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Adolescent Issues


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Title: Adolescent Issues

Adolescent Issues
  • Puberty, Hygiene and Sexuality

Chantal Sicile-Kira Autism One 2009
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Overview of Presentation
  • Growth and Development
  • Hygiene and Health
  • Masturbation
  • Modesty, Privacy and Personal Safety
  • Sexuality
  • Resources for more information

Top 13 Things Parents Need to Know
  • about raising an adolescent on the autism

  • 13. Teenage behavior cannot be blamed on
  • or the parents genetics.

12. Some teenagers care about smelling good. Or
11. Some teenagers like order and neatness. Or
10. Teenagers like to make their own choices.
Usually they are not the same as yours.
9. Teenagers learn self esteem at home and
school. Or not.
  1. Teenagers do not develop good organizational
    skills or self-care skills through osmosis.

7. Moodiness and raging hormones is a normal
teenage thing.
6. Self-regulation is a needed life skill not
practiced by teenagers.
5. Noncompliance is normal teenage behavior.
4. So is whining.
3. Masturbation is normal, teenage activity.
2. Learning about sex from known and trusted
adults is not.
1. You will survive the teen years. Barely.
  • Teenage years were the worst years of my life.
    When my hormones turned on I began to have
    unrelenting panic attacks. As if this was not bad
    enough, then the teasing started. I was called
    retard and tape recorder because I always
    kept talking about the same thing. Walking back
    from class another girl called me a retard, so I
    hurled a book at her. This got me kicked out of
  • Temple Grandin, Foreword
  • Adolescents on the Autism Spectrum by Chantal

  • Risk of Seizures for 1 in 4 teens on the spectrum
  • Meltdowns or aggression may increase in some, and
    decrease in others
  • Physically mature at same rate as peers, however
    emotionally less mature
  • Some have early onset of puberty
  • Risk of depression

Why Puberty is hard on ASD teens
  • Most do not like change, yet body is changing and
    they cannot control it
  • Most do not pick up information by osmosis from
    siblings or peers or through sitting in Health
    classes in school
  • They do not understand why they are feeling
    different than before
  • Do not understand all terms or clang used by
    peers (ie boobs instead of breast)
  • They hear about sex from others but may not

Sensory Challenges in School
  • Change classrooms during the day
  • Special ed classrooms noisy with staff and
    students coming and going
  • Different environments to adapt to
  • Crowds to walk through between classes, lunchtime
    and locker room
  • Other students brushing up against student while
  • Different people / voices to get used to
  • More noise

Other Challenges
  • Social expectations increase
  • Peer relationships more complex
  • More demands on social competency

Emotional Health - Consider
  • Important to teach the teen re puberty and body
    changes of both sexes
  • Look at sensory / transition challenges
  • Connection with a trusted adult other than a
    parent (therapist, uncle, aunt) important
  • Psychologist / Psychiatrist / medication may be
    helpful if knowledgeable about ASD teens, and as
    part of whole educational/ treatment plan (ie
    look at environmental issues, relationships, etc
    before medication)

Why They Need to Know
  • That is how many of our people will experience
    puberty in school left behind and alone and
    feeling steadily worse about it. People who had
    time to before, now don't. That time is now
    shared with people who go around in groups of
    social pairs. There are rumors of social and
    even sexual activity that usually only serve to
    make our kids feel more left out. True, the
    people telling the stories are usually not nearly
    as active as they claim to be

  • Listening to a group of school boys in locker
    rooms is like listening to a blind man teach
    defensive driving. But to the people totally
    left out, especially autistic boys who have
    little personal experience to compare with what
    they are hearing, it sounds true enough.
  • Jerry and Mary Newport, Autism -
    Aspergers and Sexuality Puberty and

Now, a fun exercise..

  • Boys age of onset at 11 or 12
  • Girls age of onset earlier, at 9 or 10
  • Early onset of puberty possible in some
  • At latest, should begin to tell them when their
    bodies begin to change (better to start sooner)

What They Need to Know
  • Need to know what happens to other gender at same
  • Need to know they are developing into a woman or
    man (like mom and dad are already)
  • Correct name of body parts and what they are
    used for
  • Teach the synonyms of words (ie breasts and boobs)

  • Explain that good and bad feelings will come as
    part of changing into an adult body. Girls who
    are interested in logic and facts may be
    interested in charting their own mood on a
    calendar to see if there is a cyclical pattern
    coinciding with their menstrual cycle.
  • Have a collection of ideas to help adolescent
    boys and girls when their mood is low (remember
    risk of depression)

Explaining the Obvious is Important
  • Some changes will only be associated with the
    same sex (e.g. a boy will not begin to grow
    breasts, but a girl will)
  • Hair will only grow in certain places (the child
    may think the whole body eventually becomes
    progressively covered in hair like a werewolf)
  • Explain that extra hair just grows on the
    underarms and on pubic area in women
  • Explain that extra hair grows on the underarms
    and on pubic area, and on the chest, and face
    and chin of a man.

