Supporting Menstrual Hygiene Skills in Adolescents with Autism: A Structured Learning Approach
DOI:
https://doi.org/10.29408/jhm.v12i2.34668Keywords:
autism spectrum disorder, educational intervention, functional independence, menstrual hygiene education, self-care skillsAbstract
Adolescents with Autism Spectrum Disorder (ASD) often experience challenges in managing menstrual hygiene due to limitations in adaptive functioning and self-care skills. Limited preparation prior to menarche may increase dependence on caregivers and reduce independence in daily activities. This study aims to examine the effectiveness of a structured instructional approach in improving menstrual hygiene skills among adolescents with ASD within an educational context. This study employed a single-subject (A-B) design with mastery criteria and maintenance assessment. The participants were two female adolescents aged 9-10 years. The intervention targeted essential skills, including menstrual pad application, cleaning and disposal of used pads, and independent daily practice. Instruction was delivered through systematic, step-by-step procedures supported by prompting, repetition, and reinforcement to facilitate skill acquisition and retention. The results indicated that both participants achieved increased independence within 17-22 days. The acquired skills were successfully generalized and applied during naturally occurring menstruation. Parental involvement contributed to consistent practice and supported the transfer of skills across settings. These findings suggest that structured instructional strategies are effective in enhancing menstrual hygiene skills and promoting functional independence among adolescents with ASD. Integrating practical life-skill training into educational programs is essential to support puberty preparation and long-term independence.
References
Anwar, A., Sutadi, R., & Miranda, C. (2022). Development of Discrete Trial Training (DTT) Procedure in Smart Applied Behavior Analysis (Smart ABA) for Autism. Journal of Psychology and Behavior Studies, 2(1), 44–63. https://doi.org/10.32996/jpbs.2022.2.1.7.
Appiah-Agyekum, N. N., Nyamekye, M. A., Agbenu, I. A., & Otoo, D. D. (2025). Menstrual hygiene knowledge and practices among female senior high school students in the new Juaben North municipality of Ghana: a cross-sectional study. BMC Public Health, 25(1), 1563. https://doi.org/10.1186/s12889-025-22836-8.
Arneliza, A., Rahmawati, S., Sutadi, R., Alsa, A., & Yunanto, K. T. (2025). Experiences and Strategies of Competent Smart ABA Therapists in Treating Children with Autism. Pakistan Journal of Psychological Research, 40(2), 351–372. https://doi.org/10.33824/PJPR.2025.40.2.21.
Arneliza, A., Sutadi, R., Alsa, A., & Yunanto, K. T. (2026). Development and Implementation of Smart Measurement and Evaluation (Smart ME): A Trial-by-Trial Monitoring System for Autism Therapy. Journal of Culture and Values in Education, 9(1), 106–124. https://doi.org/10.46303/jcve.2026.5.
Arunkumar, A. (2023). The significance of imparting life skills education. In Pooja Gupta (Eds.) Life Skills in Contemporary Education Systems: Exploring Dimensions. Nova Science Publishers.
Blakemore, S.-J., & Mills, K. L. (2014). Is adolescence a sensitive period for sociocultural processing? Journal of Child Psychology and Psychiatry, 55(9), 926–932. https://doi.org/10.1111/jcpp.12263.
Cengher, M., Budd, A., Farrell, N., & Fienup, D. M. (2018). A Review of Prompt-Fading Procedures : Implications for Effective and Efficient Skill Acquisition. 155–173.
Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied behavior analysis. Pearson UK.
Corbett, B. A., Muscatello, R. A., Cyperski, M., Sadikova, E., Edmiston, E. K., McGonigle, T. W., Calvosa, R., & Vandekar, S. (2024). Gender diversity in autistic and neurotypical youth over adolescence and puberty: A longitudinal study. Autism Research, 17(7), 1450–1463. https://doi.org/10.1002/aur.3141.
