Sourced from https://www.autismparentingmagazine.com/autism-in-teens-puberty-expectations-symptoms/ on 10.12.2020.

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Sourced from https://www.spectrumnews.org/news/gender-and-sexuality-in-autism-explained/#refs on 18.06.2021.

Verbal signs of autism in a teen might include:

Not knowing how to engage in a two-way conversation; usually talking about a single topic without allowing the other person to talk or respond.
Only wanting to talk about a single topic and not wanting to talk about things that do not interest him/her.
Taking things literally, such as holding a ball close to his/her eye when told to “Keep your eye on the ball.
”Speaking with an accent, in monotone, or with a singsong voice.
Using unusual vocabulary that can sometimes be old-fashioned.
Having a hard time following instructions.

Non-verbal signs of autism in a teen include:

Difficulty reading non-verbal cues like tone of voice, gestures and body language.
Using minimal eye contact, especially when talking to others.
Very limited/few facial expressions.

When it comes to autistic teenager behavior, a teen with autism might:

Want to spend time on his/her own rather than with friends.
Want other children to play by the rules.
Not understand social expectations, like making friends.
Have few or no friends outside their inner circle.
Prefer to talk to people older than him/her.
Stand too close; no concept of personal space.

Diagnosing autism in teenagers

The process of getting diagnosed with autism during the teenage years is no different from that of getting a diagnosis at an early age, but it will involve more questions about the teen’s behavior in school and how he/she interacts with peers.

A formal diagnosis might involve one or more experts in the field of autism such as developmental pediatricians, psychiatrist, psychologists, occupational therapists, and speech pathologists.

The diagnostic procedures can include:

An interview with parent or caregiver.
Actual observation of all interactions with others.
A physical exam to rule out other medical conditions.
A developmental screening (an assessment of developmental progress from infancy to present age).

Differences between boys and girls with autism

Recent studies have suggested that there is a significant difference in how autism affects girls and boys, which often result in undiagnosed cases in girls with autism.

Autism in Teenage Girls

A study (behavioral and cognitive characteristics of females and males with autism in the Simons Simplex Collection) published in the Journal of the American Academy of Child and Adolescent Psychiatry concluded that autistic symptoms in girls could go unnoticed.

Girls who have normal intelligence levels can “mask” their symptoms. Because they are of average or above-average IQ, girls with autism can appear neurotypical even though they have poor verbal and non-verbal skills.

Another contributing factor is culture. A girl who is quiet and non-responsive can be considered feminine and well-behaved, while a boy who is quiet can be seen as unusual or different.

Autism in Teenage Boys

Boys are four times more likely to be diagnosed with autism than girls. There is no definite reason why this is, but some theories state that girls are genetically less likely to inherit autism. The research found that girls can handle genetic mutations and can handle more instances before they reach the diagnostic threshold for autism.

Autism and Puberty

From experiencing sexuality for the first time to asking a girl out, a teenager with autism needs constant support to enjoy this time of his/her life fully. Parents should be aware of the changes that will come once a child with autism hits puberty and beyond as autism in the teenage years can have its challenges.

It’s important to understand that puberty happens regardless of the developmental delays of a child with autism. Puberty typically starts at the age of 12 for girls and 14 for boys but may be earlier for some.

Parents, family members, and caregivers of teenagers with autism will notice significant changes during puberty. These changes are mostly physical, but some are emotional and psychological.

The teenage years can be challenging, especially when it comes to the pressures of dating. Parents and caregivers are expected to guide teenagers with hygiene and understanding sexuality.

Hygiene

Unlike their peers, teenagers with autism might not see the importance of keeping their body clean. Other teens with autism might even have sensory aversions to taking a shower, so they avoid it altogether.

Parents and caregivers need a develop consistent strategies to help a teen with autism routinely wash and add hygiene routines like putting on deodorant and clean clothes. For girls, it’s important to share hygiene tips for menstruation, such as using a tampon/sanitary pads at this stage.

Sexuality

A teenager with autism will start feeling attracted to the opposite sex and develop sexual urges. It is not uncommon for autistic teens to masturbate, so it’s important that they are taught about the appropriate place that it is done.

