Signs of autism: older children & teenagers

Signs of autism spectrum disorder

Some of the main social communication and behaviour signs of autism spectrum disorder (ASD) in middle childhood and adolescence are listed below.

These signs often become noticeable when children reach school age and have difficulty adjusting to new social situations in a school environment – for example, following and taking part in conversations appropriately, making friends, and having age-appropriate interests.

You might find that some of the signs sound a lot like your child. Others might not sound like your child at all. All children (and adults) have some of the difficulties below. It’s only when enough of these signs are present that your child might get a diagnosis of ASD. Generally, health professionals will make a diagnosis of ASD only when they’ve ruled out other possible explanations for a child’s behaviour.

If you’re worried about your child, the best place to start is your child’s GP. The GP will be able to refer your child to an appropriate professional.

Social communication signs of autism spectrum disorder

Older children and teenagers with autism spectrum disorder (ASD) typically have trouble with both verbal and nonverbal communication for social purposes.

Verbal communication
Older children and teenagers with ASD might:

have trouble taking 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 favourite topics, but find it difficult to talk about a range of topics
be confused by language and take things literally – for example, they might be confused by the expression ‘Pull your socks up!’ and actually pull up their socks
have an unusual tone of voice, or use speech in an unusual way – for example, they might speak in a monotone or with an accent
have very good vocabularies and talk in formal, old-fashioned ways
find it hard to follow instructions with more than one or two steps.

Nonverbal communication
Older children and teenagers with ASD might:

have trouble reading nonverbal cues, like body language or tone of voice, to guess how someone else is feeling – for example, they might not understand when adults are angry based on tone of voice, or they might not be able to tell when someone is teasing them using sarcasm
use eye contact in an unusual way – for example, they might make less eye contact than others, or not use eye contact when they’re spoken to
express few emotions on their faces, or not be able to read other people’s facial expressions – for example, they might not be able to tell whether someone likes them in a romantic way
use very few gestures to express themselves.

Developing relationships
Older children and teenagers with ASD might:

prefer to spend time on their own, rather than with friends
need other children to play by their rules
have trouble understanding the social rules of friendship
have few or no real friends
have trouble relating to children their own age, and might prefer to play with younger children or adults
have difficulty adjusting their behaviour in different social situations
invade personal space and get too close to people.

Behaviour signs of autism spectrum disorder

There are some behaviour signs that older children or teenagers might have autism spectrum disorder (ASD).

Repetitive behaviour and interests
Older children and teenagers with ASD might:

have unusual interests or obsessions – for example, they might collect sticks or memorise football statistics but not really be interested in the game
have compulsive behaviour – for example, they might line things up or have to close all the doors in the house
have an unusual attachment to objects – for example, they might carry toys around, or collect unusual items like chip packets or shoelaces
be easily upset by change and like to follow routines – for example, they might like to sit in the same seat for every meal or have a special order for getting ready in the morning
repeat body movements or have unusual body movements, like hand-flapping or rocking
make repetitive noises – for example, grunts, throat-clearing or squealing.

Sensory sensitivities
Older children and teenagers with ASD might:

be sensitive to sensory experiences – for example, they might be easily upset by certain sounds or uncomfortable clothes, or eat only foods with a certain texture
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 flicker.

Other difficulties associated with autism spectrum disorder

Older children and teenagers with autism spectrum disorder (ASD) often have other difficulties as well. These might include:

difficulty with sleep – for example, they might have difficulty falling asleep, or might regularly wake up at 4 am
anxiety or feeling overwhelmed – for example, they might feel anxious about going to new places, or being in social situations
depression – older children and teenagers who are aware of their differences are also often aware of how others see them and can feel like outsiders. These feelings might be intensified by changing hormone levels during puberty
aggressive behaviour – they often have sensory sensitivities that can lead to sudden aggressive behaviour. They might have difficulty understanding what’s going on around them, which can lead to frustration building up
eating disorders – for example, they might have difficulty moving to secondary school and might develop an eating disorder to cope with feelings of anxiety
difficulty with organisation skills – they might find the increase in complexity at secondary school hard to manage
school refusal or not wanting to go to school – they might feel overwhelmed or confused at school.

These signs might be the starting point for a late diagnosis of ASD. Although this can be a huge shock, having a diagnosis can help you get services and funding to support your child’s development.