10 Must Have Skills to Prepare a Child with Autism for Puberty

The thought of preparing any child for puberty is daunting enough. Preparing a child with ASD for puberty is even more challenging. Thanks to the talk on 17th March, delivered by Chloe Jorgensen (BCBA, BeyondAutism Schools) in partnership with Focus Surrey, we received a few tips on the topic. Here is a brief summary of the talk:


What to skills to teach?

There are four categories of skills in general: “must have skills”, “should have skills”, “good to have skills” and “nice to have skills”. Start from the “must have skills” and work your way up to the “nice to have skills”.


The “must have skills” are suitable for all level of learners. They are divided into three areas:


Health Literacy

[The WHO have defined it as “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health” in their 7th Global Health Promotion Conference (2009)]

  1. Indicates discomfort

  2. Pointing to their own body parts when asked to

Sensory and Change Acceptance

 3. Accepts direction to use the appropriate bathroom

 4. Accepts being washed/ co-operate in hygiene or grooming routines

 5. Accepts or adapts to changes to routine/ schedules or transitioning (after all, puberty is a big change!)

 6. Accepts hair/ finger nails being cut

 7. Wears clothing throughout the day



 8. Using the toilet independently

 9. Maintaining basic hygiene- wash hands, wash face, brush teeth and brush hair

 10.Can dress themselves with minimal help


When to start?

The earlier the better! Some of these skills could be taught when a child started toilet training. There is no reason why you can not start teaching any of these skills from a young age. Aim to start with the most intimate skills, e.g. wiping themselves clean after using the toilet, so the child has more independence and dignity.


How to teach?

There are a few categories of teaching methods: video-based instructions, teaching as the behaviour occurs and social stories. Every child responds differently, so the teaching method will need to be individualised.

Procedures such as chaining, a step-by-step teaching method can help with more complex skills such as brushing teeth and washing hands. The key is that you teach one step at a time, be consistent with how you prompt the child- if one parent takes the hands of the child to wash it and the other parent demonstrates how to do it, it will take the child a very long time to learn. Provide lots of praise and possibly a short, fun activity when the child can do the step by themselves.


Where to go after these 10 skills have been taught?

Move on to the “should have skills”, such as shaving, putting a bra on/ taking it off, shutting the door when using the toilet/ changing clothes, identifying gender and age.

Remember, it is important to let your child to know that they have a choice in doing certain things in a certain way, such as shaving, using a sanitary pad or tampon and taking medication for period pain. In fact, NHS England's service model for commissioners of health and social care service (October 2015) includes choice and control as a key element of good service and support for people with a learning disability and/ or autism.

Sexual behaviour is a subject that is usually avoided when working with young adults with learning disability. People with autism have the same feelings and emotions as everyone else, so they have a right to understand their bodies. Don't give in to the stigma and embarrassment as it is important to teach your child what and where it is appropriate to engage in natural activities.


You may find the information on the following websites helpful on this topic:

National Autistic Society: http://www.autism.org.uk/about/communication/sex-education.aspx

Stages Learning Materials: http://blog.stageslearning.com/blog/autism-and-puberty

NHS England's service model for commissioners of health and social care service (October 2015): https://www.england.nhs.uk/wp-content/uploads/2015/10/service-model-291015.pdf


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If you would like our support to help your child with self care skills, please following this link to see our Parent & Child Interaction programme: https://www.headstartaba.org/parent-child-programme

Written by Danthy Lo Leça, a Behaviour Analyst who is passionate about training, working with schools and being creativity in her practice

Sian Vermaut