December, 2014
Thank you for your interest in the Adapted Puberty Health Education Program for boys with autism
spectrum disorder and other special needs. This program was developed by the staff and other
professionals at the Robert Crown Center for Health Education. We are grateful for the support of
Autism Speaks for funding the development of this program.
The fidelity of this program is dependent on its delivery by a trained professional health educator.
This program is presently in a pilot phase and under continual review, as well as being
professionally evaluated.
If you have any questions or concerns about this program, please contact the Robert Crown Center
for Health Education.
Copyright © Robert Crown Center for Health Education, 2014
Robert Crown Center for Health Education
SCRIPT FOR ‘ADAPTED PUBERTY HEALTH EDUCATION PROGRAM FOR BOYS WITH AUTISM SPECTRUM DISORDER/SPECIAL NEEDS’
December, 2014
Materials
Activity/Content/Teaching Point
Power Point:
Slide
This script is specifically intended for children with autism spectrum disorder or other special needs. The
level of comprehension is starting at that of a 3-4 year old. Instructor may modify the presentation to
accommodate a higher level of learning.
If students come to the Center, places for them to sit will be marked with a X. This structure/order
provides a sense of comfort and safety to students. Hand fidgets (stress balls) may be available to help
students with any restlessness or anxiety they may experience during the program. Instructor should call
the school about a week ahead of a scheduled program to establish a relationship with teacher(s) and
aides and address any special concerns or needs they may have. At that time, schools coming to the
Center will be sent the social story explaining the field trip experience to the Robert Crown Center to allow
teachers to present to students. All schools should be sent a list of vocabulary words used in program to
help prepare students.
INTRODUCTION: Welcome to the Robert Crown Center for Education. I am happy you’re here today.
My name is _________. Do you know why you came to the Robert Crown Center for Health Education
today? This will provide feedback of their knowledge of the subject as well as their expectations about
the program. I don’t want to do all the talking today. I hope to hear from you too. Please let me know if
you have any questions about anything we discuss today, at any time. This is a safe time and place to ask
questions about what we will be talking about and I will try my best to answer your questions. Let’s try
to talk one at a time and raise our hands like this (demonstrate raising hands) when we have something
to ask or say.
Copyright © Robert Crown Center for Health Education, 2014
Age ranges are difficult to understand. The pictures of boys with ages above will help students
understand this concept. Today we are going to talk about puberty. Puberty means the changes your
body goes through as you get bigger/grow taller and grow up. Boys start puberty changes between the
ages of 10 and 17. These are changes you may SEE or may have already SEEN with yourself and your
friends. The word see is simple and easy for students to understand vs. the word notice which is to
abstract. What these students can see and experience is imperative to their understanding so the goal is
to use language that allows that.
One of the changes you will experience during puberty is you will grow taller and bigger. Bigger is also a
word that is easier for students to understand and comes early in students’ development. What things
should we do to grow bigger and be healthy?
As you get bigger and taller, your chest will get bigger and wider. Your arms will get muscular. This is
normal and happens to all boys as they grow into men.
Copyright © Robert Crown Center for Health Education, 2014
It is often a challenge for a child with ASD/special needs to eat a healthy diet consisting of a variety of
foods. Discuss briefly healthy food choices, good portion sizes. List specific examples. Explain that
everyone needs to eat healthy foods for their body to be healthy. You may not like all healthy foods but
you should try different ones to decide which ones you like the best. Reinforce that healthy foods can
taste good. These students will often associate healthy foods with doing without the things they love.
Also be sensitive to many of the students being on special diets. Some are very picky. Qualify this by
saying, “Not everyone will need the same foods for their body.”
Discuss briefly benefits of exercise and ask if there’s any type of exercise students like to do. Adapt this
portion to discuss exercise appropriate for the group. Reinforce that exercise is fun and discuss with
students different ways in which it can be fun-swimming, biking, etc. Depending on group, students may
even run in place, do push-ups, etc.
