Considering what a frightening thing the onset of menstruation can be for a girl, it can be much more so if there are communication deficits. It may be natural, but it is still blood, and it can be alarming. The transition for girls with autism can be difficult, but it can be done. All that's required is sensitivity and some education.
Indications of Menarche
The best way to help a girl beginning her menstrual cycle is to be prepared ahead of time. Watching for the signs that show your daughter is entering into menarche will allow you to teach her as much as possible about what is happening to her body and prepare her for what is to come.
When girls enter puberty, one of the first indications may be their behavior. Parents will notice irritability, which will be difficult to distinguish from the irritability or angry outbursts associated with autism. It takes little to provoke a bad mood in a prepubescent girl, and outbursts of anger are common as well. Things that were once loved are now a source of embarrassment. But how do you recognize the arrival of puberty in a child when irritability and outbursts have always been part of the daily routine?
One helpful aspect of the menstrual cycle is that it can often be charted, although beginning menstrual periods may be quite irregular. People with autism often like to use a calendar, loving the structure of the routine, and if a girl's cycle is regular this can help parents plan for any problems.
It is important for parents of girls with autism to be attuned to their daughter's behavior. Routines can now be your best friend—even though you may have felt a slave to them in the past, they can help you be aware of what is going on with your daughter. If you notice that things are upsetting her that didn't six or twelve months ago, and you see a hair-trigger temper, that is a warning sign.
Breast development is usually the first physical sign that puberty has started. Her figure will start changing and she will develop hips and a waistline. She may develop quickly or slowly, as each girl's growth pattern is different. These are changes she may or may not acknowledge depending on how aware she is of her own body. At this point, it is time to start preparing her for the onset of her menses.
Preparing Your Daughter
Purchase supplies and select several different brands for your daughter to see. She may have a sensory reaction to one product and prefer another one based on criteria that do not apply to you. The color of the package, the shape of the pad, or an odor associated with the packaging will be some of her determining variables.
Children with autism are notoriously immodest. If you permitted your kids to run around without clothing when they were young, puberty is the time to teach them modesty. Children with autism do not understand that different environments require different clothing, and you don't want your teen stripping in the grocery store.
When you begin teaching your daughter how to handle the hygiene issues of having a period, it is important that a woman be part of the instructional process. If you are a single dad, you need to find some help. A girl should never believe that it is appropriate and acceptable for any male, of any age or relationship to her, be in any kind of intimate contact with her. That is a rule that must never be broken. Single fathers can rely on their own mother, sister, a school nurse, or another trusted female. It is impossible to teach a girl what is appropriate for her own body if that rule is not adhered to closely.
Buy an easy-to-read calendar and put it in the bathroom. Begin by showing your daughter the calendar and the pads you purchased. Talk to her as though she understands each word you say even if she is totally nonverbal. Take a red pen, circle the date on the calendar, and then place some red food coloring on the pad. The goal is to imitate in a nonthreatening way what she will see when her periods begin. Handle the situation in a matter-of-fact manner. Dispose of the “used” pad, replace it with a new one, and repeat this every two to three hours. Continue this practice for about five days. Twenty-eight days later, repeat the process.
If the menstrual cycle is extremely difficult and hygiene is a constant battle, discuss your options with your daughter's doctor. Some physicians put girls with autism on medication or give an injection to suppress their periods. This may be an option if it is medically appropriate.
When the big day arrives, and remember, you will have no warning of the actual date, fall back on your planning techniques. Keep in stride as you circle the day on the calendar and attend to hygiene. Remember to teach her proper disposal of the pads and be sure you keep a supply of her preferred brand.
There are no guarantees this will be the magic bullet and that your daughter's periods will begin and continue uneventfully. There are likely to be trying times for the entire family. Hygiene may be a continual problem or it may go smoothly, without any problems at all. Every teenage girl is different and there is no way to know how your daughter will feel about any of this. If you can convey calmness and avoid a production over the situation, the chances are greater she will take it in stride.