How Your Child’s Pediatrician Can Help

All children and teens, including those with autism spectrum disorder (ASD), have questions about physical changes in their bodies, emotions, and feelings during and after puberty. It is important to help children and teens understand these changes by talking with them early and often about puberty and sexuality. 

Talking about these topics may make parents feel uncomfortable, anxious, or embarrassed. A child’s pediatrician can help. This is an important topic because sexuality is a healthy, normal, and key part of being a teen and an adult. 

Most teens, including those with ASD, are curious about their own bodies and the physical and emotional changes of adolescence. Like other teens, they see and hear about sexual behaviors through TV, movies, and online. However, these sources may not be true and not aimed at people with ASD. So, all teens need to be given information about sexuality in a way they can understand. Parents of children or teens with ASD need to start discussing sexuality with them early.

What to Consider When Visiting Your Child’s Pediatrician

During visits with your child’s pediatrician, talk about your concerns with your child’s sexual development. Think about these things.

• All children and teens have the right to privacy. You and your child’s pediatrician should respect that privacy during physical examinations. For example, at some point it may become inappropriate for you to be with your child during the physical examination. If your child prefers that you not be with him, you can join him and his doctor after the examination is done.
• Your child’s pediatrician can teach you about the phases of puberty. That way, you can be aware of changes in your
  child. You will see how puberty might change the way he looks and acts.
• As children enter puberty, they will have to learn new ways to clean and care for their bodies. These new skills should be taught in steps. Children with ASD may need special training and extra time to learn these new skills.
• Some youth with ASD may have more difficulty making, keeping, and understanding relationships than children without ASD.
• However, appropriate social behaviors can be learned, often with practice, repetition, and reward, until the skills become more natural.
• Youth with ASD may need help learning basic social skills, such as how to meet and interact with others, how to show good manners, and what is OK and not OK in social settings related to sexual language and behaviors. They need help on how to understand social relationships with potential partners.
• Children and youth with disabilities, like ASD, have a higher risk of being sexually abused. This risk may decrease when they know the difference between behaviors that are appropriate and those that are not.
• All children receive sexuality education at school. However, students with ASD may need sexuality and relationship education in different ways or with special teaching materials. They may need more reviews of the information. Make sure you know when sexuality education occurs in your child’s school; it may begin at a younger age than you think. Parents and teachers should talk about changes in body parts during puberty, hygiene, medical checkups, information about periods, masturbation, intimacy, and accepting and advocating for themselves. Some people with ASD may
  have inappropriate sexual behaviors because they don’t understand social signals or because they have repetitive behaviors. Appropriate behaviors should be taught.
• If your child has an Individualized Education Program (IEP), the IEP should have information on how your child should learn about sexuality. For example, use of clear language, pictures and videos, and repetition of material may be helpful.
• Some girls with ASD struggle with hygiene related to their periods. Talk with your child’s pediatrician about ways to control how often and how long periods might last. Also, ask about how your child can take care of her period when she is out in public. Gynecologic checkups can be very stressful for some teens and may need special planning. 
• You or your teen might wonder about how likely it is for him or her to have a baby or child with ASD in the future. Or, you might wonder about whether other people in your family will have a baby or child with ASD. Your child’s pediatrician can help you understand how genetics affect likelihood.
• All children should receive human papillomavirus vaccination.
• Coping with the changes of growing up, going through puberty, and being a teenager or young adult is not easy. It may be harder for young people with ASD. As parents, you can help support your child by talking about puberty and sexuality often and in a matter-of-fact way. There is no reason to be embarrassed, and it helps to have a good sense of humor!
• It is also important to respect children’s privacy and give them independence. Talk with your child’s school about sexuality education classes. 
• It is important to be aware of any risk of sexual abuse. Teaching your children about strong communication, appropriate boundaries, and their own sexuality will help them protect and respect their bodies. Remember that your child’s pediatrician is also there to help you with any questions.

Resources

American Academy of Pediatrics (AAP) HealthyChildren.org, the official AAP website for parents: www.HealthyChildren.org

Vanderbilt Kennedy Center Healthy Bodies toolkit, includes sex-specific sets of pictures with English and Spanish descriptions to help with comprehension: https://vkc.mc.vanderbilt.edu/healthybodies

Wrobel M. Taking Care of Myself: A Hygiene, Puberty and Personal Curriculum for Young People with Autism. Arlington, TX: Future Horizons Inc; 2003

Diverse City Press Inc., offers teaching videos: www.diverse-city.com

Future Horizons, Inc., a world leader in ASD, Asperger syndrome, and pervasive developmental disorder publications: www.fhautism.com

Teach-a-Bodies, distributes anatomically correct dolls useful for teaching youth with developmental disabilities such as ASD: www.teach-a-bodies.com

© 2020 American Academy of Pediatrics. All rights reserved.