Some Topics for Puberty Social Stories for Girls
  • I am growing into a woman
  • breast development and widening of the hips
    (could be titled the shape of my body will
  • 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)

Topics for Puberty Social Stories for Boys
  • I am growing into a man
  • 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 my body will do new things)
  • voice deepening (title my voice will sound

Hygiene and Health
  • Hygiene needs to be addressed and good habits to
    be developed and emphasized
  • Explain WHY important (social stories tailored to
    ability level)
  • Health reasons - Stay healthy
  • Social reasons - Make friends

Self- Care
  • Analyze problem areas in self-care
  • Task analysis - ie washing hands
  • break down each task into small steps
  • take data on each step
  • Work on problem areas separately
  • Put back into task
  • Start with step before
  • To teach new task, backward chain

Task Analysis
  • Note prompt levels
  • I - independent
  • V- verbal
  • G - gestural
  • M- model
  • Pos - positional
  • Pph - partial physical
  • Fph -full physical

  • Fix problem areas in self-care routines
  • Desensitization of sensitive areas
  • Hand over hand for motor memory
  • Visual schedules
  • Verbal schedules
  • Use of different products

  • Natural activity that you may not necessarily
    teach, but contain if it occurs
  • You will be able to control where and when, but
    you will not be able to stop it
  • Home and school need to work together on this if
    it is occurring outside the home
  • Teen must be allowed a private place at home
    he can masturbate

Concept of Private vs Public
  • Picture icon with word
  • Private - figure in underwear
  • Public figure with clothes
  • Put outside / inside appropriate areas or rooms
    at home and special ed classroom.

  • May be necessary to teach person how to
    masturbate if he or she is not figuring it out
    on own and becoming very frustrated and
    aggressive due to this.

Modesty, Privacy, Personal Safety, Sexuality
Modesty, Privacy, and Personal Safety
  • Teaching notion of privacy starts with familiar
    adults and how they treat the teen
  • Asking permission before doing physical activity
    on/with a person (ie physical therapy)
  • Explaining appropriate and inappropriate touching
  • Teach concept of modesty at home
  • Concept of privacy needs to be taught and
    reinforced in all environments

Why it is important children and teens understand
about appropriate behavior from an adult
  • The abuse rate for children with a developmental
    disability is 3.4 times the rate of children
    without disabilities (Boystown., 2001, Patricia

  • Teach the right to say or communicate NO or Go
    away in appropriate situations
  • Teach to not touch own private parts in public
  • Teach to not touch other peoples private parts
    in public
  • Teach them it is never OK for an adult to do
    certain things to them
  • Teach them to communicate if an adult has asked
    them to do certain things, or has touched them

  • Relationship Boundaries different
    relationships, different boundaries
  • Appropriate types of conversation and behavior
    for each type of various relationship
  • The notion of Circles
  • Private circle
  • Hug circle
  • Far away hug circle
  • Handshake circle
  • Wave circle
  • Stranger circle

Wave Circle
Stranger Circle
Handshake Circle
Far-Away Hug Circle
Hug Circle
Private Circle
Friendship vs Romantic Interest
  • Adolescent crush ASD teen may not be able to
    read the cues from another person as to whether
    the interest is reciprocal. Teen needs to have
    explicit instruction about indications that
    someone likes them, as opposed to being
    interested romantically.
  • Attraction to other person
  • feeling tingly when being near another person,
  • thinking about that person a lot of the time

  • Due to social immaturity, ASD teen may not show
    interest in others romantically until much later
    than their peers, despite their sexual maturity.
  • In this case, need to explain to teen that
    attraction to another person may happen in the

  • Talking to the teen can help demystify the change
    in their classmates behavior from mainly
    same-sex interaction, to mixed interaction, with
    flirting, touching, showing off for the benefit
    of potential girlfriends / boyfriends
  • Helps them make sense of what is going on around
  • Helps them to understand that behaviors such as
    teasing, playful punching, etc. may be an
    indication of flirting rather than an offence
    needing to be reported to the teacher

