Understanding health services and puberty for autistic adolescents and those with disability: A scoping review to inform occupational therapy practice.
Sarah Hausler, Kate Sargeant, Emma George
18.9% of OTs working with pubertal-aged children address menstruation.
Across 17 studies, the most consistently advocated support is anticipatory education before menarche, delivered in a person- and family-centred way.
Key findings
1Only 17 articles were included across all health services, and just 2 of these focused specifically on occupational therapy.
2In a 2021 North American survey of OT practice, 18.9% addressed menstruation and 25.6% addressed masturbation in pubertal-aged children.
3Across the included studies, anticipatory education before menarche was the most consistently advocated form of support, with practical demonstrations of pad use and visual tools identified as key methods.
Still to come
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
Only 17 articles were included, ranging from single case reports to surveys and qualitative studies, with no quality appraisal performed (by design of the scoping review). Only 2 of the 17 articles focused specifically on occupational therapy, so the OT-specific evidence base is extremely thin. Most findings come from parent or caregiver perspectives rather than the young person's own voice; the authors note this limits how directly the findings can be applied to the adolescent's experience. Several findings are culturally specific (e.g., cloth pad use in South India, virginity-based treatment restrictions in Iran) and may not transfer to other contexts. The review did not separate findings by gender or sex, and the authors note this is a gap given the range of gender identities in the population. Most included studies were from the US, Australia, Canada, Iran and South India; the authors note a distinct lack of Australian-specific perspectives and that service structures (e.g., NDIS funding) differ from the US context of the main OT survey.
Declared interests
The authors formally declare no known conflicts of interest. However, the positionality section states that the lead author is the founder, director and principal OT of Bloom Wellbeing, an Australian OT provider with a special interest in puberty transition, and the second author is a senior OT at the same practice. Both authors have a direct professional and commercial interest in the topic the review addresses.
The easy way to misread this
Do not read this as evidence that specific OT interventions work for puberty support. It is a scoping review mapping a gap in the literature, not a test of any intervention. The 17 included articles range from single case reports to surveys and were not quality-appraised, so the findings describe what exists in the literature, not what has been shown to be effective. A hurried reader might also treat the culturally specific findings (e.g., cloth pad use in South India, virginity-based treatment restrictions in Iran) as generalisable, but the authors themselves flag these as context-bound.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →