UofL_Stripe
PUBERTY 

Eva R. Markham, Ed.D. 

Associate Professor, Pediatrics 

Weisskopf Center 


Objectives 

 


•Overview of puberty 
•Overview of normal sexual development 
•Discussion of the intersection of autism and 
puberty 



Puberty and Adolescence 

 
•Puberty is the time when sexual and physical 
characteristics mature. It is triggered by 
hormonal changes. 
•Adolescence is the period between puberty 
and adulthood. It is more socially defined. 



Typical Changes in Puberty 

 
•Increased attention to physical appearance 
•Interest in romantic love 
•Increased need for independence 
•Mood changes 
•Desire for peer approval 
•Masturbation 



Puberty in Boys 

 
•Testicular enlargement 
•Increased height 
•Increased shoulder width 
•Genital growth 
•Body and facial hair growth 
•Nighttime ejaculations 
•Voice changes 
•Sometimes acne 



Puberty in Girls 

 
•Breast development 
•Body hair increase 
•Increased height 
•Increased hip size 
•Menstruation 
•Sometimes acne 



Sexual Development 

 


•Sexual behaviors occur across the course of 
life. 
•Adolescence tends to bring an intensification 
of sexual interest and activity, coinciding with 
the onset of puberty. 



Age 0-1 

 
•Child discovers pleasant sensations by 
experience. 
•Most important activities, like feeding, involve 
physical closeness. 
•Child may monitor other’s reactions to 
touching themselves and adjust behavior. 



•Child continues to be interested in own body. 
•Child may note differences and ask questions. 
•“Bad words” may appear. 
•Child may model adult behavior 
indiscriminately. 
•Peer exploration may occur. 


 

Age 2-5 
Age 6-12 

•Self-stimulation may continue. 
•Peer exploration may occur (will be more 
secretive than earlier). 
•Develop sense of modesty/ privacy. 
•“Boyfriends” and “girlfriends”. 
•Onset of puberty 



Age 13+ 

•Rapid growth 
•Sexual maturity – can reproduce. 
•Interest in sexual experience. 
•Continued self-stimulation. 
•Intimacy in relationships. 
•Parental input critical. 



Autism Spectrum Disorders 

 
•Qualitative impairment in verbal and 
nonverbal communication. 
•Qualitative impairment in social interaction. 
•Restricted, repetitive, stereotypical behaviors. 
•Sensory issues. 



Autism and Sexuality 

 
•Children learn gender specific behavior by 
observing and modeling the behavior of 
others. 
•Children are reinforced by adults for gender 
appropriate behavior. 
•Children with autism are less likely to learn 
though modeling and are not as motivated by 
adult attention, etc. 



Autism and Sexuality 

 
•Peer pressure is less of a factor in some 
cases. 
•The “adolescent awfuls” may seem to be 
delayed relative to typically developing peers. 
•May continue to show interests peers deem 
“babyish”. 



Autism and Sexuality 

 
•May fail to internalize privacy/ modesty 
norms. 
•May over-generalize greetings, touching 
others,and other behaviors that are 
acceptable in young children but not in 
adolescents or adults. 
•May lack social and communication skills 
needed to facilitate relationship development. 



Assessment of Sexual 
Knowledge 

 
•Young people need to understand what 
“private” is and be able to identify private 
body parts, activities, conversation topics, etc. 
•Young people need to have factual 
information about sexual development and be 
able to develop comfort with their own 
sexuality. 



Individualized Curriculum 

 
•Age, language, social interest, and 
developmental level direct teaching plan. 
•Visual materials are helpful. 
•Schedules, scripts, etc. may provide guides 
for successful actions. 



Safety Issues 

 
•Personal body safety concerns. 
•Sexual feelings and activities. 
•Sexually transmitted diseases. 
•Contraception. 



Personal Hygiene 

 
•Grooming and personal hygiene routines may 
have to be taught and reinforced. 
•Use visuals, social stories, etc. for teaching. 



Social Skills 

 
•Initiating interaction. 
•Chatting with someone. 
•Asking for a date or other contact. 
•Planning the date. 
•What to do on the date. 
•Intimacy skills. 



Cultural Context 

 
•Family 
•Peer group 
•Religious community 
•Community 
•Nation 



 Problem Sexual Behavior 

 
•Behavioral issues. 
•Partner selection difficulty. 
•Lack of knowledge. 
•Medical issues. 
•Sensory-related. 



Problem Sexual Behavior 

 
Analysis of the “problem behavior” should 

guide development of a teaching plan to 

teach acceptable behavior. 

 


Team Work 

 

 Family, school staff, health care providers, 
mental health professionals, clergy, and 
others may all be needed to address 
sexuality related issues. 


Intentional 

 


Intentionality in integrating sexuality related 

material into the program of the youngster with 

an autism spectrum disorder offers the best way 

to allow optimal quality of life with regard to this 

aspect of human experience. 


 

Contact: 

 Eva R. Markham, Ed.D. 

 502-852-7528 

 ermark01@louisville.edu