Teach Interested / Not Interested
  • Not Interested
  • Looking away
  • Turning away
  • Moving away
  • Looking unhappy
  • Having arms folded
  • Not responding when
  • talked to
  • Interested
  • Giving strong eye contact
  • Leaning forward to hear what is said
  • Smiling
  • Flipping or touching hair
  • Laughing at your jokes
  • Other person initiating
  • conversation

  • Sexual feelings are natural
  • Some individuals on the spectrum want intimacy
    and want to get married, others do not
  • Even if the teen is not interested in
    relationships or the idea of marriage and
    intimacy, it is important to teach them about sex
  • they may be interested as they get older
  • they need to understand what other teens are
  • they are at a higher risk of getting abused

Remember HOW you say it and teach it,
  • is just as important as WHAT you say and teach

Some Guidelines
  • Determine your comfort level in discussing
    sexuality and sex with your youth.
  • Look for resources
  • Find specialist if you feel it will be helpful
  • Determine where your youth is at in their
  • Obtain social and emotional age appropriate
    materials to use while teaching your youth.

  • If the youth is physically mature but delayed
    socially and emotionally, communicate openly and
    consistently with the youth's teachers, care
    providers, and if appropriate with local
    authorities, on where the youth is at in
    development, as well as what you are teaching
  • This will help prevent social and/or legal
    issues arising from unintentionally inappropriate
    public behavior.

Before Seeing Specialist or Teaching Child,
  • What are the youth's language and communication
  • What are the youth's abstract reasoning skills?
  • Is the youth hyper or hypo sensitive to Visual,
    Auditory, Tactile, Smell, or Taste?
  • Does the youth have any other physical
    challenges that could affect learning?
  • Where is the youths social and emotional (S/E)
    age in comparison with their chronological age
    and intellect?

Teach Early, Teach Often
  • The Basics
  • Sexual awareness - What is sex, what is
    acceptable behavior and when is it acceptable?
  • Boundaries - What boundaries should we have for
    our bodies, as well as when interacting with
  • Who, When, Where and How of sex, sexuality and
    personal boundaries.

  • In Other Words, Teach
  • Sex education (the birds and the bees)
  • Appropriate behaviors from others
  • Appropriate behaviors towards others
  • Giving or withholding consent (self advocacy)
  • Next lessons
  • What is heterosexuality, What is homosexuality,
    peoples different choices
  • sexually transmitted diseases and AIDS

  • Important for teens safety that he / she
    should be able to identify places on his/her body
    where it is appropriate to be touched by others
    they are not on an intimate relationship with
  • Important that teen be able to tell someone when
    he/she is touched in an off limits area of his
    /her body

  • Aspergers Syndrome and Sexuality From
    Adolescence through Adulthood by Dr. Isabelle
  • Autism - Aspergers and Sexuality Puberty and
    Beyond by Jerry and Mary Newport. Jerry Newport
  • Taking Care of Myself A Hygiene, Puberty and
    Personal Curriculum for Young People with Autism
    by Mary Wrobel
  • Handmade Love (men) and Finger Tips (women) books
    and videos at

Closing Comment
  • Jeremy is a complicated young man who people
    cannot judge on appearance. A good metaphor would
    be to describe Jeremy as an artichoke. Each leaf
    on the artichoke has to be taken separately, each
    having its own characteristics. As you go through
    each layer of the leaves, it becomes apparent
    that there might be something inside, something
    worth getting to. It takes time to get there, but
    there is a heart inside, worth the time and the
    effort to expose, as some people say it is the
    prize for the patience of delving through the
    layers. Jeremy is this man.
  • Allan Gustafson, teacher

Chantals Books (pub by Penguin)
  • Autism Life Skills From Communication and
    Safety to Self Esteem and More 10 Essential
    Abilities Every Child Deserves and Needs to Learn
  • Adolescents on the Autism Spectrum A Parents
    Guide to the Cognitive, Social, Physical, and
    Transition Needs of Teenagers with Autism
    Spectrum Disorders
  • Autism Spectrum Disorders The Complete Guide to
    Understanding Autism, Aspergers Syndrome,
    Pervasive Developmental Disorders and other ASDs
    (ASA 2005 Book of the Year)

Contact Information for Chantal
  • The Real World of Autism
  • on Autism One Radio http//
  • Webinar moderator on