Stages of Adolescence and Autism Spectrum Disorder

Without the right support, adolescents on the autism spectrum retreat into themselves during this period of growth.

They experience loneliness and confusion, and there is an increased risk of depression and suicide during these years as well.

Not only is their social world unpredictable during adolescence; their response to this stress can be equally challenging.

Adolescents on the autism spectrum have unique challenges that are often difficult for their parents, teachers,

and peers to cope with. Children on autism spectrum rely on consistency and predictable social environments,

and teens enter this phase of life at an extreme disadvantage.


Many children with autism spectrum disorder (ASD) are diagnosed in early childhood. But for others, the signs might

not be as clear. It might not be until they’re at primary school or even secondary school that the question of ASD comes up.

During these years, social and behavioral differences can become more obvious as children respond to the social and

educational challenges of school.

Parents need to rule out and address underlying medical and sensory problems. It’s important to have your child evaluated for underlying medical and sensory issues that may be contributing to the breakdowns.

So if you haven’t already, please consult with your child’s therapist and physician about evaluation and therapy options.


Supporting them during adolescence requires an understanding of the syndrome and knowledge about strategies that will

give them the skills they will need to thrive and reach their potential. Using the chart below, you can check the milestones

your child has reached by the adolescent growth stage, from the age of 11 until he or she is 18 years old.


In this article, we cover the milestones of – Physical Development, Cognitive Development, and Psychosocial

Development of children in their teens. The first chart gives you some indicative behaviors of normal growth

in Pre-adolescents, Adolescents and Late Adolescents followed by red flags that you must watch for in autistic children,

for the age group mentioned.  These expectations will help prepare caregivers before and during this critical stage.

pre adolescence and autism spectrum disorder

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Developmental Stage: Pre-adolescent 11-13 years

Physical Development Social & Emotional Development Cognitive Development

·         Pubic hair pigmented, curled.

·         Height growth spurt

·         Breast development continues.

·         Labia enlarged.

·         Menstruation begins.


·         Prepubescent physical development.

·         Beginning growth of testes, scrotum, and penis.


·         Begins to move from concrete toward abstract thinking

·         Increasingly interested in ideas, values, social issues; often narrow in understanding and dogmatic.

·         Is very interested in music and personal appearance

·         Changes in friends are common.

·         Has same-sex relation- ships most often, although has concerns, anxiety, and experimentation with opposite sex

·         Depends on family but increasingly tests limits.




·         Is anxious about peer acceptance.

·         Is concerned with self- identity.

·         Has abrupt mood and behavior swings.

·         Females highly concerned with body image, physical changes.

·         Increasingly interested in peers and peer culture.


 Autism Red Flags during Pre-adolescent stage 11-13 years

·         Have trouble taking turns in conversations –find it hard to answer questions about herself

·         Talk a lot about a favorite topic, but find it difficult to talk about a range of topics

·         Have an unusual tone of voice, or use speech in an unusual way – she might speak in a monotone or with an accent

·         Have a very good vocabulary and talk in a formal, old-fashioned way

·         Find it hard to follow a set of instructions with more than one or two steps.

·         Have trouble reading non-verbal cues, like body language or tone of voice, to guess how someone else might be feeling

·         Use eye contact in an unusual way – make less eye contact than others, or not use eye contact when he’s spoken to

·         Express few emotions on his face, or not be able to read other people’s facial expressions – for example, he might not be able to tell if someone likes him in a romantic way


Developmental Stage: Adolescent years: 13-15 years

Physical Development Social & Emotional Development Cognitive Development

·         Pubic hair fully developed.

·         Continued breast growth.

·         Menstruation well established

·         Ovulation


·         Pubic hair pigmented, curled, penis, testes, and scrotum continue to grow

·         Height growth spurt

·         Mustache hair.


·         Has continued interest in ideas, ideals, values, social issues

·         Is reliant on and anxious about peer relationships.

·         May experiment with drugs

·         Females somewhat more comfortable with body image and changes.

·         Males highly concerned with body image and changes as puberty begins.




·         Concerned with achievement, experiences, and accomplishment

·         Continues to be interested in appearance, music, and other elements of peer culture

·         Shows fully developed abstract thought and can apply in more situations.


Autism Red Flags during Adolescent stage 13- 15 years

An older child or teenager with ASD might:

•         Prefer to spend time on her own, rather than with friends

•         Need other children to play by her rules

•         Have trouble understanding the social rules of friendship

•         Have few or no real friends

•         Have trouble relating to children her own age, and might prefer to play with younger children or adults

•         Have difficulty adjusting her behavior in different social situations

•         Invade personal space and get too close to people.



Late Adolescent Stage:  15 – 18 Years

Physical Development Social & Emotional Development Cognitive Development

·         Full development of breasts and auxiliary hair.

·         Uterus develops fully by age 18-21


·         Facial and body hair.

·         Voice deepens.

·         Testes, penis, and scrotum continue to grow.

·         Muscle growth and increase in motor skills.


·         Maintain more stable relationships with peers and adults.

·         Has reasonably well-established body image, especially among girls

·         Has more realistic and stable view of self and others and nature of problems and is better at problem solving.


·         Abilities for abstract thinking and for practical problem-solving skills are increasingly tested by the demands associated with emancipation and/or higher education


·         Has continued need for achievement and recognition for accomplishment.



teenagers and autism spectrum disorder

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Autism Red Flags in Late Adolescent stage: 15-18 years

An older child or teenager with ASD might:

•         Have unusual interests or obsessions – he might collect sticks or memorize football statistics but not really be interested in the game

•         Have compulsive behavior – have to close all the doors in the house

•         Have difficulty with sleep – they might have difficulty falling asleep, or might regularly wake up at 4 am

•         Have anxiety or feeling overwhelmed – they might feel anxious about going to a new place, or being in social situations

•         Have 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

•         Be aggressive behavior – they often have sensory sensitivities that can lead to sudden aggressive behavior. They might have difficulty understanding what’s going on around them, which can lead to frustration building up

•         Have eating disorders – they might have difficulty moving to secondary school and might develop an eating disorder to cope with feelings of anxiety

•         Have difficulty with organization skills – school refusal or not wanting to go to school; they might feel overwhelmed or confused at school, they might find the increase in complexity at secondary school hard to manage



Older children and teenagers often realize they’re different in some ways from other children their age,

so don’t be afraid to talk to them about this. You can focus on your child’s strengths – telling her that she has an

excellent memory, is good with numbers or is very kind to animals – as well as the things that she finds challenging

like making friends. Talking to older children with this condition is probably the best way to address their fears

and turn it into manageable strategies that they understand as a solution to cope with their unique problems.