Generalized Effects of Social Stories with Task Analysis for Teaching Menstrual Care to Three Young Girls with Autism

Understanding autistic youths' menstrual product preferences and caregivers' product choices

LAY ABSTRACT

There is little research exploring the menstrual product preferences of autistic youth, especially those who recently started their period. Study authors surveyed caregivers' choice of menstrual products for their autistic children. They provided popular menstrual materials to autistic youth to try, then asked them which product(s) they preferred, did not try, and why they did not try it. Caregivers selected sensory impact as the most important feature they consider when choosing a menstrual product for their child, and youth participants preferred to use period underwear. Therefore, autistic youth may benefit from purchasing and using period underwear, and caregivers, clinicians, and companies should consider the impact of menstrual product features, like sensory sensitivities, on young autistic menstruators and how best to support them.

Investigation of Menstrual Hygiene and Self-Care Skills of Adolescent Girls with Autism Spectrum Disorder: Mother Views

PURPOSE

Puberty a period of transition from childhood to adulthood, poses problems that are difficult to manage for typically developing adolescents, but even more difficult for adolescents with autism. It is vital that girls with autism spectrum disorder (ASD), like their typically developing peers, are able to manage these physiological processes in a healthy way and learn self-care and hygiene behaviours without being dependent on others. Given the contribution of mothers to the menstrual hygiene and self-care skills of adolescent girls, this study aims to explore the views of mothers.

METHODS

The study is a case study designed in the qualitative research model. The research was carried out with the participation of 10 mothers met the necessary criteria and agreed to take part in the study voluntarily. The data obtained were subjected to descriptive and thematic analysis. Codes, sub-themes and main themes were created.

RESULTS

The research identifies the themes of self-care and menstrual hygiene, preparations made during menstruation, behavioral problems in adolescents, the person who carries out hygiene and self-care, and situations that tire/strain mothers during menstruation.

CONCLUSION

At the end of the research, it was concluded that the adolescent girls with ASD are mostly unable to perform their self-care and hygiene adequately, and that the mothers do nothing to prepare their daughters for adolescence. It was also concluded that the most stressful situation for mothers during adolescence is usually the difficulty their daughters have in using sanitary pads, cleaning armpits and genital hair, and bathing.

Menstrual education programs for girls and young women with intellectual and developmental disabilities: A systematic review

BACKGROUND

Providing menstrual education and guidance for menstrual management for girls and young women with intellectual disabilities is recommended to ensure smooth pubertal transitions and to support menstrual self-agency.

METHOD

The purpose of this systematic review is to explore menstrual education interventions for girls and young women with intellectual disabilities.

RESULTS

Nine studies were included. Interventions were provided in small groups (n = 4) and individually (n = 5). Most studies used dolls (n = 7) and task analysis (n = 7) to teach pad-replacement skills. All reported significant improvements in participant skills and/or knowledge following the intervention. Only one study addressed self-agency and self-esteem as an outcome of the intervention. Menstrual education for girls and young women with intellectual disabilities is largely focused on pad-replacement skills.

CONCLUSION

Further research is needed to understand the impact of menstrual health and hygiene education on variables apart from skill improvement such as self-agency and long-term health outcomes related to menstrual health.

Effect of Video Modeling With Simulation on Improving Menstrual Hygiene Skills for Adolescents With Autism Spectrum Disorder

