Introducing the Concept of Pregnancy to your Child with Autism

Hello Everyone,

       I hope the new year is going nicely so far for you.  I am a bit late writing this post due to recently welcoming my first son into the world earlier this month.  Along with several questions raised by others and by myself, I thought a post on how to introduce the concept of having a baby to your child with autism would be particularly appropriate for this month's post.
        Pregnancy can be a wonderful and very exciting experience for the whole family, yet special considerations need to be taken when deciding how to tell your child with autism; please note this is an especially important consideration if your child is the only child.  Once you know you are pregnant, it is a good idea to begin planning how to tell your child depending on your knowledge of them and their level of functioning.  As the expert on your child, take into account how they adjust to change in their environment (social, home, community, school) and their ability to manage their psycho-emotional self.  Depending on their level of functioning, they may have a very difficult time managing these changes and finding appropriate means of expressing themselves.  Please remember to be mindful of how difficult it can be to wrestle with the complex emotional reactions to the concept of being pregnant and then think how difficult it must be for a child who, due to having autism, is much more limited in their interpretation, processing, and integration of psycho-emotional inputs.  Having such mindfulness can be very useful to finding fun, creative, and safe ways to tell your child with autism that you are pregnant.

Prepare early!  As mentioned above, it can take a child with autism a much longer and more challenging time to understand they will be having another person joining the family and competing with them for attention and care not to mention disrupting their routines.  Think of creative ways to tell your child with autism they will have a new sibling.  Describe the process of having a baby and slowly introduce them to the different steps involved in the process of having a baby.  Remember to use clear language and avoid using metaphors such as "I have a baby growing inside me" unless your child benefits from using such examples as bridges to explaining more complex aspects of understanding pregnancy.  Here are some ideas:

-Show pictures of people from infants to adults to show the progress of growth, taking special note to point out what the baby may look like and where your child is in the growth process.

-Watch videos online or on television about having babies and the care they need.

-If you have close friends or families who have babies consider arranging for your child to ask them questions and visit with the newborn to ease anxiety and help them connect what information they are gaining from you through stories or videos

-Consider getting a baby doll to demonstrate through a concrete example what a baby looks like and demonstrate how you will care for them.  This is also a great way to play act caring for your own child in the presence of your child with autism to introduce the concept of shared time and help them adjust to no longer having your undivided attention.  Make sure they understand the doll is fake and an item used to illustrate caring for a baby before attempting this suggestion.

Be prepared to create alternative plans! As we all know, children with autism thrive when they have routines and schedules to help manage their daily activities and overall assisting in self-regulation.  Having a baby represents a major change and disruption to these routines but does not have to be painful.  You can create a nice visual outlining appointments and other important dates with your child; it also helps to remind them in advance that appointments will be coming several days in advance as well as letting them know there may be times, especially around the delivery date, when sudden disruptions are expected.  Work with your child and other family members to create alternative plans around these events.  For example, if you know your child likes to go to the library every week at a certain time but you have an appointment coming, identify someone else to take them or find another time with the child to go.  As will be mentioned below, maintaining alternative plans and having contingencies is critical to helping maintain a sense of stability.

Prepare your child to handle divided attention!  If your child with autism has already experienced another sibling being born into the family, this may not apply as much, but is still important given the high threshold of time required to assist in providing for their needs and comfort.  As part of alternative plan making, consider finding respite care or someone in the family who is trusted and close to your child who will be accepted as an alternative care provider for when you cannot do so.  Introduce shared and divided time very early in combination with explaining the care requirements of a baby.

Create social stories around topics related to babies! You can create simple social stories with pictures to address a wide range of topics around baby care ranging from being an older sibling, care of a newborn, preparing to go to the hospital for delivery, and sharing time with another child.  See my post on creating effective social stories for some further suggestions.

Try to anticipate and plan for any major changes to your child's routine or living environment early!  For example, make transitions to new bedrooms, school day or after daycare programs, and changes to daily care needs early when you can devote more time to helping them adapt and integrate changes.  Consider informing any others involved in your child's care that these changes are anticipated so they can help your child make the transition.  Also consider fun and creative ways to make these changes as well as the time it may take your child to adjust based on what you know of them.

Address medical anxiety!  Autism and doctor visits often do not play nice together.  if this is an area of concern for you, consider having someone else watch your child when you go to doctor's appointments or, if you cannot avoid taking them, inform them well in advance and work through any anxiety they experience.  Consider letting them be involved by asking your doctor questions and be present during the appointment to see what is happening.  Be very honest and use clear language during the appointment and always have a back up plan in case they become overwhelmed and are not able to control themselves during the appointment.  Doing so allows them to have a safe escape if they become overwhelmed.  Praise and reinforce their bravery!
                  As a side note, consider arranging to take your child on a tour of the maternity ward if possible so they can see where you will be delivering and can understand that you will be well cared for.  again, be prepared to answer any questions while keeping a good eye out for signs of distress which you can address.

Maintain some normalcy!  I cannot stress this one enough and it has already been mentioned previously, but warrants further mention.  Despite the many changes occurring in your and your child's life, it is important that some aspects of their routine and daily living environment remain intact, at least in the beginning as you slowly introduce them to changes.  Not only will doing so help them manage and self-regulate as these changes occur, but also lets them know that these changes do not need to be dangerous and that you are still available for them and are caring for them.  Consider finding ways to integrate some favourite shared activities or rituals into your changing schedule.  Also consider integrating and adopting new ones to share together as you move farther along in your pregnancy.  For example, you might start a shared activity around going to the ice-cream store next to your doctor's office after an appointment.

Take care of yourself!  Be sure you are as mentally and emotionally prepared as possible to handle your own reactions to being pregnant and expecting before you tell your child with autism.  Despite common myths that children with autism do not register emotions, they do.  If you are portraying an air of panic when telling your child, they may suspect something is wrong and become worried or fearful.  They will also pick up on your stress and anxiety, which can cause a great deal of damage to their already limited self-coping skills.  Remember that they look to YOU to stay ok and if you do not, it will show.  Do activities that you enjoy to stay emotionally healthy and plan how you will tell your child.  You can do this!

In closing, I would like to share a couple of links to information about helping your child with autism get introduced to the concept of pregnancy.

Helping your Cild with ASD Adjust to New Siblings-This is an excellent general overview, which is easy to read and access for quick future reference.

Great Ways to Announce your Pregnancy to your Kids-This is a quick article with some suggestions on how you can introduce pregnancy to your kids.  Although not directed to children with ASD, the ideas may be tailored accordingly depending on your child's level of functioning.

Birth of a Baby Social Stories-A quick read with very good suggestions for creating social stories around having a baby

How to Prepare your Special Needs Child for the New Baby- Very thorough and very useful for parents of special needs children in general.