Explore UAB

Colleges & Schools

Inquiro UAB's Undergraduate Research Journal
inquiro vol 12 banner - illustration of an earth-like planet floating in space, with artistic white streaks and a few stars across the planet and the black space background.

Inquiro Volume 12

Navigating Puberty: A Systematic Review of Sex and Puberty Education for Autistic Children

Victoria A. Boatright, Shannon M. Kirshy, Caroline G. Richter

Department of Psychology

Abstract

This literature review explores research on sex and puberty education for autistic children, emphasizing the need for customized educational approaches. By analyzing existing studies, it identifies key themes, instructional strategies, and obstacles to effective education. The findings reveal a significant research gap, as much of the literature emphasizes the challenges faced by autistic children rather than evidence-based interventions. When strategies are discussed, they highlight the importance of individualized, structured, and visual learning methods. Additionally, this review underscores the necessity of incorporating caregiver and educator perspectives to develop holistic educational models that support informed decision-making and overall well-being. By addressing these gaps, this synthesis lays the groundwork for developing targeted interventions that enhance the accessibility and effectiveness of sex and puberty education for autistic children.

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by differences in social interaction, communication, and behavior (American Psychiatric Association, 2013). As autistic children approach and experience puberty, they undergo the same physical and emotional changes as their neurotypical peers. However, these transitions often present heightened challenges due to the intersection of social communication differences, sensory processing sensitivities, and cognitive inflexibility, all of which can impact their ability to navigate new experiences and relationships (Holmes et al., 2020). These overlapping challenges highlight the critical need for comprehensive, developmentally appropriate sex and puberty education for autistic youth.

Despite this need, many autistic individuals receive limited or inconsistent education on sexuality and puberty from educators, healthcare providers, and caregivers, leaving them underprepared to navigate essential aspects of development (Brown-Lavoie et al., 2014). Effective sex and puberty education must extend beyond biological changes to address critical areas such as personal boundaries, consent, safety, and social communication (Beddows & Brooks, 2015). Autistic children face an increased risk of exploitation due to challenges in interpreting social cues, understanding interpersonal boundaries, and communicating discomfort or harm (Mandell et al., 2005; Cridland et al., 2013). Alarmingly, Brown-Lavoie et al. (2014) found that 78% of autistic participants reported experiencing at least one instance of sexual victimization during childhood, compared to 47.4% of their neurotypical peers. These findings underscore the interrelated need for protective education and skill development in boundary-setting, self-advocacy, and harm reporting (Holmes & Himle, 2014; Van den Toren et al., 2021).

Additionally, research challenges the persistent misconception that autistic individuals are inherently disinterested in relationships or asexual. In reality, many autistic adolescents desire intimacy, connection, and romantic or sexual relationships, though their experiences may be shaped by differences in social communication, sensory needs, and cognitive processing (Dewinter et al., 2015; Hancock et al., 2019). Without inclusive and affirming education, autistic youth may struggle to explore and express their identity safely and confidently, increasing vulnerability to isolation, misunderstanding, and stigma (Dekker et al., 2017).

Comprehensive sexuality and puberty education provide an essential framework for addressing these overlapping challenges. Effective programs teach about physical and emotional changes while fostering communication skills, social understanding, emotional regulation, and identity development within a neurodiversity-affirming framework (Donnelly et al., 2023). A growing body of literature underscores the importance of empathetic, individualized instruction that recognizes the diverse ways autistic youth experience puberty and sexuality, promoting safety, autonomy, and dignity (Beddows & Brooks, 2015; Holmes et al., 2020; Donnelly et al., 2023).

Ultimately, these educational efforts must also consider broader legal, ethical, and policy issues. Disparities in access to sexuality education continue to exist globally, shaped by regional policy barriers, stigma related to disability and sexuality, and insufficient training for educators (Schmidt et al., 2020). As awareness and advocacy grow, there is a crucial need for research-informed guidance to ensure that sex and puberty education for autistic youth is both inclusive and rights-based.

This systematic review synthesizes current research on sex and puberty education for autistic children and adolescents, examining common challenges, evidence-based practices, and the broader legal and ethical considerations shaping this field. In doing so, this review aims to serve as a valuable resource for educators, caregivers, healthcare professionals, and researchers dedicated to supporting autistic youth through puberty and into adulthood.

