Puberty isn't a breeze for anyone, but for kids with autism and other developmental disabilities (and those who are trying to help them get through it), the experience can be particularly challenging. Changing bodies, ever-increasing peer pressure and sexual and romantic urges may be extremely alarming for children on the autism spectrum.
Teach about puberty early and often
It's extremely important to talk to your child before any of these changes take place — explaining periods and how to use feminine hygiene products to girls, for example, and preparing boys for their voices lowering and their penises growing larger. Both sexes should be prepared for the growth of pubic and armpit hair and a higher probability of acne.
"It is important to teach children with autism about puberty early and often," said Dr. Cora Taylor, pediatric psychologist at Geisinger Health System’s Autism & Developmental Medicine Institute. "Children with autism, including those with co-occurring intellectual disability, generally experience puberty at the same time as typically developing children, and some may experience early puberty. Parents and teachers should use the same techniques to teach about puberty that they use to teach other concepts, which may include the use of visuals, social stories and lots of repetition. Some children with autism may struggle with change, so using effective techniques and prepping early is crucial. Children with autism who also have language concerns may have a hard time learning new vocabulary. Families should consider using formal words or family-decided words to teach the names of body parts as early as possible."
Establish good hygiene practices
One concern for parents of children on the autism spectrum might be putting good hygiene practices in place. Taylor recommends building in structure and having consistent expectations. "Some adolescents with autism may not recognize the social cues surrounding the importance of good hygiene," she said. "Visual schedules and hygiene kits are two helpful ways to help children understand what steps are required for good hygiene. A visual schedule breaks down each step of a hygiene task. For younger children, this may include the individual steps required in a very small task, such as brushing teeth. Older children may be able to use a schedule that includes a complete 'morning routine' (make bed, shower, brush teeth, put on deodorant). Hygiene kits are individualized boxes or kits that contain all items required for a specific part of a morning routine and can be used in combination with visual schedules. For example, a child might have a 'shower kit' that contains all items that need to be used for a shower."
A child's unique challenges should always be taken into account when putting together a program to teach hygiene. For example, a child with fine motor deficits may need adapted equipment, such as a vibrating toothbrush, to help them carry out tasks independently.
Explain public and private behaviors
When children on the autism spectrum reach puberty, distinguishing between public and private behaviors is more important than ever. Taylor suggests using a sorting task as a simple way to start the teaching process. "Make a list of places and behaviors, some of which are public and some of which are private," she said. "Work with your child to identify which places and behaviors are public or private. If your child engages in a private behavior in a public place, use redirection to either guide the child to a private place (if available) or cease the behavior. Be mindful to not use punishment or draw too much attention to the private behavior, as this can sometimes make the behavior worse."
Set clear rules about relationship boundaries
Parents need to teach their children about the different types of relationships (family, friend, teacher, acquaintance, stranger) and explain what behavior is appropriate in each case. "This may include teaching appropriate types of greetings (hugs are for family and friends) and the types of things that we can talk about with each person," said Taylor. "Many children with autism will show an interest in dating or having romantic relationships. Like with other children, parents should set clear rules about what behavior is acceptable. For example, issues around how old a child must be to date and supervision of dates."
For more information, see The Healthy Bodies Toolkit.