Periods and girls with autism spectrum disorder
Your daughter with autism spectrum disorder (ASD) will go through lots of changes in puberty, just as other girls do. One of the most significant milestones is her first period. It's a sign that the physical changes in her body have only a couple of years to go.
Most girls get their first period when they're between 11 and 14½, but anywhere from 9-16 years is considered normal. If a girl has a major growth spurt and has grown some underarm hair, periods are likely to be just around the corner.
ASD doesn't affect when girls start their periods.
When to start talking about periods - and what to say
Children with autism spectrum disorder (ASD) often need longer to adjust to and understand changes in their lives than typically developing children do. And because you can't know exactly when your daughter will get her first period, it's a good idea to start talking about it early.
Also, if girls don't know or understand what periods are, they could be frightened that something is wrong with them or that they're hurt. It can help to make sure your daughter is prepared.
Social Stories™ can help you and your daughter get ready for periods. Here's an example.
Social Story: I will begin to have my period
- As my body changes I will get my period.
- When I get my period, blood comes out through my vagina.
- I will need to use a cloth, pad or tampon so my clothes don't get stained.
- Most girls and women have a period every 28 days. Sometimes it might be sooner or later. This is OK.
- A few days before I get my period, I might feel more upset about things. I might feel angry, I might feel sad, I might feel frustrated, or I might feel other emotions. Feeling this way is normal and usually stops when my period starts.
- My breasts, stomach and the lower part of my back might feel sore at this time. This is normal.
- Putting a hot water bottle on my stomach and having some pain relief medication can help me feel less sore.
- I might have my period for 4-7 days. It might be shorter. This is OK.
- If my period goes for longer than seven days, I will talk to an adult who cares about me.
Practical preparations for periods
Your daughter will also need to know what pads and tampons look like and how to use them. You could go to the supermarket and choose some different pads or tampons together. You know your child best, so you'll be able to decide whether pads or tampons will be best for her.
If your daughter keeps her pads and tampons in a particular drawer in her bedroom, or in the bathroom, she'll know where they are when she needs them.
If your daughter uses visual supports, a visual schedule that shows the steps involved in changing a reusable cloth, pad or tampon can be useful. It will also help if you show your daughter where to attach the cloth or sanitary pad - you could mark her underwear to show where it goes.
Once your daughter's periods have started, you could show her how to use a calendar or an app to plan when her period is due.
You might need to tell your daughter who to go to at school if her periods start there - for example, the school nurse.Girls of any age can use tampons, but it can take some time and practice to get used to them. It's probably easier to manage and less overwhelming for your daughter if she starts with pads before tampons. When your daughter is first starting with tampons, the type that come with applicators can be easier to use.
PMS and girls with autism spectrum disorder
Girls with autism spectrum disorder (ASD) will experience the same range of symptoms of premenstrual syndrome (PMS) as typically developing girls do. But if your daughter has trouble communicating or finds it hard to regulate her emotions, her emotional symptoms might lead to challenging behaviour.
You can help your daughter to manage the emotional symptoms of PMS by letting her know that she might:
- feel cross and cranky
- have trouble concentrating
- feel depressed
- feel sleepy.
Pictures to illustrate these feelings might be useful.
If your daughter understands why she's having these symptoms and how long they're likely to last, it can help her feel more in control of her changing body. At first you could note your daughter's behaviour and make the link for her. For example, 'You seem a bit grumpy today. I wonder if your period is coming soon'.
A Social Story™ specific to your daughter's PMS symptoms might also help. Here's an example.
Social Story: how I feel when I'm getting my period
- For the first two weeks after my period, I feel fine.
- In the third week, I start getting headaches, feel tired, have trouble concentrating and get annoyed more often.
- I know this means I will probably get my period in a few days. I know these feelings will go away and that I will feel better soon.
If your daughter's PMS symptoms seem to be severe or are stopping her from doing normal activities, talk to her GP about medical and other options for managing the symptoms.You'll probably need to go over these messages many times with your child. Try to be patient with your child - and yourself. You might find it helpful to share experiences and get support from other parents. You could try online or face-to-face support groups.