Autism Spectrum Disorder (ASD) is a widespread neurodevelopmental disorder. ASD is marked by differences in social communication and interaction and repetitive behaviors or restricted interests. ASD symptoms vary from person to person. As of 2020, it is said that 1 in 36 kids have ASD. Since ASD awareness has increased in recent years, providers are now more able to detect and accurately diagnose people with ASD.
Today's teens and adults are in an age group where ASD may not have been properly detected early on. Diagnosing ASD during one's teen years can help a teenager get treatment and support, learn important skills, like self-care and communication skills, better understand themselves, and improve their quality of life long-term.
First, let's cover common signs and symptoms of ASD in teens and the challenges and benefits of diagnosing ASD in teens. Then, we'll discuss strategies that aid the diagnostic process, including how online Autism screening tools can help your family before an official ASD assessment.
Signs and symptoms of Autism in teens
Learning about ASD symptoms and how they can present in teens can help parents looking for a teenage autism test determine the need for an official Autism assessment. Please note that the symptoms listed in the categories below are just examples and do not account for all of the ways ASD symptoms can present.
Social difficulties
Teens with ASD might have trouble fitting in with their peers. Some teens may “mask” symptoms of ASD to fit in socially, but even this can pose unique challenges and doesn't mean that an ASD diagnosis isn't important. Here are some potential examples of the social difficulties a teen with ASD may run into.
- Talking about a specific topic, like a special interest, excessively (may not pick up on non-verbal indicators that it is time to stop talking).
- Doing or saying inappropriate things, not realizing that they are inappropriate.
- Seeming younger or older than they are, based on interests or other traits.
- Trouble picking up on social cues or understanding social norms.
- Difficulty understanding personal space.
- Difficulty making and keeping friends.
- Avoiding eye contact.
Impacting school, friendships, and other parts of life, communication challenges can be part of what makes social situations challenging for teens with ASD.
Communication challenges
Communication challenges in ASD can relate to verbal and non-verbal communication. The diverse range of communication challenges or differences autistic teenagers experience might be hard to pick up on at times, especially in teens with strong language skills. Here are some common signs of communication challenges in teens with ASD.
- Coming off as rude, sarcastic, "dry," or "sassy" without intending to (peers and adults may misinterpret your teen and use these words to describe them; the teen may feel confused or hurt, not understanding why they were interpreted this way).
- Making overly/atypically expressive facial expressions or making few, limited, or "flat" facial expressions.
- Difficulty interpreting facial expressions and other non-verbal cues made by others.
- Using overly formal language (may have an excellent vocabulary) or speaking in an old-fashioned way.
- Feeling confused by slang language or common phrases used by peers.
- Misinterpreting others during conversation (e.g., taking things literally).
Sometimes, symptoms like emotion regulation difficulties, flat affect, or hyper-expressive tendencies can be interpreted differently in younger kids than in teens. Emotional responses viewed as developmentally appropriate in younger kids might start to be perceived as "difficult" in a teen. Watch out for this and take care to understand your teen’s distress.
Repetitive behaviors
People with ASD experience restricted or repetitive patterns of behavior and interests. Like other ASD symptoms, these can present in many different ways. Commonly, teens with ASD may experience or display:
- Special interests (an atypically intense or obsessive interest in a specific topic, which can be anything from math to horses, cars, psychology, a TV, movie, or book series, or something else).
- Repeated body or hand movements, such as stepping from one foot to another, pacing, shaking arms, flapping hands, rocking, flicking fingers, pulling hair, tapping feet, picking skin, or biting nails.
- Difficulty with change or transitioning from one task to another.
- Repeating words, phrases, or sounds.
Repeating words, phrases, sounds, or other behaviors, like hand and body movements, can connect to sensory needs in autistic teens at times. This is called “stimming.”
Sensory sensitivities
Sensory sensitivities, often called “sensory issues,” fall under the "repetitive behaviors and restrictive interests" category of ASD symptoms. Sensory issues can include being over- or under-reactive to sensory input. Here are some examples of what sensory sensitivities could look like in teens.
- Hyposensitivity: A high pain tolerance, under-reacting to sensory stimuli, finding it difficult to pick up on how their body feels during injury or illness (e.g., may not notice that they are bleeding), and sensory seeking behaviors (e.g., craving certain noises, movement, physical pressure, extreme hot or cold, or chewing on objects, like shirt sleeves).
- Hypersensitivity: Restricted food preferences due to food textures or taste, extreme sensitivity to certain sounds or noises (e.g., the vacuum, a loud movie theater), sensitivity to bright lights, not wanting to wear certain clothes due to materials (e.g., denim) or clothing tags.
Most autistic people experience sensory sensitivities, but non-autistic people can, too. It is possible to experience both hyper and hypo-sensitivity. A teen who listens to hard rock music and hardly notices that they're injured could have an extreme sensitivity to specific noises, scents, foods, textures, and other types of stimuli.
Challenges of detecting Autism in teens
Undiagnosed teens with ASD may encounter unique challenges when seeking a diagnosis. Prior to Autism testing, it can be helpful to learn about the challenges providers might face in detecting ASD in teens. That way, you can advocate for your teenager during the diagnostic process.
Masking behaviors
People with ASD who go undiagnosed until their teen or adult years often learn how to "mask" or camouflage their symptoms at a relatively young age. Examples of masking behaviors include:
- Mimicking other people, whether friends or characters on TV, to fit in. May say words and phrases they’ve heard before to fit in, even if they wouldn’t usually.
- Changing the way they speak (e.g., attempting to be more or less “animated” if they are hypo or hyper-expressive).
- Suppressing stimming behaviors, such as repetitive body or hand movements.
