Healthy Bodies: Preparing for Puberty

Cassandra Newsom, Psy.DAmy Weitlauf, Ph.D.Cora Taylor, Ph.D.

Puberty: Here it comes!•For children with autism, puberty

generally occurs around the same time as other children.

•Just because a child shows developmental delays or differences does not mean their bodies will develop at different rates, too.

•It is important to start talking about puberty before it happens to make the transition as smooth as possible for your whole family.

Talking about puberty• Start early!• Teach body parts using formal words• Use visual supports and be consistent, using the

same techniques that work best when your child learns other topics

• Ask a professional for help

Stay Active!

•Teaching children to be active can prevent weight gain in adolescents and improve mood and self-esteem

•Schedule active “play time” for younger children and make it routine.

•As children get older, turn “play time” into family walks or active chores.

•Make exercise rewarding▫Use a first-then board

Encourage Good Hygiene

•Make a picture book or visual schedule▫What supplies are needed for hygiene?▫How do I use the supplies?

•Create a hygiene kit▫Shower Kit: shampoo, conditioner, face

wash, soap, razor, shaving cream▫Dental Kit: toothbrush, toothpaste, floss,

mouth wash▫Morning Routine: body lotion, deodorant,

face wipes, face lotion, hair brush

Tips for Common Hygiene Hang-Ups

• Hair: Take a picture of your child and other family members when they first wake up in the morning (bed-head and all!) and then when they are clean and dressed. Talk about what other people might think if you went to work or school looking like you did when you first woke up.

• Bathing: Use an action schedule that shows which action or step comes next (shampooing and rinsing, body parts to wash). Laminate the schedule so it can hang in the shower.

• Shaving: Try using an electric razor or asking your occupational therapist about weighted razors/razor cuffs to help improve grip on the razor. Use travel-sized packets of shaving cream for portion control.

• Teeth: A vibrating or weighted toothbrush may help children who have difficulty holding and brushing their own teeth. Use a visual timer so children know for how long to brush.

Example visuals for hygiene kit

Moods and FeelingsMoodiness can be normal during puberty.

It is important for teenagers to be able to express their strong feelings. Help your child learn to do this by labeling these feelings when you notice them (“It sounds like you’re feeling angry”).

If your child is less verbal, use visuals like cartoons, photos, sign language, or word cards.

Helping Your Child Label Feelings

Is this more than “moody”?Mood changes can be caused by something more serious, like medical problems. Mood changes can also be a symptom of depression or anxiety.

Watch for behavior changes like the ones listed below.

• Emotions: Crying, shouting, laughing for no clear reason • Behavior: Pacing, rocking, rubbing hands together, picking at skin • Aggression: Hitting, biting, scratching, head-banging, throwing items• Appetite: Eating more or less• Wellness: Complaining about headaches, stomachaches, or other body

aches• Sleep: Sleeping more or less, trouble falling or staying asleep,

nightmares• Thinking: Seeming confused, having trouble focusing, seeing things

that are not there• Energy: Moving more or less, acting withdrawn, not doing things they

used to enjoy

Example mood/behavior diary

Peer RelationshipsPuberty can be hard for all children. Friends, social skills, and appearance matter more. Start to think more about your child’s:

•Clothing•Hair/Make-up•Activities

Be sure that they are age appropriate to help your child fit in with his or her peer group.

All About Girls: Bras•Breast development is a normal part of

puberty for girls. Use pictures and social stories to explain what is happening.

•Prepare your daughter early. Help her get used to wearing something under her clothes by using training bras, camisoles, tank tops with thin straps, and/or sports bras.

•Keep it comfortable. Think about buying a bra that snaps in front or pulls on easily if bras are hard for your daughter to fasten.

•Talk and teach about menstruation is before your daughter has her first period.

•Using clear, matter-of-fact language will help her understand that having a period is normal.

•Teach your daughter in the way that works best for her. For example, if she learns best with visual aids, try using pictures or videos instead of stories or lists.

All About Girls: Menstruation

All About Girls: What to Teach About Menstruation

• What she will see: She will see what looks

like blood. You can practice by adding food

coloring or markings to a pair of underwear.

• What she will feel: Some women feel

different during their periods.

