Professional Documents
Culture Documents
ASD - Puberty
ASD - Puberty
Latrobe University
Project supervisor, Dr Diane Jacobs,
Pauline Greenwood,
Amanda Harris,
Shelly Newton,
and all the other parents of children with an ASD
who generously shared their experiences but
wished to remain anonymous.
Written by:
Elizabeth Ford
Gabriella Ptasznik
Megan Blumberg
Samantha Clayton
Sara Beeching
Contents
Introduction ............................................................................................................................. 1
Physical Changes- Information for Parents .......................................... 2
What are the physical changes that occur during puberty? .......................... 2
Talking to your child about puberty .............................................................................. 2
Strategies to use when talking to your child about
Puberty .......................................................................................................................................... 3
Menstruation .............................................................................................................................. 4
Strategies to prepare your daughter for her period ............................................ 4
Talking about ejaculation with your son .................................................................... 4
Strategies to help your child with hygiene, including wet dreams ............. 5
Talking to your child about the importance of hygiene..................................... 5
Strategies to help your child develop healthy hygiene
routines ......................................................................................................................................... 6
Masturbation .............................................................................................................................. 6
Physical Changes- Information for Girls ................................................... 7
What is puberty? .................................................................................. 6
Physical changes for girls..................................................................... 7
Pimples ................................................................................................ 7
Keeping clean ...................................................................................... 7
Guide to showering ............................................................................ 8
What is a period .................................................................................. 8
Menstruation step by step .................................................................... 8
Masturbation ....................................................................................... 9
Guide to feminine hygiene.................................................................... 9
Physical Changes- Information for Boys ............................................... 10
What is puberty? .............................................................................. 10
Physical changes for boys ................................................................ 10
Pimples .............................................................................................. 10
Keeping clean .................................................................................. 10
Guide to showering ............................................................................ 11
Different dreams ................................................................................ 11
My penis ............................................................................................ 11
Voice changes ................................................................................... 11
Masturbation ...................................................................................... 11
Step by step masturbation.................................................................. 12
Social Changes- Information for Parents.............................................. 13
Social changes during puberty ........................................................... 13
Social interest .................................................................................... 14
Strategies to help your child with social skill
development ...................................................................................... 14
Liking someone more than a friend .................................................... 15
Strategies to help your child with romantic relationships .................... 16
Stalking .............................................................................................. 16
Strategies to help your child deal with stalking
behaviours ......................................................................................... 16
Touch ................................................................................................. 16
Strategies to help your child deal with good touch
verses bad touch ................................................................................ 17
Masturbation management and private verses public
places ................................................................................................ 17
Strategies to help your child with private verses public
places ............................................................................................... 19
Social Changes- Information for Adolescents................................. 20
Liking someone differently to how you like a friend ............................ 20
Signs that people show when they are your friend ............................. 20
Signs of disinterest ............................................................................. 20
Stalking .............................................................................................. 21
Defining touch .................................................................................... 21
Things that should be done in private with no other
people around (girls) .......................................................................... 22
Things that should be done in private with no other
people around (boys) ......................................................................... 22
Masturbation management................................................................. 23
Places that are okay to masturbate .................................................... 23
Places that are not okay to masturbate .............................................. 23
Circle of friends activity ...................................................................... 24
Emotional Changes- Information for Parents ................................... 25
Mood changes ................................................................................... 26
Emotional awareness and regulation ................................................. 27
Strategies to help your child distinguish between different emotions .. 28
Regulating mood ................................................................................ 29
Strategies for helping your child to regulate their mood ...................... 29
The Alert Program .............................................................................. 29
Understanding the emotions and perspectives of
others ................................................................................................. 30
Strategies for increasing empathy and understanding
of other people‟s perspectives ............................................................ 31
Depression ......................................................................................... 31
Symptoms of depression in neurotypical individuals .......................... 32
Possible behaviours reflective of symptoms of depression
in individuals with an autism spectrum
disorder .............................................................................................. 32
Strategies to help lowered mood in adolescents with
an autism spectrum disorder .............................................................. 33
Anxiety ............................................................................................... 33
Strategies for parents to decrease anxiety-provoking
situations for individuals with an autism spectrum
disorder .............................................................................................. 34
Girls- PMS and emotional changes .................................................... 36
Strategies for managing the emotional symptoms of
PMS ................................................................................................... 36
Anger, aggression and problematic behaviours.................................. 36
Factors that may cause/worsen aggressive or
problematic behaviours ...................................................................... 37
Strategies for managing problematic behaviours................................ 38
Medications to manage problematic behaviours................................. 38
Self-identity and self-esteem .............................................................. 39
Strategies to encourage self-identity and self-esteem ........................ 40
Bullying .............................................................................................. 41
Strategies to manage bullying ............................................................ 41
Emotional Changes- Information for Adolescents ..................... 43
Understanding personal emotions – Happiness ................................. 43
Understanding personal emotions – Sadness .................................... 43
Understanding the emotions and perspectives of
Others ................................................................................................ 43
Managing Behaviour – Becoming angry ............................................. 44
Visual schedule: When you get angry or frightened ........................... 44
Visual schedule: When you feel worried or nervous ........................... 44
Managing PMS .................................................................................. 45
Managing Bullying .............................................................................. 45
Increasing self-identity and self-esteem ............................................. 45
Useful Contacts ................................................................................................................ 46
References ............................................................................................................................. 47
Introduction
This resource has been developed to provide parents, families,
friends and caregivers information to assist teenagers with an Autism
Spectrum Disorder (ASD), including Asperger‟s Syndrome and
Pervasive Developmental Disorder Not Otherwise Specified
(PDDNOS) to recognize and manage the emotional, physical, and
social issues that individuals diagnosed with an ASD will encounter
during puberty.
This resource has been designed to fill the gap that has been found
to exist in current information and data. Investigations determined
that the vast majority of the information available regarding changes
in adolescence for the HFASD population was a) directed to
professionals, parents, and care-givers of teenagers with an ASD,
and b) discussed predominately physical changes and masturbation.
In addition to investigating the available research literature, 13
parents of both male and female adolescents with a diagnosis of an
ASD were interviewed. These interviews identified that parents had
difficulty discussing puberty with their child, particularly the
associated physical changes in a way that was meaningful to
adolescent with an ASD. Parents also highlighted concerns regarding
a focus on negative or problematic issues relating to puberty and
adolescents with an ASD. All parents reported that being able to
easily access an appropriate resource addressing the physical,
emotional, and social changes would be of great benefit.
Introduction
1
PHYSICAL CHANGES- milestones occur in the same
succession for all individuals; however,
INFORMATION FOR the age at which they occur often
PARENTS varies significantly (Marieb & Hoehn,
The physical developments (sexual 2007).
and body changes) that occur during
adolescence occur alongside For males, the major event that
important psychological and social proclaims the onset of puberty is the
changes that mark this period as a enlargement of the testes and scrotum
critical stage towards becoming an between the ages of 8 and 14 (Marieb
adult (WHO,2011). The continuity of a & Hoehn, 2007). Following this, the
familiar routine is vital for individuals penis starts to grow and the young
with an Autism Spectrum Disorder man will start to become sexually
(ASD) as they have particular difficulty mature. This is frequented by
coping with change. Thus, in order to unexpected and often embarrassing
relieve the pressure and stresses of erections and „wet dreams‟ (sexually
understanding the changes that are orientated dreams which cause the
taking place it is essential young man to emit semen during his
to explain sleep) as a consequence of surging
to your levels of testosterone.
child the
processes For females, the initial sign of puberty
that are is evidenced by budding breasts which
occurring appear between the ages of 8 and 13
during this (Marieb & Hoehn, 2007). This is
time. followed by armpit and pubic hair. The
young woman‟s first period may occur
approximately two years later.
This material is designed to assist
you and your child with…
1. Understanding how the body Talking to your child about puberty
changes during puberty, including: Typically, the time at which an
General body changes adolescent, even without an ASD,
Menstruation goes through puberty can be stressful
Masturbation for all family members. Although, when
2. Understanding good hygiene a child has an ASD, these stressful
practice times are compounded and may
become more complex. (Artclesbase
2008).
