Robert Crown Center for Health Education PUBERTY EDUCATION PROGRAM ADAPTED FOR BOYS WITH ASD/SPECIAL NEEDS- SCRIPT Barb Barrett, Senior Health Educator September 30, 2014 Materials Power Point: Slide Activity/Content/Teaching Point 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 level. 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.
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 student s 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.
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 good 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 challenging topics later.* 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. 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.
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.
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. 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. Once complete, power point image should be put up on screen and briefly explained again. Show three squares at a time to allow students to process the information without being overwhelmed. What can you do after you shower that will help you smell nice and not feel as wet or sweaty? Deodorantright. 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. 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 are on medications and this can be confusing for them) and the need to get help with this from a parent or a trusted adult. 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 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. 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. 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 most of these students have severe and 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. 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. 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 excited 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 embarrassing-this 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.
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. 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 a private matter. 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 or dad 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 itit 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. 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.
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.
Discuss Safe 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? 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.