• How to keep it private: Find ways for your

daughter to bring pads to school that are not

obvious.

All About Girls: Self-Care During Menstruation

•Start with pads.•Before her period starts, purchase different

sizes and types. Let your daughter pick one that feels comfortable.

•Model how pads are used and make a visual schedule showing the steps.

•Let her practice wearing pads or liners before her period starts to help her get used to how they feel. Try using a timer and reward her for wearing the pad for longer amounts of time.

All About Girls: Self-Care During Menstruation•Work with your daughter’s teacher to

make it easy for her to ask for a break when she needs to change her pad.

•Consider adapting: Add Velcro to the sides of pants or buy elastic waist pants. Buy pads with easy-to-remove wrappers. You also can remove the wrappers and store them unwrapped for your daughter to use.

•Teach independence and how to ask for help.

Example schedule showing how to change a pad.

You can keep this schedule in a folder in the bathroom, on a velcro strip, or on a ring to put in your pocket.

All About Girls: The Female Health Exam•Prepare your daughter ahead of time

(telling her what will happen, doing a practice visit).

•Use a visual schedule and/or have the doctor explain each step (e.g., “Next, I am going to…”).

•A practice visit to the office with a tour of the exam room may also reassure her.

•Call the office ahead of time to let them know about your daughter’s preferences.

All About Girls: The Female Health Exam

All About Boys: Erections•Erections are a normal part of puberty.

They are often out of your son’s control.

•Erections may happen several times a day. They are not necessarily caused by sexual thoughts.

•Because they are out of your son’s control, they may be embarrassing to him if they happen in public.

Erections: What to do? •Remind your son not to talk about them

with friends or strangers, only to you or his doctor.

•Avoid sweatpants and other baggy pants. Well-fitting briefs may make erections less obvious.

•Give your son things he can do if an erection happens in public, such as:▫Stay seated. It will eventually go away.▫Carry his books low to block his private

area.▫Tie a jacket around his waist.

Becoming a Man Social Story

Noctural Emissions: What are they?

•As your son enters puberty, he may ejaculate while sleeping. This is called a nocturnal emission.

•This is normal and out of your son’s control. He cannot stop this from happening.

•The best way to handle nocturnal emissions is to:▫Prepare your son▫Teach him ways to handle them when they

happen

Nocturnal Emissions: What to do?

•React calmly! Remember: These are a normal part of your son growing up.

•Teach your son:▫That this is a sign he is becoming an adult.

Link it to pictures of the changes his body is undergoing during puberty.

▫That he did not wet the bed. Some children may think this and feel embarrassed.

▫Independence. Use visual schedules to teach him how to change his sheets. If he cannot do this by himself, he can use a door hanger to let you know his sheets are dirty.

Handling Nocturnal Emissions: Story

Public vs. Private Behaviors:Why Do They Matter?

•Private behaviors include things like going to the bathroom, passing gas, touching personal parts for any reason, and changing clothes

•Keeping these private helps children:▫Fit in with peers▫Experience less bullying▫Avoid trouble with law enforcement

Public vs. Private Behaviors: How Do I Teach Them?• Set rules for the whole family: “We are only

naked in the bathroom or in our own bedroom with the door closed.” Set these rules from an early age, if you can.

• Use visuals. Make a list of places that are public and places that are private. Work with your child to come up with examples of behaviors that are okay in each setting.

• Use stories. Stories also can help your child understand these rules and why we have them.

• Redirect. Tell your child where to go to perform private behaviors using simple words or pictures. For example, say something like, “You can do that in your (bedroom, bathroom)” or show them a visual labeled “Private.”

Private Parts

Public vs. Private Behaviors:Touching Personal Parts• All kids at some point will discover their personal

parts. • You can teach your child which parts of the body are

“personal parts” by describing them as the parts of the body covered by a swimsuit or underwear.

• If your child touches personal parts in public,▫ Redirect to a private space, if possible (e.g.,

bedroom).▫ Redirect to another activity using a visual like “No

Hands in Pants” or a First-Then board (First wash hands, Then fun activity).

▫ If possible, stop the behavior quickly and quietly. Paying too much attention can make it happen more.

Public Private Behaviors-Story

Ok To Touch/Don’t Touch