What are the physical changes that
Physical Changes
2
how much preparation time he/she If you notice that your child
needs to understand the changes frequently asks questions at
associated with puberty (The National inappropriate times, it may be
Autistic Society, 2011). helpful to establish a fixed
response, which can be utilized
by all family members. For
To ensure that your child is example, a response may
adequately prepared for the include; „That‟s a fantastic
changes that will occur/ are question, but let‟s talk about it
occurring, you may inform your child when we are at home‟ (National
from a young age that you are Children‟s Bureau, Sex
always available to talk about any Education Forum, 2003). Ensure
questions he/she might have that you do revisit your child‟s
regarding their body. This will serve question when you return home,
to highlight that pubertal changes otherwise your child may be
are part of a normal occurring hesitant to ask you questions in
physical process and he/she should the future (The National Autistic
not be ashamed. These preparatory Society, 2011).
conversations will also help
maintain your child‟s self confidence Always answer in a positive tone
so that your child feels
(The National Autistic Society,
comfortable to approach you
2011).
again (Autism Society of
America, 2011).
When explaining different female
Strategies to use when talking and male body parts be sure to
to your child about puberty use the correct medical
terminology as abstract concepts
Expect your child to ask a variety
are particularly difficult for many
of awkward „why‟ questions. It is
individuals with an ASD to
particularly important with
comprehend (Autism Society of
children with an ASD that you try
and stay patient and sensitive America, 2011).
when answering their questions. Ensure that you frequently
(National Children‟s Bureau, Sex remind your child that he/she
Education Forum, 2003). should be happy with their body.
Always be honest with your child. It is helpful to view puberty as
It is also okay to just say „I don‟t just another step of your child‟s
know‟ or „how about we look it up developmental process.
together‟ (The National Autistic
Physical Changes
3
MENSTRUATION Make a mark on your daughter‟s
Menstruation (when a underwear to indicate exactly
girl gets her period) is where the sanitary pad should be
the principle stage of placed in her underwear.
female puberty. It is
one of several physical Go to the supermarket with your
signs that a girl is daughter and ask her to choose a
developing into a grown variety of different sanitary pads
woman. Your daughter with you.
may be excited or even Watch a video about
feel afraid or anxious menstruation online;
prior to getting her first http://kidshealth.org/teen/sexual_
period. During health/girls/
adolescence, most girls
have very little understanding of how When your daughter gets her first
the reproductive organs function which period, plan a party to celebrate
causes this change to be even more her entry into womanhood.
confusing (Kids Health, 2011).
4
While talking to your son Ensure that you use a calm and
about erections may be sensitive voice when explaining
an awkward and what has happened (Autism
uncomfortable topic to Society America, 2011).
approach, especially if your
child has an ASD, it is Relate „wet dreams‟ and erections
imperative to explain these to the other changes he is noticing
events prior to them with his body during this time.
occurring. Remind him that all these changes
are normal and help him grow into
a man (Autism Society America,
Strategies to help your 2011).
child with hygiene,
including wet dreams Talking to your child about the
The majority of Individuals with an importance of hygiene
ASD have greater strength in Accompanying the aforementioned
learning with visual material. physical pubertal changes that occur
Therefore, you may find it useful to both young females and males
to take pictures that relate to some comes new and often unfamiliar daily
of the steps that are included in hygiene routines. Thus, educating
the visual aid in order to ensure adolescents about hygiene skills is
that the aid is as familiar and pivotal as they learn the importance of
effective as possible. Once you modesty, responsibility and self-care.
have taken the appropriate photo This is especially crucial throughout
you may want to stick them beside puberty as cleanliness is a contributing
the steps already provided. For element to their health and self-
example, it may be useful to take confidence.
a photo of your child putting on
deodorant or washing their face.
Use the tailored tales provided in
this resource to discuss the basic
physical changes that occur with
puberty.
Remind your son that ejaculation,
„wet dreams‟ and masturbation are
all perfectly normal (Autism
Society America, 2011).
When your child has an erection
Physical Changes
5
teasing your son/daughter that he/she to having friends
smells bad. It is for these reasons that may encourage
ensuring your child forms healthy your child to focus
hygiene routines is critical. on complying to a
healthy hygiene
routine (American
Strategies to help your child Autism Society,
develop healthy hygiene 2011).
routines
Be sure to be specific and precise
when communicating with your
Use the visual aids provided to child. For example, reiterate that if
help show your child a healthy your child smells like sweat,
hygiene routine in a sequential people will not want to be around
format. him/her (American Autism Society,
2011).
Model the steps of the visual aid
for your child.
MASTURBATION
Place the visual aid in the location A behavioural result of surging
where they are most likely to be testosterone and oestrogen levels in
used. For example; place the young males and females is
showering visual aid on the masturbation. Don‟t be alarmed if your
bathroom wall or on the outside of adolescent child masturbates as it is a
the shower. perfectly normal and expected
behaviour.
Associate hygiene behaviours and
routines to something concrete. It is best to assure him/ her
For example, highlight the that this is normal and
significance of personal hygiene to encourage him/her to
your child by explaining that in masturbate in a private place. If you
order for him/her to have friends, notice that your adolescent child is
he/ she needs to make sure they masturbating constantly you should
stay clean (American Autism seek help from your family doctor.
Society, 2011). You may continue
by stating exactly what needs to
be done for this to occur. For Additional strategies and
example; brush your teeth every information regarding how to talk
morning and before you go to bed, to your child about masturbation
have a shower every day and wear are provided in the social section of
Physical Changes
6
PHYSICAL CHANGES- BODY CHANGES
My body shape will change.
INFORMATION FOR
ADOLESCENT GIRLS HEIGHT
I will grow taller
WHAT IS PUBERTY?
HIPS
My hips will widen
I once was a child but now I am
growing up. My body is changing as I
GROWING BREASTS
become an adult, this is called puberty.
I will notice small bumps underneath
Pubertal changes are different for boys
my nipples which may feel slightly
and girls.
tender. My breasts will continue to
grow and I will need to wear a bra. A
PHYSICAL CHANGES FOR GIRLS bra will support my breasts.
I was once a baby, then I was a girl.
I am now an adolescent, which means GROWING HAIR
I am becoming a woman and I will I will grow hair in places where there
notice some changes with my body. was none.
I will start to grow hair on my private
areas and under my arms. In the
beginning my hair may be thin and soft
but as I grow older it may get thicker. I
may want to shave the hair under my
armpits. This may help me in keeping
this area clean.
PIMPLES
When I am growing up I may notice
red spots on my face, these are called
pimples. I can wash my face to keep
my skin clean. I may need to put some
cream on my pimples, this may feel
different, that is ok. It is best if I leave
these spots to go away.
KEEPING CLEAN
Childhood During Adulthood I will notice that I am sweating more
Puberty
than I use to because my sweat glands
Physical Changes
7
Deodorant will help stop my body period every 28 days, sometimes it
smelling badly. I can also carry may be sooner or later, this is ok.
deodorant in my bag just in case I feel When I get my period blood comes out
that I am sweating too much and I am through my vagina. A few days before
starting to smell. I get my period I may feel more upset
about things; I might feel angry, I might
STEP BY STEP IN THE SHOWER feel sad, I might feel frustrated or I
FOR GIRLS might feel other emotions.
1. I will wash my face, arms, Feeling this way is normal and usually
stomach, feet and legs with stops when my period starts.
soap and a face-washer My breasts and stomach may feel sore
2. I will wash under my armpits at this time. This is normal. Placing a
with soap hot water bottle on my stomach and
3. I will wash around my vagina having some pain relief medication
with soap may help me feel less sore.
4. After the shower:
I will dry my armpits with If your child experiences any of
a towel these emotional changes
I will dry my vagina with a mentioned above, please refer to
towel the “emotional” section of this
I will put deodorant under resource.
my armpits If your child experiences pain,
5. I will get dressed into clothes please amend as appropriate,
that are clean. e.g. heated wheat bag for hot
water bottle etc.
The above routine may be adapted
for your child specifically. For I may have my period for 4 to 7 days. It
example, if your child performs may be shorter, that is okay. If it is
other routine based activities during/ longer than 7 days I will talk to an adult
after her shower time ie. Using that cares about me. When I first get
pimple cream or putting her towel in my period it may only come every few
the laundry, this may be added. months but as I get older it may come
more regularly (Better Health, 2011).
