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Following is a long paper on puberty and ASD given in

a presentation in Florida recently.

-Draft-

Puberty, Adolescence and Autism Spectrum Disorder:

Living through the times of turmoil

Sheila Wager, M.Ed.

[An excerpt from “Inclusive Programming for High

School Students with Autism/Asperger’s in process”]

All individuals go through the adolescent angst of

puberty. Some have an easy time and sail through with

few difficulties; others turn their entire lives and

the lives of their families upside down during this

time. Students in the autism spectrum will go through

adolescent changes and experience the same increased

hormonal levels, but they usually have a very

difficult time understanding what is happening and the

reasons for it. This handout will identify some of

the problems that parents and teachers will be

experiencing with their adolescent students with

autism or Asperger’s syndrome, and will hopefully,

suggestions as to how to “live through it”.

Before going farther, let us examine the typical

adolescent student so that we can be fully grounded in

‘normal’ development. The on-set of puberty can vary

from person to person, but usually starts between the

ages of 8 and 13 for girls, and 10 and 15 for boys.

This time of turmoil can last until 18 or so. During

this time, rapid changes occur in both boys and girls.

Both experience emotionalism, tearfulness, growth

spurts, “sexual awakening”, acne and “growing pains”

and a new “awareness” of the opposite sex. Girls

experience the on-set of menstruation or ‘periods’

(usually between 9 and 16), breast development,

rounder hips and narrowing waists and areas of hair

growth – (armpits and genital area). Boys’ feet

usually begin growing first and may reach full size

quickly, outpacing their coordination. Boys’ muscle

development also begins in earnest, resulting in

larger chest size, enlarged genitalia, lower voice

tone, all over-body hair growth and the need to begin

shaving. Boys may also start experiencing nocturnal

emissions, or ‘wet dreams’ and, as with girls, may

begin to explore masturbation.

During this time, emotions are on a roller-coaster

ride, going from lethargy and the need for extra

sleep, to giddiness, tearfulness and hair-trigger

anger – sometimes all in one day! Adolescence can be

an exciting time for families watching their children

go from being a child to an adult with all the wonders

that nature can afford, or it can be hell-on-wheels

for the entire family. Those experiencing adolescence

have one foot in childhood and one in adulthood and

never really know which is suitable for any particular

time frame. This is also a time of comparing oneself

to peers – in body, attitudes, clothing fashions,

friends and fitting into the social hierarchy at

school. “Best” friends can change on a moment to

moment basis depending on what peers say or who is

being awarded the “most popular” slot. It is also a

time of testing independence and parental authority.

Adolescents push their limits and try to establish

their authority as newly formed adults.

Unfortunately, parents find this the most trying

aspect of puberty and adolescence and often do not

want to give up any of their authority to their

children. A balance between parent and child is

ideal, allowing the child to experience more and more

responsibility for their lives under gentle guidance

so they will know how to handle adult situations.

This does not always occur, sometimes resulting in

arguments, anger, strict enforcement of any & all

rules and a distancing between parent and child. The

child often doesn’t feel that he needs a parent any

longer. Contrary to their belief, this is perhaps the

most important time for parent involvement.

Adolescents still require parenting, as their push for

independence leaves them open to experimenting with

sex, drugs, new cultures and beliefs and heightened

resistance to authority figures. In 2001, CDC’s

National Center for Health Statistics reported

(6/6/02) that the rate of teen mothers, although

dropping, was 45.9 births per 1,000 females aged

15-19. Experimenting with the sexual awakening aspect

of puberty has results! The need to acquire ‘power’

and higher social status can encourage an adolescent

to challenge others that they perceive in authority.

And what makes this so dangerous? Because in the mix

of this incredible time of turmoil and uncertainty and

challenge to everything they have known previously, we

adults give them driver’s licenses. Two out of five

deaths among teens in the United States are the result

of a motor vehicle crash (CDC 1999 data) - from

driving too fast, and violating traffic laws.

According to the CDC, teen drivers were involved in

roughly 560,000 crashes resulting in death or injury

and only 33% of high schoolers used seat belts. This

push for independence can be deadly and adolescents

need parental controls more than they realize or want.