This is also a good time to communicate the following points:

Do not expose yourself in public.
Do not let people touch you or your privates.
Do not join a group to participate in anything sexual.

Whether or not a parent is okay with this topic, it cannot be ignored.

Gender Identity

Gender identity and sexuality are more varied among autistic people than in the general population, and autism is more common among people who do not identify as their assigned sex than it is in the population at large — three to six times as common, according to an August 2020 study 1.

Gender and sexuality in autism, explained

https://www.spectrumnews.org/news/gender-and-sexuality-in-autism-explained/#refs

How common is gender diversity among autistic people?

Many studies have examined the prevalence of gender diversity among autistic people. One of the most frequently cited studies found that about 15 percent of autistic adults in the Netherlands identify as trans or nonbinary; the percentage is higher among people assigned female at birth than among people assigned male, a trend seen in other studies². By contrast, less than 5 percent of adults in the Netherlands’ general population have an identity other than cisgender³. And in a 2018 study in the United States, 6.5 percent of autistic adolescents and 11.4 percent of autistic adults said they wished to be the gender opposite of what they had been assigned at birth, compared with just 3 to 5 percent of the general population⁴. This study also found that, on two measures of autism traits, higher scores were associated with a higher likelihood of gender diversity. A 2019 study found a similar association in children who are not diagnosed with autism⁵.

Similarly, autism appears to be more prevalent among gender-diverse people than it is in the general population. A 2018 Australian survey of transgender adolescents and young adults found that 22.5 percent had been diagnosed with autism, compared with 2.5 percent of all Australians. Some experts estimate that 6 to 25.5 percent of gender-diverse people are autistic⁶.

Sexuality also appears to be more varied among people with autism than among those who do not have the condition. Only 30 percent of autistic people in a 2018 study identified as heterosexual, compared with 70 percent of neurotypical participants⁷. And although half of 247 autistic women in a 2020 study identified as cisgender, just 8 percent reported being exclusively heterosexual⁸.

The potential for seizures can increase during puberty

The chance of your autistic teen having seizures during puberty is four to one. The cause is not known but is believed to be brought about by hormonal changes in the body.

Teens with autism might also experience subclinical seizures during puberty. Subclinical seizures are seizures that are too faint that they can go unnoticed. Several diagnostic tests can be done to find out if a teen with autism is experiencing seizures so if you have a concern, contact your child’s doctor.

How do teens with autism communicate?

Teens on the spectrum can still be delayed in speech or language skills even when they have normal to above-average intelligence.

Teens diagnosed with Asperger’s syndrome, also known as high functioning autism, typically don’t have the delays in speech, motor, and physical skills. The delay is on social and communication skills which are made more obvious once the child has been exposed to social situations.

Because of their social and verbal limitations, autistic teens might:

Not respond appropriately.
Only talk about a specific interest.
Not respond to jokes or sarcasm.
Talk using a formal, business-like tone.

How does ASD affect a teen?

ASD can greatly affect a teenager in all aspects of his/her life. At a time when one experiences physical changes and social milestones, autistic teens can have a hard time coping and dealing with multiple life events.

Some examples of potential challenges for a teen with autism are:

Difficulty following complex school routines.
Rebellious demeanor at home and in school.
Unable to make friends because of poor hygiene.
Difficulty understanding romantic and sexual feelings.
Giving in to peer pressure without realizing the consequences.
Becoming a target of bullying due to poor social and communication skills.

There is no telling what surprises await parents who have teenagers with autism, but keeping open communication between parent and child can make these challenges easier to manage. However, some teens can be stubborn and resist a parent’s guidance. In this case, parents can seek help from a counselor or psychologist.

Autism doesn’t affect when puberty starts.
https://raisingchildren.net.au/autism/development/physical-development/preparing-for-puberty-asd

Stages of Adolescence

https://www.healthline.com/health/autism/

By: Brittany Allen, MD, FAAP & Helen Waterman, DO. Sourced from: https://www.healthychildren.org/English/ages-stages/teen/Pages/Stages-of-Adolescence.aspx

Adolescence is the period of transition between childhood and adulthood. It includes some big changes—to the body, and to the way a young person relates to the world.