You may find it useful to take pictures I will need to use a pad or a tampon so
that relate to some of the steps that my clothes don‟t get stained. These
are included in the visual aid in order come in many different shapes and
to ensure that the aid is as familiar and sizes.
effective as possible. Once you have Periods are private. I may want to talk
taken the appropriate photo you may about my period with my good friends
want to stick them beside the steps and parents. This is ok. I should only
Physical Changes
already provided. For example, it may talk to these people about my period.
be useful to take a photo of your child
putting on deodorant or washing their MENSTRUATION STEP BY STEP:
face. I will change my pad at least every four
hours.
WHAT IS A PERIOD? I will wash my hands.
As my body changes and I become a I will go to the toilet and close the door.
woman I will get my period. I will pull down my underwear and sit
A period is also known as on the toilet.
menstruation. Most women have a
8
I will take the dirty pad off my me too, I need to make sure that the
underwear. person I am touching likes it as much
I will wrap the dirty pad up in toilet as I do.
paper.
I will put the dirty pad in the bin. Additional information
I will un-wrap a clean pad. regarding good touch and
I will take the sticky strip off. bad touch is included in
I will stick the clean pad in my the social section of this
underwear. booklet.
I will wipe my vagina with toilet paper.
I will pull up my underwear.
I will wash my hands.
MASTURBATION
As my body changes, I will start to feel
new sensations that feel nice. I may
touch parts of my body because it
feels good. This is okay. This is
private and should be done only in a
private place. For example; my
bedroom with the door closed or my
bathroom with the door closed. Other
people may dislike me talking about
masturbation, so I will keep it private.
9
PHYSICAL CHANGES- HEIGHT
I will grow taller
INFORMATION FOR
ADOLESCENT BOYS MUSCLES
I will grow muscles in my arms, legs,
WHAT IS PUBERTY? chest and all over my body. This will
I once was a child but now I am make me stronger and heavier.
growing up. My body is changing so I
can become an adult, this is called GROWING HAIR
puberty. These changes are different I will grow hair in places where there
for boys and girls. was none. I may start to grow hair on
my face, private areas, under my
arms, on my back and on my legs. The
Pubertal changes may occur at hair on my body may grow thicker as I
varying rates and times. Your child get older.
needs reassurance that these
changes are normal and they may The hair on my face may feel strange,
not develop at the exact same rate this is ok. If it is uncomfortable I can
as their friends talk to mum or dad about shaving with
a razor and cream or with an electric
PHYSICAL CHANGES FOR BOYS razor. If I don‟t shave the hair on my
I was once a baby, then I was a boy. face I may grow a beard and
I am now an adolescent becoming a moustache.
man and I will notice some changes
with my body. PIMPLES
When I am growing up I may notice
red spots on my face, these are called
pimples. I can wash my face to keep
my skin clean. I may need to put some
cream on my pimples, this may feel
different, that is ok. It is best if I leave
these spots to go away.
KEEPING CLEAN
I will notice that I am sweating more
than I use to because my sweat glands
are becoming more active. Sweating is
when my body releases small amounts
of fluid in order to make sure I am not
too hot. I may notice this when it is hot
Physical Changes
10
I am sweating too much and am my dad‟s, uncles, or grandfather‟s
starting to smell. voice. When my voice first starts to
change, it may sound squeaky or
croaky. This is normal. Later my voice
STEP BY STEP IN THE SHOWER may sound like a man‟s voice sounds.
FOR BOYS
1. I will wash my face, arms, MY PENIS
stomach, feet and legs with My penis will grow longer and thicker.
soap and a face-washer My testicles (balls) will also get bigger.
2. I will wash under my armpits I will begin to have erections. This
with soap means my penis will get larger and
3. I will wash around my penis with harder. Erections may happen at any
soap time, this is normal, all my male friends
4. I will pull back the foreskin may also have this happen. I may
gently and clean under it need to cover my erection. Other
5. After the shower: people would prefer it if I did this.
I will dry my armpits with
a towel
I will dry my penis with a Ensure that your child understands
towel that this may occur at any time or
I will put deodorant under place. However, he should know
my armpits that this is normal and is expected
6. I will get dressed into clothes (Better Health, 2011).
that are clean.
DIFFERENT DREAMS
The above routine may be When I am sleeping I may have a
adapted for your child specifically. dream and when I wake up I might find
For example, if your child performs that my sheets are sticky and wet, this
other routine based activities is called a wet dream. When I have a
during/ after his shower time ie. wet dream I should always wash my
Using pimple cream or putting his testicles (balls) and penis when I wake
towel in the laundry, this may be up. Wet dreams happen to lots of boys
added. and men.
11
When I touch myself, semen might
come out of my penis. This is normal. I
should use tissues to clean myself and
throw them in the bin when I am
finished and then wash my hands.
12
SOCIAL CHANGES- For example, the vocabulary chosen,
and the length of information contained
INFORMATION FOR in tailored tales or visual aids (e.g.
PARENTS charts, schedules) can be altered
The transitions and changes that occur depending on the level that the
during puberty can be a difficult time individual‟s parent or guardian feels
for all adolescents and can be will be most appropriate.
especially difficult for children with an
ASD for various reasons. A number of
changes will take place; in addition to SOCIAL CHANGES DURING
the physical changes previously PUBERTY
discussed in this resource, Individuals with an ASD typically
adolescence is a time of social exhibit difficulty with social skills, thus
change. Most children with an ASD impacting upon their ability to
have difficulty adjusting to this establish meaningful social
transformation (Teens Health, 2011). relationships with others (Morris,
Thus, the continuity of a familiar 2008). For example, many
routine is vital. In addition, explaining adolescents with an ASD may have
the changes that will occur will make difficulty simply having a conversation
this time of development easier. Using and understanding how others think
this resource will assist adolescents and feel (Workforce Council, 2011).
with understanding and coping with the
changes that are occurring in their Please note: Not all adolescents
evolving bodies and minds. with ASD will have difficulty
building and maintaining
This material is designed to work relationships. This may not apply to
towards your child understanding your son/daughter.
the following objectives…
1. Liking someone differently to how As a parent of an individual with an
you like a friend ASD, it is normal for you to have
2. Signs of disinterest concerns regarding your child‟s social
3. Defining touch functioning, particularly during
4. Who is appropriate to touch? puberty. It may be especially
5. Things that should be done in frustrating for you when you notice
private for both girls and boys that your child is trying to create and
6. Appropriate places to Masturbate maintain friendships, but is often
Social Changes
13
signs of being more than a friend, others will be discussed later on in
good touch versus bad touch, and this section. Signs of interest and
knowledge of their circle of friends. signs of disinterest can be explicitly
taught to children with an ASD using
lists, examples, and pictures.
14
exposure to social situations that interests. Problems will arise if
your child feels comfortable with. teenagers with an ASD do not use
subtlety when expressing their feeling.
LIKING SOMEONE MORE THAN A Consequently, other teenagers may
FRIEND react badly (Attwood, 2009).This may
Individuals with an ASD may have be embarrassing and cause teasing
trouble developing relationships amongst friendship groups (Attwood,
(Attwood, 2009). One of their main 2009).
difficulties is being able to identify how
someone else may be feeling (Nichols,
Moravcik & Tetenbaum, 2009). Children with an ASD find it
Usually, individuals develop this skill challenging to build and
naturally through having practice and maintain romantic relationships as they
experience with family members and are likely to have limited social and
friends. These acquired skills naturally communication skills.
assist the development of a romantic
relationship. However, children with an
ASD may have limited social skills,
Strategies to help your child
poor communication skills and a
with romantic relationships
reduced ability to communicate
emotions. Therefore, their capacity to
maintain a long term romantic Explicitly teach your child how
relationship is impacted (Attwood, others may be feeling. This
2009). includes explaining that most
teenagers are embarrassed about
Even though the adolescent with an having a crush or developing
ASD may have difficulty understanding romantic relationships.
others emotions and communicating
their feelings, it is still possible for In order to form solid social skills, it
them to develop a romantic is crucial to assist your child in
relationship. However, it is likely to be developing friendship skills from a
more difficult for them than it is for young age. In addition, this will also
others. aim to improve self-esteem. Thus,
assisting them in developing
romantic relationships appropriately
When developing a romantic in the future.
relationship, it is important that your
child understands the importance of It may be useful to use the tailored
Social Changes
15
will serve to further consolidate including types of behaviours that may
their experience and skills when be seen as stalking.
next striking up a conversation. For
example, pretend to be the boy/girl
your child has a „crush‟ on while Strategies to help your child
your child practices conversing with deal with stalking behaviours
you appropriately.