Adolescent Students with Autism Spectrum Disorders

Adolescents with ASD experience all of the same

physical changes, growth, resistance to authority and

need to express themselves as typical adolescents, but

they also have the impairments inherent in autism –

problems with socialization, communication and

behavior. This is a time that many parents of children

with autism start seeing aggression in their child.

They may find that they are starting to question their

previously-held beliefs about meds. Adolescents

within the autism spectrum also have a 25% chance of

developing seizures at this time. Adolescents with

autism display many age-typical behaviors, but do not

have the (limited) controls that typical students

have. Parents and teachers may see behaviors such as

masturbation, attraction to others (which may become

obsessions), sexual acting-out behaviors or physical

stimulation in inappropriate places, and a lack of

modesty regarding their developing bodies.

Adolescents with more severe autism will not

understand the societal norms that we all function

under and cannot understand that, if they can touch

their elbow anywhere, anytime, why can’t they touch

other parts of their bodies similarly? Parents of

girls will now have the added worry of how to handle

menstruation instruction and all that it entails.

Parents of boys may find that they are embarrassed by

their child’s frequent erections and masturbation and

not know how to handle the situation either.

Let us take each of these problems separately and

address all of the issues involved.

Seizures: All parents of children with autism

spectrum disorders need to be aware of the statistical

possibility of developing seizures beginning in

puberty. Seizures can be complex-partial or absence

seizures. They can be quite severe with loss of

control or so slight as to be unnoticeable. Teachers

and parents should consider the possibility of

seizures if the child’s behaviors change quickly, he

appears to be lethargic and sleepy for no apparent

reason, his attention wavers in class, or he becomes

argumentative or aggressive. 25% chance is

substantial – therefore, always consider this as a

cause when conducting functional analysis of behavior.

Parents will want to discuss the issue with their

pediatrician, family practitioner, or child

neurologist if there is even a hint of seizure

activity. Different types of EEG’s

(Electro-encephalograms) can be conducted (routine,

sleep-induced, 24-48 hour, etc.) to determine the

presence of any unusual brain activity.

Aggression: Children with autism often experience

turmoil during the adolescent years. If they have

been aggressive in the past, it may become more

severe; if they have never been aggressive in the

past, they may begin to exhibit aggression towards

themselves or others; or they may sail through

adolescence with no aggressive episodes at all. There

is absolutely no way to predict whether a child with

autism will display acts of aggression towards

themselves or others during puberty.

If you are witnessing aggression in an adolescent with

autism, behavior modification techniques should be

employed to help the student find other ways to

express his anger. Questions to ask yourself and the

teachers are:

1. Has anyone been hurt?

2. How long as the aggression been happening?

3. Has anyone conducted a functional analysis of

behavior? What were

the results?

4. Does my child have a consistent program?

5. Does my child already have a positive behavior

plan, and when was it

last examined for efficacy?

6. What motivators are being used with my child’s

program?

7. At what times of the day is my child most likely

to be aggressive?

8. Does my child have an effective communication

system?

9. Does my child have the support necessary to

implement a solid

behavior program?

10. What is the best guess as to why my child is

aggressive?

11. How has the school handled this aggression in the

past?

These questions can only begin to determine why the

student is aggressive. These questions (and many

more) should be asked in the early stages of

aggressive episodes, to try and prevent future

problems. This adolescent is now in puberty when all

avenues must be examined and all hatches battened down

in the hopes of riding it out. Parents will need help

from schools in particular during adolescence because

some of our teens with autism can become quite unruly

and cause serious injury to themselves or others if

left unchecked.

If the adolescent has Asperger’s syndrome, you will

have a talkative, possibly argumentative person at

this age. Aggression can still occur with this

highly-verbal individual, because puberty is making so

many changes to the person’s body and mind – and those

with AS typically have low coping skills and low

frustration tolerance. This volatile mixture can lead

to aggression. The questions listed above are still

applicable to parents and teachers who should work

together to assist the adolescent in learning new ways

to express himself.

