Later signs of autism: pre-teens and teenagers

About signs of autism in pre-teens and teenagers

Signs of autism sometimes become clearer or more noticeable when children are in their pre-teens or teens.

This might be because a new primary or secondary school environment involves more demanding schoolwork, more responsibility and more complex social relationships. These things can be challenging for autistic pre-teens and teenagers, and the signs of their autism become more obvious as a result.

Some of the main signs of autism in the pre-teen and teenage years 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.

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 your child’s behaviour.

Social communication signs of autism in pre-teens and teenagers

Autistic pre-teens and teenagers have differences in the way they use verbal and nonverbal communication to interact with others.

Verbal communication
Autistic pre-teens and teenagers might:

not take turns during conversations – for example, they might not ask questions about the other person’s ideas or find it hard to answer questions about themselves
talk a lot about their intense or special interests but find it difficult to talk about a range of topics or things they don’t find interesting
take things literally – for example, they might be confused by the expression, ‘Pull up your socks!’, and actually pull up their socks
have differences in their voices or ways of speaking – 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
Autistic pre-teens and teenagers might:

not notice or understand nonverbal clues to other people’s feelings – 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 find it easier to interact when they aren’t face to face
not show much emotion on their faces or not be able to read other people’s facial expressions – for example, they might not be able to tell when someone is bored
not use gestures to express themselves.

Developing relationships
Autistic pre-teens and teenagers might:

prefer to spend time on their own rather than with their peers, or they might prefer to interact with adults or much younger children
want other children to play by their rules and get upset if their rules aren’t followed
have difficulty understanding the unspoken social rules of different relationships, like the differences between being friends and being strangers
have difficulty making friends, and might have few or no friends
have difficulty adjusting their behaviour in different social situations
rely on social scripts to interact with others and find it difficult to handle unexpected or challenging social interactions.

Behaviour signs of autism in pre-teens and teenagers

Repetitive behaviour and intense interests
Autistic pre-teens and teenagers might:

have very intense or special interests – for example, they might collect objects or memorise football statistics but not really be interested in the game
have behaviour that seems repetitive or 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 things 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 or use repetitive speech – for example, they might clear their throat repeatedly or repeat phrases they’ve heard from TV.

Sensory sensitivities
Autistic pre-teens 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 certain textures, or flutter their fingers at the sides of their eyes to watch the light flickering
respond less to pain than other children or not notice when they’re too hot or cold.

Common challenges for autistic pre-teens and teenagers

Sometimes pre-teens and teenagers have challenges that might get you thinking about autism. The challenges listed below aren’t signs of autism in themselves, but they might prompt you to talk with your GP or another health professional about getting a late autism assessment for your child:

Sleep difficulties – pre-teens and teenagers might have difficulty falling asleep, or they might wake up a lot or have disrupted sleep patterns.
Anxiety, feelings of being overwhelmed or meltdowns – pre-teens and teenagers might feel anxious about going to new places or being in social situations with a lot of people.
Depression – autistic pre-teens and teenagers who are aware of how they’re different from other people can feel alone or isolated. Other people might bully them for their differences. This can lead to feelings of low mood, which are made worse by changing hormone levels in puberty.
Aggressive behaviour – autistic pre-teens and teenagers sometimes express their emotions through challenging or aggressive behaviour. For example, if they have difficulty understanding what’s going on around them, they might feel frustrated and lash out at people around them.
Eating disorders – these can develop in autistic pre-teens and teenagers as a way of controlling their environment or because of strong sensory responses to food smells or textures.
Difficulties with planning, organising, prioritising, and managing time – because of these difficulties, autistic pre-teens and teenagers might find it hard to manage aspects of secondary school, like complex timetables.
School refusal – autistic pre-teens and teenagers might feel overwhelmed or confused at school. They might also be vulnerable to bullying at school.

If your child gets a late autism diagnosis, they can then get services and funding to support their 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, find friends with shared interests and experiences, and learn to advocate for themselves.

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.