Signs Of Autism In Teens
Signs of autism in teens who do not (yet) have a diagnosis are likely to be subtle. If the signs were not subtle, they would probably have been picked up and assessed at a younger age. The signs often come to the surface in the early teenage years.
At Everlief, the child psychology clinic I run with my husband Mike, we specialise in working with older children who have subtle traits of autism. I will run through the signs of autism in teens, and how to support a teen with autistic traits, whether or not they have a diagnosis.
What are the Main Symptoms of Autism?
Unfortunately autism is often referred to as a “disorder” or a “condition”, but in my service we explain it as a difference, which can bring many strengths as well as difficulties. A lot of the difficulties are caused by the way the world works, rather than a fault within the autistic individual. That being said, the key traits of autism are:
- Social communication difficulties (e.g. reading and using body language/facial expression, generating two-way conversation)
- Difficulties with social imagination (e.g. making inferences, predicting what might happen next in a social interaction)
- Repetitive behaviours and intense interests
- Sensory processing difficulties (such as sensitivity to sounds)
If a child is autistic there will have been signs early on in a child’s life, but with “milder” autism these may have been so subtle that they are only spotted in hindsight.
Though autism is considered a lifelong condition the “symptoms” of autism are now considered much more fluid than we first thought. In other words, they can change over time. For example, specific social skills can improve a lot with practise and/or coaching (though the person may still find socialising exhausting). Also, the signs of autism are more obvious when a person is under stress. That’s why children often fall under the radar during primary school, but their autistic traits are more noticeable when faced with the increased demands of secondary school.
What are the Specific Signs of Autism in Teens Which May Go “Under the Radar”?
Often the early teenage years are a “perfect storm” when it comes to the emergence of autistic traits. Where once these where mild or hidden, they may now start to bubble up to the surface. The following are some of the reasons why:
- Puberty: Hormonal changes and identity exploration
- Academic pressure as the GCSE curriculum is taught
- Increasing gap between the teen and their peers (for example, social relationships become more complex and they can’t keep up).
Here are some of the issues teens may face which means they may not get the support they need straight away:
They Appear “Fine” in Class But They Are Only Just Coping
This has nothing to do with intelligence. Autistic brains work in a different way and may need adaptations in teaching style in order to achieve their potential. Perfectionism (e.g. having to re-draw a diagram over and over until it is “right”), slower processing speed, difficulty filtering out background noise, difficulty with inferences, or difficulty following multi-part instructions can make learning overwhelming and exhausting. Autistic people also tend to struggle with unlimited/too many choices, so open-ended or unstructured tasks can be a nightmare for some. If group or partner work is required, the additional social communication demands can be too much for some teens. Most teens with autistic traits won’t experience all of these issues, but most will experience at least one.
They Mask Their Sensory Difficulties So Adults Don’t See the Stress Building Up
If you have a sensitive startle response to light touch, and twenty people brush past you in the corridor, your nervous system will become overloaded within minutes. If you find loud noises hard to bear, the sound of the school bell ringing all day may send you to breaking point. Having to wear a scratchy school blazer all day and shoes that feel too tight might cause a constant sense of high stress. Every teen’s sensory profile will be different but often the adults around them are completely unaware. To make things even more complex, sometimes the teen themselves is not aware, until they reach their limit.
They Appear to Be Good at Social Interactions But May Actually Struggle
Often teenagers who come to my clinic appear to be in one of three “camps”. The first group is those who have a happy, close group of friends with whom they can truly relax, but outside of this group they find interactions unpredictable and exhausting. The second group is those who have people they “hang out” with but desperately crave closer relationships and friends they can be themselves around. The third group is those who find nearly all interactions stressful, and need more quiet/alone time than neurotypical teens. This group may or may not feel lonely. In each of these groups teens may find it difficult to connect emotionally with others. They may for example notice that someone is upset, but be unsure how to respond.
They Have More Difficulty Describing and Understanding Their Emotions Than “Neurotypical” Teens
Not only do some teens have difficulty understanding and describing emotions, but some also have less awareness in the body of the emotion and the accompanying physical sensations. This means that they can be incredibly stressed but not fully realise it until they explode or break down. There are strategies we can use to help. Psychologists often use visuals to create concrete descriptions and images of emotions. They also like to create personalised “roadmaps” of what that emotion might feel like as it builds up.
The Combination of Increased Sensory, Social and Academic Demand Can Overwhelm the Nervous System Causing Stress, Anxiety and Sometimes Depression
If life is constantly demanding and overwhelming, this can cause chronic mental ill-health and can contribute to physical ill-health. Teenagers with autism and autistic traits are more likely to experience mental health difficultiesthan their neurotypical peers. Chronic stress is a risk factor for physical ill-health too. One reason is that cortisol (the stress hormone) causes inflammation in the body and negatively impacts the immune system. Feeling stressed all the time is exhausting and deflating. This (and other factors) can lead to low mood or depression.
