Tuesday, November 19, 2013

Entering Puberty

Puberty can be hard. Some families breeze through, but this is rarely the case when the dynamic includes a diagnosis on the Autism Spectrum and the child may not have the developmental maturity matching the physical changes they are experiencing.

Parents of kids with ASD know better than anyone that the strategies to deal with any change, including puberty, need to be individual and flexible and very much depend on the level of skill in communication and cognition.

Respond to questions and a growing awareness of any physical differences in an age appropriate way, as you would any other child, and prepare them by discussing the changes in a ‘grown up body’.  For example if they notice a man with a beard or underarm hair, or a woman with ‘bumps on her chest’, use these as an opportunity to open the discussion around how we change and grow as we get older.

When appropriate, use the commonly used terms, for example ‘bumps’ might become breasts, and you can introduce the concept of puberty, particularly for kids of upper primary school age who might  already be noticing changes in their friends and classmates.

You know your child best, therefore you will need to make a judgement about whether advance discussion will increase or decrease anxiety around the changes - although do bear in mind the approximate age range for the commencement of puberty in order to help reduce uncertainty.  Girls, on average enter puberty around 11, with some starting as early as 8, and boys begin at around 12-13 years of age although as young as 91/2 is possible. Early onset puberty is an added challenge for any family but even more so if the child’s developmental age is not that of their peers.

As uncomfortable as discussions around puberty can be for any parent, in the case of children with ASD, it is essential the subject is addressed no later than the actual onset of the changes. For girls, it is when their breast buds begin to develop and for boys, it might be when they begin their growth spurt and appear to be all ‘arms and legs’.  Delaying the discussion any further may cause the child to think they are ill and add even more confusion and fear.

If your child is extremely literal, it’s important to highlight the changes that happen to girls but not boys, and to what extent.  It would be terrifying for a boy to think he would grow breasts for example.

A social story may well be the best way to demonstrate the changes puberty brings, and a personalised story for each of the changes can be the best way to address the different aspects growing into adulthood brings.

Autism Victoria has a fantastic fact sheet with strategies and resources and the following suggested list of topics for a social story.  Not all may be necessary depending on the way your child copes and changes, however this is a great resource for preparing your family and the child for what may be challenging times.

  • Breast development and widening of the hips (could be titled 'the shape of my body will change')
  • Pubic and underarm hair development (title 'extra hair will grow')
  • Onset of menstruation (title 'I will begin to have my period')
  • Growth acceleration (title 'I will get taller')

  • Growth acceleration (title 'I will get taller')
  • Pubic, underarm, and facial hair development (title 'extra hair will grow')
  • Testicular and penile enlargement (title 'my body will look different')
  • Spontaneous erections, sperm production, wet dreams (title 'body will do new things', or use simplified versions of these terms as titles)
  • Voice deepening (title 'my voice will sound different')

The issues around puberty are many and varied, not limited to physical changes as discussed here but also personality and emotions, awareness of the opposite sex and sexuality, hygiene and expectations from others as you ‘grow up’.

No parent or caregiver can predict how any person will respond to puberty, whether they have an ASD diagnosis or not.  Some kids may in fact breeze through some of the changes whilst struggling with areas you would not have expected.  Prior preparation and information will ease the anxiety for all, particularly the family or carer. Your local Autism support networks and information services will have resources and recommended reading available should you need extra assistance.

You can’t hold back the clock or prevent your child growing up, as much as you may like to, so it’s best you are as prepared as you can be.

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