Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 16 nº 3 - Jul/Sep - 2019

Review Article Imprimir 

Páginas 111 a 120

Construction of a playful game for sex education of teens with autism spectrum disorder

Construcción de un juego lúdico para la educación sexual de adolescentes con trastorno del espectro autista

Construção de um jogo lúdico para educação sexual de adolescentes com o transtorno do espectro autista

Autores: Célia Conceição1; Juliana Vieira Almeida Silva2; Mayara Cristine Schmitz da Silva Pereira3

1. Student of Psychology, University of Vale do Itajaí (UNIVALI). Itajai, SC, Brazil
2. Doctor in Psychology from the Federal University of Santa Catarina (UFSC). Professor at the University of Vale do Itajaí (UNIVALI). Itajai, SC, Brazil
3. Student of Psychology, University of Vale do Itajaí (UNIVALI). Itajai, SC, Brazil

Célia Conceição
Universidade do Vale de Itajaí (Univali), Campus Itajaí - Psicologia
Rua Uruguai, 458 - Centro
Itajaí - SC, Brasil. CEP: 88302-901

Submitted on 12/08/2018
Approved on 18/03/2019

PDF Portuguese      



How to cite this article

Keywords: Autism Spectrum Disorder, Sex Education, Adolescent, Game and Toys.
Palabra Clave: Trastorno del Espectro Autista; Educación Sexual; Adolescente Juegos y juguetes.
Descritores: Transtorno do Espectro Autista; Educação Sexual; Adolescente; Jogos e Brinquedos.

OBJECTIVE: Create a playful game for the sexual education of adolescents with Autism Spectrum Disorder (ASD).
DATA SOURCE: It is a construction of a board game done with support of an integrative literature review at the databases of CAPES, PUBMED, SCIELO. For the construction of the game were used some steps suggested by Jaffe (2011), such as: game concept, game platform, game theme, gameplay, elaboration and a method of communication for adolescents with ASD, as an additional step.
DATA SYNTHESIS: The game board was called "The adventure of the teenager with TEA: discovering sexuality", consists of 17 illustrated houses, three peons, a dice and an illustrative book to introduce the theme to the players.
CONCLUSION: It was observed after the integrative review the shortage of materials focused on thematic, with that, the construction of the board game was carried out, to develop knowledge to the players with ASD in a playful way on the sex education.).

OBJETIVO: crear un juego lúdico para la educación sexual de adolescentes con trastorno del espectro autista (TEA).
MÉTODO: es la construcción de un juego de mesa realizado con apoyo en una revisión de literatura integradora en las bases de datos de CAPES, PUBMED, SCIELO. Para la construcción del juego, se utilizaron algunos pasos sugeridos por Jaffe (2011), a saber: concepto del juego, plataforma del juego, tema del juego, forma de juego, elaboración y un método de comunicación para adolescentes con TEA, como un paso adicional.
RESULTADOS: El juego de mesa se tituló "La aventura adolescente con TEA: Descubriendo la sexualidad", que consta de 17 cuadros ilustrados, tres peones, un dado y un libro ilustrativo para presentar el tema a los jugadores.
CONSIDERACIONES FINALES: hay una escasez de materiales centrados en el tema, con esto, se llevó a cabo la construcción del juego de mesa, para desarrollar el conocimiento de los jugadores con TEA de una manera lúdica sobre la educación sexual.

OBJETIVO: Criar um jogo lúdico para a educação sexual de adolescentes com Transtorno do Espectro Autista (TEA).
MÉTODO: Trata-se da construção de um jogo de tabuleiro feito com respaldo em uma revisão integrativa da literatura nas bases de dados da CAPES, PUBMED, SCIELO. Para a construção do jogo foram utilizadas algumas etapas sugeridas por Jaffe (2011), sendo elas: conceito do jogo, plataforma do jogo, tema do jogo, jogabilidade, elaboração e um método de comunicação para adolescentes com TEA, como uma etapa acrescentada.
RESULTADOS: O jogo de tabuleiro foi denominado "A aventura do adolescente com TEA: descobrindo a sexualidade", é composto por 17 casas ilustradas, três peões, um dado e um livro ilustrativo para introduzir o tema aos jogadores.
CONSIDERAÇÕES FINAIS: Há escassez de materiais voltados a temática, com isso, realizou-se a construção do jogo de tabuleiro, para desenvolver conhecimentos aos jogadores com TEA de uma forma lúdica sobre a educação sexual.