Background Menstruation is a biological process experienced by women every month. This project intends to improve menstrual hygiene skills using video modeling with simulation. Educating adolescent girls with autism spectrum disorder to engage in personal care during their menstrual cycle, particularly sanitation and hygiene, is essential. It is important to develop the knowledge and skills necessary for effective self-care during menstruation to prevent sexual health problems. Additionally, the project aims to provide a safe environment for adolescents to practice their menstrual hygiene routines and relieve the stress from their caregivers. Aim and objective The study aims to evaluate the effect of video modeling with simulation to improve menstrual hygiene skills in adolescents with autism. The ultimate objective of the study is to determine whether video modeling with simulation in the experimental group enhances the practice of menstrual hygiene among adolescent girls with autism, as well as the impact of traditional occupational therapy intervention on improving menstrual hygiene in this population. Methodology This is a quasi-experimental design with convenience sampling and selected samples (n=50), who were then split into two groups: an experimental group (n=25) and a control group (n=25) based on the inclusion and exclusion criteria. The experimental group received video modeling and simulation, while the control group did not receive any specific intervention except parent education and pictorial representations. Pre- and post-tests were conducted to measure the changes. Indian Scale for Assessment of Autism was the screening tool used and the Menstrual Practice Needs Scale (MNPS) was administered. The duration of the study was six months, three sessions per week, lasting 45 minutes to an hour each. The statistical analysis was done with significance at a 1% alpha level using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, NY, USA). Results The pre-test and post-test data were analyzed using the Wilcoxon signed-rank test and the Mann-Whitney test. The results demonstrated the comparison of the pre-test and post-test mean scores of the MNPS scores were highly statistically significant (p-value of 0.000) when compared to the control group. Following the implementation of video modeling with simulation, the experimental group's post-test scores were significantly higher than the control group's (p-value of 0.000). Thus, the study showed that video modeling with simulation improved menstrual hygiene in adolescents with autism spectrum disorder. Conclusion The clinical significance of this study was that the adolescents were excited to watch the videos and perform the activities; furthermore, after video modeling with simulation was implemented, there was a significant improvement in the experimental group when compared to the control group. This enhances the practice of the menstrual hygiene skills independently by the adolescents. Video modeling with simulation has paved the way for improving menstrual hygiene in adolescents with autism. Although the findings from the study are positive, more clinical trials are needed to prove that video modeling with simulation can be used as a therapeutic modality.

An Analysis of Teaching Menstrual Care Skills Using Single-Subject Methodology: A Systematic Literature Review

PURPOSE

There is a paucity in research supporting procedures to teach skills needed during an individual's menstrual cycle. The purpose of this study was two-fold. First, a literature review was conducted to find publications on the topic of menstrual care. Second, the studies found were evaluated against What Works Clearinghouse™ (WWC) standards and analyzed to determine the presence of clinical components relevant to teaching these skills.

METHODS

A literature review was conducted according to PRISMA guidelines. The review identified publications that taught menstrual care skills to individuals diagnosed with autism spectrum disorder (ASD) or other disabilities. The review focused specifically on studies that employed single-subject research methodology. Studies found were analyzed against the WWC's criteria to assess the rigor of each studies' methodology. Finally, studies were categorized across indicators that are clinically relevant to teaching menstrual care skills.

RESULTS

The results highlighted a lack of empirical support for teaching menstrual care skills. 7 single-subject design studies were identified in the previous 40 years of research. One study met all criteria required to receive the WWC's highest rating.

CONCLUSION

The complexity and private nature of menstrual care skills can make intervention development daunting. This paper was intended to provide menstrual care researchers with guidance in implementing high-quality studies. Additionally, scientist-practitioners can find guidance regarding important considerations to support programming that is both effective and respectful.

Effectiveness of menstruation hygiene skills training for adolescents with autism

BACKGROUND

Adolescents with autism spectrum disorder (ASD) may encounter many difficulties with their menstrual cycles. Potential challenges that adolescents with ASD may face include understanding physical changes, coping with symptoms, emotional sensitivity, communication, personal care, and hygiene.

AIM

To evaluate the effect of menstrual hygiene skills training given to adolescents with ASD on their menstrual hygiene skills.

METHODS

The study was conducted with 15 adolescents diagnosed with ASD by the single group pre-test and post-test model in three special education centers in Türkiye. Data were collected with the Adolescent and Parent Information Form and the Adolescent-Specific Menstrual Hygiene Skill Registration Form.