*Encourage brief discussion of these health topics with positive reinforcement. Establishing a positive
relationship early in the program with ‘easier’ topics will enhance trust as you discuss more ‘sensitive’
topics later.*
Copyright © Robert Crown Center for Health Education, 2014
One more thing that is very important to help us keep growing healthy is sleep. Discuss need for sleep
briefly; again adapting level of discussion to group’s comprehension level. Bedtime and recognizing the
need for sleep can be a challenge for students with ASD/special needs. Reinforce that when we sleep well
at night we feel awake, happy and our bodies feel ready to do things the next day. If we don’t get
enough sleep we will feel tired, unhappy and won’t feel ready to do things the next day.
Another change that you will SEE is you will grow hair under your arms and SOMETIMES the hair on your
arms and legs will get thicker and darker. This is hair that will stay on your body. This can be confusing
because students already have hair on their arms and legs-that’s why the word sometimes is necessary
to avoid confusion. Make sure to point out these changes in these pictures otherwise students may
focus on something else.
You may also grow hair on your chest and sometimes your back. This hair will also stay on your body.
Again, point out specific changes in pictures so students recognize changes and don’t focus on something
else.
Copyright © Robert Crown Center for Health Education, 2014
You will also grow hair on your face like a man. If the hair grows long above your lip, it is called a
moustache. If the hair grows long on your face, it is called a beard. Ask students if they know anyone
who has a beard and/or moustache and allow brief discussion. Again, point out specific areas of hair
growth on faces.
You may need to shave off the hair on your face. Many of these students will use an electric razor to
shave while others will use a regular razor with a blade. It is very important for them to understand that
they should always have an adult help them when shaving. Some men use a sharp razor and shaving
cream to shave their faces. Some will use an electric shaver to shave their faces. Mom or dad or another
adult will need to help you shave. You may accidentally cut your skin with the razor because the razor is
sharp. You will need to tell an adult and put a little tissue on the cut until it stops bleeding. Sometimes,
men cut themselves when they shave. That’s normal. It happens to lots of men. It happens to me.
Here’s a picture of different razors. Have any of you seen any of these at home? With students input,
point out the difference between razors with a blade and electric razors. Again emphasize that razors are
very sharp and you should never touch the razor with your finger. Instruct students to only shave areas
on their face where they have hair that they’ve covered in shaving cream or gel. Remind students they
should not shave eyebrows.
Interaction is very important to make this program a success. It is important not to expect the right
answer or even an answer at all times but it will encourage interaction. These students will benefit from
answering questions and receiving positive reinforcement for that, even if the answer is not correct. Try
to guide students to answer some questions correctly when able.
Copyright © Robert Crown Center for Health Education, 2014
Pass around boxes with different shaving creams and gels in it for students to see or have students come
down in front where containers of different types of shaving cream/gels are available. Discuss how
shaving cream feels and that it is like soap and will feel cool and creamy. Remind students that they can
only shave when the shaving cream is on their face unless they are using an electric razor. Due to allergy
issues, do not allow students to touch or explore products.
After playing video, explain steps emphasizing the following information:
1. You need to be careful when shaving and have a parent or another trusted adult help you.
2. The razor is sharp and you shouldn’t touch the blade.
3. You can only shave your face when you have shaving cream on it unless you’re using an electric
razor.
4. Softly go down your face with the razor.
5. The shaving cream/gel and face hair will come off on the razor.
6. You should only shave the hair under the shaving cream, never eyebrows or hair on your head.
7. When you are done shaving, wash off shaving cream and then dry your face.
8. Your face will feel smooth and soft.
9. If you accidentally get a small cut on your face, tell an adult and dab the blood with a tissue until
it stops bleeding.
Once video complete-review
1. Hold up items needed-razor, shaving lotion, asking students to define them.
2. Discuss with students input, how often and when to shave (usually morning).
3. Verbally and physically act out steps. This will serve as a review. Ask questions like, “Where
should you shave your face (sink or shower)” Guide students along, “Once you put the shaving
cream on, what should you do next?”
Repetition is key to students understanding these concepts. Emphasize to students not to share razors
with anybody else.
