ASD and Adolescence – thinking about changes in mind and
body.
“I look different and my voice sounds different, it’s gone squeaky and Mum said it’s
because I’m an adolescent and not to worry about it but I do. Maybe it will always be
squeaky! I’m 13 now. I have read stuff and I know that adolescence is the time between
being a child and a man. I find myself thinking a lot about things I never used to. I think
about the future. I worry about what I am going to do when I leave school. Will I always
have to take my epilepsy tablets? The girls at school look different too and they don’t act
like they used to. It’s all confusing.” (Andrew has an ASD and goes to secondary school)
Does this sound familiar to you? Do you have a teenage son or daughter or is there a student
at your school who says things like this?
The core features of Autism and Asperger’s Disorder (we call it Autism Spectrum Disorder
now, ASD for short) don’t go away but may look different as kids get older. To really help
them you need to be familiar with how their ASD is affecting them now each and every day at
home, school and when they are out and about socially. The following fact sheet ASD and
Adolescence – thinking about changes in mind and body gives information about ASD and
answers questions such as- What is adolescence?
- What happens when a child with an ASD becomes an adolescent?
- How do adolescents with an ASD think and learn?
- How might adolescence be affecting their health?
- How we can help students with an ASD manage this stage of development?
- What else can I read to find out more?
ASD and Adolescence – thinking about changes in mind and
body.
Dr Avril V. Brereton
Why talk about adolescence? This fact is about adolescence and changes in cognitive
development (thinking) and physical development. If you understand the changes that are
going on in the adolescent’s thinking, it may well help you to understand him/her better. Also,
knowing what stage of cognitive development the adolescent is at should help you to choose
management strategies that suit their age and stage. Similarly it can be helpful to take time to
think about changes to body (physical and sexual development) that adolescence brings to
the young person. These changes can be both exciting and stressful for all teenagers and
particularly for young people with an ASD and their parents and teachers. There are questions
for parents/teachers to consider and talk together about. You might like to do this in a
meeting or just do it in your own time.
Let’s start by asking a broad question: What is adolescence?
Adolescence – A time of change: the period and process of development from child to adult.
The word adolescent is derived from the Latin word adolescere to grow. Now we use the term
adolescence when we refer to young people who are no longer children but are not yet
adults. Adolescence begins at the time of puberty when sexual development begins, at
around 11-14 years of age. It ends with the social transition to independence from the family
but there is no clear marker of when that time is. In our society, some young people are not
independent of their parents until their twenties.
How is the young person with an ASD that you know coping with becoming an
adolescent? How are you coping?
Cognitive development and thinking
IQ scores on standardised tests of intelligence of children with autism typically show an
unusual and distinctive pattern of performance with poorer verbal sequencing and
abstraction skills and better rote memory skills. Tasks requiring manipulative, visuo-spatial
skills or immediate memory may be performed well, such as copying block designs and
putting complex puzzles together. In contrast, children diagnosed with Asperger’s disorder
may have an uneven developmental profile with better language skills and poorer motor
skills. High functioning adolescents often continue to have difficulties with social skills and
joining community activities. They may also have a discrepancy between their IQ score and
their ability to achieve academically at school because social and behavioural difficulties get in
the way of learning and adapting to school life.
Adolescence brings about changes in thinking in the young person. Piaget (1952) developed a
cognitive-developmental theory to explain the development and functioning of the mind. The
pre-adolescent thinks in a concrete way, speaking of specific people, events and objects.
He/she cannot understand concepts such as the relationship between the individual and
society. In most children thinking becomes more abstract between eleven to fourteen years
of age. By fourteen years of age the adolescent can conjure up make believe situations, think
about hypothetical possibilities, what might be, the future and the remote. For example an
adolescent can think about what he/she is thinking about and reflect on his/her thoughts. As
thought becomes more abstract, the adolescent begins to understand that a community of
people is bound together by largely invisible rules and obligations (Hoffman et al., 1988). This
ability to deal with abstractions and logical possibilities was described by Piaget (1952) as the
stage of formal operations, the final stage of cognitive development.
Some adolescent feelings and behaviours arising from changes in cognition (thinking)
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Improved ability to use speech to express self
Tendency to revert to more childish behaviour, particularly when stressed
Mostly interested in the present, with limited thoughts of the future
Rule and limit testing
More consistent evidence of a conscience and sense of morality
Realization that parents are not perfect
Self preoccupation and tendency to take things personally (self reference)
Inconsistent beliefs, ideas and behaviours from the general to the particular
You may find it helpful to think about this in relation to your son/daughter or the students
you are teaching. Write down your thoughts about these two questions.
Which adolescent feelings/ behaviours in the list above are noticeable in the young
person with an ASD that you know?