The many physical, sexual, cognitive, social, and emotional changes that happen during this time can bring anticipation and anxiety for both children and their families. Understanding what to expect at different stages can promote healthy development throughout adolescence and into early adulthood.

Early Adolescence (Ages 10 to 13)

During this stage, children often start to grow more quickly. They also begin notice other body changes, including hair growth under the arms and near the genitals, breast development in females and enlargement of the testicles in males. They usually start a year or two earlier in girls than boys, and it can be normal for some changes to start as early as age 8 for females and age 9 for males. Many girls may start their period at around age 12, on average 2-3 years after the onset of breast development.
These body changes can inspire curiosity and anxiety in some―especially if they do not know what to expect or what is normal. Some children may also question their gender identity at this time, and the onset of puberty can be a difficult time for transgender children.
Early adolescents have concrete, black-and-white thinking. Things are either right or wrong, great or terrible, without much room in between. It is normal at this stage for young people to center their thinking on themselves (called “egocentrism”). As part of this, preteens and early teens are often self-conscious about their appearance and feel as though they are always being judged by their peers.
Pre-teens feel an increased need for privacy. They may start to explore ways of being independent from their family. In this process, they may push boundaries and may react strongly if parents or guardians reinforce limits.

Middle Adolescence (Ages 14 to 17)

Autistic children often need more time than typically developing children to adjust to and understand changes in their lives. If your child is well prepared for the physical changes that happen in puberty, your child is less likely to feel confused, or worry that there’s something wrong.
https://raisingchildren.net.au/autism/development/physical-development/preparing-for-puberty-asd

Physical changes from puberty continue during middle adolescence. Most males will have started their growth spurt, and puberty-related changes continue. They may have some voice cracking, for example, as their voices lower. Some develop acne. Physical changes may be nearly complete for females, and most girls now have regular periods.
At this age, many teens become interested in romantic and sexual relationships. They may question and explore their sexual identity―which may be stressful if they do not have support from peers, family, or community. Another typical way of exploring sex and sexuality for teens of all genders is self-stimulation, also called masturbation.
Many middle adolescents have more arguments with their parents as they struggle for more independence. They may spend less time with family and more time with friends. They are very concerned about their appearance, and peer pressure may peak at this age.
The brain continues to change and mature in this stage, but there are still many differences in how a normal middle adolescent thinks compared to an adult. Much of this is because the frontal lobes are the last areas of the brain to mature―development is not complete until a person is well into their 20s! The frontal lobes play a big role in coordinating complex decision making, impulse control, and being able to consider multiple options and consequences. Middle adolescents are more able to think abstractly and consider “the big picture,” but they still may lack the ability to apply it in the moment. For example, in certain situations, kids in middle adolescence may find themselves thinking things like:
- “I’m doing well enough in math and I really want to see this movie… one night of skipping studying won’t matter.”
- Do I really have to wear a condom during sex if my girlfriend takes the pill?”
- “Marijuana is legal now, so it can’t be that bad.”

While they may be able to walk through the logic of avoiding risks outside of these situations, strong emotions often continue to drive their decisions when impulses come into play.

Late Adolescents (18-21… and beyond!)

Late adolescents generally have completed physical development and grown to their full adult height. They usually have more impulse control by now and may be better able to gauge risks and rewards accurately. In comparison to middle adolescents, youth in late adolescence might find themselves thinking:

“While I do love Paul Rudd movies, I need to study for my final.”
“I should wear a condom…even though my girlfriend is on birth control, that’s not 100% in preventing pregnancy.”
“Even though marijuana is legal, I’m worried about how it might affect my mood and work/school performance.”

Teens entering early adulthood have a stronger sense of their own individuality now and can identify their own values. They may become more focused on the future and base decisions on their hopes and ideals. Friendships and romantic relationships become more stable. They become more emotionally and physically separated from their family. However, many reestablish an “adult” relationship with their parents, considering them more an equal from whom to ask advice and discuss mature topics with, rather than an authority figure.