Adolescence is the life stage that most generates apprehension in parents and professionals dealing with adolescents with Autistic Spectrum Disorder (ASD). There are many obstacles encountered by parents in relation to increased aggression at this stage of development, as well as difficulties involving hygiene care and sexual maturation, as well as the lack of guidance on how to pass on their children regarding the topic¹.

The biological development of human sexuality basically depends on two directly related processes: organic growth and the maturation process, which are linked to the nervous system development, metabolism and hormone secretion, ie any human being, with or without disability. , will go through this process. Therefore, guidance from parents and professionals is required².

A form of guidance that helps parents and professionals can be done in a playful way, being the game a favorable instrument, with educational format, and in the case of this study, aimed at adolescents with ASD. Given this, the question arises: how to develop a playful game on sex education for adolescents with Autistic Spectrum Disorder? To answer this problem question, it was defined as a general objective to develop a playful game about sex education for adolescents with Autistic Spectrum Disorder. With specific objectives: to gather information about games for adolescents with ASD; characterize what are the benefits of playful games for the teaching-learning process; To define a communication method for the creation of the game and to describe the steps for the construction of a playful game about sexuality for adolescents with ASD.

Teen with ASD and Sexuality

Autistic Spectrum Disorder (ASD) is characterized by presenting changes in communication, social interaction and repetitive behaviors according to the criteria of the Diagnostic and Statistical Manual Mental - DSM-5³. These changes impair the child's development and may increase concerns in adolescence, due to issues related to sexuality of this individual with ASD 4. It will be described in this topic about adolescents with ASD, how their sexuality is seen, as well as the use of playful games as a teaching-learning tool.

Adolescence is marked by a period of development characterized by changes in different proportions, namely, physical, cognitive, social, psychological, drive, emotional and intellectual5-6. In this phase, there is the identity crisis, in which one becomes aware of a new space, new realities and confusion of concepts, and therefore, the identity is built personal and social, happening from their exchanges in the environment where is inserted7. During this period, puberty begins, first occurring in girls around 10 to 12 years old when the menstrual cycle begins, and in boys between 12 years and ejaculation6. For adolescents with ASD, this phase happens in a slower way that hinders their development in social and psychological aspects4.

Therefore, for a healthy sexuality, the adolescent must receive adequate information in order to provide: communication about the theme, sexual pleasure, autonomy, equality, privacy, sexual health². Sex education contributes to this process of adolescent development, so that it can have autonomy, self-confidence, body knowledge and awareness in prevention. Sexuality has great importance in the development and psychic life of people, because regardless of reproductive potentiality, it is related to the pursuit of pleasure, a fundamental need of human beings8.

For healthy development in adulthood, adolescents with ASD need to be in contact with family, school, friends, and leisure to improve their skills in the social environment, to help for them entire life4. In a research9 conducted with mothers of children and adolescents with ASD aged 10 to 22 years, reported that their children are "infantile" and "innocent" and some mothers neglect their children's sexuality. It can be understood that it is from this representation of "childishness" of the child that this characteristic emerged that these children and adolescents are out of date. Therefore, more information is needed on family members of adolescents with ASD about sexuality.

Adolescents with ASD may present, to varying degrees, some undesirable behaviors such as aggression, isolation, sadness, suffering, self-mutilation, illness, emotional withdrawal and distress. According to the author above9, to benefit both parents and adolescents themselves, the use of games can help to explain social rules in a simple way, establishing a positive point of view about sexuality.

Play Games and TEA

The game helps in a playful way the learning of subjects to be developed in a fun way, seeking to attract the attention of the players10. It is understood that the playful is an educational contact, so that the subject faces obstacles during the teaching-learning process. The playful activity, contemplates a more effective learning, because it draws the attention of a certain subject, thus allowing a wide discussion among all involved11.

The game is integrating and helps in the motor, cognitive, affective and social aspects for the individual, while the playful are intellectual activities such as memory and language, being enjoyed by any age, as they work as participatory and enable development12. A humanoid robot was created to promote attention, communication and socialization skills with adolescents with ASD. Participants using the humanoid robot reduced repetitive behaviors13.

