PUBERTY & AUTISM SPECTRUM
By Melissa Dubie
At a parent group meeting, a mother asked “since
my daughter’s mental age is about a third grade level, why is she
starting her period? This doesn’t seem possible.” All children go
through puberty regardless of IQ or social skills. The brain does
not tell the body to stop growing if the boy or girl’s developmental
level is younger than their age. Puberty is a stage of development
just like moving from being an infant to a toddler. Puberty is considered
to begin around age 12 for girls and age 14 for boys. The physical
changes of puberty are centered on the development of secondary
characteristics and the onset of menstruation (in girls) and ejaculation
girls and puberty
For girls, the physical changes usually begin
between ages 7 and 14. Girls begin to have growth spurts, develop
breasts, pubic and underarm hair, and have vaginal discharge. It
becomes increasingly important to have good hygiene by taking a
shower or bath each day, washing your hair, underarms, and vaginal
area. A girls menstruation (period) usually follows within a year
or two of these changes. The average age a girl starts menstruating
is around 12 or 13 but some girls start as early as 9 and others
are as late as 17 (Strong, DeVault, Sayad & Yarber, 2005).
For example, as a parent sees their daughter start
to develop physical changes of puberty, it is essential to start
talking to her about menstruation. A father called Indiana Resource
Center for Autism concerned that his daughter screams loudly and
runs around the room every time she sees the sight of blood even
if the cut on her finger is small from a piece of paper. She doesn’t
become calm until they put a bandage on the cut. How will she react
about blood from her vagina? It was discussed that the term for
the menstrual pad would be called a very large bandage. This language
would help their daughter transition to starting to menstruate.
In addition, the family decided it was going to be essential to
start practicing the steps from wearing a pad to changing it regularly
before the important day came. Here are some ideas to assist in
Put red food coloring in her underwear to show
what the blood might look like when she starts her period.
Have her mom model for her the steps to wearing
and changing a sanitary pad. If possible, include other girls in
the house as well.
Mark the pad and panties with a different color
to show where the pad should be placed in her underwear.
Go to the store and buy a few different kinds
of sanitary pads. One could try different sizes, thicknesses, wings
or no wings, fragrances, and brands. View www.kotex.com to identify
some of the options this company has available.
Make a visual schedule of how often the sanitary
pad should be changed. Remember her school schedule. Try to arrange
the changing time with the times that she would change classes (normal
breaks in the day) at school. The more the schedule is the same
at home and school, the easier the transition will be.
Watch a video on a teens health website if they
want to know why the menstrual cycle is necessary: http://kidshealth.org/teen/sexual_health/girls/menstruation.html.
If your daughter learns best with facts, go to
the bookstore to buy a book on getting your period. See references
at end of article. Having a full explanation of her menstrual phases
may help your daughter transition to this part of her life. For
others, the information may be overwhelming. As a parent you have
learned what manner your daughter learns best. Apply the information
you already know about her to this stage called puberty.
Plan a celebration party for when she starts her
period. Growing into a woman is exciting and should be celebrated.
Boys and puberty
For boys, the physical changes usually begin around
age 13. Some boys start prematurely at age 12 while others begin
as late as 17 or 18 years of age. Generally, boys’ puberty lags
behind girls by two years. The secondary characteristic for boy’s
includes: growth spurts, bigger hands and feet, increased muscle
mass, deepened voice, facial and underarm hair, and more hair in
the pubic area. Their penis and testicles also develop (Strong,
DeVault, Sayad, Yarber, 2005). Like girls, it is imperative to be
showering or bathing each day. Be sure to wash hair, underarms,
and in genital area.
At puberty, boys begin to ejaculate semen. Many
boys are unnerved by the first appearance of semen which will probably
occur while sleeping (e.g., wet dreams). It is important to differentiate
to your son that he is not urinating in bed. One parent shared that
her son didn’t want to disappoint her because he was a “big boy”
now and didn’t wet his bed. So when he started having nocturnal
emissions (e.g., wet dreams), he was afraid to tell her because
he thought she would be disappointed. His behavior escalated and
he refused to go to bed at night. In addition, boys may have erections
at odd or unplanned times. This is part of puberty and one should
not be alarmed. Unplanned erections will go away during puberty.
What can parents do about these changes in boys?
Don’t overreact or under react. Remember your
son probably doesn’t have any idea of what is happening to him when
he has nocturnal emissions. Change the sheets or have him help you.
Use a calm voice. Don’t yell. Use the time to
explain what is happening during puberty with your son. Relate the
nocturnal emissions to other changes he is experiencing (secondary
characteristics), then explain that this is part of puberty and
growing into being a man.
Go to the library or bookstore to read about how
boy’s bodies change from being a teenager to a man.