- Concealing or trying not to talk about special interests.
- Reducing reactions to or hiding sensory sensitivities.
- Forcing eye contact.
Masking is part of why it can be so integral that providers thoroughly assess a teenager's history, understanding all of the different ways ASD can present.
Misdiagnosis
ASD symptoms can look similar to signs of other diagnoses. For example, social anxiety disorder, obsessive-compulsive disorder, and mood or personality disorders. Sometimes, this can mean that a teenager gets diagnosed with a mental health condition they don’t actually have. Alternatively, teens could have one or more co-occurring conditions in addition to ASD, which may complicate the diagnostic process. In this case, it’s integral that symptom causes are differentiated.
Lack of awareness
Although ASD awareness is improving, many non-specialists aren't well-trained in detecting ASD. Specifically, it may be harder for providers to detect high-functioning Autism (high-functioning Autism generally refers to ASD in someone with lower support needs). It may also be more challenging for providers to detect Autism symptoms in women and girls.
Learn more about high-functioning Autism here.
Benefits of early detection in teens
Sometimes, parents wonder, "Why does a diagnosis matter for older children and teens?" The truth is that getting a diagnosis as a teenager can be life-changing. For example, in Paige Layle's book "But Everyone Feels This Way: How an Autism Diagnosis Saved My Life," the author writes about how a diagnosis at age 15 helped her discover the right coping skills, understand herself, and create success as an adult. Knowing that you're autistic as a teen can help you better understand yourself and build a sustainable, supported life.
Access to early intervention services
A formal diagnosis provides access to appropriate support. This can include therapies used to treat ASD symptoms and school-related adjustments. For example, an individualized education plan or 504 plan could help a teenager get their needs met and have a more enjoyable time at school. The treatment(s) a teen benefits from could depend on their needs. Teens may benefit from social skills training, Applied Behavior Analysis (ABA), occupational therapy, or working with speech therapists for speech therapy.
Improved social skills and communication
An accurate diagnosis and appropriate treatment can help teens improve their social communication and interaction skills. Social skills training (SST), for example, can help teens make and keep friends, learn conversation skills, and navigate potentially tricky social situations better. SST can occur at school, home, or in an office setting.
Better academic outcomes
Some studies show that early diagnosis can lead to better academic outcomes. The accommodations a teenager is able to get after receiving an official diagnosis from a medical or mental health professional can support their education in multiple ways. For example, they could get sensory breaks, extra classroom support, or changes could be made to their assignments. Treatment options like SST could improve social interactions at school, which might be advantageous as well. When a teacher is educated on ASD, it can help reduce miscommunication in the classroom. Distress can be avoided, reduced, or better accommodated.
Enhanced quality of life
Many teenagers with ASD struggle with their mental health, self-care, and daily living skills. This can start to become more apparent as they age. Many ASD treatment options can provide autistic teenagers with skills they need for employment and other purposes as they grow into adults. Overall, knowing that you’re autistic, getting appropriate support, and understanding yourself or having ways to communicate your needs to others can be essential for quality of life. In fact, research connects early intervention with a better quality of life and the other positive outcomes listed above.
Strategies for early detection in teens
Now that you know why a formal Autism diagnosis can be so essential, how do you get your teenager an official ASD evaluation? Autism testing is a multi-step process. Here are three steps parents can take to help their teen get to and through the Autism testing process.
Screenings and assessments
Online screening tools can help parents detect potential signs of ASD in teens. However, not all online Autism tests are created equally. Questionnaires recommended by professionals are often the most helpful. While online Autism tests can't replace an official diagnostic assessment, they can be beneficial. Taking the test results from a screening tool to a healthcare provider, for example, could aid in diagnosis. Here are some screening tools and assessments that may be suitable for autistic teenagers, some of which are available as online tests.
- The Autism Spectrum Quotient Test.
- The Ritvo Autism Asperger Diagnostic Scale-Revised.
- Childhood Autism Rating Scale.
Although online tests can detect potential signs of ASD, an official evaluation is more thorough and will entail reviewing a teenager’s medical history, ruling out other symptom causes, and so on. During the evaluation process, a healthcare professional will use official assessments such as the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R).
Observing behavior patterns
To help your teen get a proper diagnosis, observe their current behavior patterns as well as signs that may have been present at a younger age (e.g., during preschool-elementary school years). Consider reviewing the diagnostic criteria for ASD and writing down the symptoms your child experiences in each category. This can help you convey the need for an ASD assessment to a healthcare provider or center offering diagnostic services in your area.
Consulting with healthcare professionals
If your teen may have ASD, seeking an official Autism assessment is the next step. The Autism Society website is a helpful resource for finding a qualified healthcare professional who can provide an official diagnostic assessment and formal diagnosis. Parents may also be able to find providers able to administer official Autism assessments through a Google search, by asking their teen’s pediatrician, or by calling their health insurance company.
Conclusion
Autism Spectrum Disorder, or ASD, is one of the most common neurological and developmental disorders. Until recently, ASD was largely under-diagnosed. Early diagnosis can be life-changing, leading to benefits like improved quality of life long-term, fewer emotional or school-related challenges, and access to appropriate treatments, like social skills training. With these benefits in mind, it's essential that parents, educators, and healthcare providers are vigilant in recognizing signs of Autism in teens.
Getting a comprehensive evaluation from a qualified professional is the only way to receive an official diagnosis. The Autism testing process is often multi-step and can require advocacy from parents. Although online Autism tests can't replace Autism assessments, they can be informative in some instances and can help you collect evidence for your teen's official evaluation.
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About
Dr. Joe Raiker, PhD
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