How Can Adults Help Autistic Teens or Teens with Autism Traits?
Here are some tips for supporting teens with autistic traits while they await an autism assessmentor whilst you gather evidence or consider the merit of an autism assessment. These pointers are also suitable for teens who already have a diagnosis of autism/ASD.
If There Are Traits, Treat as Autism
Early intervention is crucial for a child to thrive. There is nothing to be lost by assuming a child is autistic if you have observed traits. This will allow you to take a step back and view the child from a different perspective, considering what individual needs they may have.
Look Below the Surface
In school but sometimes at home too, many teens “mask” their difficulties in order to fit in or because they are scared of being told off. By the time children become teens they may be masters of masking. For instance, they may nod that they have understood a complex instruction, rather than admit that the instruction was given too fast for them to keep up. They may laugh along with a joke even though they don’t understand why it’s funny, to fit in.
Look Beyond the Stereotypes
There are many stereotypes about autism. Often these are based on one particular group of people with autism and are not reflective of teens with subtle signs of autism. For example, just because someone can give eye contact, this does not mean they are not autistic. They may have practised hard at using eye contact, or they may only use eye contact in some situations. Or maybe eye contact is not actually difficult for them, but other areas of social communication are.
Similarly, just because a teenager has friends, it does not mean they are not autistic. They may (sometimes with difficulty) be able to “do” one-to-one or small group friendships successfully but find larger groups stressful. Some teens may find that they have a friendship group, but they feel they have to work very hard to maintain it and find it exhausting. Others may feel a sense of detachment from their peers or feel on the edge of friendship groups.
Encourage Increased Rest and Down Time
Teens with autism or autistic traits will almost always need to have more down time or rest than neurotypical teens. Down time is difficult to define as it is so different for every child. It involves giving the nervous system and brain a break to recover from overstimulation and too much demand. Examples might include:
- Using a time out card or exit pass to take a break from the classroom.
- Going to a quiet space to listen to soothing music.
- Engaging in deep pressure activities (such as pressing against a wall) or activities which stimulate the vestibular system (such as swinging) to regulate the nervous system.
When they get home from school students are often exhausted and need sufficient time to decompress before any demands are placed on them. This includes homework. I suggest a minimum of one to two hours.
Be Flexible
Teenagers with autism or traits of autism need the system around them to be flexible. For instance, just because most children in a school take 10 GCSEs, this does not mean it is right for every child. If you have a slower processing speed or sensory overwhelm in the classroom, it can be a massive relief to drop a subject or two. This allows for free periods to catch up in other subjects and to decompress from overwhelm. As another example, most students are expected to attend assemblies but the cons of attending assemblies may outweigh the pros for some autistic teens.
Be Subtle
In the teenage years, fitting in is of utmost importance to most children. Be aware that some of the suggestions you make will not be acceptable to many autistic teens, if they involve being openly treated as “different”. Sometimes strategies will need to be adapted to make them more subtle.
Be Consistent
It’s incredibly important that parents and all teachers have a shared understanding of what works for an individual with autism. This means it’s important to have a higher level of communication between home and school, and between teaching staff. This is the case even if a child appears to be coping. The most successful strategy I have come across is as follows:
- A key member of staff (often SENDCo or Head of Year) has daily or weekly communication with parents.
- This member of staff “checks in” with the child regularly at school (at least once a week) and establishes a rapport.
- The child has a written plan (to which they have contributed) outlining their needs in one A4 page e.g. “These are the areas I find difficult and this is what works for me.” This is shared to the form tutor and all subject teachers. It is updated once a term.
- The key member of staff shares any immediate issues or concerns with subject teachers and vice versa. They adopt a flexible, problem-solving approach.
Increase Your Knowledge
ASD: Thriving in the Teenage Years (Blog)
Girls Growing Up on the Autism Spectrum: What Parents & Professionals Need to Know (Book)
How to Live With Autism & Asperger Syndrome: Practical Strategies for Parents & Professionals(Book)
Autism Education Trust (Website and Good Practice Guidelines)
This article was written by Dr Lucy Russell and was originally published here in May 2021. Lucy is a Clinical Child Psychologist with many years of experience working with children and families, both in the NHS (National Health Service) and in her independent clinic, Everlief. Her two children are aged fifteen and eleven.
She founded They Are The Future because her team at Everlief cannot meet demand for face-to-face support. They needed to find a way to reach and support the families who can’t access our face-to-face clinic.
If you enjoy Lucy's blog, join her free Facebook group for regular tips on supporting teens and pre-teens with their mental health! Join the group: Parent Tips for Positive Child Mental Health UK.
Originally Released On 23 March 2022