Chung et al.14 showed in their studies that gambling stimulates brain activities within the cingulate, frontal lobe and insular cortex, thus resulting in the recognition of facial emotions by adolescents with ASD. Another study showed the effectiveness of using cooperative toys in improving interaction, resulting in the interaction between children with ASD and their peers, feeling confident without hesitating to ask their peers15.


This is an integrative review that allows the use of experimental studies or not, to investigate the purpose of exploratory-descriptive research16, using articles indexed in databases of the Higher Level Personnel Improvement Center (CAPES), as well as the Scielo and PubMed databases. The following descriptors were used: games; sex education; autism; adolescence, from this made it possible to gather information and definitions of the research method for the problem in question and to direct future research. The review provided the foundation and theoretical models for assimilating the creation of the sex education board for adolescents with ASD. Steps were sought in the literature for the construction of the board game that constitutes establishing strategies to meet the demand to be researched; the steps suggested by Jaffe17 were used for the construction of the board: Concept of the game, Platform of the game, Game Theme, Gameplay and Crafting.

In a first search in the databases the time period of the publications was not delimited, in which 430 articles were found, being 421 in the CAPES database, six articles from Pubmed and three articles from Scielo, selecting four articles, two from the CAPES database and two from Pubmed, as they were the only articles that met the objectives proposed in this article. After reading the abstracts, we conducted the selection of studies published from 2010 to 2018, and considered as inclusion criteria: 1- articles that have in the title or abstract the theme; 2- articles that answer the problem question; 3- articles published between the periods 2010-2018; 4- articles that are available for free. Thus, review articles that do not meet the previously proposed criteria were excluded.


As already described in the literature methodology, the analysis will be divided into the following categories: Games about sexuality, in which the formats of games found in the literature will be discussed; Game Construction, which contain the steps used for the construction of the board and the topic Communication Methods, which will analyze the form of communication for adolescents with ASD.

Sexuality Games

It was raised the articles that had as theme games for the sexual education of adolescents with ASD, thus making an analysis in relation to the objective and the way the games were built.

In article 1, a board for children aged 6 to 9 years with ASD was created, which aims to promote knowledge and interaction through illustrative questions (tree or chair; chicken or zebra), consisting of a board and two pieces, for two players. For the construction of the board we considered the PECS method, to facilitate the communication of children, thus providing two answer options illustrated in each illustrative question. If the answer is correct, it lights up green and sounds, if it is wrong it lights up red, the child only moves if the question is answered correctly. The board was chosen to promote interaction, creativity, reasoning, develops skills and stimuli through sound that may mean image and sound18.

The article 2 is a board aimed at children from 7 to 8 years old with the objective of providing knowledge about sexuality, containing 10 players at a time. The trail on the board contains drawing images of a healthy heart and a sick heart, and according to luck in the die, a card is removed. In the letters are tips and curiosities about sexuality. If the player falls into a house and can´t answer, he will not play a round19.

Article 3 developed a shared game with adolescents from Vila Cafezal, a community in a slum area of Belo Horizonte. Through workshops in operative groups, a space for dialogue on sexuality and teenage pregnancy was created. The topics chosen were: dating, contraceptive methods, first sexual intercourse, sexually transmitted diseases, human body, teenage pregnancy and drugs. The game was designed with the help of teenagers aged 10 to 14 years, in a board with questions and answers, and the participants would be of different sexes. It was established that the rule of the game would be in the form of dispute. Included in the game are eighty Q&A letters; a deck of reflection and a deck of venues, demarcating public spaces of Vila Cafezal20.

In article 4 is a game called G-TEA a tool to aid the learning of children with Autistic Spectrum Disorder, based on the Applied Behavior Analysis (ABA) methodology. It is a tool to assist Psychology professionals dealing with autistic children. The G-TEA game was designed for tablets because it is easy to handle and was initially tested on three autistic children. The tool aimed to help professionals to teach colors and followed the ABA methodology. The learning of color is divided into small tasks, followed by positive reinforcements every time they get it right and there are no negative interactions, and the professional can infer when necessary to stimulate learning21.

