Renowned child development specialist and textbook author John W. Santrock defines puberty as a period of rapid physical maturation involving hormonal and bodily changes that take place primarily in early adolescence. Santrock's definition of adolescence is the period of transition between childhood and adulthood that involves biological, cognitive and socioemotional changes. As the mother of two teenagers who are currently contending with both puberty and autism, the word in those definitions that resonates most with me is 'changes'.
Parents and others who have experience caring for and working with children with autism already know that change can be one of the most challenging aspects of living with autism, to say the least. But once the biological, cognitive and socioemotional changes of adolescence and the rapid physical transformations of puberty are combined with the inherent characteristics of autism, it is not difficult to see the potential for chaos that the combination and puberty and autism present.
Explaining the Physical Changes of Puberty
During puberty, your adolescent with autism will undergo a number of exciting yet confusing physical changes. Girls will experience their first menstrual period (menarche). Boys will have their first ejaculation (spermarche). Both genders will experience growth spurts that will rapidly transform their appearance from childlike to that of a sexually mature young adult.
The best way to help your autistic child deal with puberty is to maintain a cool head and be prepared to educate him or her about the changes his or her body is undergoing. In other words, you'll need to be able to calmly and clearly tell your daughter that her height gains, growth of pubic hair and onset of menstruation are all normal processes for girls who are growing into young ladies. It also means explaining to your son that his height spurt, growth of pubic hair, increase in penis size and testicular development are part of the natural experience of growing up and becoming a young man.
It's highly advisable that you initiate the conversation about physical changes when your child is about to enter puberty (about age 10), but before his or her body starts to undergo changes. However, since some children may begin undergoing pubertal changes earlier, use your own judgment and the advice of your child's pediatrician as a guide.
Try to coordinate beginning discussions with your child with compatible health and sex education programs being offered at his or her school. Speak with your child's homeroom and/or health teacher to find out what will be covered in the curriculum and if any of the materials may be available for home use. Obtain pamphlets and other literature, photographs and illustrations and other visual aids to help you talk with your child about puberty in a way that he or she will understand, and use learning aids that address their specific learning styles. For some adolescents, you may need to use anatomically correct dolls, picture systems or videos.
Personal Care and Puberty
Explain to your daughter why she menstruates and the specific personal hygiene rituals she will need to perform to stay clean and healthy during her period. Emphasize to her that menstrual blood on her underwear is not a sign that she is injured or has soiled herself. You may want to use a marker to draw simulated menstrual blood on a pair of underwear to demonstrate the concept to her. Show her how to use sanitary pads. In addition to going over the instructions on product packages, you may want to use baby dolls to demonstrate how to use, change and dispose of sanitary napkins.
Make it clear to your son that when he spontaneously ejaculates (has a wet dream) during his sleep, it doesn't mean he's urinated on himself, or done anything wrong. Explain to him that it is perfectly normal for young men to ejaculate when they become sexually aroused, even when they are asleep and are not conscious of their arousal. Let him know that he will need to dry himself, put on fresh underwear and change his sheets. Make it clear that he has nothing to be embarrassed or ashamed about.
Don't be surprised if your adolescent daughter asks if she looks fat or your preteen son wants to know if he's going to get any taller. Excessive concern about body image and the perceptions of others is common among adolescents going through puberty. Reassure your daughter that her body weight is normal, and suggest that she eats a healthy, balanced diet and engages in regular exercise in order to maintain a healthy weight and overall good health. Explain to your son that boys experience different aspects of puberty at different rates, and that many boys experience rapid growth in height between the end of middle school and the beginning of high school.
Make it clear to your child that curiosity about and interest in the opposite sex is normal. Discuss sex and sexuality with your child openly and honestly. Communicate your expectations with regards to premature sexual activity. Speak honestly about the pitfalls of engaging in sexual behavior too early, such as unwanted pregnancies, sexually transmitted infections, being taken advantage of and getting bad reputations.
Set ground rules for your child. Talk about appropriate and inappropriate touching, peer pressure, recognizing unsafe situations and steps to take if he or she feels threatened. Discuss whom they should talk with about sexual matters, where these conversations should take place and what is considered acceptable to talk about and why.
Puberty and Autism: Conclusion
More often than not parents find that the anticipation of having their child enter puberty is much scarier than the actual experience of having a child go through puberty. By discussing puberty in a way your child can easily understand and by keeping an open mind and creating an atmosphere that makes your child comfortable communicating with you about anything and everything you can make your family's experience with puberty and autism a positive one.
If you don't feel comfortable talking with your children about certain issues pertaining to puberty, speak with your child's pediatrician or a child psychologist to get advice. Such professionals should be able to direct you to resources–such as pamphlets, books, manuals and websites–that can make the conversations easier.
Author's own experience.
McDevitt, Teresa and Jeanne Ormrod. Child Development: Educating and Working with Children and Adolescents. Prentice Hall, 2003.
Santrock, John W. Adolescence. McGraw Hill, 2007.