Association for Behavior Analysis International

Though caregivers of females with disabilities commonly express concerns about teaching feminine hygiene and other related skills, there is limited applied research focus in this area (Veazey et al., 2016). Additionally, many adolescents with Autism Spectrum Disorder (ASD) face increased adversity in coping with and understanding the rapid physical, cognitive, emotional, and social changes experienced during puberty compared to neurotypical peers. Independence with feminine hygiene routines can potentially also impact access to social relationships and employment. As such, it is critical that clinical practitioners, caregivers, and other professionals can skillfully support individuals with ASD in acquiring this skill repertoire. To this end, this symposium will discuss ethical, compassionate intervention approaches developed in one-to-one behavior analytic school settings to prepare and support individuals with ASD to independently attend to their menstrual hygiene needs. Specifically, we will discuss (a) partnering with medical providers and caregivers to engage in ethical and culturally sensitive pre-menarche planning, (b) case studies illustrating individualized task analysis, intervention procedures, and modifications across learners with a variety of skill repertoires prior to and following menarche, (c) ancillary self-management skills taught to support learners’ independence, and (d) analysis of associations between menstrual symptoms and interfering behaviors, leading to subsequent individualized environmental modifications.

The target audience is behavior analysts serving individuals with autism spectrum disorder nearing or experiencing menarche and/or experiencing menstruation as well as those in training roles such as supervisors, clinical directors, or executive directors in organizations providing behavior-analytic intervention services.

Determining when, what, how, and whose input to incorporate into teaching menstrual hygiene skills to learners with autism spectrum disorder (ASD) is a responsibility fraught with ethical implications. To put it mildly, balancing the ethical responsibility to advocate for learners’ needs with sensitivity to caregivers’ cultural and personal expectations, experiences, and comfort level discussing menstrual hygiene is no easy task. Yet, it is our duty as behavior analysts to address the needs of those we serve regardless of the challenges, unfamiliarity, or discomfort we may face in having such conversations or designing such procedures. In this presentation, we discuss our multi-site procedures and experiences incorporating the input and facilitative roles of school medical personnel and the value of rich histories of rapport-building with learners’ caregivers in productively navigating conversations and clinical timeline decision-making regarding the implementation of menstrual hygiene skills instruction for learners with ASD. We will specifically highlight considerations in individualizing conversations and discussion across learners and follow up by connecting these to pre-menarche intervention data across multiple learners.

The use of self-management interventions for individuals with Autism Spectrum Disorder (ASD) increases opportunities to engage in actions that will change one’s environment, and ultimately, lead to changes in their own behavior (Skinner, 1953). Incorporating self-management strategies may provide a client with autonomy, enhance their receptivity to intervention, and accelerate skill acquisition and independence, thereby maximizing benefits to the client. This presentation will review intervention procedures introduced for two females with autism in a one-to-one behavior analytic school setting to teach independent self-management of feminine hygiene skills during menstruation, and strategies used to promote generalization and maintenance of these skills. We will further discuss the importance of self-management in the context of menstrual hygiene skills with respect to potential impact beyond individual personal care to areas of life such as social relationships and employment, and how this may impact broader decision-making by practitioners, caregivers, and other professionals providing services to individuals with ASD.