The Official Puberty Guide

 
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Discussing puberty with children is a difficult topic to tackle, but discussing it with a developing child on the autism spectrum can be even more challenging. Children with Autism Spectrum Disorder (ASD) undergo puberty just like everyone else, the gap between physical and other developmental aspects, while seemingly out of sync, should not hinder parents from being as clear and informative as they can be.

Puberty in girls normally occurs around the age of twelve, but can range from age nine to seventeen. In boys, puberty normally begins around the age of fourteen, but can range from the age of twelve to eighteen.

For children with autism to fully grasp the various aspects of puberty, they must receive an in-depth explanation for each component, which must be provided by their parents, and possibly reinforced by their therapist. Each child on the spectrum differs in diagnosis and level of functioning, therefore, parents should adjust and modify the following information for their child to best understand it. 

The following is an overview of what occurs during puberty and helpful tips for parents when explaining this important milestone with their children:

Advice to Parents

As parents, you are the primary educators of your children, who need to teach them an array of information on a daily basis, without being completely conscious of it. When it comes to teaching them about puberty and upcoming changes that accompany this process, it is important to realize that as their primary source of information, you must provide unbiased and factual information. This includes being prepared to receive and answer any and all questions your child may have, in a way that they will best understand it. Therefore, medical terminology should be used from the beginning and all bodily changes should be explained to the best of your ability. 

Now, your own family beliefs and values surrounding the topic of puberty and sexuality can influence how and what information is delivered to your child, so before beginning the discussion, parents should assess their own beliefs and be ready to discuss them with their child and explain them as well. The factual information provided to your child is crucial due to the gap in physical development and other developmental delays, be it mental, academic, social or more. Because you know your child best, you should utilize the same teaching strategies used for other things when discussing sex education and you should try to turn any mistakes your child makes into lessons. This will help establish a foundation for your child’s future actions.

During the explanation process of the upcoming changes, visual aids can prove to be a parent’s best tool, as they help children understand the processes they will experience and can serve as a point of reference when acting. One form of visual aid could be pictures of you or your partner at various ages. The pictures can be useful in showing your child not only bodily changes associated with puberty, but also the process of growing up in general. When showing these pictures or relating to yourself and/or others, it is important to use clear and direct statements so that your child is aware it will happen to them, given that children with autism have difficulty generalizing information. 

Body Changes

The changes that occur in children during puberty revolve around the development of secondary characteristics. In girls, these changes include growth spurts, development of breasts, growth of underarm and pubic hair, and vaginal discharge. One of the major body changes for girls is menstruation, which we will discuss in more detail. In boys, these changes include growth spurts, bigger hands and feet, increased muscle mass, development of a deeper voice, growth of underarm, facial, and pubic hair, and the development of the penis and testicles. One major body change associated with the other changes is ejaculation. 

Puberty in Girls

One of the key things that parents should do once noting these changes and the development of secondary characteristics, is to begin the discussion on menstruation. Typically, these changes will occur a year or two before menstruation and beginning the discussion then will get rid of the surprise factor and make their child aware, prepared, and feel in control. Getting your child accustomed to the topic of menstruation is the first step, but you must also prepare them for the procedures they will have to follow. Showing them what pads and tampons are, explaining why they are used, and how to use and dispose of them. Alongside the aspect of bleeding, wearing pads and tampons can cause sensory issues for individuals with autism. That is why having your child wear a pad from time to time and teaching them how to dispose of it properly, by going through the routine, with them will help prepare them for the time their period starts and helps ensure they are taking necessary hygiene steps. Practicing the motions will help you reduce the anxiety your child may feel about the change that is going to occur and make them feel more in control by knowing what will happen. Additionally, when your child begins menstruations, it is also important for you to inform staff at their school so that your child may receive assistance, if they need, with pads and changing. 