Your child may need to be
constantly reminded of
STALKING appropriate and inappropriate
behaviour after each social
As mentioned above, children with situation they encounter.
an ASD often have trouble
perceiving verbal and nonverbal
You may want to provide explicit
communications from others
and visual instructions, including
(Mesmere, 2007). If your child has
appropriate and inappropriate
trouble perceiving others, it is
behaviours to your chid.
possible that they may make poor
judgement decisions such as
It may be useful to utilise the
touching someone who may not want
tailored tales provided in this
to be touched, following someone
resource to assist you in
when they may not want to be
describing these behaviours to
followed, or calling someone
your child.
continuously when they may not
want to be called (Legal Aid, QLD,
1997). This can be misinterpreted by Pictures and videos may be
others as stalking. beneficial in order to teach
appropriate and inappropriate
Amongst all the social skills required behaviours such as stalking.
throughout puberty, appropriate
boundaries are a crucial skill.
Teaching your child these types of TOUCH
boundaries will ensure fluid social It is important to explicitly teach the
encounters in the future, avoid difference between good touch and
embarrassing situations and will bad touch to your adolescent with an
prevent them from getting into ASD.
dangerous circumstances. Personal
boundaries are frequently a problem Good touch is something that friends
for children with an ASD, particularly and family may do to show their
Social Changes
during puberty (Betts & Patrick, affection for one another. These
2008). touches may include; a handshake to
say hello, a hug or a kiss. A bad touch
Usually, children learn appropriate is something that feels
and inappropriate behaviours wrong or
through discussion and social uncomfortable,
situations. However, children with an such as a
ASD need a more precise and clear- stranger asking
cut explanations (Betts & Patrick, for a kiss
2008). (Goulstein,
It is important that your child 2010).
understands boundaries,
16
explore one‟s own body (Better
Health Channel, 2011). Many males
It is important that your child begin masturbating between the ages
understands the difference of 13 and 15 years (Better Health
between good touch and bad touch. Channel, 2011). The onset among
female masturbation occurs more
gradually. These statistics are for all
Strategies to help your children including individuals with an
child deal with good ASD (Morris, 2008).
touch verses bad touch
Masturbation is an uncomfortable
The difference between good topic when discussed with anyone,
touch and bad touch should be including parents, friends, or within
discussed. someone‟s own family.
It is important to explain to your
child that a touch may be a good As your child grows and develops,
touch for one person, but the they will begin to discover their
same touch may be a bad touch bodies. As Sex hormones become
for someone else. For example, active during puberty; many
one person may like to be tickled adolescents begin to have
(this is a good touch), whereas pleasurable and excited feelings
someone else may not enjoy about their bodies. It is important that
being tickled (this is a bad touch). you understand that your child with
an ASD, like all children may be
Explicit and visual instructions attracted to and interested in other
including appropriate and people‟s bodies during this pubertal
inappropriate touching needs to transformation. It is important for you
be given to children with an ASD. to understand that these feelings are
For example shaking someone‟s normal. They may be difficult for your
hand to say hello can be shown as child to describe and they may be
a good touch. Whereas you may difficult for you to describe to your
show videos to highlight the child. It is essential that you explain
effects of a bad touch. For to your child that these feelings will
example, someone being tickled happen at different times and in
when they do not want to be. different ways for all boys and girls
(Morris, 2008).
Modelling appropriate touching
with peers and adults has also Your child should not feel
been reported to be helpful in
Social Changes
17
daughter is able to understand the Strategies to help your
appropriate social cues associated child with private vs.
with these behaviours (Haywood & public places
Saunders, 2010). Typically,
adolescents understand that It may be useful to utilise the
masturbation is a private behaviour to tailored tales in this resource to
be done in a private place. In assist you in describing private
addition, they commonly understand and public places to your child.
that these matters should not be Pictures or photos can be used as
discussed with everyone or in a a way to visually demonstrate the
public area. In comparison, difference between private and
individuals with an ASD may be public places
unaware of the reactions of others.
They may continue to discuss an It may be beneficial to use videos
uncomfortable topic despite the in order to inform your child about
negative reactions of others (Morris, the importance of privacy.
2008). They might naturally start
touching themselves in public and Compare masturbating to another
may not realize that it is wrong experience that he/she does by
(Haywood and Saunders, 2010). This himself/herself in private, such as
is certainly a pivotal topic to address taking a shower or using the
with your child. restroom. It is essential to teach
private and public places when
Possible reasons for inappropriate your child is young.
masturbation include: It is important to teach your child
- No structured routine and time private versus public places.
made available for masturbation Private places should be
- Not enough education about described as one‟s bedroom or
privacy bathroom, where he/she is alone.
- Not enough opportunity during Contrastingly, a public place
the day for privacy should be explained as a place
- There may be no locks on where other people reside.
bedroom doors to provide privacy
- Parents or siblings and other Teaching your child appropriate
residents may not respect the times and places to masturbate
privacy of another person‟s will be beneficial in order to
bedroom ensure that he/she does not begin
masturbating in public.
Social Changes
18
You may wish to play a game in
order to consolidate your child‟s
ability to differentiate between
private and public places. For
example, in your house, instruct
your child to run to a private/public
place and hide. You may then go
and find him/her. Once you find
he/she is found, ask him/her why
that particular place was chosen
as a private or public domain.
You may find it useful to take
photos that relate to your child‟s
own private and public places.
This will ensure that the aid is as
familiar and effective as possible.
Once you have taken the
appropriate photo you can stick
them beside the lists of private
and public places that have
already been provided. For
example, it may be useful to take
a photo of your child‟s bedroom,
or a familiar shopping centre.
Social Changes
19
SOCIAL CHANGES- If people show me these signs then it
is appropriate for me to continue
INFORMATION FOR talking to them.
ADOLECENTS
If there are any other signs of
LIKING SOMEONE DIFFERENTLY interest you feel appropriate to
TO HOW YOU LIKE A FRIEND mention, you may add them to the
A friend is someone I know very well. list above.
My friends care about me and I care
about them too. I trust my friends and
they trust me. Sometimes I may want
to have a special friendship with SIGNS OF DISINTEREST
someone. I may start to feel different Looking away
about them. I may not be able to stop Moving away
thinking about them. I may think this Looking unhappy
person is attractive and they are not Turning away
related to me. I may like them to be my from me
boyfriend / girlfriend. It is okay to feel Crossing their
this way but they may not always feel arms
the same way about me. Sometimes it Doesn‟t listen to
is hard to know if someone feels this me
way about me. I should know that just
because someone is being friendly to If people are showing me these signs I
me does not mean that they like me should stop talking to them and leave
like a special friend and want to be my them alone because these people are
boyfriend / girlfriend. not interested in talking to me.
20
STALKING Shaking somebody‟s hand when I
Stalking is when I follow someone meet someone new
around, to their house, to school or
any places they often go (Farlex, Bad touch is something that make me
2011). feel confused and uncomfortable
For example;
If someone is stalking me, they will When someone I don‟t like more than
constantly; a friend touches me in my private
areas
- Follow me Someone hitting me
- Comes over to my house over When someone touches me and
and over again, even though I makes me feel unsafe or
don‟t want them to uncomfortable
- Call me or speak to me over When someone kisses me when I
and over again, even though I don‟t want them to
don‟t speak
- Send me messages over and It makes a difference WHO is giving us
over again, even though I don‟t the touch
send messages back to them Hugs, kisses and touches from people
- Make me feel uncomfortable I know and love can be GOOD
touches.
If someone is doing this to me, it is not BUT the same touches from people I
right and I should tell a grown up. don‟t know and love can be BAD
touches.
