22Is your training director Dorothy.
53:26So I. I think of myself as you're sort
53:31of other mom and you make us all proud,
53:36but this is really a terrific project.
53:39I'm so glad you did it and I
53:41am now starting to think of
53:44next. What next? Because
53:48I think as we said, seeing it once,
53:51you actually have to practice and
53:55like any exposure therapy.
53:57So this has been just.
54:01Absolutely terrific. And I
54:03think I look forward to all
54:04of us being able to, you know,
54:07talk more openly about this issue.
54:09One question I have talking about kids,
54:14sexuality, religion, any of those things
54:18have gotten to be sort of political.
54:21How do you have thoughts about how to
54:24sort of navigate some of those issues?
54:28Because we were doctors,
54:29we want to make sure that you know
54:32we're giving information, but.
54:35It's gotten really
54:37sort of difficult at this point.
54:38Do you have thoughts about that?
54:40I do, it's gotten difficult.
54:43You know, I always recommend addressing
54:45these issues in the same way that
54:47we do other sensitive topics,
54:49which is especially the younger the child
54:51is in front of the parent to the parent.
54:54So instead of turning to
54:55Johnny or Susie and saying,
54:56you know how's your sex life going,
54:58you can turn to the parent and say, you know,
55:00we always talk about puberty at this age,
55:02and the things that are coming up,
55:03are you aware of?
55:04Two sources let me tell you so.
55:06If the parent says you know
55:07we don't talk about that.
55:08Whatever you can say, well, you know we
55:10can talk about the health parts of it.
55:11How about that?
55:12You know I'm not promoting dating?
55:14If that's not, you know,
55:15something that you're OK with,
55:16but we should still talk about the
55:18physical changes and how to you know,
55:20respond to other people and safety.
55:21And, you know,
55:22usually most parents are trying
55:24to care about their kids.
55:26And if you can kind of appeal to them,
55:27even from a safety perspective,
55:29to say we have to talk about this.
55:30I think **** is the most universal
55:33like head exploder for parents.
55:34No matter how progressive,
55:35no one wants to talk about **** but every
55:37kid almost has seen it by the time it took.
55:40And so I say like you,
55:42I know,
55:42I know, I know.
55:43But the same way that we talk about
55:45drinking and drugs and everything
55:46else we need to talk about this,
55:48because throwing your head in the
55:49sand is not going to help and it
55:51would be a shame if **** was your
55:53child sex education and that that is,
55:55I think,
55:55a nice tactic with parents to say
55:57that's what's going to happen
55:59if we don't talk about this.
56:01But you have to navigate.
56:02And if they say no then you can
56:03back away slowly, you know.
56:04You can only
56:05do what you can do
56:06that that's wonderful. Thank you.
56:07The next question comes from France and
56:09Brazil, where I hear there is no sex.
56:14Thank you, Andres.
56:16I so you mentioned that you
56:18have a several documents and and
56:20video together on our website.
56:21So I wonder would it be possible?
56:24Have you thought about like having a
56:27this kind of website accessible on
56:28the kind of high level platform where
56:31pediatricians can access it primary
56:33care providers? Because I feel that
56:35there are a lot of different content
56:37different videos like autism for.
56:42Sexual health in general,
56:43but there is nothing
56:45together where where a nurse could
56:47log on and and look what what what
56:50you wants to to see you know,
56:52right? That's a good idea.
56:54I feel like this.
56:55They probably are a little bit hard to find.
56:57It almost makes me think of access mental
56:58health as potentially a good starting point.
57:00I don't know if they have resources,
57:02but I think that's a great idea to more
57:04widely disseminate this sort of info,
57:06and I would love if there were repositories
57:08for teaching videos like this.
57:09Just in general that medical school,
57:11school, medical schools,
57:13medical schools and residencies,
57:15and other training programs I know
57:18could easily access to teach, right?
57:20Because not everybody has a bunch of people
57:22you know who can talk on these topics.