Borrow books and videos from CeDIR (Center for
Disability Information and Referral at the Indiana Institute on
Disability and Community, www.iidc.indiana.edu/cedir or 812-855-6508).
For parents, when talking about boy and girl body
parts use the medical terminology. Language concepts are difficult
for many individuals with Autism Spectrum Disorder. Therefore, if
they learn the word “pee pee” to mean penis when they are young
it will be awkward and inappropriate for them to still be calling
their male genitalia “pee pee” when they are young adults or men.
It is best to start with the medical terminology from the beginning.
Get used to saying the words such as penis, testicles and pubic
hair for boys and vagina, breasts, and menstruation for girls. Here
are other critical points to ponder:
Before you can effectively communicate your values
about sexuality to your children, you need to know what you believe
You are the main educators of sex for your son
and/or daughter. Whether you are comfortable or not, wouldn’t you
rather they get factual information from you than to follow a classmate’s
or friend’s advice? See www.familiesaretalking.org for information.
You must be “askable” (Gordon & Gordon, 2000).
This means one should be prepared for any question or incident that
involves your son or daughters sexuality. Always say, “That is a
good question.” You can decide to answer the question immediately
or say, “We’ll discuss it when we get home.” If you answer with
a positive tone, then your child will continue to ask questions.
Also, remember to answer the questions simply and directly. Don’t
give too much information to your adolescent.
Children are not perfect. They make mistakes and
it’s up to us to turn their mistakes into lessons.
Remember to use the same teaching strategies that
you have used to teach your children other skills. Just apply these
strategies to teaching them about menstruation and nocturnal emissions
as they go through puberty. Some of these strategies may include
visual schedules or check off lists, videos, facts in books, pictures
of what is happening to their bodies, stories to predict what might
occur, or specific terminology. Think of puberty as just another
stage of development. Embrace this time and move forward.
American Girl Library (1998). The care & keeping
of you: The body book for girls. Middleton, WI: Pleasant Company
Crissy, P. (2005). Personal hygiene?: What’s that
got to do with me? Philadelphia: Jessica Kingsley Publishers.
Gordon, S., & Gordon, J. (2000). Raising a
child responsibly in a sexually permissive world. Avon, MA: Adams
Gravelle, K., Castro, N., & Castro, C. (1998).
What’s going on down there?: Answers to questions boys find hard
to ask. New York: Walker and Company.
Gray, J., & Jilich, J. (1990). Janet’s got
her period. Carlton, Australia: Social Biology Resources Centre
(Available from James Stanfield Company, Santa Barbara, CA at http://www.stanfield.com).
Harris, R.H. (1994). It’s perfectly normal: Changing
bodies, growing up, sex and sexual health. Cambridge, MA: Candlewick
Jukes, M., (1998). Growing up it’s a girl thing:
Straight talk about first bras, first periods, and your body changing.
New York: Borzoi Book Publisher.
Madaras, L., & Madaras, A. (2000). The what’s
happening to my body? Books for boys: A growing-up guide for parents
and sons. New York: W.W. Norton & Company.
Loulan, J., & Worthen, B. (2001). Period:
A girl’s guide. Minnetonka, MN: Book Peddlers (Also available in
Mayle, P., (1975). “What’s happening to me?” New
York, NY: Kensington Publishing.
Sexuality & disability: A resource list for
those who work with, live with, or care for people with disabilities.
(2004). New York: Planned Parenthood Federation of America, Inc.
(Available at http://www.plannedparenthood.org).
Specher, J. (Producer). (1999). Body parts &
grooming. Milwaukee, WI: Anything’s Possible, Inc. [Video tape].
(Available at http://ww.specialkids1.com).
Strong, B., DeVault, C., Sayad, B.W., & Yarber,
W.L. (2005). Human sexuality: Diversity in contemporary America
(5th ed.). New York: McGraw-Hill Companies, Inc.
Stanfield, J. (Producer). (1996). Hygiene for
females. Santa Barbara, CA: James Stanfield Company. [Video tape].
(Available at http://www.stanfield.com).
Stanfield, J. (Producer). (1996). Hygiene for
males. Santa Barbara, CA: James Stanfield Company. (Available at
Topics on puberty presented by Planned Parenthood.
New York: Planned Parenthood Federation of America, Inc. (Retrieved
May 25, 2005, from http://www.teenwire.com).
Wrobel, M. (2003). Taking care of myself: A hygiene,
puberty and personal curriculum for young people with autism. Arlington,
TX: Future Horizons, Inc.
Reproduction kindly allowed by
Indiana Resource Center Autism. Visit their site for more useful
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and autism fact sheets and personal stories at www.autism-help.org