Medications: Many parents and teachers feel that

medications are the real solution to this business of

puberty and autism. It is true that medications often

play an important role in controlling behaviors in

some individuals with ASD. Parents considering

medications as a solution should be warned that

medications are not a ‘magic bullet’ and should not be

viewed as the sole answer to a behavioral problem.

Often teachers and parents jump to medications as a

solution when a full analysis of the problem has not

been done. Inconsistencies in programming, lack of

support needed in school, inadequate teaching methods

and a myriad of other components can create a

situation evoking aggression from the adolescent. It

is not fair to medicate the adolescent when the root

of the problem lies elsewhere. Medications when used

should be viewed as a temporary fix (except in the

case of seizures or other medical conditions) to

provide time so the adults can make a full analysis of

the situation. Once a positive behavior program is

implemented and found to be effective, the physician

may wean the medications in favor of the natural

supports.

Parents wishing to inquire about medications should

first sit down and discuss the situation with a

child/adolescent psychiatrist with training in

psychopharmacology for individuals with autism. They

should learn which drugs are used for children with

autism, potential side effects of taking the

medications, and the long-term results seen in those

with an autism diagnosis. Many family physicians are

uncomfortable with administering psychiatric

medications to this population because of the

potential for adverse effects. Individuals with

autism spectrum disorders are often quite sensitive to

medications and may not respond in the manner in which

the physician expects. Therefore, it is very

important that the medications be prescribed by a

doctor with experience and training in this field.

If an adolescent is on behavioral medications, it is

very important that the school and home work together

to provide the doctor with sufficient information to

monitor the effects of the medicine over time. Too

often, the prescribing physician only has information

from the parent to rely upon when judging the

effectiveness of medication. Teachers can provide a

wealth of information by simple observational data

collection over a two-week time period prior to any

doctor’s appointments. An observational form to

assist in the medication monitoring at school can be

obtained by calling the MONARCH Program at the Emory

Autism Center.

Menstruation: Many parents of young girls with autism

fear the day that their child’s menstruation or

“period” begins because they are at a loss as to how

to teach the needed skills, the embarrassment that

might be caused by it in public, and because the

parents must face the reality that their child is

coming into sexual maturity. Fear of the mechanics of

dealing with the periods has sent many mothers to

school each month to assist their daughter in changing

sanitary pads (instead of forcing the teachers “to

deal with this”). Parent sometimes bring their

daughter home and keep them there for a week each

month. Parents also worry that this is “just one more

thing” that will place their daughters in a vulnerable

position if they are not there to assist. Those with

daughters with severe autism profiles sometimes seek

medical intervention, including medications that can

prevent the onset of the periods. In extreme cases,

surgical intervention such as hysterectomies has been

performed in the past as a remedy. Parents with

daughters that have milder cases of autism or

Asperger’s syndrome realize that their child may cause

great embarrassment to those around them if they speak

aloud comments relating to their periods such as “time

to change my pad”, or informing all around them that

they have begun their period that day. These kinds of

statements do not usually go over well in middle or

high school classrooms, and parents and teachers alike

worry about the social damage to the adolescent when

these ‘private’ issues are discussed in public.

Without doubt, menstruation is a serious area for

parents to worry about. However, parents and teachers

are encouraged to relax, take a deep breath and

discuss what can be done about this area.

First of all, menstruation is a natural part of the

human female body and should be viewed as just another

‘rite of passage’, just as wisdom teeth, the need to

purchase brassieres, and the need to start wearing

deodorant. This is just one more ‘routine’ that will

need to be taught to the person and should be viewed

as such – there’s nothing fearsome about it – it just

needs to be taught. The most important component of

this whole issue should come way before the on-set of

the periods themselves. Planning how you will teach

the skills should be done well in advance of the onset

of your daughter’s periods. One of the easiest ways

to help prepare a young girl for the onset of her

period is to initiate her into wearing panty-liners in

the year before you expect them to start. By

desensitizing her with wearing panty-liners, she will

be ready to wear the heavier sanitary pads when

needed. Experiment with several styles, types and

brands so that she will be able to accept any form of

panty-liner or pad later on. When first teaching her

to wear the panty-liner, she should be taught to

follow these steps:

-the location of the panty-liners (cupboard, purse,

etc.)

