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Thank you for your interest in the Adapted Puberty Health Education Program for girls with autism
spectrum disorder and other special needs. This program was developed by the staff and other
professionals at the Robert Crown Center for Health Education. We are grateful for the support of
Autism Speaks for funding the development of this program.
The fidelity of this program is dependent on its delivery by a trained professional health educator.
This program is presently in a pilot phase and under continual review, as well as being
professionally evaluated.
If you have any questions or concerns about this program, please contact the Robert Crown Center
for Health Education.
SCRIPT FOR ADAPTED PUBERTY HEALTH EDUCATION PROGRAM FOR GIRLS WITH AUTISM SPECTRUM DISORDER/SPECIAL NEEDS
December, 2014
One of the changes you will experience during puberty is you will grow taller and bigger. Bigger is also a
word that is easier for students to understand and comes early in students development. What things
should we do to grow bigger and be healthy?
It is often a challenge for a child with ASD/special needs to eat a healthy diet consisting of a variety of
foods. Briefly discuss healthy food choices and good portion sizes. List specific examples. Explain that
everyone needs to eat healthy foods for their body to grow bigger and taller. You may not like all healthy
foods but you should try different ones to decide which ones you like the best. Reinforce that healthy
foods can taste good. These students will often associate healthy foods with doing without the things
they love. Also be sensitive to the fact that many of the students may be on special diets. Some are very
picky. Qualify this by saying Not everyone will need the same foods for their bodies.
Another thing that is very important to keeping us healthy and growing is sleep. Briefly discuss the need
for sleep, again adapting the level of discussion to the groups comprehension level. Bedtime and
recognizing the need for sleep can be a challenge for students with ASD/special needs. Reinforce that
when we sleep well at night, we feel awake, happy, and our bodies feel ready to do things the next day. If
we dont get enough sleep we will feel tired, unhappy and wont feel ready to do things the next day.
Another change you will SEE is you will grow hair under your arms and SOMETIMES the hair on your arms
and legs will get thicker and darker. This can be confusing because students already have hair on their
arms and legs--thats why the word sometimes is necessary to avoid confusion. Make sure to point out
these changes in these pictures otherwise students may focus on something else.
What can you do after you shower that will help you smell nice and feel less wet and sweaty? Use
deodorant, right? We need to talk about deodorant with an adult we trust before we do it ourselves,
though. What does deodorant look like and how do we use it? Pass deodorants around. Instructor will
demonstrate the process of applying deodorant.
After youve done such a good job cleaning your body, you want to make sure you put on clean clothes;
not the clothes on the floor or in the laundry basket, right? Make sure not to use teaching methods that
involve humor. Humor and jokes can be difficult for autistic and special needs children to understand and
may cause stress for them. Simple, clear concise information in a friendly manner is effective.
If you shower in the morning, how should you clean your body at the end of the day, before you go to
bed at night? Allow answers and again, any answer is a positive answer. The more interactive the
program for students, the more effective it is. You need to wash your face and brush your teeth. You will
get some red spots on your face and maybe even your back and chest. They are called pimples. They look
like this. These red bumps are okay and they do not mean you are sick. Many of these students think that
pimples mean they are sick and need a doctor. They will need reassurance. You need to wash your face
with a washcloth or clean hands, soap and water. Sometimes you may put some medicine on your
pimples or red bumps. A parent or trusted adult can show you how.
These are some of the things you will need to wash your face. Can you name any of them? Instructor
explains how each item is used.
BEFORE SHOWING SLIDE SAY: Everyone needs to brush their teeth 2-3 times a day to keep them clean
and healthy. What are the times you should brush your teeth? Allow answers and provide positive
feedback. Brushing your teeth will also prevent cavities which are bad for your teeth and can make them
hurt. Show slide. You should brush your teeth in the morning, after you eat when possible and before
you go to bed.
Here are some things you need to brush your teeth. Can you name one of these things? Rather than
asking them to name any of these things, asking a student to name one is easier for them to
understand. Demonstrate the correct way to put toothpaste on the toothbrush and show an appropriate
amount.
Demonstrate and explain proper brushing and flossing of teeth using RCC model and toothbrush.
After we brush our teeth is a good time to remember to brush our hair. People brush their hair so it looks
nice and is not tangled. You should brush or comb your hair when your hair is wet, after you wash it, and
every morning before you go to school. Sometimes you will need to comb or brush your hair during the
day to keep it looking nice. You should brush or comb your hair in the bathroom or bedroom and not
around food. Make sure not to share your hairbrush or any of your personal items, like your razor or
toothbrush.
This is a topic that can cause worry for students. Many are sensory challenged and the transition to
wearing a bra is difficult. Students will need to understand that wearing a bra is very important.