Corbett, B. A., Muscatello, R. A., Kim, A., Vandekar, S., Duffus, S., Sparks, S., & Tanguturi, Y. (2022). Examination of pubertal timing and tempo in females and males with autism spectrum disorder compared to typically developing youth. Autism Research, 15(10), 1894–1908. https://doi.org/10.1002/aur.2786.
Corbett, B. A., Vandekar, S., Muscatello, R. A., & Tanguturi, Y. (2020). Pubertal Timing During Early Adolescence: Advanced Pubertal Onset in Females with Autism Spectrum Disorder. Autism Research, 13(12), 2202–2215. https://doi.org/10.1002/aur.2406.
Cridland, E. K., Jones, S. C., Caputi, P., & Magee, C. A. (2018). Being a girl in a boys’ world: Investigating the experiences of girls with autism spectrum disorders during adolescence. Journal of Autism and Developmental Disorders, 48(4), 1261–1274. https://doi.org/10.1007/s10803-017-3366-5.
Cummins, C., Pellicano, E., & Crane, L. (2020). Supporting Minimally Verbal Autistic Girls with Intellectual Disabilities Through Puberty: Perspectives of Parents and Educators. Journal of Autism and Developmental Disorders, 50(7), 2439–2448. https://doi.org/10.1007/s10803-018-3782-8.
Dunkel, L., Saengkaew, T., Howard, S.R. (2024). Disorders of Puberty and Their Management. In: Dattani, M., Maghnie, M. (Eds.) Paediatric Endocrinology. Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-030-23709-7_6.
Dural, Ö., Taş, İ. S., & Akhan, S. E. (2020). Management of Menstrual and Gynecologic Concerns in Girls with Special Needs. Journal of Clinical Research in Pediatric Endocrinology, 12(1), 41–45. https://doi.org/10.4274/jcrpe.galenos.2019.2019.S0174.
Fei, Y. F., Ernst, S. D., Dendrinos, M. L., & Quint, E. H. (2021). Preparing for Puberty in Girls With Special Needs: A Cohort Study of Caregiver Concerns and Patient Outcomes. Journal of Pediatric and Adolescent Gynecology, 34(4), 471–476. https://doi.org/10.1016/j.jpag.2021.03.008.
Groenman, A. P., van der Oord, S., & Geurts, H. M. (2024). Navigating adolescence: pubertal development in autism spectrum conditions and its relation to mental health. Archives of Women’s Mental Health, 27(6), 913–921. https://doi.org/10.1007/s00737-023-01414-0.
Hantman, R. M., Johnston, E. B., & Tager-Flusberg, H. (2024). Parental Perspectives: How Sensory Sensitivities Impact the Transition to Adulthood in Adolescents and Young Adults with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 54(2), 544–562. https://doi.org/10.1007/s10803-022-05815-5.
Jones, G., Helsley, S., Fox, R., Tumminello, A., Grasso, A., Potter, A. M., Wynarczuk, K., & Reinson, C. (2025). Parent Perspectives: Menstruation and Menstrual Hygiene Management for Autistic Daughters. The American Journal of Occupational Therapy, 79(6), 7906205060. https://doi.org/10.5014/ajot.2025.051141.
Kientz, M., & Dunn, W. (2012). Evaluating the Effectiveness of Contextual Intervention for Adolescents with Autism Spectrum Disorders. Journal of Occupational Therapy, Schools, & Early Intervention, 5(3–4), 196–208. https://doi.org/10.1080/19411243.2012.737271.
Kolb, D. A. (2015). Experiential Learning: Experience as the Source of Learning and Development. Pearson Education.
Larson, S. K., Nielsen, S., Hemberger, K., & Klug, M. G. (2021). Addressing Puberty Challenges for Adolescents With Autism Spectrum Disorder: A Survey of Occupational Therapy Practice Trends. The American Journal of Occupational Therapy, 75(3), 7503180020. https://doi.org/10.5014/ajot.2021.040105.
Leaf, J. B., Cihon, J. H., Ferguson, J. L., Leaf, R., & McEachin, J. (2019). Comparing no-no prompt to flexible prompt fading to teach expressive labels to individuals diagnosed with autism spectrum disorder. Education and Training in Autism and Developmental Disabilities, 54(3), 274–287. https://doi.org/10.1177/215416471905400307.