Parents: How To Help Your Children Navigate Adolescence

Here are some helpful tips on how to prepare your autistic teen for puberty, by https://raisingchildren.net.au/autism/development/physical-development/preparing-for-puberty-asd

Being careful with language about puberty

You might need to be careful about your use of language, particularly if your child takes things literally.

For example, if you describe your child’s voice as ‘breaking’, your child might find this worrying. Instead you could say something like, ‘Your voice is changing and will get deeper’. You could also explain that men’s voices are usually deeper than women’s. Your child’s father’s voice, or their older brother’s voice, could be good examples.

It’s best to use formal terms like ‘breasts’ or ‘penis’ for body parts. But it’s also a good idea to teach your child other informal words that they might hear at school or other places – for example, ‘boobs’ for breasts. You could also explain that people talk about a voice ‘breaking’ when they mean a voice getting deeper.

Tricky questions about puberty from autistic children

If your autistic child asks awkward or tricky questions, try to be patient and honest. It’s OK to say, ‘I don’t really know – let’s work it out or look it up together’.

If your child asks questions at inappropriate moments, it might help to have a standard response that everyone in the family can use – for example, ‘That’s a good question, but let’s talk about it when we get home’. Your child needs to know, though, so remember to deal with the question when you get home.

You can also help your child feel good about themselves and develop a positive self-image by reassuring your child that physical and sexual changes are a natural part of growing up.

Visual supports to help autistic children understand puberty

You could show your child pictures of yourself at different ages so your child can see how you looked different. This can help your child understand when puberty happens.

You could also use drawings of a body to show how puberty looks at different ages. Label the body parts and highlight the changes that will happen – from getting taller to growing pubic hair.

Social stories to help autistic children understand puberty

You can create social stories for many puberty topics.

For autistic girls, social stories might cover developing breasts and widening hips, starting periods and so on. For example:

The shape of my body will change.
I will start to have periods.

For autistic boys, social stories might cover penis and testicle growth, erections, wet dreams and voice changes:

My body will look different.
My body will do new things.
My voice will sound different.

Here’s an example of a social story on wet dreams:

When I’m sleeping, I might have a dream. When I wake up, my sheets might be sticky and wet. This is called a wet dream.
When I have a wet dream, I should always wash my testicles (balls) and penis when I wake up.
Wet dreams happen to many boys.

Boys can be unsettled when they see semen for the first time, so it’s a good idea to explain about erections and wet dreams before they happen. Let your child know it’s normal. If you relate wet dreams and erections to the other changes your child is noticing, like more hair, this can help them understand that it’s a normal part of growing up.

You’ll probably need to go over these messages many times with your child. Try to be patient with your child – and yourself. It might help to share experiences and get support from other parents. You could try online or face-to-face support groups.

Children and their parents often struggle with changing dynamics of family relationships during adolescence. But parents are still a critical support throughout this time.

Here are some things you can do:

Help your child anticipate changes in his or her body. Learn about puberty and explain what’s ahead. Reassure them that physical changes and emerging sexuality is part of normal, healthy development. Leave room for questions and allow children to ask them at their own pace. Talk to your pediatrician when needed!

Start early conversations about other important topics. Maintain open communication about healthy relationships, sex, sexuality, consent, and safety (such as how to prevent sexually transmitted infection and pregnancy, and substance use). Starting these conversations during early adolescence will help build a good framework for discussions later.

Keep conversations with your child positive. Point out strengths. Celebrate successes. Be supportive and set clear limits with high (but reasonable) expectations. Communicate clear, reasonable expectations for curfews, school engagement, media use, and behavior, for example. At the same time, gradually expanding opportunities for more independence over time as your child takes on responsibility. Youth with parents that aim for this balance have been shown to have lower rates of depression and drug use.

Discuss risky behaviors (such as sexual activity and substance use) and their consequences. Be sure to set a positive example yourself. This can help teens consider or rehearse decision-making ahead of time and prepare for when situations arise.

Honor independence and individuality. This is all part of moving into early adulthood. Always remind your child you are there to help when needed.The adolescent years can feel like riding a roller coaster. By maintaining positive and respectful parent-child relationships during this period, your family can (try to) enjoy the ride!

Autistic Teens