-ALWAYS go into the bathroom, shut (and lock) the

door

-how to pull the paper strip off

-how to secure it onto her panties

-when and how to remove it

-how to carefully fold it into halves or thirds

-how to wrap it with toilet tissue

-where to throw the used pad after wrapping

-how to secure the new pad

Most individuals with autism are visual learners. If

this is the case with your daughter, make up a visual

list of the steps that are needed and place it on the

wall in the bathroom. Many non-verbal, severely

autistic adolescent girls have been taught to become

fully independent with their periods through the use

of picture cues. Mayer- Company has pictures

that may be useful in teaching the steps for

menstruation, but parents may want to draw their own

pictures with natural cues as a part. Use

reinforcement in teaching your daughter these

important steps. As with other routines, independent

management of menstruation requires positive

programming and heavy reinforcement for appropriate

completion. Motivators can be attached to this

routine like any other behavioral routine taught in

the home and school. This is no different! It can be

‘scheduled in’ to a picture schedule at the same times

each day to develop a comfort level surrounding the

teaching. Menstruation should be viewed objectively

by all involved. Emotionalism should be avoided since

the person with autism may pick up on the tension

projected by others, begin to reflect it in herself,

and view the whole procedure negatively. Stay calm,

provide clear instructions and praise her for

accomplishing this ‘rite of passage’ into adulthood.

Teaching the adolescent girl what she should be doing

each month may take a long time. All steps should be

broken down and assistance in the way of

demonstration, verbal and physical cues may be

necessary to help her better understand. Although it

may be a lengthy process with some adolescents, it may

be surprisingly quick with others. Patience and a

full understanding of the individual’s profile of

autism and cognitive functioning will determine the

level of instruction needed for this important aspect

of growing up.

Ob-Gyn Exams: Along with menstruation comes the

on-set of Ob-Gyn visits, which can be enough to strike

terror in the minds of typical adolescent girls, much

less girls with ASD. Many of our female adolescents

with this disorder are terrified of doctors and are

totally resistant to visiting a physician’s office –

let alone taking their clothes off and having an

intimate exam. However, Pap Smears are recommended if

the adolescent is sexually active, or yearly from age

18 on so parents with daughters that have autism will

be facing this issue sooner or later. Routine breast

exams and pap smears are extremely important to

physical health, and it is very important that

adolescent females with autism are able to participate

in these medical procedures without traumatic results.

A full desensitization procedure may have to be

implemented with a cooperative nurse or physician.

This procedure involves the slow introduction of the

patient to the doctor’s exam room and all that it

entails over the course of months, and sometimes

years. The steps of this procedure should be broken

down into the tiniest parts and explained as they are

introduced to the patient. How long this whole plan

lasts will depend on the adolescent and her

understanding of what is happening. If the adolescent

with ASD has cognitive impairment or her social

judgement is severely limited, it may be best to

choose a female doctor for this entire process, to

prevent her from having to judge which males may have

access to her intimate parts of her body and who must

not. This may be an injustice to male physicians, but

it is probably best to err on the side of caution in

the cases of patients with ASD.

Masturbation: As part of puberty and sexual

awakening, adolescent boys and girls begin to explore

their bodies and discover what wonderful things can

happen when they engage

in certain physical actions. This is part of the

normal human condition and should be viewed as a part

of entering adulthood. Unfortunately, many of those

with an autism spectrum disorder do not understand

that these feelings and actions are to be kept

strictly private, such as inside a locked bathroom or

bedroom, and that they are an individual sport, not a

participatory sport! Those with an autism disorder do

not often experience embarrassment, leading them to

perform private actions in public. As a result, our

adolescents with this disorder may inappropriately

touch themselves in classrooms, hallways, in public

malls or restaurants, during the family meal and in

front of stuffy grandparents or aunts & uncles

resulting in flustered teachers, students, parents and

relatives. The extent of their touching may be

through the outside of the clothing or inside of it.

It is not entirely their fault, though. Their bodies

are under-going dramatic changes and appears, at

times, to be almost daring the person to engage in

masturbation. Adolescent boys begin to think that

their genital area is taking on a life of its own and

surprising them when they least expect it. As part of

the normal process of puberty, boys who are developing

along typical lines will experience erections without

even thinking about anything sexually stimulating.