Copyright © Robert Crown Center for Health Education, 2014
Everyday your body gets dirty. Most people take a bath or shower every day to clean their bodies. As
you get bigger, you are also going to sweat more. Ask students if they know what you mean by sweat
and remind them sometimes we feel sweat on our face or neck and other places when we get hot. We
feel WET. We feel WET on different place on our body, especially under our arms and not just when we
are hot. That will smell really bad and that’s not good. What should we do every day so that we don’t
smell bad to our teachers, friends and family? Shower or take a bath. These are the things that you will
need to shower. Can you name one of them?
As students provide answers instructor provide positive affirmations for any response provided.
Let’s talk about what to do when we take a shower.
1. Turn water on and take off clothes. Either one first is fine.
2. Get body and soap wet with water or use body wash.
3. Rub on all parts of your body and name parts. You can use a washcloth or your hands.
4. Rinse off with water.
5. Turn shower or bath off.
6. Dry body off with a towel.
7. Put on clean clothes.
Instructor should act out steps as she lists them using props.
Copyright © Robert Crown Center for Health Education, 2014
Washing hair can be a challenge because of soap/shampoo getting into eyes. Many students don’t like to
have soap or water on their heads. Reinforce how important and necessary it is to wash hair. Your hair
can get dirty, greasy, and smell bad too, so sometimes you will need to wash your hair. You may do this
when you are taking a shower. What do you need to wash your hair? Again thank students for answers
even if not correct. This positive reinforcement will encourage continued interaction. That’s right:
shampoo. Shampoo will clean your hair and make it smell nice.
1. Squeeze a small amount of shampoo into your hand.
2. Rub hands together.
3. Rub shampoo into your hair. The shampoo will smell nice and feel soapy.
4. Sometimes the shampoo may get into your eyes. That’s okay. Sometimes that happens to
people when they wash their hair. Try to keep your eyes shut and, if the shampoo gets into your
eyes, you can wipe your eyes with a wash cloth.
5. Get under the water and get all of the shampoo out of your hair. You will need to feel your hair
to make sure all the shampoo is out.
6. Repeat.
REVIEW: Social Story. Repetition is very important for these students. This activity is done on a magnetic
board with pictures individually laminated using magnets. Depending on student level, students can
come up and arrange pictures one line at a time (pictures are in a container for student to pick out) in
order while other students explain steps or instructor could put pictures in order and with or without
students input, again depending on their level, explain steps. Show three squares at a time to allow
students to process the information without being overwhelmed. Once complete, power point image
should be put up on screen and briefly explained again.
Copyright © Robert Crown Center for Health Education, 2014
What can you do after you shower that will help you smell nice and not feel as wet or sweaty?
Deodorant-right. We need to talk about deodorant with an adult we trust before we do it ourselves,
right? What does deodorant look like and how do we use it? Show students deodorants. Instructor will
demonstrate process of applying deodorant.
REVIEW: Social Story. As previously mentioned, repetition is very important for these students. This
activity will be done on a magnetic board with pictures individually laminated using magnets. Depending
on student level, students could come up and arrange pictures one at a time (pictures would be in a
basket for student to pick out) in order while other students explain steps or instructor could put pictures
in order and with or without students input, again depending on their level, explain steps. Once
complete, power point image should be put up on screen and briefly explained again.
After you’ve cleaned your body you want to makes sure you put on clean clothes. Not the clothes on the
floor or in the laundry basket, right? Make sure not to use teaching methods that involve humor in
program. Humor, jokes can be difficult for ASD/special needs children to understand and may cause
stress for them. Simple, clear concise information in a friendly manner is effective.
Copyright © Robert Crown Center for Health Education, 2014
If you shower in the morning, how should you clean your body at the end of the day before you go to
bed at night? Allow answers and again, any answer is a positive answer. The more interactive for the
students the more effective. You need to wash your face and brush your teeth. You will get some red
spots on your face and maybe even your back and chest that are called pimples. They look like this.
These red bumps are OK and they do not mean you are sick. Many of these students think that pimples
mean they are sick and need to go to the doctor. They will need reassurance regarding this. You need to
wash your face with a washcloth, soap and water. Sometimes you may put some medicine on your
pimples or red bumps that a parent or adult you trust can show you. You don’t need to touch them or
pick them. If you do, you may get more pimples and they may get bigger.