Leal Fuentes, I., Pey Burchard, A., & Troncoso Espinoza, P. (2025). Explorando la salud menstrual en niñas y adolescentes: Una revisión de alcance. Andes Pediatrica, 96(5), 668-681. https://doi.org/10.32641/andespediatr.v96i5.5676.
Long, H., Park, E., Norton, K., Morlino, R., & Herrod, J. (2025). Functional Curriculum and Life Skill Instruction for Students with Extensive Support Needs. In Bakken, J. P. (Eds.) Handbook for Educating Students with Disabilities. https://doi.org/10.1007/978-3-031-60258-0_20.
Lundy, K. M., Fischer, A. J., Illapperuma-Wood, C. R., & Schultz, B. (2025). Understanding autistic youths’ menstrual product preferences and caregivers’ product choices. Autism, 29(2), 447–461. https://doi.org/10.1177/13623613241275280.
Lundy, K. M., Wenzbauer, M. A., Illapperuma, C. R., Fischer, A. J., Feng, M. J., Jensen, R. L., Maldonado, A. F., Mathis, S. N., Meservy, J. O., & Heller, H. N. (2022). Evaluating the Acceptability and Social Validity of a Caregiver-Led Technology-Based Menstrual Hygiene Management Intervention for Youth on the Autism Spectrum. Advances in Neurodevelopmental Disorders, 6(3), 315–330. https://doi.org/10.1007/s41252-022-00261-x.
Manjur, S. Bin, Nur, N. N., Rahman, M. M., Basunia, R., & Khan, M. M. (2021). Educational Web Application for Young People to Raise Awareness on Menstruation. 2021 IEEE World AI IoT Congress (AIIoT), 0165–0169. https://doi.org/10.1109/AIIoT52608.2021.9454177.
McGogo, J. (2023). ASD:Adolescents and sexual experiences in rural Mpumalanga. In Clasquin-Johnson, M., Mahlo, D., & Clasquin-Johnson M. (Eds.) Autism Perspectives from Africa (Volume I). Rourledge. https://doi.org/10.4324/9781003365631-10.
McMahon, M., Cooney-Miner, D., Bourne, M., & Brown, H. (2025). Pilot educational intervention for the care of adolescents with autism spectrum disorder during puberty. Journal of the American Association of Nurse Practitioners, 37(1), 36–43. https://doi.org/10.1097/JXX.0000000000001033.
McPherson, A. C., King, G., Rudzik, A., Kingsnorth, S., & Gorter, J. W. (2016). Optimizing life success through residential immersive life skills programs for youth with disabilities: study protocol of a mixed-methods, prospective, comparative cohort study. BMC Pediatrics, 16(1), 153. https://doi.org/10.1186/s12887-016-0694-7.
Memarian, A., & Mehrpisheh, S. (2015). Therapeutic and ethical dilemma of puberty and menstruation problems in an intellectually disabled (autistic) female: A case report and review of the literature. Acta Medica Iranica, 53(10), 663–666. https://acta.tums.ac.ir/index.php/acta/article/view/5014.
Muscatello, R. A., Rafatjoo, E., Mirpuri, K. K., Kim, A., Vandekar, S., & Corbett, B. A. (2022). Salivary testosterone in male and female youth with and without autism spectrum disorder: considerations of development, sex, and diagnosis. Molecular Autism, 13(1), 37. https://doi.org/10.1186/s13229-022-00515-4.
Nichols, S., Moravcik, G. M., & Tetenbaum, S. P. (2020). Girls growing up on the autism spectrum: What parents and professionals should know about puberty and adolescence. Autism Research, 13(10), 1732–1743. https://doi.org/10.1002/aur.2350.
Oshinski, M. K., Falcomata, T. S., & Erhard, P. (2023). Interventions to Teach Intimate Care Skills to Individuals with Autism and Other Developmental Disabilities: A Systematic Synthesis of the Literature. Journal of Developmental and Physical Disabilities, 35(5), 709–741. https://doi.org/10.1007/s10882-022-09884-3.