57:24And it's no.
57:25It's not good to reinvent the wheel,
57:26because it probably won't be as good
57:27as as something thoughtfully done.
57:29So I would love if there was a
57:31better you know hub for these
57:32sorts of specialized materials.
57:35I see Adam and Bridget and Rob
57:38Lebrillo and I wasn't sure if
57:40Adam raising his bottle was.
57:42I want to speak or Bridget or Rob,
57:44but is that a yes Adam or Rob?
57:48Any questions from there.
57:51This is when we engage our zoom
57:53friends hello zoom friends
57:54rob Librillo go ahead. Sure
57:57Linda. Thank you for this
57:58awesome presentation. Always
58:00good to see you doctor
58:02should be raised an interesting
58:03question about sexuality and
58:04then also religion being tough topics.
58:07How do you deal with
58:08them when they merge together when like?
58:12A parents belief system is really
58:16opposed to even ***********.
58:20And they and they and pushing
58:21that on to the kid.
58:24So again, I just tackle it
58:25from a safety perspective,
58:27the same way you know I'm not
58:29pushing weed on your kid by talking
58:31to them about weed and safety and
58:33talking to them about alcohol.
58:34I say it's the same thing I try to
58:36advise the parents that you know.
58:37I also don't want their child to
58:39look at *********** if that's
58:41not in their belief system,
58:42but there's a high likelihood that they
58:44will be exposed to it at some point.
58:46I won't say no.
58:47Your kids going to look,
58:47but they're horrible friends.
58:49They're indecent friends are going to
58:50show it to them, and you know, it's that.
58:53It's important to know.
58:54And that even if you think
58:56something is for adults,
58:57we still teach children about you.
58:59Know allowances and budgets and money,
59:03even though they don't run their own
59:04money until they're over 18, right?
59:06But you can prepare children to be
59:08ready for adult behaviors early on,
59:10so that it's not a surprise.
59:11And when the time comes they
59:13are ready and not afraid.
59:14And in sex therapy,
59:15one of the most common situations
59:17we see is people raised in very,
59:18very religious households where
59:20sex was demonized and then they
59:21get married and all of a sudden
59:23they're supposed to have lots
59:24and lots of sex and procreate.
59:25And they can't do it,
59:27and so it is better to get the conversations
59:29going and have it be less pressurized.
59:32But again,
59:32in the end it's the parents choice.
59:34It's their child.
59:34You don't want to,
59:35you know,
59:36make a a divide there so we feel
59:38it out as we do with everything
59:40in psychiatry and try to
59:41maintain the relationship above
59:43all else and then safety.
59:46Thank you, thank you Linda.
59:47We have one more question.
59:49We're getting a Direct Line
59:51from our embassy. Go ahead.
59:54Well, so thank you for a great presentation.
59:57It wasn't really a question,
59:58it was just me saying hello but.
01:00:04Great topic and lots of
01:00:06things. We're working with
01:00:08children on the spectrum and
01:00:10adolescence on the spectrum,
01:00:11and this is such a void in
01:00:13education and strategies for kids,
01:00:16and in fact like a few months back we
01:00:18will looking for a good educational
01:00:20program and as always a great things
01:00:22come out of the Child Study Center so
01:00:24we didn't need to go look too far away.
01:00:27Linda, thank you.
01:00:28This is really wonderful
01:00:30intervention that we will
01:00:31use a lot with with our.
01:00:33He is on the spectrum in
01:00:34particular. Thank you,
01:00:36thank you and and again, Linda.
01:00:38Thank you for making everything available.
01:00:40We're very proud of you.
01:00:41We love you dearly.
01:00:42I know that Linda Mace is watching over.
01:00:44Linda has been very key in having
01:00:46you be still the part of the
01:00:48Child Study Center which you are.
01:00:50So please for Linda.
01:00:58Yep.
01:01:00Thanks for coming guys.