These are some of the things you will need to wash your face. Can you name any of them? Instructor
explains how each item is used.
Instructor again briefly explains need for acne ointment (avoid use of word medicine-many students use
medications and this can be confusing for them) and the need to get help from a parent or a trusted
adult.
Copyright © Robert Crown Center for Health Education, 2014
BEFORE SHOWING SLIDE SAY: Everyone needs to brush their teeth 2-3 times a day to keep them clean
and healthy. What are times you should brush your teeth? Allow answers and provide positive feedback.
Brushing your teeth will also prevent cavities which are bad for your teeth and can make them hurt.
Show slide. You should brush your teeth in the morning, after meals when you can and before you go to
bed.
Here are some things you need to brush your teeth. Can you name one of these things (rather than
using the word any, asking a student to name one is easier for them to understand)? Demonstrate
correct way to put toothpaste on toothbrush as well as amount.
You will brush your teeth at the sink. The toothpaste may taste like mint or cinnamon or even
bubblegum but you don’t eat it. When you’re done brushing your teeth, make sure not to swallow the
toothpaste and spit it all out into the sink. You will then rinse your mouth with water and spit again.
Demonstrate and explain proper brushing and flossing of teeth using RCC model and toothbrush.
Copyright © Robert Crown Center for Health Education, 2014
After we brush our teeth is a good time to remember to brush our hair. People brush there hair so it
looks nice and is not tangled. You should brush or comb your hair when it is wet after you wash it and
every morning before you go to school. Sometimes you will need to comb or brush your hair during the
day to keep it looking nice. You should brush or comb your hair in the bathroom or bedroom and not
around food. Make sure not to share your hairbrush or any of your personal items, like your razor or
toothbrush.
At the end of this section instructor should place all the items discussed out on a table and call on
different students (look for ones who really seem to need some movement) to come and pick out one
thing they would need to complete one of the activities (i.e. Show the group one thing you would need
to wash your face. Show the group one thing you could use to help you smell good.). Depending on the
size of the group you could have the whole group come down and explore items and then ask individuals
to volunteer to show one thing you would use to wash your face, etc. Again, depending on the group’s
ability, students could walk through steps with props for each activity just described.
Copyright © Robert Crown Center for Health Education, 2014
We just talked about a lot of changes that have or are happening quickly to your bodies and things you
need to do to take care of your body. How you feel can also change quickly. Sometimes these changes
don’t always feel good so you need to talk to mom or dad or another trusted adult and they will be able
to help you. Feelings are some of the hardest things for these students to understand or explain. It is
difficult and abstract. Change is also a difficult concept so by showing a clear representation, students
will be better able to grasp the concept. Depending on group you can discuss healthy ways to handle
emotions-talking, exercise, deep breathing, etc. Instructor will need to be very aware of audience
because for some ASD/special needs students this can be an overwhelming topic and just talking about it
can cause anxiety. It may be enough just to let them know their emotions will change quickly and to talk
with a trusted adult when needed.
It can be difficult for ASD/special needs students to understand what’s appropriate to talk about with
others. ASD/special needs students often have difficulties reading the reactions of others and find it
difficult to determine if what they say is appropriate or not. It will need to be reinforced who they can talk
to about these topics. You may need to talk to adults you trust about what we are discussing here today.
These are personal things to talk about so you want to make sure you talk with trusted adults. Here are
some people you can talk to about these things. Are there other adults you can talk to about these
things? Be aware that some of these students have negative reactions to the word doctor. They would
not consider in their experience a doctor to be a safe person they could confide in. Explain that a doctor is
a safe person to talk to because their job is to understand the things that happen during puberty and help
kids through it to help them stay healthy. As you go through each picture, ask students to show a thumbs
up or thumbs down to demonstrate their understanding of who they can discuss these changes with, then
show on screen whether there response was correct and discuss. Animation will show thumbs up or
thumbs down after each picture.
Copyright © Robert Crown Center for Health Education, 2014
Here are some people you shouldn’t talk to about these things. Go through slide demonstration done
with previous slide. These students are receptive to guided language-it provides clarity to the topic.