Visual aids can be a helpful tool to illustrate changes and reinforce routine. Posting pictures with the step by step process of how to remove a used pad and apply a new one, in addition, to necessary hygiene steps in your bathroom, can help your child become familiar with the procedure and reassure them. The utilization of a twenty-eight day calendar or period app can also help create predictability for your child of when their period will come. When menstruation first begins, your child’s cycle may not be twenty-eight days and it may last for four to seven days, so it is important to explain that this is a normal thing that all girls go through at their age. Depending on your child, you can also determine whether to introduce the topic of ovulation and mark it on the calendar alongside their anticipated flow dates.

 
 

Additional helpful tips when utilizing visual aids include using food coloring to show what blood looks like so that they are not surprised when they first bleed and also marking on their underwear where the pad goes. There are also specific underwear that outline where the pad goes and helps keep pads in place. Having someone else model how to put on and wear a pad, such as a parent or sibling, can be helpful with familiarizing and normalizing the action to your child. Taking your child to the store when purchasing sanitary products grants them control and independence in this area when making their own decisions, but also trying out different types and sizes of sanitary products can ensure comfortability. These tips can make the difference between a terrible and manageable experience with menstruation.

Given that children with autism may struggle with change, it is important to use positive language when discussing menstruation so that they don’t have a negative attitude towards it and to ease their potential anxiety and fear. While this is not to say that children with autism should be told that their period is something amazing and is nothing to worry about, parents should talk to their children about the realities of periods and the many side effects and changes that come along with it- but in a reassuring tone so that children understand that it is normal. This can also be done by using language and phrasing that your child will understand better, but it is important to make sure that the proper, scientific terminology is being used when speaking to your child. This dialogue must exist so that your child is aware of changes in mood that may occur during their period, cramps and pain they may experience, and methods of relieving their pain and cravings. The more your child is aware and reassured, the easier it will be for them to handle the change and feel a sense of control.

 
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Puberty in Boys

The changes brought on will start the male process of ejaculating semen; this can be unnerving to individuals on the spectrum and can cause sensory issues. This commonly begins to occur in their sleep, known as nocturnal emission, and can cause them to become embarrassed and fearful of disappointing their parents, as it can be interpreted as wetting the bed. Due to these feelings, it is not likely that they will feel comfortable to share these events with parents. Around this time is when boys will begin to experience erections as well. In the beginning stages, this event can occur randomly and in an unplanned fashion. With this change, children can feel frustrated at what can be interpreted as a lack of control over their own body and may lash out as a result. Parents should be aware of the development of the secondary characteristics associated with puberty in boys, and begin discussing the upcoming changes their child will experience. Starting the discuss in advance can help prepare your child for what is to come and to help them feel more in control and aware. Whether done so in advance or once these events are already taking place in the child’s life, parents should act in a reassuring manner and be calm- not under or over react. When discussing these occurrences, parents should explain completely why and how these changes come about and possibly relate to their child’s experience. This includes explaining that nocturnal emission is not urine, that it is a normal bodily process like developing an erection, and that both are normal and the randomness of the occurrence will pass.

Hygiene

Hygiene is an important aspect in general, but becomes crucial during puberty. When children experience the development of secondary characteristics, they also experience the development and awakening of glands, the secrete sweat and odor. This is why it is important to explain the importance of hygiene procedures and to ensure that your child can perform these processes on their own, depending on the severity level of their autism. The primary hygiene routine that must be established is the process of taking a shower or bath. Explain to your child that showering or taking a bath daily is necessary due to the accumulation of dirt and sweat and that they must wash themselves thoroughly, especially their underarms and gential areas. Allow them to select their own hygiene products to ensure comfortability with the smell and use of the product. To help explain the process, you can utilize visual aids that depict the process of cleaning one’s body or you could guide them through the process in the beginning stages. It is important that your child learn this process and be able to perform it independently, if possible, to maintain privacy and responsibility in your child’s life.