RESULTS

While the mean age of adolescents was 16.06 ± 0.88 years, the mean age of individuals responsible for adolescent care was 43.66 ± 5.56 years. While 60.0% of the adolescents noticed the onset of bleeding before training, this rate was 93.3% after training. The Adolescent-Specific Menstrual Hygiene Skill Registration Form showed a statistically significant increase in the application steps after the training. The difference between the menstrual hygiene skill scores of adolescents diagnosed with ASD before and after training was significant.

CONCLUSION

The menstrual hygiene skills training given to adolescents with ASD was beneficial in increasing their menstrual hygiene skills. These individuals must take responsibility during menstruation and independently manage their continuous care activities.

Comparison of Menstrual Care Skills Training Programs Provided to Girls with Intellectual Disabilities By a Healthcare Professional and Caregivers: A Randomized Controlled Trial

Objective: To compare the effectiveness of the training provided by the professional and caregivers in developing menstrual care skills of girls with intellectual disabilities. Methods: A randomized controlled trial was conducted with 22 moderate girls with intellectual disabilities randomly assigned to G-I and G-II. Both groups received training program using chaining technique and modeling on a doll and on itself for 8 weeks. Assessments were made on the 1, 15, 30 and 60 days. Results: The girls' median age was 15 (14-18) years. Scores skill of menstrual care were significantly increased in both groups (p < .05; effect size = 0.61). G-I's a pad placement and changing dirty pad skill scores were higher than G-II (p = 0.05; effect size = 0.44). Conclusion: The training process performing by caregivers can be affected by the complexity of the menstrual self-care skills. School-parents cooperation-based reproductive health programs may be facilitated the teaching of complex menstrual care skills of girls with intellectual disabilities.

A rule-based theoretical account of social stories to address the double empathy problem

Social Stories™ (SS) is one of the most popular and researched interventions for autistic children. To date, research that focuses on outcomes has been prioritized over the investigation of the psychological mechanisms that inform the intervention. In this article we consider theoretical accounts proposed thus far which could underpin SS. We argue that mechanisms that are based on social deficit theories lack validity, and propose a rule-based theoretical account to inform a strengths-based approach toward conceptualizing the mechanisms that underpin SS. We apply this account to the 'double-empathy problem' to propose that SS can be adapted to involve all parties in the development and delivery of SS support by adopting a rule-based perspective. We use the example of systemizing (the drive to analyze and explore systems in terms of 'if-and-then' rules), which is proposed to be a relative autistic strength, as a form of rule-based thinking that can provide a theoretical account of SS and a framework to address the double-empathy problem.

"A scoping review: Social stories supporting behavior change for individuals with Autism"

Social Stories (also known as social narratives) help individuals participate in and understand social situations. This scoping review identifies and synthesizes social narrative research targeting behavior change in individuals with ASD. Using the following questions as a guide: (a) What is the scope of social narrative interventions used for individuals with ASD, (b) What behavior change outcome measures are evaluated, and (c) What research designs are used; five databases were searched from 2007-to-2018. Fifty-six articles met the criteria. Primary outcomes were sorted into two macro-categories: Reduce Disruptive Behaviors and Increase Desired Behaviors. Most, but not all, studies were found to be effective for various behaviors such as aggressive actions, verbal protests, identifying emotions, executive functioning, following directions, and responding in social situations. Social narratives can be used to promote skills/behaviors in individuals with ASD to enable participation, an important goal in occupational therapy practice. They are an accessible and feasible intervention that can be implemented in various settings for behaviors including activities of daily living, social skills, independence, and self-regulation. Most research reviewed the single subject design, which is a limitation of the research as it makes results difficult to generalize. However, through replication, functional relationships can be determined. Additional research utilizing randomized control trials is recommended.