During puberty you will also go through changes that no one else will be able to see. These changes are
in areas that are covered by your underwear. These are changes you share with only a few other people.
These are called private or personal changes. What does it mean if something is personal or private? It
means that it is not shared with everyone. Briefly review thumbs up/thumbs down slides. Is anyone
curious to learn about these private changes?
These things we will be talking about today may make you feel silly or make you want to laugh or giggle
but every boy goes through these changes as he becomes a man. Avoid using the word embarrassingthis is a hard emotion to understand.
Some personal or private changes you will see are not only will you get hair under your arms, in your
armpits, your face and maybe your chest and back but you will also get hair on your private area around
your penis. Your voice will also get lower and deeper. Sometimes as this happens your voice may squeak
at times but that will pass and happens to all boys. Again, you can talk about these changes with just a
few people. You can share things that are personal and private with certain people you feel safe with
and trust.
Copyright © Robert Crown Center for Health Education, 2014
Hair will grow around your penis and testicles. Testicles hang under the penis. There are two testes
under the penis. The two testes are inside a bag/sac called the scrotum. When you grow bigger/taller
your penis and testicles also grow bigger. Again, this is normal and happens to all boys as they grow into
men.
Have students squat down like they are little children. Ask a few students to say what their body is like as
a little boy, 4 years old (short, little, small penis, no facial, chest or pubic hair). Then have them stand up
a bit and call on a few students to talk about what their body is when they are a little older, 7 years old (a
little taller, penis a bit larger but still no facial, chest or pubic hair). Then have them stand up and tell
about changes that would be happening to a 14 year old body (taller, penis and testicles larger, pubic and
facial hair, hair under arms, pimples, sweating more and smelling, etc.). Then have them stand with
hands way above their head and tell what their body is like after puberty is done, 21 years old. This
activity represents the idea more fully to the students of the growth they will be experiencing during
puberty.
Copyright © Robert Crown Center for Health Education, 2014
An “erection” means that your penis gets bigger and becomes very hard. The penis can get bigger and
harder if it is touched. The penis will become soft and smaller after an erection. If you have a higher
level group you may pull in the following concepts: Feelings of excitement and sometimes things that
you “think” can cause erections and that happens to all boys as they grow up and become men.
Sometimes an erection can happen for no reason at all. The concern is the word excitement can mean
many different things and referring to things you think about causing erections is challenging because it
deals with thinking or mental states which are hard to understand. Addressing these components will
depend on the level of the group. It is normal to have a few erections a day. If you have an erection at
school, you can wait until the erection goes down or just stay seated. Carrying your books in front of you
can help too or tying a jacket around your waste. Don’t tell other people when you’re having an
erection. It is private. Instructors need to be careful when discussing erections because it is important for
these students not to feel ashamed of this. Many of these students are already embarrassed about this
happening.
Sometimes when you have an erection, you will have an ejaculation. That means semen will come out of
your penis and that’s okay. Semen is a white liquid that will come out of your penis. There is nothing
wrong and you did not urinate or wet your pants. This happens to many boys as they go through
puberty. Having an ejaculation can be messy. You will need to go to the bathroom and wipe your penis
with toilet paper or wash yourself in the bathroom. You will also need to put on clean underwear.
Sometimes you may have an ejaculation in bed when you are sleeping. This is called a “wet dream”. You
will need to ask mom, dad or another adult you trust to help you wash the sheets when this happens
because they will be messy. This is a difficult concept because it is not in the ‘here and now’ so when it is
discussed some boys may have experienced it and some may not have experienced it. If they haven’t
experienced it, then when they actually talk about it-it will not be connected to themselves unless they
have a very solid language system. Remind them again that this is totally normal and happens to boys as
they grow bigger and taller.
Copyright © Robert Crown Center for Health Education, 2014
Reinforce again that these are private changes that happen to every boy as get grows bigger and taller
and into a man. And who can you talk to about these changes again?
Have students do “Thumbs up, Thumbs down” as you go through the pictures again listing examples of
things they can discuss with these people and things they can’t.
