Autism spectrum disorder (ASD) refers to a range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. Autism symptoms and their severity vary greatly across these domains, which is why autism is called a “spectrum” disorder. Although ASD is typically diagnosed in early childhood, some individuals do not receive a diagnosis until adolescence or even adulthood.
What are the signs of autism in teenagers?
Some common signs of autism in teenagers include:
- Difficulty with social interactions and maintaining friendships
- Poor eye contact or unusual body language
- Repetitive behaviors or focused interests in specific topics
- Difficulty understanding jokes, metaphors or figures of speech
- Sensitivity to loud noises, bright lights, certain textures or other sensory input
- Difficulty organizing tasks, thoughts and activities
- Problems with focus, concentration or impulse control
- Anxiety, irritability or mood swings
However, because the teenage years come with many developmental changes, diagnosing autism in adolescents can be tricky. Many autistic teenagers may have learned to mask some of their symptoms over the years, making their condition less obvious.
Why is autism sometimes diagnosed later in life?
There are a few reasons why autism may not be diagnosed until the teenage years or later:
- Milder symptoms that may have been missed earlier
- The child learned to cope and mask their challenges
- Differences were dismissed as shyness, quirkiness or “just a phase”
- Limited access to developmental and medical services
- Missed developmental milestones were attributed to other causes
- The criteria for diagnosing autism has expanded over time
Some females and minorities may be particularly likely to be diagnosed later in life. Their symptoms can present differently and may be overlooked by professionals less informed about identifying autism in these groups.
Can autism be diagnosed accurately at age 14?
Yes, autism can be accurately diagnosed at age 14 or even into adulthood. However, it is important to work with a doctor or mental health professional who has specific expertise in diagnosing autism spectrum disorder.
The evaluation process for autism at age 14 may include:
- Physical exam to rule out other possible conditions
- Interviews with parents about developmental history
- Interviews with the teenager about their symptoms
- Observation of the teen’s communication and behavior
- Review of school, medical and other records for patterns
- Psychological testing to assess intelligence, cognitive skills, etc.
- Use of autism diagnostic tools like the ADOS-2 test
It can take more than one visit to complete the full evaluation. Since autistic teenagers have learned to compensate for some behaviors over time, diagnosis requires looking closely at their developmental history for patterns consistent with ASD.
What is the ADOS-2 test?
The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) is a semi-structured assessment tool designed to observe signs of autism. It consists of various activities that allow the examiner to see how the individual communicates, interacts socially, plays or handles imagination.
The ADOS-2 has different modules based on the person’s language level and age. Using this observation tool along with parent interviews and history can help clinicians identify behaviors associated with autism versus other conditions. However, the ADOS-2 alone cannot diagnose ASD and must be used as part of a complete evaluation.
How is autism diagnosed in teenagers vs younger children?
Diagnosing autism in teenagers involves looking for similar core symptoms as diagnosing children, including differences in:
- Social communication and interaction
- Restricted, repetitive patterns of behavior
- Sensory reactivity
However, there are some key differences in making an autism diagnosis later in life:
- Focus is on developmental history rather than current behaviors
- Importance of getting observations from multiple environments like home and school
- Interviewing the teenager directly about their symptoms and experiences
- Assessing differences in social interaction with neurotypical peers versus younger children
- Considering mental health conditions that commonly co-occur with autism like anxiety, ADHD or depression
The diagnostic process aims to uncover long-standing patterns of behavior rather than just current functioning, which may be masking underlying autism.
Does autism present differently in teenagers than young children?
Autism symptoms can look different in teenagers compared to younger kids in a few key ways:
- May seem less “classic” autistic and present as socially awkward
- Repetitive behaviors become more subtle or internalized into mental routines
- Have better language and communication skills on the surface
- More likely to fly under the radar at school but struggle in unstructured social situations
- Puberty and adolescence brings hormonal changes that can heighten anxieties and sensitivities
- Teens may consciously try to hide their autism traits to fit in socially
While the core neurodevelopmental differences are still present, increased age, learned coping skills and social awareness make autism less overt in teens. Diagnosis requires a discerning professional.
What are the benefits of a late autism diagnosis?
Although an earlier autism diagnosis is ideal for early intervention, diagnosis in the teen years can still provide many benefits:
- Access to tailored support and accommodations at school
- Knowledge to understand one’s challenges and strengths better
- Specialized services like speech therapy, social skills training and counseling
- Direction for parents on how to best support their teen’s needs
- Community connections with other autistic teens
- Preparation for transition to college or career with needed supports
- Self-acceptance and reduced anxiety from finally having answers
While some issues like peer relationships may be harder to change later in life, an autism diagnosis at 14 or later can still help the teenager, parents and others provide appropriate support.
What challenges do autistic teenagers face?
Autistic teens face diverse challenges depending on where they fall on the spectrum. But some common struggles include:
- Social isolation, bullying or rejection by peers
- Problems managing stress, anxiety and emotional regulation
- Trouble organizing tasks, planning ahead and managing time
- Sensory sensitivities that may worsen during puberty
- Rigid thinking and behavior that limits interests and activities
- Issues with focus, working memory and processing speed
- Misinterpreting social cues and unwritten “rules” among peers
- Depression or lack of self-esteem from social difficulties
- Problems generalizing skills between home and school settings
Navigating the increasing social complexity of high school and adolescence can be very challenging. But personalized supports, accommodations and therapy can help autistic teens adapt and thrive.
Are autism symptoms in teens temporary, or will they improve with age?
Autism is a lifelong neurological difference, not a temporary condition. The way symptoms present may evolve over time as teens learn adaptive skills, develop self-awareness and move into different environments. But the underlying neurocognitive features do not disappear.
Some autistic teens show improvements in areas like:
- Everyday communication skills
- Regulating emotions and behavior
- Expanding interests and flexibility
- Advocating for their own support needs
However, core challenges like social reciprocity, sensory issues and need for routine tend to persist through adulthood. Symptoms may wax and wane across settings and developmental stages. An autism diagnosis is lifelong, although additional conditions like anxiety, ADHD or depression may require separate treatment.
Can teenagers “grow out of” or lose an autism diagnosis?
Autism spectrum disorder is considered a lifelong neurodevelopmental difference. There have been very rare instances where individuals who were diagnosed at 2 or 3 years old seemed to “lose” their diagnosis by age 5 or older.
However, in-depth study of these unusual cases reveals the children never had true ASD to begin with, but likely had other developmental conditions like language disorder, intellectual disability or family stressors impacting behavior. Their symptoms improved with age, intervention, or were a misdiagnosis, giving the impression of “growing out” of autism.
True autism stems from underlying neurological differences in brain structure and wiring. These do not change significantly once a child reaches school age. Autism symptoms and how they present can change and improve over time, but autism itself does not disappear.
Can high-functioning autism go undiagnosed until the teen years?
Yes, high-functioning autism (HFA) is one of the most common subtypes to remain undiagnosed until adolescence. Also referred to as Level 1 ASD, teens with high-functioning autism tend to have average or above average intelligence and language development.
As younger children, they may have:
- Reached developmental milestones like talking on time
- Strong academic skills and test scores
- Quieter or “easy” temperaments
- Ability to imitation others’ social behavior
These factors can mask the social communication challenges, repetitive behaviors, sensory issues and learning differences of HFA. But symptoms become more impairing by high school as social rules grow more nuanced, academics more demanding, and peers less forgiving of quirkiness. Many “Aspie” teens get diagnosed after struggling more noticeably.
Can girls be more likely to be diagnosed with autism later in life?
Yes, autistic girls are often diagnosed much later than boys, in some cases not until adolescence, adulthood or even older. Multiple large studies show the average age of diagnosis is 5-7 years later for females.
Some key reasons autism gets missed or diagnosed late in girls:
- Less likelihood of externalizing problem behaviors that draw attention
- Ability to initially mimic social behavior they observe in peers
- More reserved, inward-focused symptoms
- Special interests may align more closely with typical female activities
- Sensory issues around clothing textures or grooming masked as “fussy” or “particular”
- Historical diagnostic bias centered around male phenotypes of autism
By their teens, the gap between an autistic girl’s maturity and that of peers often becomes much more apparent. Diagnosis enables access to helpful supports.
Conclusion
While autism spectrum disorder is classically diagnosed around ages 2-3, identification and diagnosis during the teenage years is also entirely possible. Autistic adolescents often benefit from expert assessment, even if they were not identified as children. An accurate ASD diagnosis enables teens and their families to understand challenges, identify strengths, access supportive services, and plan for a successful transition to adulthood.