Sometimes I may like someone and
feel like I want to spend a lot of time Although I enjoy touching myself and
with them but they may not feel the sometimes may enjoy others touching
same way about me because they me, I need to make sure that the other
may not want to spend time with me person that I am touching likes it as
like I want to spend time with them. much as I do.
They may not return my calls or invite Please note, if you know your
me over to their house. I should not go child does not feel comfortable
over to their house if I am not invited. being „pat on the back or hugged‟
customize the tailored tales to be
If I do go to their house or follow them, appropriate for your child
that would be wrong. specifically.
Social Changes
DEFINING TOUCH:
Good touch and bad touch:
Good touch is something that makes
us feel happy and comfortable.
For example;
When I hold hands with my friends
When I hug my parents
When my teacher pats me on the back
for doing great work
21
THINGS THAT SHOULD BE DONE in
private WITH NO OTHER PEOPLE
AROUND (GIRLS):
Pee or Poo
Having a shower
Picking your nose
Scratching private parts
Changing your pad (a pad is
what I put on my underwear
when I have my period. This
stops my clothes from getting
dirty when I have my period.)
Masturbating
Changing clothes
22
MASTURBATION MANAGEMENT PLACES THAT ARE NOT OKAY TO
As my body changes, I will start to feel MASTURBATE:
new sensations that feel nice. I may Places with people around
touch parts of my body because it Other rooms in the house that
feels good. This is okay. are not my bedroom or the
I should masturbate in private places bathroom.
so that no one can see me. Just In class
because it is a private place does not In shops
mean I have to masturbate every time At friends houses
I am there. In the car
At the park
Some children with ASD may
misinterpret this to mean they
must always need to masturbate Please amend the list to suit you
when in a private room and may and your child‟s needs.
need clarification should this Masturbation in public is not
occur. something all children with ASD
will do, therefore it may not be
PLACES THAT ARE OKAY TO appropriate to discuss this with
MASTURBATE: your child.
In my room with the doors and
blinds closed so no one can see
me
On the toilet with the door
closed
In the shower with the door
closed
In the bath with the door closed
In the shopping centre toilet
with the cubical door closed
23
Circle of Friends Activity
Self: This is me.
Family: These are the people who live at home with me.
Extended family: These are the people who are my family but don‟t live in my home
with me. For example; my grandmother, my grandfather, my aunty, my uncle and my
cousins.
Friends: A friend is different to an acquaintance. A friend is someone I know very
well. My friends care about me and I care about them too. I trust my friends and they
trust me.
Acquaintances: There is a difference between being an acquaintance and a friend.
An acquaintance is someone whose name I know, who I see every now and then,
whom I might have something in common with and who I feel comfortable around.
For example; I might see this person only on the train and not in my home.
Teachers: These are the people who stand in front of the class at school and teach
me things.
Helpers: These are the people who help with things that I find difficult.
Servers: These are the people who work in shops like cafes, restaurants or clothing
stores. It is their job to serve customers like me
Strangers: A stranger is someone I do not know, I do not know their name and I
have never seen them before.
INSTRUCTIONS:
* Discuss with your child who falls into each circle
* Discuss what level of touching contact should occur with each individual
* This activity will help highlight to your child which people are appropriate to touch
and which are not.
Social Changes
24
EMOTIONAL CHANGES- our own abilities), can emerge or be
worsened by puberty in individuals
INFORMATION FOR with an ASD (Diagnostic and statistical
PARENTS manual of mental disorders, Forth
The transitions and changes of edition – Text Revision (DSM-IV-TR)
adolescence can be a difficult time for American Psychiatric Association
all adolescents, and can be especially (APA), 2000; Branden, 1992; Harre &
difficult for children with an ASD for a Moghaddam, 2003; Volkmar &
number of reasons. A number of Wiesner, 2009).
changes will take place; in addition to
the physical and social changes Thus, in order to relieve the pressure
previously discussed in the Physical and stresses of understanding the
and Social sections of this resource, changes that are taking place it is
adolescence is a time of emotional essential to explain the processes that
change. are occurring during this time.
25
(e.g. charts, schedules) can be altered Bipolar II Disorder: one or more
depending on the level that the Major Depressive Episode
individual‟s parent or guardian feels accompanied by at least one
will be the most appropriate. Hypomanic Episode (elevated
or irritable mood over the
MOOD CHANGES course of at least four days that
There are a number of disorders that does not meet criteria for Manic
involve a disruption of mood, or the Episode).
“pervasive and sustained emotion that
colours the perception of the world” Cyclothymic Disorder: at least
(DSM–IV–TR; APA, 2000, p. 825). two years of periods of
These mood disorders include: Hypomanic symptoms that do
not meet criteria for a Manic
Major Depressive Disorder: one Episode and numerous periods
or more Major Depressive of depressive symptoms that do
Episodes (at least two weeks of not meet criteria for a Major
depressed mood or loss of Depressive Episode.
interest accompanied by at
least four additional symptoms Bipolar Disorder Not Otherwise
of depression – see Symptoms Specified: bipolar symptoms
of depression in neurotypical that do not meet criteria for any
individuals for more of the specific Bipolar
information). Disorders.
26
than their neurotypical peers (Volkmar Specific examples of
& Wiesner, 2009). problematic behaviours
In individuals with ASD and a and strategies to help manage these
comorbid intellectual disability problematic behaviours will be
or difficulty communicating, discussed later on in this section.
changes in mood can
commonly take the form of
irritability, tantrums, or self- Many of the problems caused by these
injury (Volkmar & Wiesner, mood changes stem from difficulties
2009). with awareness and regulation of
emotions (Geller, 2005).
In individuals at the higher-
functioning end of the autism
spectrum, mood changes are Emotional awareness and
often demonstrated through regulation:
difficulty adapting to change, Emotional awareness refers to our
trouble concentrating, or ability to identify which emotion we are
depression (Volkmar & feeling and the reason for it; emotional
Wiesner, 2009). regulation refers to the ability to
manage and control our emotions, as
Although these mood changes can well as our ability to express them
often resemble those associated with (Geller, 2005; Matson & Sturmey,
bipolar disorder (periods of 2011). Emotional regulation can
hyperactivity alternating with periods of include maintaining a particular
decreased activity or depression), it emotion, increasing or decreasing the
has not been proven that individuals extent to which we feel an emotion, or
with an ASD are more likely to changing an unwanted emotion into a
experience bipolar disorder (Tilton, different one. Regulating your
2004; Volkmar & Wiesner, 2009). emotions can take place while you are
feeling that emotion, or before you
Mood changes in adolescents with begin to feel it (Geller, 2005).
ASD can cause (or worsen)
problematic behaviours such as Individuals with an ASD often have
temper tantrums and aggressive difficulty regulating their emotions
behaviour. These behaviours may (Matson & Sturmey, 2011). The
interrupt the individual‟s social reasons include:
relationships, academic participation, Having difficulty or requiring
and can even be harmful to more time to process
Emotional Changes
27
Having difficulty telling different For example, if the individual
emotions apart. For example, appears to be happy, discuss the
they may see all negative or emotion of happiness as the way
unpleasant emotions as fear. you feel when something good
happens or when you feel good
Having difficulty choosing inside; discuss that it often makes
appropriate facial expressions, you smile or laugh; discuss the
or knowing when to use them, reason that you think that they
to express their emotions to are happy (i.e. if they are smiling,
others. laughing, or doing something that
they enjoy).