Game Construction

Step 1: Game Concept

For the action of the game to happen some topics must be raised, including: the theme of the game, the definition of the target audience, the choice of platform and the operation of the game from what has been raised in the literature. It can be seen that article 3 allowed teenagers to choose the theme of the game. In articles 1 and 317-19-20-22, the authors created themes from the purpose and purpose of the game to provide adolescents with knowledge about sexuality with the designer of a city or forest. The game formulated by the authors of this article, entitled "Adolescent Adventure with ASD: Discovering Sexuality", will target adolescents in the 1- 1- mild level of ASD, aged 12 to 18, according to the age established by the Child and Adolescent Status (ECA) 23. The game will have as its theme a camp to teach about adolescent sexuality in various scenarios of the chosen theme24. It was through the place that one thought of the possibilities of subsidizing the subthemes that involve the sexuality like, the houses of the campers, the difference between boy and girl; the forest, meaning the dangers they may encounter (sexual abuse).

Step 2: Game Platform

Articles 1, 2 and 3 observed a choice of board game to provide interaction and entertainment among participants. The composition of the material will include interaction, creativity, reasoning and the development of skills and stimuli18. On the other hand, article 421 opted for technology using the tablet, as it is a method that attracts the child's attention more easily.

In order to reach the goal of passing information to adolescents in a way that players could exchange experiences, it was decided to build a board game to assist in the development of interpersonal relationships and the teaching of a particular subject25.

Step 3: Game Theme

To develop a game is necessary to characterize which experiences you want to pass to the player. Articles 2 and 3 discuss different issues related to adolescent sex education such as dating, contraceptive methods, first sexual intercourse, sexually transmitted diseases, human body, teenage pregnancy or drug use17-19-20. Thus, the board was developed in order to be a strategy to be used by parents and professionals to contribute to sex education, as it is a delicate subject to be addressed by the parents of adolescents with ASD9. Based on the discussions by Nogueira20 and the Adolescent Booklet26, the following subthemes were chosen for this study to address the sexual education of adolescents with ASD: discovering the body; intimate hygiene; the difference between man and woman; the menstrual cycle; contraceptive; dating and sexual abuse. Based on the data described, it was necessary to create steps and methods to explain the themes mentioned in a playful and interactive way for adolescents.

4th step: Gameplay

In articles 1 and 2 it was observed that the gameplay works through errors and hits, ie, according to the player's questions, the player will stay or advance a box18-19. The number of participants varies according to the authors and the objectives of the game, but it can be observed that the games involve one to three players18-19-21.

The number of participants for the gameplay of the present study will be two to three players, requiring a parent or professional instructor (mediator) to guide the adolescent(s) during the game. The instructor should have knowledge of the step-by-step manual (Appendix A) and the objectives, where an illustrative book was elaborated to explain in a playful way about the theme, seeking to attract the attention of the players to venture in. board¹¹. This will provide the teenager(s) interaction with the instructor in a dynamic and fun way, enabling players to communicate in different ways18.

5th step: Elaboration

In this last stage will be made other preparations for the board game: the manual, the pieces for the game, the elaboration of the board design. From this, we found in articles 1 and 3 the materials that made up the board: two pieces (pawns), eighty questions and answers cards, a deck of reflection and a deck of local places, which in this case demarcated public spaces from Vila Cafezal where the work was developed17-20-18.

It was proposed for the creation of the game "The adventure of the adolescent with ASD: discovering sexuality", the insertion of the questions and answers in the board itself, in order to facilitate the comprehension and handling of the game, for both the adolescent and the instructor who will be making use of this. The questions and answers will be supported by illustrations containing objects and situations to identify what it is.

Figure 1 shows how the board is composed, with 17 illustrated squares, three pawns, a dice and an illustrative book to introduce the theme to players (Figures 2 and 3), plus a human body puzzle.

Figure 1. Example of the board developed in the present study.
Source: Own (2018).

Figure 2. Presentation of the illustrated book "The Adolescent Adventure with ASD: Discovering Sexuality".
Source: Own (2018).

Figure 3. Example of the content of the picture book developed in the present study.
Source: Own (2018).

