A practical puberty plan for autistic teens and families

The direct answer

Education

Autistic teens may benefit from explicit, direct education about puberty and body changes

Sensory and self-care needs

Sensory needs can affect hygiene routines, clothing, body hair, menstruation, and other self-care changes

Social and emotional changes

Social pressure and emotional changes can make adolescence more demanding, so regular check-ins matter

Adult transition

Ontario Autism Program services end at 18, so families can begin adult-transition planning before that change

Why Puberty Is Uniquely Challenging for Autistic Teens

For most teenagers, puberty is a period of significant change and challenge. For autistic teenagers, those challenges are amplified by several intersecting factors.

The physical changes of puberty, new sensations, new smells, new bodily experiences, occur rapidly and without a clear end point in sight. For autistic people who rely heavily on routine and sameness for stability, this period of constant change can be destabilizing.

At the same time, the social world of adolescence becomes dramatically more complex. The implicit social rules that govern teenage peer relationships, around appearance, music, romantic interest, group membership, multiply and become more complicated. The social cost of getting these rules wrong increases. Many autistic teens describe adolescence as the time when their differences first felt isolating.

Hormonal changes also affect sensory processing and mood regulation, and autistic teens may be less equipped with the emotional regulation tools needed to cope with this. The combination of physical, social, and emotional change happening simultaneously makes this a high-risk period for mental health difficulties.

Preparing for physical changes

Preparation is key. Autistic teens who are caught off guard by pubertal changes, menarche, voice changes, body hair, acne, often have more difficulty coping than those who were given detailed, advance information.

Effective puberty education for autistic teens:

• Uses direct, explicit language, avoid euphemisms and assume no implicit understanding of social norms around bodies
• Is specific and sequential, explain what will happen, in what order, and roughly when
• Uses visual supports, books, charts, social stories about puberty
• Is repeated over time, begin before puberty starts, and revisit regularly
• Addresses the sensory aspects of self-care, shaving, deodorant, period products all have sensory dimensions that should be addressed practically and ahead of time

Several books specifically designed for autistic young people address puberty in a direct, accessible way. Ask your child's developmental pediatrician or occupational therapist for recommendations appropriate to your child's communication style and cognitive level.

Emotional and social changes

Adolescence is a period of identity formation for all young people. For autistic teens, this often includes grappling with their autistic identity, understanding what autism means for them, whether to disclose it to peers, and how to handle the gap between their experience and that of their neurotypical classmates.

Key concerns during this period:

• Masking and its costs, adolescence is when masking often intensifies, as social stakes increase. This is exhausting and a significant contributor to the autistic burnout that many autistic people first experience as teenagers.
• Mental health, depression and anxiety rates increase significantly in autistic adolescents. Proactive mental health monitoring and support is important.
• Romantic relationships and sexuality, autistic teens may have limited understanding of romantic social norms. Explicit education about consent, healthy relationships, and personal boundaries is essential and should be incorporated into puberty education.
• Online safety, autistic teens may be more vulnerable to exploitation online, partly because they may take social communications more literally and be more trusting of online connections.

Planning for the transition to adult services

In Ontario, the Ontario Autism Program (OAP) provides services only up to age 18. This is one of the most significant transitions autistic families face, and it requires advance planning, ideally beginning at age 14.

Key transition planning steps:

• IEP transition plan, Ontario requires schools to include a transition plan in the IEP of students 14 and older. Ensure this plan is substantive and individually tailored.
• Adult developmental services are provided by Community Living and other regional organizations. Access is through Developmental Services Ontario (DSO) (opens in new tab). DSO eligibility rules apply, and not every autistic teen qualifies. Waitlists can be very long, so register with your regional service provider early.
• ODSP, Ontario Disability Support Program provides income support for adults with disabilities. Learn the eligibility criteria and application process in advance. See our ODSP guide for autism families.
• Post-secondary supports, many Ontario colleges and universities have accessibility services that provide accommodations for autistic students. Research these options early if post-secondary education is a goal.

See also: Autism in Adults | Autism and Anxiety | Autism and School

Frequently asked questions