They can occur at the most inopportune times –

surprising and embarrassing the young man horribly.

Typical boys learn quite quickly that they need to

duck into the nearest bathroom until they can get

themselves under control, pull their shirt out from

their pants to then hang over their waist (and below),

or to turn away from people quickly and start thinking

about anything or everything that they feel is gross

or unpleasant in the hopes that it will have an effect

on their “privates”.

As amusing as this seems to adults, typical

adolescents can sometimes feel as if they are ‘doomed’

when unexpected sexual reactions occur in embarrassing

places. Peer relations can be destroyed as a result

and a person can go from being a popular person to a

‘perv’ and outcast in a matter of moments. This is an

area that is fraught with problems.

Adolescents with an autism disorder are also going

through the same physical changes and urges, including

the frequent and unexpected erections of typical

males. The problem is, they may not be affected by

the ‘embarrassment’ factor and, instead of ducking

into a bathroom or quickly adjusting their clothing to

hide the fact, they may instead try to relieve the

physical feelings wherever they happen to be through

touch or stimulation. The touch, since it is highly

reinforcing, can result in a brief touch only, or

proceed to full masturbation. If this problem is

present in your classroom or home, then it is best to

take the ‘bull by the horns’ and address this issue.

If it has happened once in public, then it will happen

again. Ignoring it is not a solution. If the

receptive language of the adolescent is such that they

will understand explanations about what is happening

to their bodies, then the adolescent should be

provided with information and concrete directions as

to what to do and where to do it. Many adolescents

with autism or Asperger’s will need concrete rules

about what they can touch in public and what they

cannot. You may have to accompany your concrete rules

with a behavior plan which reinforces them for

“appropriate” touching during set intervals of the

day. Allow them to ask to go to the bathroom when

needed and teach them how to do so appropriately in

the middle of the classroom or day. Oftentimes, young

men learn that this is an interesting and pleasurable

way to pass the time of day and may ask to “use the

bathroom” numerous times a day. If that is true, then

you may have to set a finite number of times that they

are allowed to go into the bathroom.

In all cases, adolescents with an autism disorder

should be taught the difference between “public” and

“private”. Since this is an abstract concept, it may

be difficult for them to understand what you mean by

public and private so you will have to use various

means to help them understand, including using

pictures of each setting, writing out lists of what

falls in each category, defining people in each

setting, and writing social stories to help them

better understand. Parents and teachers should put

their heads together to write up an instructional plan

for teaching public and private definitions and how

best to get the adolescent to understand each

environment.

Along with the definitions of public and private,

parents and teachers should also decide on how to

handle the situation when masturbation, erections,

indiscreet talking about the subject in public, etc.

occurs. It is important NOT to place blame on the

adolescent or cause them to be fearful of normal body

reactions, but to assist them to better control it.

How should you handle it when they place their hands

deep into their pockets during math? What will you

say to redirect the student without causing attention

to be drawn to them, or causing them to become upset

and flustered? Let’s take one example: A student

with Asperger’s syndrome is attending general

education science class. At one point in the lesson,

the teacher notices that his hand is in his pocket.

The teacher is certain that he is engaging in

self-stimulation. The teacher calls on the student

next to this person to answer a question (in the hopes

that it will distract the student from this activity).

If this doesn’t work, then she can call on this

particular student to bring his book to the front of

the room to show his work, call on him to answer a

question or any other action which will divert his

attention back to the lesson without causing any

embarrassment or problem. After the class is over,

she may retain the student and tell him that she

wishes to talk to him after school, where she (and

another teacher) will discuss the incident in private

and work out “secret signals” that can be given to him

if it occurs again. A behavior plan can be attached,

if necessary. This may be enough to eliminate the

behavior from happening again. If it doesn’t, it will

set the stage for a team meeting with the parents to

decide on how to proceed.