Method

This literature review employs explicit inclusion and exclusion criteria to ensure the relevance and quality of selected studies. Studies were included if they focused on children and adolescents diagnosed with ASD or related conditions, such as pervasive developmental disorder not otherwise specified (PDD-NOS), within the age range of 3 to 22 years. Eligible studies examined comprehensive puberty and sexuality education programs, including curricula, interventions, and training programs. Participants included autistic children, parents, educators, or professionals working with them. The review considered studies that reported on the impact, effectiveness, and outcomes of sex education programs, explicitly evaluating knowledge acquisition, skill development, well-being, and safety. Only peer-reviewed journal articles published in English from 1994 onward were included.

Studies were excluded if they focused on populations outside the specified age range, involved individuals with non-ASD-related conditions, described interventions unrelated to puberty and sexuality education, or examined outcomes that did not align with the research objectives. Studies published before 1994 were omitted to align with the DSM-IV and DSM-V diagnostic criteria for ASD. Furthermore, research that exclusively targeted individuals aged 18 to 22 was not included, as previous reviews have primarily concentrated on adults. Systematic reviews were also excluded to preserve the originality and specificity of the selected studies.

The literature search utilized multiple academic databases, including PsycINFO, PubMed, the Educational Resources Information Center (ERIC), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Web of Science. The search strategy incorporated a blend of Medical Subject Headings (MeSH) and free-text keywords tailored to the topic. The primary search terms included “Autism spectrum disorder” OR “ASD” OR ‘Pervasive developmental disorder” OR “PDD-NOS,” “Sex education” OR “Puberty education” OR “Sexuality education” OR “Comprehensive sexuality education," “Intervention” OR “Curriculum” OR “Training program," and “Children” OR “Adolescents” OR “Youth." Boolean operators (AND, OR) were employed to refine the search strategy and exclude irrelevant studies. Filters were applied to limit results to peer-reviewed journal articles, English-language publications, and studies published since 1994.

The initial database search yielded 557 papers related to puberty and sexuality education for autistic children. After removing 108 duplicates, 449 studies remained for relevance assessment. The screening process occurred in two phases. First, two independent reviewers screened the titles and abstracts to assess relevance based on the inclusion and exclusion criteria. In the second phase, 47 full-text articles were evaluated for methodological rigor, relevance to comprehensive sex education, and alignment with the study’s research questions. Following this final review, 11 studies met all eligibility criteria for inclusion in the literature review.

Results

Several included studies reported that autistic individuals experience puberty differently due to the interplay of sensory sensitivities, communication differences, social challenges, and emotional difficulties. These interconnected factors were shown to influence both the experience of puberty and the effectiveness of educational interventions.

Sensory sensitivities were consistently linked to increased distress related to bodily changes, including discomfort with body odor, menstruation, and personal hygiene routines (Chan & John, 2012). One study suggested that structured learning environments, gradual exposure to puberty-related stimuli, and targeted instruction could help reduce distress and promote adaptation (Klett & Turan, 2011). Explicit instruction on hygiene skills, including menstrual care and deodorant use, enhanced self-care confidence among autistic adolescents (Klett & Turan, 2011). Visual supports, such as task analyses and social stories, proved effective in teaching hygiene routines (Stankova & Trajkovski, 2020). Similarly, gradual exposure strategies within structured settings were recognized as promising (Schmidt et al., 2020), although one study noted limited evidence regarding long-term skill retention (Ballan, 2011). Despite these findings, Cridland et al. (2013) indicated a gap in research on the effectiveness of interventions specifically targeting sensory concerns.

Communication differences were another commonly identified barrier to puberty education. Difficulties in processing abstract language, interpreting nonverbal cues, and expressing questions or concerns contributed to gaps in understanding key topics such as hygiene, consent, and relationships (Tissot, 2009). Several studies emphasized the need for explicit, direct, and repetitive instruction to enhance comprehension and skill acquisition (Holmes et al., 2016). However, Pugliese et al. (2019) reported a lack of structured curricula specifically designed to address the communication needs of autistic adolescents.

Social challenges further compounded barriers to puberty education. Difficulties in recognizing social norms, interpreting interpersonal boundaries, and navigating peer relationships increased vulnerability to misunderstandings and exploitation (Brown-Lavoie et al., 2014). While interventions, such as structured role-playing and explicit instruction about social norms, have been explored (Schmidt et al., 2020; Pugliese et al., 2019), few studies have examined their long-term effectiveness, indicating a need for further research in this area (Schmidt et al., 2020).

