The Stages of Puberty for Girls with Developmental Delays

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Although there is a general timeline of when puberty will run its course, there is no set age to expect it to happen. For the most part, puberty in the developmentally disabled girl isn’t much different from puberty in any other girl. Here you will find information on the phases of puberty, what’s normal, when it should happen, any abnormalities in development, and effective strategies and information on medication to help your child or student cope.

The Stages of Puberty

Stages 1 and 2: During stage 1 of puberty there aren’t any visible signs of change in a girl’s body. The breasts are still flat and hair is not clearly visible in the private area. Most times, the physical signs of puberty begin to show around the age of 10, but can be seen normally as early as age 8.

In stage 2, breast buds, often different in size, become apparent as tissue mass increases on the chest. The area around the nipple, called the areola, will start to slightly darken but will remain flat to the breast tissue itself. You may also notice sparse hair in the vaginal and underarm areas. The use of deodorant may become necessary at this time as hormones are changing causing body odor that parents and teachers should teach the child how to address and why.

Stages 3 and 4: From ages of 9 to 14 hair will appear darker in color, thicken, and curl signifying further development of the body towards adulthood. In stage 4 (ages 10-15), breast tissue continues to grow with the areola darkening even more with the addition of papilla, or the small bumps around the nipple area, appearing. Skin changes can also be seen during this phase with the appearance of acne and darkening of the skin in the vaginal area.

All of the physical and hormonal changes observed at this point probably haven’t been very hard for her to adjust to, but monumental changes are on the horizon in the body of a girl.

The Pinnacle Moment of Puberty for Girls: Menstruation

The most significant, and many times most difficult, change in a girl’s body occurs in stage 4 of puberty with the onset of menstruation. Most girls have their first period around age 15 while some may have it several years earlier or bit later depending on what age they entered into stage 2 of puberty.

Although it may be difficult to deal with the changes that a young girl may be going through with having a period, they simply cannot be ignored. Just like you would with any other child her age, be prepared to deal with an increase in behavior problems ranging from mild to explosive throughout this time. It is important to give the girl with developmental delays as much information about what is happening to her body as you can provide and in a way that she can understand. Apply patience where needed, but also provide guidance and security in the fact that what she is going through is perfectly normal.

Final Stage

Stage 5: Breasts are fully formed with the nipple at this stage having a prominent protruding stance from the breast itself with the tissues having a distinctive fall from the chest wall. By now hair has spread from the vagina into the thigh area and has a distinctive triangular shape like an adult’s.

A sigh of relief can be had when a girl reaches stage five of puberty, adulthood is on the horizon.

Precocious Puberty

As previously stated, puberty normally does not outwardly show until a girl is at least 8 years old, but there are cases where hair has grown in the pubic region and breasts buds have begun to form before this age. In instances where the child is already showing signs of puberty, but has not reached the normal range for it to happen, they are said to be going through precocious puberty. Precious puberty differs from normal puberty by the unusual, accelerated growth observed before the child is within the normal age range for such to occur. Children with this condition are usually much taller than others their age, so much so that they tower over those in their class with growth waning or stopping completely by the time they reach adolescence making them considerably shorter adults than their peers.

If you believe she is going through precocious puberty, seek the advice of her healthcare provider.

Social Stories and Behavior plans to Help Her Cope

Social stories are one of the best ways to help a girl with developmental delays cope with nearly anything, making them very useful during puberty. Stories written on appropriate touch, menstruation, kissing, masturbation, and self esteem can all provide her with visual information on what is happening to her and how to cope. Two social stories resources are: The Gray Center website, which offers free information on writing your own stories and books, and Leeds Metropolitan University, which offers free, downloadable software for creating your own stories.

A well developed behavior plan may be a necessary tool for both teachers and parents during puberty when it comes to the developmentally delayed girl. The plan should include clear cut expectations with listed consequences for infractions all of which should be within her developmental range and provided to her on her communicative level. Also, don’t be misled; behavior plans should extend between both home and school and to all areas of the child’s life to make them effective. It also helps to include her in the development if possible to give her a sense of control by showing the value of her input.


Be very particular when deciding on the incorporation of medications to either regulate her periods or to address any behavior problems or emotional challenges related to the hormonal changes. Although tempting, the use of birth control to suppress or control menstrual periods can pose a serious and sometimes life threatening risk to her health even in the short-term due to known risks associated with such medicines, interactions with drugs she may be already taking, and systemic issues related to her disability.

The same risks can be seen when considering homeopathic remedies as well, so be sure to talk over any possibilities with your medical provider or someone certified in natural medicine before trying anything.

Remember, as tough as this time is for you, it is ten times worse for her. Puberty doesn’t last forever and many girls come out on the other side of it as perfectly well adjusted within their abilities. Be patient, be educated, and be prepared.