Puberty and Sex Education Challenges in Adolescents With Autism Spectrum Disorder: Mixed-Methods Evidence From...

Background Autism spectrum disorder (ASD) is a complex neurodevelopmental condition marked by deficits in social communication and behavior. Adolescents with ASD experience puberty similarly to neurotypical peers but face amplified challenges due to impaired emotional regulation and social cognition. In Lebanon, the absence of formal sex education and prevalent cultural taboos compound these difficulties. Objective This study explores puberty and sex education experiences among Lebanese adolescents with ASD, emphasizing intervention needs by gender and ASD severity from the perspectives of parents, educators, and allied professionals. Materials and methods Using an exploratory sequential mixed-methods design, Phase 1 comprised semi-structured interviews with nine parents and three allied professionals. Phase 2 involved a quantitative survey of 36 special education teachers. Qualitative data underwent thematic analysis, while quantitative responses were examined using descriptive statistics and correlation analyses. Results Adolescents with ASD face heightened emotional, sensory, and behavioral difficulties during puberty, including boundary confusion and hygiene challenges. Severity and gender influenced intervention needs: females faced more sensory and hygiene burdens, while severe ASD cases required individualized strategies. Teachers reported moderate resource access, high discomfort with sex education, and strong demand for training and curriculum reform. Embarrassment was negatively correlated with perceived teaching capability (r = -0.38, p = 0.021); parental cooperation and resource access were positively associated (r = 0.54 and 0.69, respectively). Conclusions There is a pressing need for culturally sensitive, gender-specific sex education programs for adolescents with ASD in Lebanon. Findings support policy reform and tailored interventions in conservative or resource-limited contexts.