Due to the above mentioned
difficulties, an individual with an ASD Begin by practicing identifying
may require help to understand and more common emotions, such as
practice the skills involved in emotional happiness, anger, fear, surprise
regulation. To be able to use strategies and tiredness. When the
to regulate or improve their mood, an individual is able to reliably
individual must first be able to identify these emotions, progress
recognise the emotion that they are to more complicated emotions
feeling, and determine (if possible) such as excitement, jealousy,
what caused this emotion. Some trust, disappointment, love,
adolescents with autism will embarrassment, and sympathy.
understand this concept already, some
will learn to identify emotions quickly, There are a number of children‟s
and some will require help to practice books available that encourage
this skill before they are able to use children to identify their own
strategies to regulate their emotions emotions and provide strategies
independently (Geller, 2005). to help them manage their
emotions appropriately; for
example: Shy Spaghetti and
Excited Eggs: A Kid's Menu of
Feelings (Nemiroff & Annunziata,
Strategies for helping your child 2011) and My Roller Coaster
to determine between emotions Feelings Workbook (Herbert,
Use tailored tales to illustrate Herbert & Herbert, 2008).
situations or events that can
cause a particular emotion. Increasing an individual with an ASD‟s
For example, to illustrate awareness of their emotions has been
happiness, create a social story shown to help them change and
about being happy: “When regulate these emotions (Matson &
Emotional Changes
28
reducing behaviours that will disturb or (e.g. too much noise, movement,
harm themselves or others. language, etc) and the pressure
of social interaction, which may
cause or worsen their distress.
your body down - this will then energy levels as a car engine:
help your brain calm down and Explain to the individual that
you will feel better”. their body is like a car engine –
Encourage the individual to walk sometimes it runs slowly and
away from the object or situation doesn‟t want to get going,
that is distressing them, or find a sometimes it runs too quickly,
quiet place to sit for a little while – and sometimes it runs just at
this will allow them to escape the right speed.
excessive sensory information
29
Say: “Your engine seems to be ideal level of alertness and energy
in low gear today – I can tell (either with prompting or
because it looks like hard work independently), and may learn to
for you to get going”, or “Your independently identify when their
engine seems to be in a really energy levels are either too low or too
high gear today – you‟re talking high to allow them to function as
really fast and it looks like it‟s effectively as they can (“Alert
making it a bit hard for you to Program™ Founders”, 2007,
concentrate”, or “Your engine September/October).
seems to be running just right at
the moment – you can Although the concepts may be too
concentrate properly on what complex for some adolescents with an
you‟re doing”). ASD, this program may still be useful
in allowing adults or peers (including
The language and concepts parents, teachers, friends, or other
involved in this analogy may be students at school) to communicate
too complicated for the about the individual‟s energy levels
individual, or may not interest (“Alert Program™ Founders”, 2007,
them. If the individual has a September/October).
particular interest that you can
use to represent their levels of More information about this program
energy and alertness, or if they can be found at The Alert Program
already refer to their energy website (www.alertprogram.com).
levels in a particular way, you
may be able to use this
language instead of the engine
analogy. Understanding the emotions and
perspectives of others
Once they become familiar with the As well as experiencing difficulty with
concept of their energy levels the process of identifying and
changing throughout an activity, interpreting their own emotions, people
establish a visual list of strategies that with an ASD may have difficulty
will help the individual either increase picturing things from someone else‟s
or decrease their energy levels point of view, and understanding the
(Williams & Shellenberger, 2006). thoughts and feelings of others; this
These strategies will differ from ability is referred to as Theory of Mind
individual to individual; however, here (Bernier & Gerdts, 2010; Goldstein,
are some examples: Naglieri & Ozonoff, 2009).
To increase energy levels: jump
up and down ten times, do ten
Emotional Changes
30
overload and withdrawal caused going to the football. Now I
by their empathetic reaction to the understand why Sarah was
other person‟s emotions, or an upset.”
inability to understand the other
person‟s social signals (such as Use everyday situations as an
facial expression, body language, opportunity to encourage
tone of voice, topic maintenance, individual to see situations from
eye contact) and respond in a another person‟s perspective.
socially acceptable way (Serhan, Throughout your day, tell the
2011). individual how you are feeling,
and why you are feeling that way.
Difficulties with empathy and After some time, you can start to
understanding different perspectives ask them to describe how they
can lead to problems with social think you might be feeling about
interaction and the formation of certain events.
interpersonal relationships (Goldstein For example: “I dropped my piece
et al., 2009). There are several of toast on the floor! How would it
strategies that parents, guardians and make you feel if that happened to
caregivers can use to encourage the you?”
development of empathy.
DEPRESSION
Adolescents who are on the autism
spectrum have been shown to have a
Strategies for increasing
greater risk of depression (for
empathy and understanding of
symptoms of depression, see below)
other people’s perspectives
than their neurotypical peers.
The strategies outlined in
Depression is more commonly
Strategies for helping your
diagnosed in individuals at the higher
child to determine between
functioning end of the autism
emotions are also useful in
spectrum; however, this may be due to
helping individuals with an ASD
the difficulty in detecting and
understand the emotions of
identifying the symptoms of depression
others.
in individuals at the lower-functioning
end of the spectrum, especially in
Develop tailored tales about individuals who do not communicate
deliberately thinking about things verbally (Nichols, Moravcik & Pulver
from someone else‟s perspective. Tetenbaum, 2009; Volkmar, Paul, Klin
For example, create a social story & Cohen, 2005).
about a class trip to the museum:
“My friend Sarah really wanted to
Emotional Changes
31
Social section of this resource) mean Recurrent thoughts of death or
that, although they generally want to self-harm
make friends and form social
relationships, they may not know The symptoms of depression in
which behaviours are socially individuals who are on the autism
acceptable and which social spectrum are essentially the same as
behaviours will help them achieve those of their neurotypical peers.
these relationships. This may lead to However, while some individuals will
social isolation, which can also cause display similar behaviours to
or worsen depression (Volkmar et al., neurotypical individuals with
2005). depression, a depressed individual
with an ASD may frequently behave
However, there are signs for parents, quite differently than the typical
guardians, caregivers and teachers to perception of people with depression
watch for, and actions that can be (Goldstein et al., 2009; Nichols et al.,
taken to treat and manage depression 2009).
if it does occur.
32
(refer to the Useful contacts professionals at this service in
section of this resource for order to facilitate a referral if
contact information) immediately appropriate.
to discuss options for managing
the individual‟s depression. If either you or the individual‟s
teacher have suggestions
If the individual has not regarding the cause of the
commented about self-harm or individual‟s symptoms, or factors
suicide, but does exhibit one or that may be worsening their
more of the above signs of apparent depression, discuss ways
depression, it is still important to to manage these factors with
contact the child‟s GP or a mental school staff and Child and
health professional as soon as Adolescent Mental Health Service
possible. professionals. For example:
1. Commencing social skills
If you have concerns regarding the training/exercises can help the
individual‟s mood, there are several individual form social relationships.
strategies that you can use, often in 2. Becoming socially involved in a
conjunction with the individual‟s hobby/area of interest can also
teachers. help with the formation of social
relationships.
3. Having a mentor or tutor may assist
your child in coping with the
demands of their schoolwork.
Strategies to help lowered
mood in adolescents with an If the individual is being bullied,
ASD refer to Self-Identity and Self-
Contact the individual‟s teacher(s) Esteem later in this section of the
and ask them: resource for ways to manage this
1. Whether they have observed (Goldstein et al., 2009).
any of them symptoms or
behaviours that you have
observed at home.
2. Whether they know of any ANXIETY
reasons for the individual‟s There are a number of disorders that
apparent depression/change in are categorised as Anxiety Disorders;
mood (for example, whether these include Generalized anxiety
they have many friends; how disorder, Panic disorder (with or
effectively they interact socially without agoraphobia), Agoraphobia
with their peers; whether they without history of panic disorder,
are being bullied; whether their
Emotional Changes
33
especially adolescence, individuals on
the autism spectrum have been shown Strategies for parents to
to have a greater risk of anxiety decrease anxiety-provoking
disorders than their neurotypical peers situations for individuals with
(Goldstein et al., 2009; Nichols et al., an ASD
2009). Many individuals on the autism
spectrum rely on routine and
The most common anxiety disorders structure, and may become
that occur in individuals with an ASD anxious or distressed if their
are: routine is interrupted (Volkmar et
Specific Phobias: defined as a al., 2005). Maintain a daily routine
marked, persistent, and at home and school as much as
excessive or unreasonable fear possible.
of a specific object or situation
(APA, 2000, p. 444). Displaying a visual timetable of
Examples of specific phobias daily activities (including: get up,
can include fear of have a shower, get dressed, have
thunderstorms, dark places, or breakfast, brush teeth, etc) may
large crowds (Goldstein et al., help many individuals with an
2009). ASD keep track of what they
need to be doing, and will
Adolescents with an ASD may also reassure them as to what will be
suffer from: happening next (Barratt, Cassell
Panic Disorder: recurrent, & Hayes, 1998).
unexpected “panic attacks” (a
discrete period of intense fear When you need to change the
or discomfort in the absence of individual‟s routine, discussing
real danger), followed by at the new activity with them in
least one month of persistent advance is generally helpful.
concern about having another Small changes to the routine may
panic attack, worry about the be discussed with the individual
implications of the panic attack, the day or several days before.
or significant behavioural On the day, introduce the new
change related to the attacks activity or setting into the visual
(APA, 2000). schedule for the day, to allow the
Social Phobia: marked and individual to see how the activity
persistent fear of social or fits in to the day‟s activities, and
performance situations in which when the schedule will return to
embarrassment may occur normal (Barratt et al., 1998).
