Top Tips on Helping Your Child With Autism Through Puberty

As a pediatric endocrinologist, this is an area of my expertise in my daily work. The early changes of puberty usually occur between the ages of 9 to 13 years. They are noticeable in girls by the budding of breasts and then pubic hair, with menstrual periods starting between 11 to 14 years of age.

Top Tips on Helping Your Child With Autism Through Puberty

Boys usually develop testicular enlargement and then pubic hair between the ages of 9 to 14 years. Underarm hair, facial hair and deepening of the voice in boys typically occur between 13 to 16 years. If there are concerns about delayed puberty, or signs of puberty that occur at an earlier age than usual, it may be necessary to refer to a specialist paediatric endocrinologist for an assessment.

Some schools may address puberty and sex education at an age appropriate level, but others may not. Preparation for this discussion is advisable as children with autism need a longer period of time to understand and adjust to changes in their bodies. Even in children who do not have autism, puberty can be a difficult transition due to hormonal changes.

Mood swings are common. For a child with autism who cannot understand what is going on, it can be so much harder and behaviors such as emotional swings, aggression, self-harming, and masturbation can sometimes be escalated. Help your child with autism understand and cope through visual aids and being explicit in your language and communication. Explain and use labelled pictures to explain when puberty happens and how each part of the body will change, including all the fluids that will come out: sweat, tears, semen, menstrual blood, and vaginal discharge.

Use visual aids to help develop a routine for hygiene in a step-by-step manner, such as which parts of the body need special attention in the bath or shower, how to shave, and how to use a menstrual pad. Do not “assume knowledge” in your child.

During puberty, it is not uncommon to have sexual urges and your child may masturbate. This is a healthy and normal part of pubertal development. It is important to explain, discuss, and reassure as some of these new sensations can cause anxieties. Teach your child the difference between being in public and in private, and that some activities should only happen in private, such as undressing or masturbation. Teach your child safety; that he/she should not let anyone touch his/her private parts, that he should never touch anyone else’s without consent; and that he/she should tell you if anything like this has ever happened.

Many adolescents can begin to develop a romantic interest in the opposite or same sex. Help your child understand these feelings and what sexual and romantic relationships are. This can be supported by using social stories and visual drawings using stick figures or photographs. It is likely your child may already have developed a curiosity about the topic. If he/she shows an awareness, be prepared to discuss it and let him/her ask you questions. Topics can progress from what is sexual intercourse, to gaining sexual consent, and the importance of protected sex as they develop further understanding.



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Puberty is an important developmental stage with many changes that occur physically, emotionally, and socially. As parents and carers, puberty can be challenging and being both prepared and informed on how to approach any related issue as it arises is advisable.

Quick Tips

  • Puberty brings many new challenges that can be behavioural, so make sure you are fully prepared
  • Do not “assume knowledge” in your child. Explain and use pictures to help him/her when puberty happens and how each part of the body will change
  • Use visual aids to teach your child to how to maintain his/her hygiene. Be explicit with naming all private parts of the body
  • Teach him/her to say “no” and the difference between private and public behaviours such as masturbation and undressing
  • Teach him/her about personal and internet safety
  • Always be involved in your child’s curiosity; be prepared to discuss and let him/her ask you questions

This article was featured in Issue 98 – Fresh ASD Guidance For A New Year

May Ng

Professor May Ng, MBBS (Hons), FHEA, FRCPCH, MSc, LLM, PhD is a Consultant Paediatric Endocrinologist and Honorary Associate Professor at the University of Liverpool, United Kingdom. She completed her undergraduate degree under full scholarship at University of Sydney, Australia and her pediatric training in Australia and the United Kingdom. She was the recipient of the prestigious UK Medical Research Council Fellowship and completed further training to obtain a Masters in Medical Science and PhD degree in pediatric endocrinology and diabetes. Dr Ng also holds a Master of Laws degree and is active in medico-legal work. She is Chair of the UK Association of Children’s Diabetes Clinicians, Officer for British Society of Paediatric Endocrinology and Diabetes and Training Advisor for Royal College of Paediatrics. She is in the Diabetes UK Council for Healthcare Professionals and Online Learning Committee for European Society of Paediatric Endocrinology. She is an active researcher with over 150 publications and has presented at more than 150 scientific meetings. She serves on the editorial board for several international journals including as Editor-in-Chief and as Associate Editor and is a regular invited referee for many high impact journals. She is a clinical lead of multiple national award-winning initiatives such as University of Liverpool Alumni Award 2020, Diabetes UK Mary Mackinnon Award 2018, winner of 2015 Diabetes Quality in Care award, Highly Commended runner up for Diabetes Team of the Year National BMJ Awards 2015, finalist for the HSJ Clinical Leader of the year 2015 and finalist in the UK Asian Woman of Achievement Award 2016. She is also a book author of ‘A Journey with Brendan’ documenting life with her son with autism as both a mother and pediatrician. For more information visit my website. Twitter @mayng888.

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