Approaching adolescence can be a challenging time for many individuals. The challenges are certainly different for each gender and females with Autism Spectrum Disorder (ASD) may experience these challenges in a unique way compared to their neurotypical peers. The uncertainty of the physical changes that are happening to their bodies and how to cope with those changes can cause stress and anxiety for many teens. While families are often well prepared for helping their daughters’ transition to various developmental stages, from kindergarten to elementary school, many females find themselves unprepared when transitioning to adolescence and approaching puberty. Parents may find themselves “caught off guard” when their daughter experiences her first menstrual cycle or when they find out their daughter is being teased in the locker room because she is not yet wearing a bra (Nichols, Moravcik and Tetenbaum 2009). Adolescence and transitioning to puberty can be a stressful time for many parents and especially for parents of girls with ASD (Zamora et al 2014). Professionals who work with families and individual females can help them become better prepared for the transition to puberty and guide their daughters to cope with some of the challenges that they may encounter during this time.
Understanding your daughter’s individual abilities may help you to set up a plan that will ease the transition to puberty. Consider your daughter’s overall intellectual ability, how she copes with change, her abilities in communicating her feelings, her organizational skills, and any sensory challenges. The physical changes that occur in females during puberty may be a time of mixed emotions for many teens. Individuals with ASD may experience sensitivities to sound, touch, taste, light intensities, and some fluctuate between hypo-sensitive and hyper-sensitive (Mandy et al 2011). For example, the experience of having to wear a bra for the first time may be met with stress and/or sensory discomfort for some females with ASD. To help your daughter plan for this transition take into consideration if she tends to have sensory challenges. If you know she has a particular preference begin to discuss the different choices that are available. Plan in advance to try out the several different types so that she can chose a style that she is most comfortable with wearing. Chose an environment in which she is most comfortable and will allow her to experience success when practicing wearing the item. Keep in mind information and skills may not be learned the first time, therefore multiple repetitions may be needed to ensure skill acquisition (Nichols et al 2009). Consider your environment in advance: do you need to practice in the comfort of your home or in a fitting room at the store? Prepare by using visual supports such as picture cues or written words to help teach the steps. Think about the teaching techniques that are most effective with your daughter and use those strategies. Some strategies to consider may include behavior chaining techniques (e.g., backward chaining, forward chaining) which can be used to build upon and improve an individual’s independent living skills. (Cooper et al 2007). Break down steps into small components and practice the steps by modeling the appropriate actions, role play, review and provide behavior specific feedback. Take the time to teach this new skill, practice often and provide positive reinforcement (Miles et al 2009). These tasks may be unpleasant to your daughter and it is important to pair this experience with a positive interaction.
Consultation with a psychologist or a board-certified behavior analyst (BCBA) can also provide guidance on the teaching methods or types of materials that would be appropriate to use with your daughter. Preparing your daughter for the changes that come with adolescence, especially during her first menstrual cycle, can ease some fear and anxiety. Talking with her medical physician will help you understand the developmental signs that may be associated with this upcoming change. Her medical doctor may be able to guide you to websites that are approved by the American Academy of Family Physicians (AAFP). Parents may want to review various teaching techniques and decide on a method that would work successfully with their daughter. Planning ahead of time and being proactive as much as possible will help her know what to expect. Teach your daughter some of the steps of personal hygiene by using detailed visual supports, using a task analysis and breaking tasks into smaller steps, and use positive reinforcement when your daughter is successful. The use of a wall calendar can also provide a monthly reminder and serve as a guide to review the steps of how to prepare. Remember the goal is for your daughter to be independent and apply strategies to reach her goals. If her goal is deal with her menstrual cycle each month independently, initially parents may help their daughter set up an action plan on how to achieve that goal. Include methods on how to self-evaluate, make adjustments, monitor progress and review the plan to see if it was a success (Agran et al 2000). Remember to keep instructions simple, use visual cues, model instruction, practice, repeat, and reinforce (Nichols 2009).
While adolescence can be a stressful time for all individuals and their families, females with ASD are faced with a unique set of challenges. Females with ASD are likely to require more direction and guidance than their neurotypical peers in order to navigate puberty and sexual development. By using evidenced based strategies, as one would to help their child acquire any new skill set, and obtaining guidance from a professional with experience in working with females with ASD, parents can more effectively support their daughters in successfully navigating through adolescence
Elena Zaklis MA, BCBA and Rory Panter PsyD, are from Behavior Therapy Associates in Somerset, New Jersey and can be reached at ezaklis@behaviortherapyassociates.com or rpanter@behaviortherapyassociates.com and at www.BehaviorTherapyAssociates.com.
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