Evaluating the Acceptability and Social Validity of a Caregiver-Led Technology-Based Menstrual Hygiene Management Intervention for Youth on the Autism Spectrum

OBJECTIVES

Menstrual hygiene management (MHM) is a critical area of daily living skills for neurodiverse menstruators in which few evidence-based interventions exist. This study evaluated the acceptability and social validity of a caregiver-mediated intervention for youth on the autism spectrum utilizing behavior skills training, animated video modeling, task analysis, and telehealth services to improve changing a menstrual pad.

METHODS

The consultant recruited three youth and caregiver dyads to test the intervention and collect acceptability and social validity assessments. Materials varied based on the phase of the study; however, a typical trial required data collection sheets, youth's underwear, a menstrual pad, and, during intervention, the video model and hardware technology. A multiple baseline design across participants and reversal design were used to demonstrate experimental effects. Due to the sensitive nature of the study, independence and accuracy data were collected by caregivers and analyzed later by the consultant through visual analysis.

RESULTS

Overall, youth participants improved their percentage of independent and accurate steps of changing a menstrual pad. Furthermore, caregivers reported moderate to high levels of acceptability of the telehealth service delivery and animated video modeling, as well as the overall MHM training program measured by the Technology Acceptability Model-Fast Form (FF-TAM) and the Behavior Intervention Rating Scale (BIRS), respectively. Youth reported high levels of acceptability of the MHM training program as measured by the Child Intervention Rating Profile (CIRP).

CONCLUSIONS

Results suggest that a technology-based, caregiver-mediated MHM intervention for neurodiverse youth would be considered acceptable and socially valid by caregiver and youth participants.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s41252-022-00261-x.

A Scoping Review of the Healthcare and Hygiene Literature for Individuals with Intellectual and Developmental Disabilities

Objectives

Previous reviews highlight the similarities in teaching healthcare and hygiene routines to individuals with and without intellectual and developmental disabilities. Additionally, similar interventions are used when interfering behaviors occur. Although these routines are topographically distinct, there are enough similarities to suggest effective procedures for one routine may be used to inform another. This scooping review aims to identify effective teaching and intervention procedures for healthcare and hygiene routines specifically for individuals with intellectual and developmental disabilities. We also evaluated the extent to which functional analyses were conducted; a dimension not included in previous reviews.

Methods

Eligible articles targeted compliance or tolerance within the context of a defined healthcare or hygiene routine as a dependent variable and used an experimental design with a demonstration of experimental control. Articles were identified through PsycINFO, PubMed, and Academic Search Premier databases. Additionally, a hand search of five related journals was conducted. Data were collected on dependent variables, functional analyses, baseline contingencies, teaching procedures, and additional experimental components.

Results

A total of 52 articles met inclusion criteria. Most experiments produced positive outcomes. The findings show all experiments involved a treatment package with multiple components. The most common teaching procedures were graduated exposure and DRA. A lack of functional analyses and social validity was noted.

Conclusions

Component analyses are needed to identify the most effective and efficient procedures. Pyramidal training to teach medical professionals how to provide preventative pyramidal training should be explored.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41252-022-00249-7.

Addressing Puberty Challenges for Adolescents With Autism Spectrum Disorder: A Survey of Occupational Therapy Practice Trends

IMPORTANCE

Understanding occupational therapy practice patterns for adolescents who have autism spectrum disorder (ASD) provides a baseline to determine areas of need and effective interventions.

OBJECTIVE

To identify puberty-related challenges addressed and interventions used by occupational therapy practitioners with adolescents ages 8-16 yr with ASD.

DESIGN

A nonexperimental survey design with a stratified random sample was used.

SETTING

The Occupational Therapy-Autism and Puberty Survey was distributed in the United States online through the Qualtrics platform (available October 2017-January 2018).

PARTICIPANTS

Occupational therapists (89%) or occupational therapy assistants with experience with adolescents who have ASD were included. The 71 eligible respondents were primarily White women with an average 16 yr of experience. Outcomes and Measures: Nine key challenges and 11 interventions regarding puberty and ASD were identified. Hypotheses were generated before data collection.