Although masturbation is a normal occurrence of

adolescence, it can, undoubtedly, cause problems,

embarrassment and frustration for all involved,

including the adolescent. Students have been

eliminated from mainstreaming and inclusion

programming because of it, and opportunities for both

adolescents and families have been lost because the

adolescent has not been taught how to manage the

situation. Avoiding the issue will not solve the

problem either. Please, do not hesitate to discuss

any occurrence of public masturbation with parents or

the IEP team. The level of embarrassment will only

get worse as the adolescent ages.

Attraction to the Opposite Sex: Again, like typical

adolescents, our adolescents with autistic disorders

can also become enamoured of the opposite sex at this

time of life and want some level of contact with them.

Although they face impairment in social understanding

and judgement, their hormones do not! One mother

stated that all of a sudden, her son went from

the Tank Engine to talking non-stop about a current

teen idol! If the level of contact with the person

they are attracted to stays within the ‘talking’

stage, there may be no problem. But if it goes beyond

that, such as the student with ASD following her

everywhere, writing notes to her, telling everyone

that “she is my girlfriend”, then there is a problem.

When a student with ASD becomes overly emotionally

attached to a peer, it may be uncomfortable for the

peer. We have had many typical students who

understand the situation and have taken guidance from

teachers on how to handle or deflect the young men (or

girls). Unfortunately, sometimes the typical peer

does not so understand and may lodge complaints with

the administration because she (or he) feels that the

student with ASD is a ‘stalker’ and they want it

stopped immediately. The situation may escalate to

verbal discussions, verbal warnings, in-school

suspension, class changes to avoid the person, more

restrictive placements, or even out-of-school

suspension if the problem is not resolved. In the

most severe cases, some of our students with ASD have

been formally charged with stalking. This has also

happened with some adults with Asperger’s syndrome as

well, because no one ever defined who (or what) a

‘girlfriend’ is, who is not a ‘girlfriend’, how to

tell the difference, and what behaviors are acceptable

if you find you are attracted to someone of the

opposite sex.

How do we solve this situation? Again, it is best to

start defining relationships to students with autistic

disorders BEFORE they reach adolescence. If they do

not understand by this age, parents and teachers

should quickly develop an instructional plan to avoid

future problems. The plan will have to be geared to

the cognitive levels of the student so that they fully

understand. Jeannette McAfee’s Privacy Circles is an

excellent strategy that places family members,

relatives, friends, classmates, etc., all on a

concrete drawing of concentric circles (with the

adolescent in the middle) allowing the student to see

what behaviors are allowed in front of the people on

each level. The parents can define the categories in

any useful way and make it clear to their child what

behaviors are allowed in each environment.

If re-directions and intensive behavioral programming

are not preventing the problem, or if the systems in

place take too long to become effective, it may be

necessary to impose complete control over the

student’s access to the particular student to prevent

problems from re-occurring. This is always a

worst-case scenario and should be avoided by teaching

the student with autism appropriate interactions with

those he or she is attracted to.

Zits, skin care and grooming: Students with ASD also

suffer from acne during adolescence, but parents may

find that their child is resistant to instruction on

how to care for their skin for various reasons. This

may involve the smell or texture of the medicine used

to treat it. In hindsight, it is always easier to

teach the child good grooming skills prior to the

crucial period of adolescence, but it can also help to

desensitize them to applying lotions, creams or

anti-acne medications or increase their own level of

skin care pre- and post-adolescence. It may be easier

to have the adolescent visit the physician or

dermatologist to introduce them to the options for

skin care and good grooming skills and to have the

“instructions” taken from the doctor, rather than from

the parent, if there is resistance to parental

controls. Parents may also find themselves setting

strict “bedtime rules of the house” to insist that the

adolescent take a shower regularly. Regular bathing

is necessary in adolescence when the rise in hormone

levels causes increased sweating and body odor.

Behavior plans and visual schedules are sometimes

written to encourage the adolescent to comply with the

rules, and are then rewarded with strongly preferred

motivators, such as money for renting a movie or video

game once a week, movie outing, or a trip to a

favorite restaurant. Motivators can certainly assist

the parent to improve their adolescent’s daily

hygiene. Adolescent girls with ASD may become better

with their grooming skills when it includes special

moisturizers, make-up, certain perfumes, even

manicures and pedicures. A promise of a facial or a

trip to the hairdresser at the end of the week may be

enough to encourage good grooming skills.