With this, during the game it will be used as a reinforcer for campers, advance a house even when you do not hit the answer and win a piece of the puzzle, because it is known that reinforcement encourages the camper to continue playing27. This reinforcement is used by Behavior Analysis, developed by Skinner between the 50's and 60's, in which the basic behavioral processes are used. This method is supported by evidence of scientific knowledge and treatment efficacy28. The Game aims to open our teaching and learning possibilities by focusing on helping adolescents to understand and learn about their body and reduce behavioral problems regarding sexuality.

Communication Methods

There are some more appropriate methods for communicating with children, adolescents and adults with ASD, as they have different perceptions of other people, and these methods are: ABA, Teacch and PECS.

Applied Behavior Analysis (ABA) is a method that covers language, motor, social and body care skills, remembering that it is based on evidence to change undesirable behaviors29. The Teacch method (treatment and education for autistic and communication deficient children) aims to develop skills of autonomy and improvement in the behavior of people with ASD. This method has some established principles as: 1- improvement in adaptation; 2- individual intervention; 3- organization in teaching; 4- acting on emerging skills; 5- active parents in the performance of the method. For Schopler, his method was used to teach parents behavioral techniques to assist in the lack of some skills30.

Picture Exchange Communication System (PECS) is based on the ABA methodology and can be applied from childhood to adulthood. This method has as its supporting material a plastic paste with velcro and figures to be attached to this instrument. It is made up of six stages, which are: the first in which the child will use the figure that pleases him or her; The second step will look for the pictures you like the most; the third will discriminate the desired illustrations; in the fourth you will learn to form sentences with the images; On Thursday, you will learn to answer the phrases made by the figures, and on the sixth and final stage, you will learn how to comment21.

After describing the communication methods for adolescents with ASD, the PECS was chosen to be used in the construction of the board with illustrative questions to facilitate communication18.


The game "The adolescent adventure with ASD: discovering sexuality" aimed to provide interaction between parents/caregivers and adolescents, using the PECS method for the teaching and learning of players about sex education, in a playful way, with a guide on some topics that are present in adolescence.

It was observed before the bibliographic research, the scarcity of theoretical productions in the Portuguese language, as well as games focused on sexual education for adolescents with ASD. However, it was easy to find games and literature aimed at the sexual education of adolescents. However, these games were not suitable for adolescents with ASD, as they do not have the same perception as other adolescents and, in addition, some games contained a lot of aggression and violence.

From the literature review and the scarcity of materials on sex education in the TEA, subthemes were used to create the board questions, based on Nogueira20 and Adolescent Primer26, which defined necessary themes regarding sex education.

It was decided to build a game to explore in a playful way the learning of subjects to be developed in a fun way, seeking to attract the attention of the players¹¹. The biggest difficulty encountered in designing the game was selecting the most effective means of communication with adolescents with ASD, as each has its strengths, but also its limitations, ability to understand and perceive. After analyzing the game's literature and theme, PECS was chosen so that the game has an easy way to communicate and be understood.

More materials and research aimed at the sexual education of adolescents with ASD are suggested for use by professionals and parents. It was also noted the need for informative materials for the family, about the transition from childhood to adulthood, demystifying about sexuality in adolescents with ASD.

After the bibliographic research, the board game was created, but it was not possible to test the game. Thus, its efficacy cannot be affirmed and it covers all the needs of adolescents with ASD, thus constituting the limitations of this study.


We would like to thank the people who participated in the creation of the board game, Natanael our illustrator, for giving life to our work, and Tais for the lives through the color of the illustrations.


Game Manual

In this game you and the other campers will spend their holidays at a summer camp. For the summer to be beneficial to all, you will need to work as a team. So pay attention to the instructions below, as they are very important about camping:

The trail can be used by two or three campers, remembering that one should be the instructor (mediator) to guide throughout the game and read the book "The adventure of adolescent with ASD: discovering sexuality" for everyone to know the standards and the operation of the summer camp.

The adventure begins with the camper on the right side of the instructor and so on. Once the camper rolls the dice, the instructor along with the player (s) will read the corresponding house question and assist by asking which of the two options would be the correct answer. If the camper does not know the answer, he may ask the instructor or the other campers for help; If the camper does not get the answer right, the instructor can explain to all campers what the correct answer is, and can use the initial book to help explain.

The instructor may not modifications to the instructions or rules as needed by campers.Instructor, use the imagination and great game to everyone.


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