Copyright © Robert Crown Center for Health Education, 2014
Again remind boys that these puberty changes can start at any of the ages displayed and that they now
know what to do when these changes happen. Remind students that this a time to ask mom, dad or
another trusted adult for help (Students can list who those adults might be.). Reinforce that everybody
has questions and will need help from a trusted adult. Have a brief discussion asking boys to list changes
that were discussed during class and maybe ideas of how to take care of those changes. Guide them with
answers if needed.
1. Get taller/bigger.
2. Hair on legs/arms may get thicker and darker. Hair will grow under arms (armpits), pubic area,
maybe chest, maybe back and face. May shave face.
3. Sweat more and be stinky so need to shower every day and use deodorant.
4. Pimples, so keep face and other areas clean and maybe put on medicine with a trusted adult’s
help.
5. Can’t forget to brush our teeth 2-3 times a day.
6. There will also be private changes. Penis and testicles will get bigger.
7. Erections and ejaculations will also happen. With boys input, discuss how to handle both.
*** These two following topics can be extremely uncomfortable to students and discussing them in 1st
person plural(we) will help them be less threatening to students.***
Discuss Private parts: Public places are where other people can see us (school, store, etc.). Private
means away from other people, like in our bedroom or bathroom with the door closed. Everybody has
private parts of their body. We can tell which parts of your body are private because we cover them
with underwear. We don’t touch our private parts in public where other people can see us. We don’t
ever put our hands inside our pants in public. Sometimes we need to remember not to touch ourselves
in public so we can put our hands by our side, cross our arms, or fold our hands (demonstrate these
motions while showing slide). Sometimes we need to touch our private parts, like when our underwear
is uncomfortable or when we itch. We can ask to go to the bathroom. When we are alone in our
bedroom or bathroom, we can touch our private parts.
Copyright © Robert Crown Center for Health Education, 2014
Discuss Appropriate Touch: When we are with friends and family, it’s usually okay to touch them and for
them to touch us on the arm, back, shoulders, or hands (point to these areas as you list them). These are
“OK” areas of the body. For example, we can give high-fives, pat them on the back, or touch them on the
arm to get their attention. It’s not okay to touch other people on parts of their body covered by
underwear, such as their behind, breasts, penis, or vagina, It’s not okay for anyone (but a doctor/
parent/______)* to touch us on parts of our body covered by underwear either unless they are keeping
us healthy or keeping us clean. These are private parts of our body and are “Stop” areas. If someone
touches us in our private areas, we should say “STOP” or “NO” and tell mom, dad, or teachers. Again,
sometimes mom, dad, another adult we trust (have students give examples) and our doctor will need to
see our private areas to help us stay clean and healthy. We need to remember that some people don’t
like to be touched on their arm, hands or head and that’s fine.
*May need to alter to include caregivers or medical professionals who need to assist with daily living
skills or perform needed medical procedures.*
Discuss examples:
1. Should a Dentist touch your mouth? Should a Dentist touch your chest or penis?
2. Should a cashier touch your chest or penis?
3. Can you shake hands with a good friend? Pat them on the back? High five? Touch their
shoulder to get attention? Should a good friend touch your chest or penis?
4. Can an Aunt or Uncle touch your shoulder to get your attention? Pat you on the back? High five
you? Touch you on your chest or penis?
Copyright © Robert Crown Center for Health Education, 2014
At this time a blue blank slide will appear on the screen indicating an interactive component of the
program. This will not have a title so that it will not be distracting to students. Instructor will have
students come up and place green or red stickers on large male/female body silhouettes demonstrating
safe/unsafe touch areas for them to be touched as well as safe/unsafe areas they can touch others. Use
the terms “OK” and “Stop” to distinguish safe/unsafe areas.
Thank students and teachers for coming and doing such a great job. Address any other questions at this
time.
Provide booklets to teachers to distribute to students and/or parents. Explain to students that the
booklet is for them to use with a parent or trusted adult. It will have information on the things we talked
about today to help remind them how to take care of their bodies during puberty and to answer
questions they may have.
Copyright © Robert Crown Center for Health Education, 2014
Copyright © Robert Crown Center for Health Education, 2014