Vulnerability: Students with ASD who are arriving at

puberty have new feelings and awakenings, and are

vulnerable to those that have evil intentions.

Because of the impairment in social judgement,

adolescents with ASD cannot detect those who will take

advantage of them. Sometimes the behaviors that the

impaired adolescent exhibits are a result of natural

sexual feelings and actions but which may result in

inadvertent overtures to others, setting the stage for

being lured into situations which will likely harm

them. Sexual abuse of individuals with disabilities

is all too common. Parents who fear this may remove

adolescents with ASD from inclusion or mainstreaming

programs. This is unfortunate because it eliminates

the proximity but does not teach the adolescent how to

handle the situation. Those adolescents with this

disability who appear to be acting towards others in

an inappropriately suggestive or sexual manner need

supervision and instruction to better prepare them for

a safe adulthood. Predators are in every level of

society; prevention through supervision and

instruction is the best hope of protection for our

individuals with ASD or other disabilities.

Depression: Adolescents with ASD are not immune to

depression by any means. In fact, 70% of adolescents

with Asperger’s syndrome are on antidepressant

medications. Often this is because the adolescent

understands that they are ‘different’ from the other

students and they do not know what to do about it.

They want and need friends, but their impairment in

the social domain limits their understanding of what

social behaviors are necessary to gain them.

Adolescents with ASD try hard to ‘fit in’ but make

social blunders due to their limited social insight,

turning off the other students. This causes

frustration, anger, tearfulness, increased isolation

and yes, depression. The depression can become so

severe that they begin to talk about harming

themselves. As they are also ‘concrete’ thinkers,

this can create panic among parents and teachers, and

rightly so. It is not wise to dismiss comments about

suicide or talk about harming themselves. Parents

should be immediately notified. They may want to

discuss the situation with their physician. In the

cases of suicidal ideation, over-reaction is better

than under-reaction.

If you as a teacher notice that one of your adolescent

students is depressed, the parents should be notified

immediately and plans should be made to alleviate the

situation. Try to figure out what is driving the

depression. Does this student have any friends? What

can be done about this? What about peer programs?

Does he or she have any interest areas which you may

be able to capitalize upon to build friendships? What

about a peer or teacher mentor? Solving this

situation is paramount to the mental health of the

adolescent with ASD. The situation can be turned

around when parents and teachers work together to

solve the depression.

Adolescents with ASD are truly a wonderful lot! Yes,

it can be a time of turmoil and angst, but often the

emotional roller coaster settles down once the person

has emerged on the other side of adolescence. His

behaviors can settle down and he can once again be a

calm, rational being. But don’t miss this period of

growth – you will learn more about your child, autism

and Asperger’s syndrome by going through it, than by

missing it! Only a few of the issues that you will

face are outlined here in this handout. There are a

myriad of other behaviors and physical events that may

occur in your child’s or student’s life. It is hoped

that you will continue your search for information in

order to better inform yourself of all that will be

brought forth by adolescence and puberty.

Author’s Note: The male gender has been used for the

most part, in this handout when discussing numbers of

adolescents with ASD. This is not meant to slight the

females in our midst, but is representing the

statistical majority of ASD, and for ease of writing.

References:

CDC – National Center for Health Statistics for 2001,

Vol. 50, No. 10, 1-20.

McAfee, Jeannie, (2001). Navigating the Social World:

A Curriculum for Individuals with Asperger’s Syndrome,

High Functioning Autism and Related Disorders. Future

Horizons, Arlington, TX.

__________________________________________________

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>

> Thanks ,

> Following is a long paper on puberty and ASD given in

> a presentation in Florida recently.

Thank you SO much for sending this

article!! This is the best one i've ever

read on this type of information!! I'm gonna

make copies for my daughters school to bring

with me for her IEP meeting on Tuesday!! (so,

perfect timing!!)

thanks again! :)

~nancy

single mom to:

joshua 17 (nt)

jenna 9 (autism, ocd)

rachelle 4 (nt)

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