Triveni Goswami Vernal
(Registered Special Educator CRR A64010)

Puberty is a challenging phase for both boys and girls, and especially so, for those on the Autism Spectrum. The previous blog, looked at puberty and self-care for boys on the Autism spectrum. This blog will shed light on the particular challenges for girls on the Autism spectrum, during puberty.

Hormonal changes associated with Puberty can bring about several challenges in young girls with Autism. An article, “Autism & Puberty Aggression” (https://www.autismspeaks.org/expert-opinion/autism-puberty-aggression), states the following,
“Research suggests that puberty brings a number of special challenges for girls with autism. They have higher rates of abnormal hormone changes. This can produce irregular menstrual cycles, cramps, polycystic ovary syndrome and severe acne. Gynecologists also report that girls with autism are more likely than girls with other types of developmental issues to have behavioral problems related to their menstruation. They may become more aggressive, obsessive and destructive. They may experience increased repetitive behaviors.”

SELF-CARE and HYGIENE include the following:
1) Bathing
2) Cleaning up after the use of the Toilet
3) Regular washing of hands and feet
4) Wearing clean clothes
5) Wearing clean undergarments
6) Regularly getting one’s hair cut
7) Personal grooming (Combing hair, wearing a deodorant/talcum powder to keep sweat at bay etc)

Besides dealing with emotional upheavals brought on by changing levels of hormones, young girls with Autism also have to understand how to care for themselves, during Menstruation.

SELF-CARE, MENSTRUATION AND HYGIENE
Menstruation can be especially challenging for young girls on the Autism Spectrum, with regards to
a) Emotional Regulation,
b) Bodily changes and expected behaviours and
c) Maintaining a Routine around self-care and hygiene during one’s period.
There are several resources available online towards imparting training towards self-care during Menstruation, for young girls with Autism. Social Stories™ are another resource that parents, caregivers and educators, can use. For example,

Social Story™: “I will begin to have my period”
(Source: https://raisingchildren.net.au/autism/development/physical-development/periods-and-autism)
“As my body changes, I will get my period.
When I get my period, blood comes out through my vagina.
I will need to use special underpants, a pad or a tampon so my clothes don’t get stained.
Periods usually come every 28 days. Sometimes it might be sooner or later. This is OK.
A few days before I get my period, I might feel more upset about things. I might feel angry, I might feel sad, I might feel frustrated, or I might feel other emotions. Feeling this way is normal and usually stops when my period starts.
My breasts, stomach and the lower part of my back might feel sore at this time. This is normal.
Putting a hot water bottle on my stomach and having some pain relief medicine can help me feel less sore.
I might have my period for 4-7 days. It might be shorter. This is OK.
If my period goes for longer than 7 days, I will talk to an adult who cares about me.”
This is just one example of a Social Story™. One can also create a Social Story™ for what an individual might feel (emotions, sadness, anger, irritation etc) during one’s period or what one is expected to do for Self-Care & Hygiene (change the sanitary napkin, clean up oneself, take rest etc).

Besides Social Stories™, one can also use Visual Schedules as reminders to help an individual navigate the experience and expected behaviours of hygiene and self-care during menstruation.

I Have my Period Visual Schedule
Source: https://able2learn.com/products/i-have-my-period-visual-schedule-1-pages.html

Source: https://myboardmaker.com/Activity/4580792
(Note: This visual schedule mentions using wipes to clean oneself. Depending on the particular cultural context, the visual can be changed to show the use of a mug of water or hand shower).

PRIVATE AND PUBLIC SPACES AND SEXUAL NEEDS IN YOUNG GIRLS
Other than teaching the concepts of Good Touch and Bad Touch, with puberty, comes sexual maturation and an increase in sexual needs and desires. While, sexual needs and desires are often spoken about as a given for boys, it is not accorded the same importance in girls. Yet, truth be told, sexual maturity also brings about an awakening of sexual needs and desires in girls, during puberty. Parents and caregivers must be open about discussing these with their wards. The young girls must be taught the dichotomy of Private & Public spaces and the expected behaviours in each. That, touching oneself /masturbation within the confines of a private space, is acceptable and that there is nothing wrong in doing so, should be communicated to them.

An article, “Puberty in Girls: Discussing Masturbation” (https://www.research.chop.edu/car-autism-roadmap/puberty-in-girls-discussing-masturbation) , states the following,
“Establish an open dialogue with your daughter about sexuality, which includes being safe and socially appropriate.
Consider addressing the following with your daughter:
• Where can masturbation occur? Instruct your daughter that masturbation is a private matter. It is not to be done in public or in an area where anyone else might be or might enter. Be explicit with where an appropriate location might be, such as in your daughter’s room with the door closed.
• How do you feel about the use of visual aids that are readily available (for example, everyday catalogs and magazines, not necessarily more graphic ones)?”

If young girls are taught what behaviours (pertaining to sexual needs and desires) are appropriate and acceptable in private spaces, they will not find themselves in situations, where they engage in behaviours that can be considered unlawful or illegal or obscene in a social space or public setting.

Thus, we see that Puberty and its associated aspects can be quite challenging for young girls on the Autism Spectrum. The focus should therefore, be on educating oneself and keeping up with the times to accept a young girl’s evolving sexuality, providing access to resources for training and implementation of a routine and helping the young individual navigate the phase of puberty, with ease.

RESOURCES:
https://cdn.brandfolder.io/BNH251ZH/as/8k6s5s2m58wb5nr4rkxk4h/Puberty_and_Adolescence_Resource.pdf
https://able2learn.com/products/i-have-my-period-visual-schedule-1-pages.html
https://able2learn.com/categories/health-and-physical-education/hygene.html
https://www.nhsggc.org.uk/media/245920/visual-aid-for-managing-periods-changing-my-pad.pdf
https://raisingchildren.net.au/autism/therapies-guide/visual-supports
https://raisingchildren.net.au/autism/development/physical-development/periods-and-autism
https://pmc.ncbi.nlm.nih.gov/articles/PMC10701206/
https://www.autism.org.uk/advice-and-guidance/topics/physical-health/menstruation
https://raisingchildren.net.au/autism/development/physical-development/preparing-for-puberty-asd
https://myboardmaker.com/Activity/4580792
*************

Author Dr.Triveni Goswami Vernal

Dr.Triveni Goswami Vernal is a Registered Special Educator (CRR: A64010), a Psychologist and an Expressive Arts Therapy Practitioner in training (UNESCO-CID). She is an Avaz Certified Educator and Certified in Dyslexia Teacher Training. She is also an art educator for children with additional needs.

---

Artwork Peacock, Artist Kabir Vernal
Oil pastels and pen on watercolour paper