Autism: signs in older children and teenagers

About signs of autism in older children and teenagers

Signs of autism sometimes become noticeable in school-age children.

This is because a new primary or secondary school environment might be overwhelming for autistic children and teenagers. The transition to it can be difficult for children to manage on their own. And if children have been hiding their autism signs until now, it might be hard for them to keep doing this in a new and overwhelming environment.

Some of the main signs of autism in middle childhood and adolescence are listed below.

If you’ve noticed some of these signs, the next step is to see your child’s GP. The GP can refer your child to appropriate health professionals for assessment and diagnosis.

If enough signs of autism are present, health professionals might diagnose your child with autism. Generally, health professionals will make an autism diagnosis only when they’ve ruled out other possible explanations for a child’s behaviour.

Social communication signs of autism in older children and teenagers

Older autistic children and teenagers have differences in the way they use verbal and nonverbal communication for social purposes, compared to other children and teenagers.

Verbal communication
Older autistic children and teenagers might:

find it hard to take turns in conversations – for example, they might like to do all the talking or find it hard to answer questions about themselves
talk a lot about their special interests, but find it difficult to talk about a range of topics or things they don’t find very interesting
take things literally – for example, they might be confused by the expression ‘Pull your socks up!’ and actually pull up their socks
have differences in their voices or ways of speaking compared to other children – for example, they might speak very loudly or with an accent, or their voices might not vary in tone or volume
have very good vocabularies and use formal language
find it hard to follow instructions with more than 1-2 steps.

Nonverbal communication
Older autistic children and teenagers might:

have difficulty reading nonverbal cues, like body language or tone of voice, to guess how someone else is feeling – for example, they might not be able to tell when someone is teasing them or using sarcasm
make less eye contact than other people, or not use much eye contact when they’re spoken to
show fewer emotions on their faces than other children or not be able to read other people’s facial expressions – for example, they might not be able to tell when someone is bored
use few gestures to express themselves.

Developing relationships
Older autistic children and teenagers might:

prefer to spend time on their own, rather than with their peers
want other children to play by their rules and get upset if their rules aren’t followed
have trouble understanding the social rules of friendship
have difficulty making friends and have few or no friends
have trouble relating to most children their own age and prefer to play with younger children or adults
have difficulty adjusting their behaviour in different social situations
be more comfortable with close personal space than other people.

Behaviour signs of autism in older children and teenagers

Repetitive behaviour and interests
Older autistic children and teenagers might:

have particular or special interests – for example, they might collect sticks or memorise football statistics but not really be interested in the game
have behaviour that seems compulsive – for example, they might line things up or need to close all the doors in the house
be particularly attached to certain objects – for example, they might carry toys around or collect certain items like chip packets or shoelaces
be upset by change and like routines – for example, they might need to be told in advance when their usual routine will change, or they might have a routine for getting ready in the morning
repeat body movements or move their bodies in unexpected ways – for example, they might flap their hands or rock back and forth
enjoy making repetitive noises – for example, grunts, throat-clearing or squeals.

Sensory sensitivities
Older autistic children and teenagers might:

be sensitive to the sensory environment – for example, they might be more easily upset by loud noises than other people, not like tags on clothes, or eat only foods with a certain texture or colour
seek sensory stimulation – for example, they might like deep pressure, seek vibrating objects like washing machines, or flutter fingers to the sides of their eyes to watch the light flickering
respond less to pain than other children.

Common issues for autistic children and teenagers

Older autistic children and teenagers often have other issues as well. These might include the following:

Sleep difficulties – for example, they might have difficulty falling asleep, or they might regularly wake up or have broken sleep patterns.
Anxiety, feelings of being overwhelmed or meltdowns – for example, they might feel anxious about going to new places or being in social situations with a lot of people.
Depression – older autistic children and teenagers who are aware of that they’re different from other people are also often aware of how others see them. They can feel like outsiders. Other people might bully them for their differences. This can lead to feelings of low mood, which changing hormone levels in puberty can intensify.
Aggressive behaviour – autistic children and teenagers often have sensory sensitivities that can lead to sudden and sometimes aggressive behaviour. They might have difficulty understanding what’s going on around them. This can lead to a build-up of frustration, which children can’t control in the moment.
Eating disorders – these can develop in autistic children and teenagers as a way of controlling their environment. For example, children might have difficulty moving to secondary school and might develop an eating disorder to cope with feelings of anxiety.
Executive functioning difficulties – these are the mental processes involved in planning, organising thoughts and activities, prioritising tasks, and managing time efficiently. Because of these difficulties, autistic children and teenagers might find aspects of secondary school hard to manage – for example, complex timetables.
School refusal – autistic children and teenagers might feel overwhelmed or confused at school. They might also be vulnerable to bullying at school.

These signs might be the starting point for a late autism diagnosis. Having a diagnosis can help you get services and funding to support your child’s development and wellbeing during adolescence and adulthood. Also, if your child knows they’re autistic, they can understand themselves better, be proud of who they are, and find friends who think, interact and learn in similar ways to them.

Autistic children and teenagers can be more likely than other children and teenagers to identify as gender diverse. If they feel distressed about this, it’s called gender dysphoria.