Emotional and psychological difficulties were frequently reported concerning puberty. Several studies described increased anxiety, mood fluctuations, and identity-related distress among autistic youth during this developmental period (Cridland et al., 2013; Mehzabin & Stokes, 2011). Interventions that integrate emotion regulation and mindfulness strategies are associated with improved emotional resilience and reduced anxiety (Pryde & Jahoda, 2018; Schmidt et al., 2020). However, Curtiss & Stoffers (2023) noted a lack of longitudinal research examining the long-term impact of these strategies.

Individualized, neurodiversity-affirming sex and puberty education has become a critical theme in multiple studies. Effective interventions have tailored content to the cognitive profiles, communication styles, and sensory needs of autistic learners (Grove et al., 2018; Stankova & Trajkovski, 2020). Visual supports, social stories, role-playing, and skill-based instructional models have enhanced comprehension and retention of puberty-related concepts (Tarnai & Wolfe, 2007; Curtiss & Stoffers, 2023). However, Brown-Lavoie et al. (2014) discovered that many autistic adolescents depend on media sources for sexual health information, which increases their vulnerability to misinformation and underscores the need for accurate, structured education.

Caregiver involvement is identified as a pivotal component of effective puberty education. Several studies have reported that caregivers often feel unprepared or uncertain about approaching these conversations (Oti-Boadi et al., 2023; Ballan, 2011). Delays in discussing puberty-related topics are commonly attributed to concerns about timing, language use, or the child’s readiness (Holmes et al., 2019). Structured guidance, caregiver training, and accessible educational materials are linked to improved communication between caregivers and autistic youth (Schmidt et al., 2020).

Finally, several studies examined the broader legal and ethical considerations surrounding sex and puberty education for autistic individuals. Inconsistent instructional practices were reported across regions due to policy restrictions on topics such as sexual orientation, gender identity, contraception, and reproductive health (Curtiss & Ebata, 2016). Individualized, ethically sound instructional strategies were recommended to promote autonomy, informed decision-making, and respect for children’s right to accurate information (Pugliese et al., 2019; Curtiss & Stoffers, 2023). Informed consent was consistently identified as a critical component of ethical puberty education (Schmidt et al., 2021).

Discussion

This review identified a consistent emphasis across the literature on the need for comprehensive sex and puberty education tailored to the developmental, cognitive, and sensory profiles of autistic individuals. Autistic youth experience puberty in ways that differ from their neurotypical peers due to the intersection of sensory sensitivities, communication differences, and social challenges (Chan & John, 2012; Klett & Turan, 2011). Without targeted, individualized instruction, autistic adolescents may encounter significant barriers to understanding bodily changes, social norms, personal boundaries, and hygiene practices, which increases their vulnerability to exploitation and social isolation (Curtiss & Stoffers, 2023; Brown-Lavoie et al., 2014).

Despite this well-documented need, disparities in access to sex and puberty education persist. This review found that the limited availability of structured curricula, caregiver discomfort with the topic, and stigma surrounding autism and sexuality contribute to significant gaps in educational delivery (Schmidt et al., 2020; Dewinter et al., 2020). A rights-based, inclusive framework — one that actively involves autistic individuals and their families in curriculum development — may improve both the accessibility and relevance of instructional content (Pugliese et al., 2019). Incorporating autistic voices in the design and implementation of educational programs ensures that the content reflects lived experiences and supports autonomy.

A recurring theme identified in this review was the importance of introducing puberty education early and in a developmentally appropriate manner. Several studies included in the review emphasized that instruction should commence before the onset of physical changes to foster emotional preparedness, reduce anxiety, and promote proactive learning (Visser et al., 2017). Structured, repetitive, and visually supported teaching methods, such as social stories, task analyses, and gradual exposure, consistently demonstrated effectiveness in reducing distress and enhancing engagement (Curtiss & Stoffers, 2023). However, it was highlighted that aligning instruction with emotional and cognitive development, rather than chronological age, is crucial due to the diverse developmental trajectories among autistic youth (Kenny et al., 2012). Flexible programming that accommodates individualized pacing is necessary to address these variations.