Reinforce that developing breasts are part of personal/private changes. If you dont wear a bra, people
can see your breasts. These are private and we dont show them to others. Your bra should feel
comfortable. Say okay if comfortable is too difficult a word for students to understand. It should not
leave red marks on your body, like something does when it is too tight and doesnt feel good. If it does
feel too tight, tell mom or another trusted adult. Mom or another adult, like your Grandma, can help you
go to buy bras. You will need to put a bra on each morning when you get dressed. Your bra and panties
are your underwear. People should not see you wearing your bra and panties. You wear your clothes on
top of your bra. You dont need to wear a bra with your pajamas and when you wear a swimsuit.
You will also grow hair in the pubic area. This will happen slowly too. You do not have hair on your pubic
area when you are a child. As you get bigger, you grow hair in your pubic area.
You will get your period every month. This happens when you get bigger and grow taller. Show
calendar/month slides. Explain that these slides mean that this will happen again and again. This is one of
the hardest things for the students to understand. If it has not yet occurred for them, they have difficulty
understanding that it happens over and over. They will see the first time as a single event rather than a
recurring event. The following slides are reviewed very quickly to reinforce that this is a recurring event.
Remember that getting your period is personal. Pads are private. You dont show them to other people.
You take them to the bathroom without showing others. You can use a purse or put them in your pocket.
As you walk through the pad placement demonstration, reference the same steps as in the picture.
Put pad on. Show how to take off the adhesive strip and place the pad on underwear. Make sure
you discuss and demonstrate placement of wings on pads because many girls will have pads that
have wings. Emphasize that the adhesive side faces down.
Many girls need frequent reminders to change their pad. Suggest to students that they may use a timer to
remind them when to change their pads. They may need some help doing this. Some school settings will
allow this. You will need to change your pad when it becomes dirty or every 3-4 hours. You may feel wet
at times, which means its time to change your pad. Pads should be changed at least at these times (on
the slide) or even more often. If not, there may be leaking which is when the blood gets on your
underpants and clothes. Discuss what to do if you leak through a pad. Describe actions using clear and
observable instructions. Be careful when using the word embarrassing. This is a difficult concept. If the
group brings it up and understands the word then you can talk about it with them. When a pad leaks, we
want to clean it up because it is messy. Periods are private/personal. If blood gets on your clothes, other
people may see it. Go to the bathroom with a new pad and new underwear and pants/skirts/shorts.
Take the pad off. Wrap it in toilet paper and throw it in the trash. Take off the clothes that got blood on
them. Put clothes in a plastic bag. Put on a new pad. Put on new clothes. Take dirty clothes and wash
them in the washing machine to clean them. Emphasize that this is normal and happens to all girls but it
can get messy so we want to take care of it properly. Reinforce again to ask for help from a parent,
teacher, school nurse or trusted adult.
Discuss signs your period is coming. Sometimes when youre going to get your period, your stomach may
hurt. Your stomach may look or feel bigger. Your breasts may hurt when you touch them. You may see
red or brown on the toilet paper after you wipe.
Reinforce again that these are private changes that happen to every girl. Who can you talk to about these
changes?
Have students do thumbs up, thumbs down as you go through the pictures again listing examples of
things they can discuss with these people and things they cant.
*** These two following topics can be extremely uncomfortable to students and discussing them in 1st
person plural(we) will help them be less threatening to students.***
Discuss private parts: Public places are where other people can see us (school, store, etc.). Private
means away from other people, like in our bedroom or bathroom with the door closed. Everybody has
private parts of their body. We can tell which parts of our body are private because we cover them with
underwear. We dont touch our private parts in public where other people can see us. We dont ever put
our hands inside our pants in public. Sometimes we need to remember not to touch ourselves in public
so we can put our hands by our sides, cross our arms, or fold our hands. Demonstrate these motions while
showing slide. Sometimes we need to touch our private parts, like when our underwear is uncomfortable
or when we itch. We can ask to go to the bathroom. When we are alone in our bedroom or bathroom,
we can touch our private parts.
At this time a pink blank slide will appear on the screen indicating an interactive component of the
program. This will not have a title so that it will not be distracting to the students. Instructor will have
students come up and place green or red stickers on large male/female body silhouettes demonstrating
safe/unsafe touch areas they can be touched as well as safe/unsafe areas they can touch others. Use the
terms OK and Stop to distinguish safe/unsafe areas.
Provide booklets to teachers to distribute to students and/or parents. Explain to students that the booklet
is for them to use with a parent or trusted adult. It will have information on the things we talked about
today to help remind them how to take care of their bodies during puberty and to answer questions they
may have.