Girls with Autism Growing Up: Preparing for Menstruation

I am frequently asked the question about how to introduce the topic of menstruation to girls on the autism spectrum. Mothers worry about how their daughters will react to getting their periods. Will there be sensory issues around blood flow and the use of sanitary pads? How will they feel about this change in their body? Will it be painful? How do you teach hygiene around menstruation? Will periods be understood and accepted?

There are ways to ease the transition into menstruation. Below are some things that worked for me when my daughter was going through this transition.

1) Introduce the topic of menstruation early: one to two years before you think it may occur, to get used to what it is about and how natural a process it is. Allow time to become familiar with the vocabulary around menstruation and practice routines. Menstruation is a hard enough transition without it being a sudden surprise.

2) Get your daughter used to pads before she needs them: have your child wear a pad from time to time to get used to the feeling of it. Teach her how to put them on, and properly dispose of them (hint: not in the toilet – wrap up a used one and putting it in the wastebasket). Visual supports can help with the process of breaking down the routine into steps. A great book that addresses this topic with the use of visual supports and social stories is Mary Wrobel’s book Taking Care of Myself.

3) Create a rite of passage: I have always liked the idea of cultures that have a rite of passage around menstruation. This makes getting your period a natural change; something to look forward to and not to be feared. Children on the spectrum will understand the concept of a celebration or event to look forward to. For the two years leading up to our daughter’s menstruation, we told her for that it was a sign of growing up. Rather than being something scary, it signified that she was moving towards independence, and making more of her own choices. Parents can create their own rites of passage. Maybe this means going to bed 15 minutes later, a little more computer time, going out for a special treat, or moving into one’s own room. The choice is yours and parents will know what will be most meaningful.

4) Use positive language around menstruation. How often have we heard negative connotations like “the curse”? Our own, and our particular cultural attitudes around menstruation can influence how our girls feel about it too. Children with ASD often fear change and unpredictability so it is important to make menstruation part of our dialogue with our children. Preparation and demystification of the process is key to easing anxiety. The more comfortable you are –the more comfortable your child will be.

5) Don’t forget to talk about social protocol: It’s fine to talk about menstruation, but there is a time and place. Teach those boundaries early. It is something you don’t announce each month to everyone! Establish what is appropriate social etiquette. If the child will need assistance with pads at school, make sure staff is informed. Will a particular aide be assigned to help the child at school?

Great books for parents and children to read together that introduce menstruation, facts of life and hygiene for girls are  The Growing Up Guide for Girls – What Girls on the Autism Spectrum Need to Know! and The Girl’s Guide to Growing Up: Choices & Changes in the Tween Years. Both books offer great illustrations and simple, accessible language. Don’t worry about introducing the male aspects right away because there is enough information to process that just pertains to girls.

I also recommend Girls Growing Up on the Autism Spectrum for parents to read. If the person with ASD is more impaired, you may wish to have a look at Sexuality and Severe Autism: A Practical Guide for Parents, Caregivers and Health Educators.