Another key theme that emerged was the importance of professional training. Many educators, clinicians, and caregivers reported feeling unprepared or under-resourced to provide sex and puberty education to autistic learners (Borawska-Charko et al., 2023; Kalyva, 2010). The literature consistently recommended targeted training in autism-informed pedagogy, neurodiversity-affirming communication strategies, and inclusive practices. Ongoing professional development and interdisciplinary collaboration were identified as critical for maintaining effective instruction and fostering generalization across settings (Curtiss & Stoffers, 2023). Embedding sex education content into teacher preparation programs, healthcare curricula, and caregiver training initiatives could normalize these discussions and enhance provider confidence.

This review also identified policy as a significant barrier to equitable access to sex education for autistic youth. Regional restrictions on topics such as contraception, sexual orientation, and gender identity were documented in several countries and U.S. states, including Poland, parts of the American South, and some Middle Eastern nations (Curtiss & Ebata, 2016). These policy limitations disproportionately affect autistic learners, who often require clear, explicit, and direct instruction. Advocacy for inclusive and affirming policies that respect neurodivergent learners’ rights to accurate information is essential for promoting equitable educational access (Schmidt et al., 2021).

Emerging research has begun to explore the potential of technology-assisted instruction in supporting sex and puberty education for autistic individuals. Digital tools, including visual supports, gamified learning platforms, virtual simulations, and online peer mentorship programs, have been found to enhance engagement and accessibility for autistic youth (Curtiss & Stoffers, 2023). These technologies may provide flexible, individualized learning opportunities that bolster comprehension and autonomy. However, this review identified a need for further research, particularly longitudinal and large-scale studies, to assess the sustainability, generalization, and long-term effectiveness of technology-based instructional models (Schmidt et al., 2021).

Overall, this review highlights the interconnected challenges that autistic children experience during puberty, encompassing sensory processing, communication, social understanding, emotional regulation, and access to accurate information. Tackling these challenges necessitates comprehensive, individualized, and affirming educational practices delivered within supportive systems, including families, educators, healthcare providers, and policy advocates. Ongoing research and interdisciplinary collaboration will be crucial for advancing the field and ensuring that autistic youth are equipped to navigate puberty and adolescence with dignity, safety, and self-determination.

Conclusion

The present review highlights a critical and ongoing need for comprehensive, developmentally appropriate sex and puberty education specifically designed to address the diverse needs of autistic children and adolescents. Autistic youth navigate puberty amid cognitive, emotional, sensory, and social differences, necessitating individualized educational approaches that foster understanding, self-advocacy, and emotional well-being. Across the reviewed studies, explicit instruction, structured routines, visual supports, and tailored teaching strategies emerged as essential components of effective programming.

Despite the increasing acknowledgment of these needs, access to high-quality sex and puberty education for autistic individuals remains inconsistent and unfair. Factors contributing to this issue include insufficient professional training, limited access to autism-specific curricula, restrictive policy environments, and ongoing societal discomfort regarding discussions about autism and sexuality. These obstacles often intersect, disproportionately impacting autistic learners and heightening their vulnerability to exploitation, social misunderstanding, and misinformation.

To address these gaps, future efforts must prioritize the development, dissemination, and implementation of evidence-based curricula explicitly designed for autistic learners. Early, individualized instruction, supported by visual tools, social narratives, and structured teaching methods, can foster emotional preparedness, enhance comprehension, and reduce anxiety surrounding bodily and social changes. Equally important is ensuring that educators, healthcare providers, and caregivers receive targeted, ongoing training that equips them with autism-informed, neurodiversity-affirming instructional practices.

Collaboration among educational, healthcare, and family systems reinforces key learning and promotes consistency across settings. Partnerships between families, professionals, and autistic individuals can enhance educational relevance, generalization, and cultural responsiveness. At the systems level, policy reform is necessary to dismantle restrictive frameworks that limit access to comprehensive sex education, particularly in regions where instruction on topics such as contraception, LGBTQ+ identities, or reproductive health is restricted. Advocacy for rights-based approaches that recognize sexual health education as a fundamental aspect of well-being is crucial for advancing equity.

Finally, more research is needed to evaluate the long-term effectiveness and social validity of various instructional models, particularly in diverse cultural contexts. Emerging technologies, including visual platforms, gamified learning, and peer-supported interventions, present promising avenues for enhancing accessibility and engagement. However, further longitudinal and large-scale studies are essential to assess their sustainability and real-world impact.

By addressing these research, practice, and policy priorities, the field can progress toward a more inclusive, empowering, and evidence-informed model of sex and puberty education. Such efforts are vital for supporting autistic youth as they navigate adolescence with confidence, safety, autonomy, and dignity.

References