RESULTS

More practitioners (>47%) addressed emotional regulation and personal hygiene, and fewer (<26%) addressed menstruation, safety, and masturbation. Nearly all practitioners (>92%) reported using social learning approaches and behavioral strategies, and most (>80%) reporting having received education in these interventions. Significant differences were found between reported education and use of behavioral skills training incorporating applied behavioral analysis (p < .001), parent training (p = .002), and technology (p = .003).

CONCLUSIONS AND RELEVANCE

Practitioners are neglecting to address puberty-specific challenges with adolescents who have ASD. Opportunities exist to expand the interventions used and challenges addressed by occupational therapy practitioners for adolescents with ASD. What This Article Adds: This article expands occupational therapy literature by giving a baseline understanding of the puberty-related challenges that practitioners are addressing with adolescents who have ASD. This information can assist the profession in developing effective interventions and educational opportunities to allow practitioners to successfully address puberty-specific challenges.

Supporting Minimally Verbal Autistic Girls with Intellectual Disabilities Through Puberty: Perspectives of Parents and Educators

Limited research has examined puberty in autistic girls, yet alone those who are minimally verbal and with additional intellectual disabilities. In this study, ten parents and ten educators were interviewed about their views and experiences of supporting these girls through puberty. Results demonstrated that many parents had concerns prior to the onset of puberty in these girls. Yet, for most girls, experiences of puberty were felt to be positive, with the girls coping well with changes that they were experiencing (e.g. menstruation, breast development and developing body hair). Thematic analysis of interview data highlighted three main themes: a range of individual experiences and needs; the importance of promoting dignity and respect; and identifying ways to support these girls through puberty.

Autism and Adult Sex Education: A Literature Review using the Information-Motivation-Behavioral Skills Framework

Adults on the autism spectrum report comparable levels of desire for sex and sexual satisfaction as adults who are not on the spectrum. However, there has been little empirical focus on the need for sexual and relationship-oriented education for youth on the spectrum as they transition to adulthood. In this review, we use the Information-Motivation-Behavioral Skills Model of sexual health behavior change as a lens through which to understand the experiences of adults on the autism spectrum. We present those insights infused with emerging data and best practices in the field. Overall, it appears clear from the extant literature that providers need to recognize the specific characteristics of autism when developing sexual education curricula. Specifically, the social communication and sensory profile of people on the autism spectrum appears to interact with access to information, motivation to engage in healthy sexual activities, and the development of skills needed to engage in healthy sexual behavior. Finally, the voice of adults on the spectrum is essential to guide the emerging understanding of healthy sexuality.

Teaching menstrual care skills to intellectually disabled female students

AIMS AND OBJECTIVES

The aim of this study was to teach pad replacement skills to intellectually disabled adolescent female students during their menstruation periods by demonstrating on a dummy.

BACKGROUND

It may be difficult to make intellectually disabled adolescents achieve self-care during menstruation. In addition, there are difficulties experienced in explaining menstruation, such as physical changes and the practice of cleaning during this period.

DESIGN

The study used a 'One group pretest and post-test model'.

METHOD

The study was performed in a special educational institution. The population consisted of 77 female students in the high school section. Calculation of a sample size was not attempted, and 54 students with no attendance issues agreed to take part in the study and were included.

RESULTS

In this work, we found that pad replacement training significantly changed the scores of mentally disabled adolescents before and after training. Our training yielded positive results, and the population improved their skills at all stages of skill building.

CONCLUSION

Training adolescents with mental disabilities helped them gain hygiene habits. Performance of these trainings occurs at the beginning of menstrual hygiene education.

RELEVANCE TO CLINICAL PRACTICE

To achieve improved success in life, it is important that adolescents assume the responsibility of self-care and manage sustained care activity on their own.