Adolescents who have an autism spectrum disorder (ASD) commonly have difficulty initiating and maintaining friendships. Peer interactions often are limited and this leads to frustration, anger and social isolation. Bullying can also occur as does acting out and challenging behaviors. These adolescents have difficulty recognizing and following accepted social norms. This lack of awareness leads to the adolescent with an ASD being identified by peers as being “different” and further social isolation that is peer and not self- induced often occurs.
Adolescents with ASDs have difficulty matching their interests to others. This pattern of special interests leads to further social isolation and decreased peer commonality. They may also have associated problems including auditory processing, executive function, anxiety and ADHD that further complicate social interaction and limits reciprocal social communication.
How do you recognize an adolescent who may have an ASD? The first step is to look for a longstanding pattern of preference for solitary activities. A recent pattern of separation would suggest depression. Look for difficulty with recognition of nonverbal social cues that limits the adolescent’s ability to understand the intent, purpose and meaning of others. Do they have difficulty making or keeping friends? Do they have highly developed or specialized interests that are appropriate for younger children or are excessive for their age? Is their eye contact limited? Do they have repetitive mannerisms of their hands or fingers? These are all signs to suspect and ASD.
You must recognize adolescents with an ASD and adjust your interaction style to meet their needs. The goal is to support healthy lifestyle behaviors including healthy diet, exercise and adequate sleep. Stress must be managed and the integration of physical activity into every day is essential. Focus on safety and security issues that place the adolescent at risk. Discuss sexuality and bullying issues openly and support age and socially appropriate peer activities.
Adolescents with an ASD have the same puberty onset patterns as neurotypical adolescents. They also have the same interests in sexuality. A difference, however, is they may have an inadequate understanding of issues relating to friendship and social cues relating to relationships. Often language for these adolescents is concrete and rigid and increases misunderstandings. These responses lead to an interpersonal disconnect and unsettling behaviors and responses often develop. If there are associated intellectual delays there can also be difficulty with self-care, personal hygiene, safety and birth control.