Autism in Teens: The Signs Parents Notice and How to Talk About Them

Why autism can surface in the teen years

Autism is a difference in how the brain develops, and signs generally appear early in life. Even so, the National Institute of Mental Health (NIMH) notes that autism can be diagnosed at any age, and that caregivers and teachers are often the first to recognize it in older children and adolescents.

The teen years raise the social bar. Friendships run on inside jokes, quick replies and unspoken rules. NIMH describes subtle communication differences that can become clearer at this age, such as trouble understanding tone of voice, facial expressions, body language, figures of speech, humor or sarcasm, and challenges forming friendships with peers.

Some teens have managed well for years by working very hard behind the scenes. When demands increase, that effort can become harder to keep up, and parents start to see the strain.

Signs parents often notice in teenagers

No single sign means a teen is autistic, and the Centers for Disease Control and Prevention (CDC) notes that some people without autism show some of these characteristics. What matters is a pattern across settings and over time. Parents often describe:

• Wanting friends but finding it hard to make or keep them, or feeling left out of group conversations
• Taking jokes, sarcasm or figures of speech literally
• Talking at length about a favorite subject without noticing the listener's cues
• Strong distress at small changes in plans or routines, and difficulty with transitions
• A lasting, intense interest in specific topics, often with impressive detail
• Being more or less sensitive than peers to noise, light, clothing textures or temperature
• Coming home drained after a day of holding it together, or needing a lot of time alone to recover
• Anxiety, worry or unusual emotional reactions, which the CDC lists among characteristics many autistic people have

Masking, anxiety and mood

Researchers use the word camouflaging, often called masking, for strategies used to appear less autistic in social situations. In research interviews described in a study on camouflaging, autistic teenage girls said they masked to seem more socially confident, often because they wanted friendships, and that the effort took a psychological toll. Camouflaging may also delay recognition and support, especially for girls.

Mood deserves close attention. CDC tracking of autistic 16-year-olds looks at co-occurring conditions such as anxiety, depression and suicidal thoughts or behavior. NIMH lists signs of teen depression that parents can watch for, including feeling sad, anxious or empty, losing interest in activities, getting easily frustrated or irritable, pulling away from friends and family, and changes in eating or sleep.

Anxiety or depression can be the first thing anyone notices. Treating those concerns matters on its own, and it can also be a moment to ask whether there is a bigger picture.

How to talk with your teen about an evaluation

An evaluation goes best when your teen understands why it is happening and has a say. The CDC notes that the American Academy of Pediatrics recommends that, starting around age 12, health care providers speak with adolescents separately from family and coach them in taking charge of their own care. That same respect helps at home.

Next steps for families

Start by writing down what you and your teen notice, at home and at school. Our free autism signs checklist can help you put it into words and decide whether to talk to someone. It is an informal checklist, not a screening test, it is not validated and it cannot diagnose.

Talk with your teen's doctor, and ask the school what it sees. NIMH notes that a school's special education team may do an initial evaluation and then recommend further evaluation by a health care provider. NIMH also says it is important for the provider to learn about a young person's strengths, so that recommendations fit them.

The CDC adds that planning for life after high school works best when it starts early, with education transition plans in place preferably by age 14 and no later than 16.

How we can help

Locascio Wellness offers a child and teen autism evaluation by secure video. Evaluations are offered only to people physically located in Pennsylvania, West Virginia or Arizona, and a parent or guardian arranges the evaluation and takes part. It usually involves an intake appointment, then one or two sessions, then a written report, which at the moment is usually ready about a month after the first evaluation appointment. No evaluation can promise a particular result.

Evaluations are private-pay, with a sliding scale available; see what evaluations cost. Start with the short evaluation request form or a free 15-minute consultation on our booking page.

We do not offer an autism therapy service, ABA, speech or occupational therapy. Therapists on our team offer teen therapy and anxiety therapy by secure video, with a therapist licensed where you live, for the stress, worry and low mood that can come along with being an autistic teen. A diagnosis may also open other supports that families arrange with their doctor or school.

If your teen is in crisis or talking about suicide or self-harm, call or text 988, or call 911. Locascio Wellness does not provide emergency services.