Pyra, E., & Schwarz, W. (2019). Puberty: Normal, Delayed, and Precocious. In Llahana, S., Follin, C., Yedinak, C., Grossman, A. (Eds.) Advanced Practice in Endocrinology Nursing. Springer International Publishing. https://doi.org/10.1007/978-3-319-99817-6_4.
Randall, K. N., Hopkins, C. S., & Drew, H. (2024). Menstrual education programs for girls and young women with intellectual and developmental disabilities: A systematic review. Journal of Applied Research in Intellectual Disabilities, 37(4), e13264. https://doi.org/10.1111/jar.13264.
Richards, S. B. (2018). Single subject research: Applications in educational settings. Cengage Learning.
Root, A. W. (2005). Sexual Precocity: A Historical Perspective And Update. Fetal and Pediatric Pathology, 24(1), 39–62. https://doi.org/10.1080/15227950590961207.
Ruble, L. A., McDuffie, A., King, A. S., & Lorenz, D. (2021). Caregiver perspectives on puberty-related challenges in adolescents with autism spectrum disorder. Autism, 25(6), 1650–1662. https://doi.org/10.1177/13623613211007029.
Schalock, R. L., Borthwick-Duffy, S. A., Bradley, V. J., Buntinx, W. H. E., Coulter, D. L., Craig, E. M., Gomez, S. C., Lachapelle, Y., Luckasson, R., Reeve, A., Shogren, K. A., Snell, M. E., Spreat, S., Tassé, M. J., & Verdugo, M. A. (2010). Intellectual disability: Definition, classification, and systems of supports. American Association on Intellectual and Developmental Disabilities.
Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and Quasi-experimental Designs for Generalized Causal Inference. Houghton Mifflin.
Sommer, M., & Caruso, B. A. (2015). Menstrual hygiene management and WASH. In Bartram, J., Baum, R., Coclanis, P., Gute, D., Kay, D., McFadyen, S., Pond, K., Robertson, W., & Rouse, M. (EDs.) Routledge Handbook of Water and Health (pp. 522–530). https://doi.org/10.4324/9781315693606-64.
Sparrow, S. S., Cicchetti, D. V, & Saulnier, C. A. (2016). Vineland Adaptive Behavior Scales, Third Edition: Manual. Pearson.
Sutadi, R., Teguh Yunanto, K., Khattak, A. Z., Prasetyo, C., & Arneliza. (2026). Implementation of Smart Discrimination Training to Improve Discrimination Skills in Autism Spectrum Disorder. Tazkiya Journal of Psychology, 14(1), 27-44. https://doi.org/10.15408/tazkiya.v14i1.51035.
Tonder, G. P. Van, Kloppers, M. M., Grosser, M. M., & Knoop, H. H. (2022). Enabling Self-Directed Academic and Personal Wellbeing Through Cognitive Education. Frontiers in Psychology, 12, 789194. https://doi.org/10.3389/fpsyg.2021.789194.
Visser, K., Greaves-Lord, K., Tick, N. T., Verhulst, F. C., Maras, A., & van der Vegt, E. J. M. (2017). A randomized controlled trial to examine the effects of the Tackling Teenage psychosexual training program for adolescents with autism spectrum disorder. Journal of Child Psychology and Psychiatry and Allied Disciplines, 58(7), 840–850. https://doi.org/10.1111/jcpp.12709.
Yilmaz, S., & Kaytez, N. (2025). Experiences of caregivers of adolescent children with intellectual disabilities in menstrual hygiene management: obstacles and needs. International Journal of Developmental Disabilities, 71(7), 1099–1109. https://doi.org/10.1080/20473869.2024.2446349.
Yuwono, I., & Novitasari, S. (2025). DESIGN SINGLE SUBJECT RESEARCH (Alternatif Metode Penelitian dalam Pendidikan Khusus). CV. Bravo Press Indonesia.
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