Puberty and Hygiene for Autistic Teens: Teaching Routines With ABA

Puberty brings big changes for every child: a changing body, new smells, hair in new places, periods, voice changes and strong feelings. For many autistic children and teens, those changes can be confusing or upsetting, especially if they arrive without warning. New hygiene routines may also clash with sensory needs: the feel of deodorant, the sound of a razor, the texture of a pad.

The good news is that hygiene routines are some of the most teachable skills there are. This guide explains when to start, how to break routines into steps, how to adapt for sensory needs, and how to teach privacy and body safety in a clear, respectful way.

When does puberty start, and when should I start preparing?

According to the National Institute of Child Health and Human Development (NICHD), the physical changes of puberty typically begin in girls between ages 8 and 13 and in boys between ages 9 and 14. Every child is different. If you have questions about when your child's puberty is starting, or whether it seems early or late, talk with your child's pediatrician.

Start preparing before the changes arrive. Many autistic children cope better with change they can predict. A year or two of gentle, matter-of-fact preparation, using books, pictures and simple words, means a first period or a first shave is something your child already knows about, not a shock.

How do I explain puberty to my autistic child?

• Use correct, concrete words. Name body parts correctly. Avoid vague phrases like "your little friend" or "that time of the month," which can be confusing for children who take language literally.
• Use pictures. Simple diagrams and picture books about bodies can help. Visual supports are one of the 28 practices the National Clearinghouse on Autism Evidence and Practice found to have clear evidence of positive effects for autistic children and youth.
• Use social stories. A short story with your child as the main character: "My body is growing. I will get hair under my arms. Every morning I put on deodorant." Social narratives are also on the clearinghouse's list.
• Keep it calm and repeat often. Short talks many times work better than one big talk.
• Answer what your child asks. If your child asks questions, it is a good sign. Give honest, simple answers.

What is a task analysis, and how do I use one for hygiene?

A task analysis breaks a routine into small, clear steps in order. Task analysis is on the clearinghouse's evidence-based list. You can write the steps on a laminated card, take photos of your child doing each step, or use a video. Your child follows the steps, and you help less over time.

Example: showering

1. Get a towel and clean clothes.
2. Close the bathroom door.
3. Turn on the water and check the temperature with your hand.
4. Get in and wet your whole body.
5. Put shampoo on your hand, scrub your hair, rinse.
6. Put soap on a washcloth. Wash face, neck, arms, armpits, chest, stomach, private parts, bottom, legs, feet.
7. Rinse all the soap off.
8. Turn off the water.
9. Dry off with the towel.
10. Put on deodorant and clean clothes.

This is an example. Your child's steps may be more or fewer, and a BCBA can help you tailor the list.

Example: deodorant

1. Take off the cap.
2. Lift one arm.
3. Swipe deodorant under that arm two or three times.
4. Repeat on the other arm.
5. Put the cap back on.

Florida heat and humidity mean many teens sweat a lot, so daily showers and deodorant become important early. A visual schedule on the bathroom mirror can help the routine stick. See visual schedules at home.

How do I teach managing a period?

Start before the first period. Show your child pads or other products, explain what they are for, and practice the steps with a pad on underwear (no blood needed) so the routine is familiar. A task analysis for changing a pad might be:

1. Go to the bathroom and close the door.
2. Pull down underwear and sit on the toilet.
3. Take off the used pad, wrap it in toilet paper or its wrapper, and put it in the trash can (not the toilet).
4. Take a new pad, peel off the backing and stick it to the underwear.
5. Pull up underwear and clothes.
6. Wash hands.

Other tips:

• Put a small kit (pads, clean underwear, wipes) in a backpack, and show your child where it is.
• Use a calendar or app to track periods, with pictures if helpful.
• Try different products to find what feels comfortable. Some children dislike the feel of certain pads; period underwear may be an option for some.
• Set reminders to change pads at regular times, such as at lunch and after school.
• Talk with your child's doctor about pain, heavy bleeding, mood changes or anything that worries you.

How do I teach shaving?

Not every teen needs or wants to shave, and that is a personal choice. If your teen wants to, an electric razor is often easier and safer to learn first. Break it into steps (plug in or charge, turn on, move slowly over the face in one direction, check in the mirror, turn off, clean the razor) and practice with the razor turned off before trying it on. If the sound or feel bothers your child, introduce it slowly, starting with just holding the razor while it is on.

What if hygiene clashes with my child's sensory needs?

The CDC lists unusual reactions to the way things sound, smell, taste, look or feel among the signs of autism. Hygiene can bring all of those. Adapt the routine instead of forcing it:

• Showers: try a handheld shower head, adjust water pressure and temperature, or a bath instead.
• Deodorant: try unscented, a roll-on instead of a spray, or a stick instead of a gel.
• Hair washing: a cup of water instead of the shower spray, a visor to keep water out of the eyes, or washing hair on separate days.
• Toothbrushing: an electric brush, a mild toothpaste, or a softer brush.
• Clothing: soft, tagless underwear and bras without wires or with comfortable fabrics.

Offer choices where you can. A teen who chooses their own deodorant is more likely to use it.

How do I teach privacy and body safety?

Puberty is a key time to teach clear, concrete rules about privacy and bodies. These rules help your child act in ways others expect, and they also help protect your child.

Privacy rules

• Private body parts are the parts covered by a swimsuit.
• We change clothes, shower and use the toilet in private, with the door closed.
• Touching private parts is something done only in private, such as in your own bedroom with the door closed.
• Knock before entering someone's room or the bathroom, and expect others to knock too.

Use pictures of public places (kitchen, living room, school, store) and private places (bedroom with the door closed, bathroom) and practice sorting them.

Body-safety rules

• Your body belongs to you. You can say no to touch you do not want, even from family.
• Nobody should touch your private parts, except a doctor or caregiver helping with health or hygiene, with a parent's permission.
• No one should ask you to keep a secret about touching. Tell a safe adult.
• Make a list, with photos, of the safe adults your child can tell.

As your child gains independence with hygiene, plan to step back from hands-on help, so your child learns that private care is done by themselves whenever possible.

In Florida, every person who knows or suspects that a child is being abused, abandoned or neglected must report it immediately to the Florida central abuse hotline (s. 39.201). If you are worried about your child's safety, call the hotline, or 911 in an emergency.

How can ABA help with puberty and hygiene?

ABA is well suited to teaching hygiene, because hygiene routines are chains of small steps that can be taught, practiced and rewarded. A BCBA can write task analyses for your child, plan how to adapt routines for sensory needs, and include privacy and body-safety goals. Teaching hygiene often happens at home, where the skills are used, with a parent learning the same steps. For more on how therapy changes for older children, see ABA for teenagers and building independence with daily routines at home.

How Hope Center can help

Hope Center for Behavior Change serves ages 1 to 99, including teens. Our BCBAs write each plan, our Registered Behavior Technicians teach routines at home and in the community, and our weekly parent training helps you continue at home. Our approach is assent-based and trauma-informed, so teens have a voice in their goals. We also offer mental health therapy for adults, including couples and family therapy, in person or by video. Book a free consultation or call 561-337-8865.