(APA, 2000).
Emotional Changes
34
change too far in advance will another teacher with a message if
cause anxiety instead of relieving their anxiety levels appear to be
it (Wilkes, 2005). When deciding rising. The individual and their
when to begin preparing the teacher may even be able to
individual for the upcoming develop a signal to allow the
change, consider whether individual to signal that they are
knowledge of upcoming changes feeling anxious or overloaded
has helped the individual accept with sensory information without
changes to their routine in the attracting attention to themselves
past. (Attwood, 1998; Volkmar et al.,
2005).
As individuals on the autism
spectrum may have difficulty Cognitive Behaviour Therapy
understanding the socially (CBT) can also help to prevent or
acceptable ways of initiating, reduce anxiety in individuals on
maintaining and ending a the autism spectrum (Attwood,
conversation, social interaction 1998; Volkmar & Wiesner, 2009).
can cause significant anxiety This method of therapy is
(Volkmar et al., 2005). Providing delivered by trained
a particular place that the psychologists, and aims to
adolescent can go to that is free change or restructure the way an
from social or conversational individual thinks and the
interruption will help decrease or behaviours that occur as a
prevent this anxiety (Attwood, reaction to the way they think. It
1998; Volkmar et al., 2005). can help increase reasoning skills
and the ability to interpret
Engage the individual in an situations appropriately, which
activity that requires physical decreases worrying, and
exertion (e.g. a trampoline or behaviours caused by anxiety
swing) – this can decrease (including avoidance of certain
anxiety and agitation (Attwood, situations, or an increase in
1998; Volkmar et al., 2005). repetitive behaviours) (Butler,
Fennell & Hackmann, 2010). You
At school – discuss with teachers can discuss whether or not CBT
whether the individual can access would be appropriate for the
somewhere quiet during times of individual with their GP or
anxiety or stress at break-time. paediatrician.
Being able to spend some time
without excessive sensory input
or social interaction may prevent
Emotional Changes
35
first two weeks, Sarah feels fine. In
GIRLS- PMS AND EMOTIONAL the third week, she starts getting
CHANGES headaches, feels tired, and has
Adolescent girls on the autism trouble concentrating, and gets
spectrum will still experience the same annoyed more often. She knows
range of symptoms of PMS, including that this means she will probably
associated emotional symptoms (such get her period in a few days. She
as irritability, difficulty concentrating, knows that these feelings will go
depression, anxiety, withdrawal from away, and that she will soon feel
social situations, difficulty sleeping, or better.”
excessive time spent sleeping) as their If you have started/plan to use the
female neurotypical peers. However, if Strategies for helping your child
your daughter has difficulty to regulate their mood with your
communicating or with regulating her daughter, describe the girl using
emotions, the emotional symptoms the strategies when she felt
that she experiences may result in annoyed to make herself feel
monthly incidences or increases in better.
behavioural problems (Nichols et al.,
2009). If your daughter‟s PMS symptoms
seem to be severe or are
preventing her from completing
normal activities, contact her GP to
discuss medical and other options
Strategies for managing the
for managing these symptoms
emotional symptoms of PMS
(Nichols et al., 2009).
Explain to your daughter the range
of symptoms that may be
associated with PMS.
ANGER, AGGRESSION AND
Understanding why these
PROBLEMATIC BEHAVIOURS
symptoms are occurring and how
The problems in social interaction and
long they are likely to last for will
communication experienced by
help increase your daughter‟s
individuals on the autism spectrum
sense of stability and control over
frequently lead to expressions of
these changes to her body (Nichols
feelings through behaviour. The
et al., 2009).
expression of frustration, anger, or fear
in individuals on the autism spectrum
Use specific language and can often take the form of behaviours
terminology and avoid that are disruptive, aggressive and
colloquialisms when explaining violent (Fouse & Wheeler, 1997).
these symptoms. For example, say
“you might have a sore stomach”
Emotional Changes
36
Behavioural reactions to particular some individuals become
emotions can vary widely between defensive or aggressive with
individuals on the autism spectrum. even a slight touch, or may
For example: have problems with touch on a
An individual on the high- particular area of the body (e.g.
functioning end of the autism palms of the hands), or with
spectrum may display anxiety particular textures. Some
by fidgeting, nervousness, individuals may prefer
muscle tension, or excessive increased levels of sensory
giggling (Fouse & Wheeler, information, and may require
1997). textured clothing or objects to
An individual with a moderate provide them with sensory
intellectual disability on the stimulation. Tantrums or
autism spectrum may display behavioural problems may be
their anxiety through increased the individual‟s way of
movement and activity, expressing their dislike of a
excessive giggling or crying, or particular type of sensory
making strange or loud noises information (Tilton, 2004).
(Fouse & Wheeler, 1997).
An individual with a severe Social pressure and
intellectual disability with an expectations: difficulty knowing
ASD may respond to their which behaviours are socially
anxiety through temper acceptable, as well as those
tantrums, screaming, violent that are socially expected, can
behaviour, or by withdrawing cause anxiety, as well as
from the situation and “shutting agitation and frustration, in
down” (Fouse & Wheeler, individuals on the autism
1997). spectrum. These emotions can
often translate into aggressive
or violent behaviours (Fouse &
Factors that may cause/worsen Wheeler, 1997).
aggressive or problematic Communication difficulties:
behaviours similarly, difficulty
As a parent, guardian, or carer of understanding what is being
individual on the autism spectrum, the said to them or difficulty
task of determining the reason for the expressing themselves can also
problematic behaviour or the message cause distress and frustration in
that the individual wishes to convey these individuals (Fouse &
can be very difficult. However, there Wheeler, 1997). This often
are a number of factors to consider results in aggressive or violent
Emotional Changes
when looking for the cause of the behaviour, but alternatively may
behaviour: cause some individuals to
Sensory issues: individuals on withdraw from social situations
the autism spectrum may react (Tilton, 2004).
differently to the sensations of
touch, sight, hearing, smell and Deviation from routine and
taste, and may have structure: just as changes to
behavioural issues surrounding routine can cause anxiety, they
any of these senses (Fouse & may also cause frustration,
Wheeler, 1997). For example, temper tantrums, or other
37
aggressive behaviours. asking an adult for help) with
Similarly, interrupting an pictures for the individual to follow;
individual‟s repetitive behaviour explain that they should try to
patterns can often cause follow the list instead of reverting to
frustration and aggression temper tantrums or other
(Fouse & Wheeler, 1997). problematic behavioural habits.
When the problematic behaviour
occurs, encourage them to follow
the list, and reward them with
Strategies for managing praise and/or an activity they enjoy
problematic behaviours (Dodd, 2005).
If the individual is able to
communicate verbally, encourage Look for patterns: does the
them to tell you what is wrong so problematic behaviour always
that you can understand why they occur in the same situation, or
are behaving in this way. Through every time they are exposed to a
their aggression, the individual may particular sight, sound, smell, taste,
be trying to tell you they need or touch or texture? If you can identify
want something (Dodd, 2005). a sensory issue that they have with
Although it is difficult do not get a particular object or situation, you
angry or yell. The individual should can then avoid or modify the objet
not feel like they are being or situation, and hopefully eliminate
punished for trying to communicate the problematic behaviour (Fouse
with you, but that there are nicer & Wheeler, 1997).
and more efficient ways to
communicate their wants and
needs.
