We will now discuss the topic that no one wants to discuss: Autism and puberty Long before my daughter's hormones began to change I had thoroughly planted myself in denial. Not only would she begin puberty far, far into the future but before it began, we would have plenty of years of cognitive development thus making it extremely simple to explain the physical changes that would occur and how to handle them. Is it necessary for me to say that I was wrong on all accounts? I was blind-sided by hormonal shifts that began long before I expected them to along with physical and psychological changes that I felt completely inept at handling. I could give you the long, agonizing story of the day I feverishly called every OT, PT and autism specialist we had ever worked with in hopes they could please. help. me. or I could just give you some of the things that helped us most. At the risk of scaring and scarring all of you I will go straight to some tips. 1. Read "The Care and Keeping of You" together over and over again. Answer questions, look at pictures, get actual anatomy books if your daughter needs to see real pictures instead of cartoon drawings, give her as much information as you can BEFORE any physical changes begin. (You may be reading and wondering if she understands what you are telling her, whether she does or not, read it anyway.) 2. When her period begins set a timer for every two hours. When the timer goes off take her to the restroom and assist her in changing her pad. As time goes on you may be able to adjust the timer for longer lengths of time or remove it completely depending on whether or not your daughter understands the sensation of needing to change. It is better to start off with the timer so that your daughter understands this is an ongoing process and will be a routine for the upcoming week (and then again the next month). 3. If your daughter has trouble with placing her pad in the correct area, take a pair of her underwear and trace the shape of a pad in permanent marker in the place where she should correctly place a pad. If she is receptive to this, repeat the process in enough pairs of underwear to get her through a cycle and use those underwear each month. 4. Difficulty with small motor skills makes not only placement of pads difficult but also disposing of them. This can become a problem when you are in a public place or she attends school. Buy brown paper lunch bags and put a pad in each. When your daughter needs to change her pad she can take the new one out of the bag and dispose of the old one inside the bag and then throw it away. If you are nervous about school, ask the school nurse or a social worker if there is a private bathroom your daughter can use. Have the bags of pads left in that bathroom at all times so that you do not have to worry about your daughter having pads with her when necessary or carrying them conspicuously. (In our case I asked that the woman who worked closest with my daughter was there to assist her in the beginning. I was not shy about how much help she might need and made sure we had someone who was up to the job.) I will stop here because you may already be breathing into a paper bag but there is more I could share and I'm sure many of you may have questions specific to your own situation. Please leave them in the comments or on the Childswork facebook page and I will answer them.