AUTHOR: Melissa Dubie, Indiana Resource Center for Autism


Puberty and Your Child with Autism

Dealing with big physical and emotional changes in your adolescent

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 (in boys).

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 that process.

What can parents do about these changes in girls?

  • 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.
  • 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.
  • If your daughter learns best with facts, go to the bookstore to buy a book on getting your period. 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.

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 Center for Disability Information and Referral at the Indiana Institute on Disability and Community (CeDIR) or contact your local library or Family Resource Center.

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 and why.
  • 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? 
  • 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.

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