Medications to manage problematic
If the individual is not able or willing behaviours
to stop and communicate with you At this point in time, no medications
about what is distressing them, the have been proven to treat or decrease
best thing to do during the tantrum the severity of the primary difficulties
itself is wait, and try to minimise the associated with an ASD (Volkmar &
risk of harm to themselves or Weisner, 2009). However, there are
others (Fouse & Wheeler, 1997). currently a range of medications
available that may be able to reduce or
Tailored tales (for example, the relieve some of the symptoms
story about dealing with anger associated with an ASD (these
described in Strategies for symptoms including depression,
helping the individual to anxiety, hyperactivity, agitation,
determine between emotions) aggression, obsessions and
Emotional Changes
38
If the individual experiences They may experience difficulty
symptoms of ASD (these with being different from
symptoms including depression, their peers, and determining
anxiety, hyperactivity, agitation, how they fit in with and relate to
aggression, obsessions or their peer group (Nichols et al.,
compulsions) that are severe. 2009).
39
Online autism chat groups and in. It will also encourage the
discussion boards, such as the development of social skills, which
Autism Support Network is likely to help their self-esteem in
(http://www.autismsupportnetwo the long run (Gabriels & Hill, 2008).
rk.com/) or Healthful Chat
Autism Chat Room Encourage the individual to
(http://www.healthfulchat.org/aut consider their likes, dislikes,
ism-chat-room.html) personality, and how they would
describe themselves to others. One
way to do this is to help them
create an „All About Me‟ book –
Strategies to encourage self- include pictures of things they like,
identity and self-esteem pictures of friends, hobbies and
Discuss with the individual the fact achievements. You can also
that everybody is different, and that discuss words that they would use
is what makes us interesting as to describe themselves, and
people. People can look different, include these in the book (Nichols
speak differently, think differently or et al., 2009).
act differently to one another, and
There are also books available
that is fine. Discuss the idea that,
(including Can I Tell You about
although they may feel different to
Asperger Syndrome?: A Guide for
the other children at school, or
Friends and Family by Jude Welton
people might tell them that they‟re
and Jane Telford, and a number of
different, they are not the only ones
other books available at Book In
who are different (Serhan, 2011).
Hand: Autism and Asperger‟s
Convert the above discussion into Supplies -
a social story that you can read http://www.bookinhand.com.au/ind
together. ex.html), that discuss common
characteristics and behaviours of
The individual may benefit from individuals on the autism spectrum,
becoming involved with others with and may help to prompt the
an ASD, especially other individual to consider their own
adolescents. This will allow them to personality traits and behaviours.
gain a greater understanding of
autism itself and the ways that it It is important to understand that it
can affect different people, and to may take individuals on the autism
share their own experiences with spectrum longer than their
an understanding audience. It will neurotypical peers to develop a
also provide them with true sense of who they are and
opportunities to interact with others what they are worth (Serhan,
Emotional Changes
40
Bullying Strategies to manage bullying
Bullying involves being repeatedly Discuss with the individual what
exposed to negative actions on the bullying is. Give specific examples
part of one or more other individuals; of behaviours that are considered
this may include physical aggression bullying, including: physical
(e.g. hitting, pinching, pulling hair, aggression (e.g. hitting, pinching,
kicking, anything that involves hurting pulling hair, kicking, anything that
part of their body); verbal abuse (e.g. involves hurting part of their body);
calling names, saying unkind or hurtful verbal abuse (e.g. calling names,
things); exclusion (e.g. avoiding talking saying unkind or hurtful things);
to them, excluding them from group exclusion (e.g. avoiding talking to
conversations or activities); indirect them, excluding them from group
bullying (e.g. spreading rumours about conversations or activities); indirect
someone to other people, or sharing bullying (e.g. spreading rumours
someone‟s secrets with others); and about someone to other people, or
cyberbullying (e.g. sending hurtful or sharing someone‟s secrets with
offensive messages via others); and cyberbullying (e.g.
text/email/social media) (Dodd, 2005). sending hurtful or offensive
Bullying can significantly increase the messages via text/email/social
risk of low self-esteem and depression media) (Dodd, 2005).
(Sanders & Phye, 2004). If the bullying
is persistent, it may affect social and Ensure that the individual
emotional development, especially if it understands that all of the above
occurs during adolescence, which is behaviours are not acceptable, and
an important time for developing these that they should inform someone,
social and emotional skills. It can also ideally you or their teachers, if
impact on an individual‟s participation these behaviours occur, whether it
and performance in their classwork is at school or outside of school
and school activities (Dodd, 2005). (Dodd, 2005).
Any child or adolescent can find Use tailored tales or a visual list of
themself the victim of bullying, whether steps to encourage the individual
they have an ASD or not. However, not to retaliate against the bully, but
because individuals on the autism to walk away from them (Dodd,
spectrum may have fewer friends, 2005; Volkmar et al., 2005).
reduced social skills, difficulty For example: “Sometimes people
understanding unspoken social cues say mean things to other people, or
(such as facial expression, body laugh at them. People do it
language) that provide information because they find it fun, or because
about how to respond appropriately in they‟re bored. Nobody likes it when
Emotional Changes
41
ASD will need to have their
responses to the bully scripted, and
some individuals will be able to
move away from the scripted
responses and adapt their
responses to suit the specific
situation being role-played (Dodd,
2005; Volkmar et al., 2005).
Emotional Changes
42
EMOTIONAL CHANGES- emotions (such as anger, fear,
RESOURCES FOR surprise, tiredness, excitement,
jealousy, trust, disappointment,
ADOLECENTS
love, embarrassment, and
sympathy).
UNDERSTANDING OWN EMOTIONS
HAPPINESS
43
Squeeze the muscles in your
MANAGING BEHAVIOUR hands for 5 seconds, then relax
GETTING ANGRY them
Sometimes things happen that make Squeeze the muscles in your
me feel angry. arms for 5 seconds, then relax
them
Everyone gets angry at one time or Raise your eyebrows for 5
another. seconds, then relax them
Squeeze your eyes shut for 5
When I feel angry, I seconds, then open them
should stop what I am Open your mouth as wide as it
doing. will go for 5 seconds, then relax
it
I should take a big breath in. Raise your shoulders up
towards your ears for 5
I should count to ten seconds, then relax them
very slowly. Push your chest out and your
shoulders back for 5 seconds,
This will help me calm down and feel then relax
better (“Tailored tales”, 2005). Squeeze the muscles in your
thighs for 5 seconds, then relax
them
Squeeze the muscles in your
Visual schedule: WHEN YOU GET lower legs for 5 seconds, then
ANGRY OR FRIGHTENED relax them
Stop what you are doing Squeeze the muscles in your
feet for 5 seconds, then relax
Take big, slow breaths in them
and out Doing these exercises will calm your
body down - this will then help your
Walk away or find brain calm down and help you feel
a quiet place to sit better (Press & Osterkamp, 2006).
down
44
Adapt this story to include the this is what makes me an interesting
symptoms of PMS that the person (Serhan, 2011).
individual generally experiences.
MANAGING BULLYING
Brad told Daniel that he was fat and
laughed. Daniel felt sad. Sometimes
people say mean things to other
people, or laugh at them. People do it
because they find it fun, or because
they‟re bored. Brad laughed because it
was funny to him. Daniel was sad
because it was not funny to him.
Nobody likes it
when people say
mean things to
them. If
someone says
something mean
to me, or laughs
at me, I can say
“I don‟t like that”
or “I‟m leaving”,
or I can just walk
away from the
person.
fine.
If we all looked,
spoke, thought
and acted the
same, the world
would be very
boring!
I must remember that even if I feel
different to the other children at school,
45
USEFUL CONTACTS
Child and Youth Mental Health
Service/Child and Adolescent
Mental Health Services (Victoria):
http://www.health.vic.gov.au/mentalhe
alth/services/child/index.htm
For general enquiries or complaints:
phone 1300 767 299
Postal address:
Mental Health, Drugs & Regions
Department of Health
GPO Box 4057
MELBOURNE VIC 3001
Autism Victoria:
http://www.autismvictoria.org.au/home/
Beyond Blue:
http://www.beyondblue.org.au/index.as
px
Lifeline: http://www.lifeline.org.au/
tml
46
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49
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