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Autism: The Teenage Years

Updated: Jul 28, 2021

‘When I was a boy of fourteen, my father was so ignorant I could hardly stand to have the old man around. But when I got to be twenty-one, I was astonished at how much he had learned in seven years.’ -Mark Twain

The teenage years are known to be a time of powerful emotions, sensation seeking, and risky behaviors and it turns out there is a good reason for this. Whilst most people blame the angst of being a teenager on hormones it is also a time of rapid brain development much like that experienced as a toddler. With the onset of puberty, a second round of mental pruning occurs. This is a process by which unused brain connections are removed and well used connections are strengthened. This process starts in the limbic system which is the area of the brain which controls emotions. The last part of the brain to be rewired and strengthened is the prefrontal cortex, which is responsible for reasoning and decision making, in fact, the prefrontal cortex is not fully developed until 25 years of age. This leaves teenagers in the tricky position of feeling powerful emotions but without the required brain capacity to regulate these emotions or to make considered decisions. Teenagers are therefore more likely to act on these emotions without consideration of the consequences of their actions leading to risk taking behaviors such as alcohol and drug use, unsafe sex, and aggression. There may be an evolutionary advantage to the brain changes in this stage of development. As we enter puberty, we are also starting the process of becoming an adult with adult roles and responsibilities. Many of these new experiences such as dating and sexual activity, leaving home and seeking employment can be frightening. The sensation seeking and risk-taking behaviors that characterize the teenage years may in fact be necessary to provide the courage to brave these tasks.

For autistic children, the onset of puberty can be more challenging. As many as 30% of autistic teenagers will show a decline in their functional and adaptive skills during this period and whilst 13% of autistic children will have epilepsy this number jumps to 26% during the teenage years. The researcher Giorgia Picci has devised a ‘two hit’ model to explain the challenges faced by autistic people during adolescence. She proposed the first hit happens in the period from prenatal to early childhood when the autistic brain starts to develop in an atypical way, the second hit happens during adolescence. She cites that the reason for the second hit is twofold being caused both by the biological brain development that happens at this time and the environmental impact of the expectation of assuming adult roles and responsibilities.

Many young autistic children will struggle to cope with sensory sensitivities, emotional regulation, and social interactions. As they develop through childhood it is likely that they will develop strategies to cope with these differences. Some strategies they may develop include reliance on learnt routines and rules and self-stimulatory behaviors (stimming). The re-emergence of powerful emotions during puberty may overwhelm these coping strategies leading to an increase in maladaptive behaviors such as aggression, self-injury and zoning out. Behaviors such as aggression and self-injury may also become more damaging as the child becomes physically bigger and stronger. There are also many changes to social rules that occur during adolescence. Peer relationships become more complex and the rule governing how we behave in different relationships (friends, family, romantic partners, authoritative figures) diversify and differentiate. For example, whilst hand holding during childhood may be appropriate with any of the above groups once you hit puberty it can become more taboo within certain relationships whilst still being acceptable in others. Autistic teenagers are faced with relearning coping strategies and social rules and will likely need extra support to do so. One protective factor for autistic teenagers is that they do not seem to show the same increase in risk taking behaviors as their neurotypical peers. The downside of this is that it may mean they lack the courage or motivation to pursue adult goals such as romantic relationships, leaving home and employment.

An additional dilemma faced by all teenagers is the emergence of sexual desire and interest. For some autistic teenagers who lack the required social awareness or impulse control this can lead to inappropriate sexual expression or activities. It is beyond the scope of this article to explore this subject in depth however I would like to look at an area that can be particularly problematic for some autistic teenagers which is public masturbation. It is important to note that masturbation is not a problem itself, and for many autistic teenagers (and non-autistic teenagers) it can be their only sexual outlet. Masturbation can however become problematic when it happens in the wrong place or at the wrong time. Education and reminders about where and when it is appropriate to engage in this type of self-stimulation may be all that is required for some individuals however a lack of understanding of social rules is not the only reason this behavior may occur and the underlying cause will need to be discovered and an alternative coping method found. An article by MJ Connor on summarizes well the underlying causes that can lead to public masturbation and this list is borrowed from there:

  • Sexual behaviour is the only source of gratification or pleasure

  • The sexual behaviour decreases anxiety or feelings of excessive demands

  • Sexual behaviour has become a way of challenging authority

  • Sexuality is perceived as way of behaving like an adult

  • Sexual behaviour compensates for a lack of stimulation

  • Sexual behaviour reflects some underlying conflict (such as anxiety about peer rejection, or uncertainty about how to initiate a relationship)

  • Insufficient differentiation is made between sexual behaviours and other behaviour, and insufficient awareness of issues surrounding context, respecting social norms, etc.)

  • Sexual behaviour or compulsiveness can provide a sense of security.

We can see that sexual gratification is not the only reason this behavior may occur in an inappropriate way. Everyone is different but if we can understand the particular need driving the behavior, we can begin to look for alternative more socially acceptable solutions.

The teenage years can be exciting but are also fraught with challenges and obstacles that many teenager’s autistic or otherwise fail to overcome. This is evident by the massive increase in mental health difficulties associated with adolescence as well as the increased risk of life altering crisis such as pregnancy, addictions, and accidents. Things change in the teenage years and all teenagers deserve respect and support as they go through this stage however this is particularly true for autistic teenagers who may find the smallest of changes difficult let alone the massive changes associated with adolescence. We can support autistic children to traverse the teenage years successfully by being aware of the potential difficulties and possible solutions. Forewarned is forearmed and with a heavy dose of compassion the teenage years can be survived without too many war wounds.


A Two-Hit Model of Autism: Adolescence as the Second Hit (

ASD and Inappropriate (as perceived) Sexualised Behaviour by Mike Connor (

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