 
Visual Aid for Showering via Living Well With Autism

Visual Aid for Showering via Living Well With Autism

 

Another factor of hygiene that must be introduced to your child during this time is deodorant. Explain to your child that this product helps reduce the odor created when their glands produce sweat under their arms. Again, having your child pick out their own deodorant is best, as there are various smells and types to choose from. Visual aids can be used to reinforce the process and you can also model the behavior by putting on deodorant together every day. Shaving is also another aspect of hygiene, but one that’s not essential. Considering that both the growth of body hair and the removal of it via shaving can cause sensory issues for your child, it is best to determine whether that is something that should be introduced into their routine based on them. Other methods of body hair removal can also be used, but may prove to be painful or equally cause issues to your child. Should shaving be opted as part of your child’s routine, desensitization may be required to alleviate sensory issues. Injury when shaving can also occur, so electrical shavers can be an option to reduce that, but can also cause sensory issues. Occupational and Applied Behavioral Analysis therapy can help implement these routines and help with any sensory issues while adjusting, as well as implementing reminders and maintaining an open dialogue with your child.

 
 
 
 

Behavioral Changes

While physical changes are most talked about when discussing puberty, it is important to note the behavioral and emotional changes your child may experience. As a result of hormone changes, your child may display emotional outbursts and mood swings. Children with autism often deal with issues regarding communication and expressing themselves, therefore this behavior may be heightened depending on the child’s place on the spectrum. Self-injurious behavior can also result from hormonal changes, so establishing a safe space for your child in which they can go to calm down is crucial. Self-regulation is a skill that needs to be addressed and taught to reduce the occurrence and impact of behavioral changes. This skill can also be developed through the help of Applied Behavioral Analysis (ABA) and Occupational therapists. 

Although these emotional changes are mostly normal, it is important to watch for emotional signs that are worrying. In particular, signs of depression should be monitored, as they can manifest into symptoms such as eating disturbances, sleeping problems, differences in behavior, increased agitation, and extreme lethargy. As soon as these signs are observed in your child you should discuss them with your child’s doctor. Children experiencing puberty can also experience an increase in sentiments of independence and responsibility. This can cause strife between you and your child, therefore allowing them the opportunity and freedom to make their own choices is crucial. These decisions do not have to be weighty and can simply revolve around daily activities. For example, allowing your child to decide what they would like to do after school or on the weekends can help instill independence and self-reliance, which are valuable for their growth and future success. This is again at the discretion of parents and guardians, but should be taken into consideration.

Social Settings and Appropriate Behaviors

Children on the autism spectrum can often have issues with social rules and boundaries. When it comes to puberty, it is important for your child to be aware of when and where it is appropriate for them to discuss aspects of puberty. Periods are nothing to be ashamed of nor are they a secret, but like everything else, there is a time and place to talk about them. The same goes for talking about nocturnal emissions and erections. Utilizing Social StoriesTM can help your child better understand the changes they are experiencing and how to operate in social settings. This tool can help you present possible scenarios on various topics to your child in a way they can best grasp the information and understand how it relates to them. As parents, you can serve as models for appropriate behavior and can display it for your child.

Puberty is also accompanied by increase sexual desire in both boys and girls. A common and natural way of relieving sexual tension and desire is masturbation and is a behavior that can be adopted by pubescent children. While this may conflict with a parent’s own or family beliefs and values, it is important to stress the normalcy of this to your child, but highlight that it is a behavior that should solely be engaged in, while in privacy. Privacy should be explained as a safe space of their own such as their bedroom. This is highly important as children may engage in this behavior in public settings. Therefore, it is imperative that distinctions and boundaries regarding private and public settings should be explained to your child.  

Do’s and don'ts should also be explained to your child in regards to the internet. It is completely at the discretion of parents to allow their child to access the internet. Based on your child and their needs, parents should utilize parental restrictions on devices that have access to the internet and have a discussion with their children. This can help with regards to safety, as it is not meant to be restrictive, but to protect children from being exposed to mature content, such as porn, earlier than the parent believes they should be. 

Recommended Reading

Although this can be too much information at once, parents do not fret. You all know your children the best and can utilize the aforementioned tips and notes in a way that would benefit your child the best. Depending on your child’s needs and areas in which they experience more difficulty, there are a multitude of books on specific aspects and topics of puberty in children with autism. Below is a list of helpful books for you to review that could prove beneficial for you and your child on this journey. Best of luck!

Info KitEliane Abou-Assi