How am you currently dealing with/ responding to them?
So far we have been considering adolescence and the changes in thinking that occur for most
typically developing young people. Those with an ASD will also be experiencing these changes,
but there are other things happening with their thinking because they have an ASD such as :
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thinking in a very rigid way,
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misunderstanding and mismanaging time,
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not accepting exceptions to rules,
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being disorganized
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not sequencing events logically or putting cause and effect together
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focusing on details rather than seeing the big picture
- these are all examples of how an ASD will be affecting the thoughts of the adolescent.
Think and talk about the “thinking style” of the young person with an ASD that you
know
and in particular how you are responding and managing.
Is all going well or is it time to stop and reconsider?
Physical development
Biological changes and physical maturation of the body involving growth in size and change in
profile are probably the most obvious changes that we see in the maturing adolescent. Early
adolescence is characterised by puberty, the process that changes the immature child into a
sexually mature person. The reproductive glands (the ovaries in girls and the testes in boys)
together with the adrenal glands, the pituitary gland and parts of the brain switch on and
interact to secrete sex hormones into the bloodstream. New hormone levels (more androgens
in boys, more oestrogen in girls) lead to the dramatic outward physical and inward organ
(including the brain) changes of puberty. It takes about four years from the beginning of this
process for a child’s body to change into an adult’s body. Hormone secretion continues to
increase throughout adolescence and peaks at about twenty years of age.
Children progress through puberty at different rates and times. For example, one girl may
reach full breast development in a couple of years and another may take four years to reach
the same development. Some body parts may initially be disproportionately large (usually
hands and feet) and growth spurts occur at an uneven pace. For example, have a look at a
photograph of the sculpture by Michelangelo of the youth David who slew Goliath with his
sling shot.
Girls. From about the age of ten, girls grow taller, hips broaden, and they add normal body
fat. This fat tissue which also is a store for oestrogen particularly gathers above the pubic are,
hips and thighs. This growth usually peaks at about twelve years of age. Breast development
starts at about ten and reaches full size about three years later. About the same time the
uterus and vagina begin to mature and the voice lowers. Pubic hair usually appears when a
girl is about eleven and underarm hair about two years later. Menarche (the first time a girl
menstruates) may occur at any time from between ten and seventeen years. For girls, the
reaction to their first period may depend upon how well they have been prepared for this
event. Girls with autism are no different to others in this regard. The difficulty for parents will
most probably be adjusting the type of preparation and the time needed for this according to
their daughter’s level of understanding. It is a time for simple and clear instruction. For some
less able girls it is necessary to instigate a pad programme and picture system a couple of
years before you anticipate her periods will start (perhaps as early as 8 or 9 years of age). For
others who are more able, the sexual development classes at school, discussion with parents
and simple, illustrated books may well suffice.
Boys. Boys usually begin their growth spurt later than girls and it usually peaks at about
fourteen years of age. Most will reach their adult height by about sixteen but some may not
begin this growth spurt until that age. Shoulders become broader, weight increases because
of increased muscle (rather than an increase in weight due to increased oestrogen storing
body fat for girls). From about twelve, the penis and scrotum become larger and will be a
mature size in three to four years. About eighteen months after the penis has begun to grow,
a boy is able to ejaculate semen, but even infant boys may have erections if their penis is
stimulated. By the time a boy is about fifteen years old, his semen contains mature sperm.
Pubic hair grows at the same time that the genitalia grow and underarm and facial hair
appear about two years later. As the larynx becomes larger, the vocal cords lengthen and the
voice becomes deeper after going through a period of fluctuation (voice breaking).
A rapidly changing body
Physically adolescents grow more rapidly during puberty than at any other stage except in
infancy which often leaves them looking and feeling awkward and different. Because visible
body parts grow at differing times, the overall effect is one of a body that is different,
ungainly, awkward, clumsy and hard to coordinate and strange. Head, hands and feet grow
fastest and will reach adult size before the rest of the adolescent’s body. Next to grow are the
neck, arms and legs with the trunk being the last to grow.
For most adolescents the physical changes that they experience at this time have a significant
effect on how they feel about themselves. Most will spend time looking at their bodies and be
preoccupied with looking at themselves in a mirror. For example teenagers can usually
recognize their own nose in a group of photographs of noses, but adults are mostly unable to
do this. Some will feel proud of the changes in their body while others may be embarrassed or
have a mixture of these feelings. Peer pressure about early or late maturation can affect the
teenager’s self esteem in either a positive or negative way. For example the boy who begins a
growth spurt and is taller and more muscular than his peers may be proud of these obvious
signs of physical change. On the other hand, a girl who has developed breasts earlier than her
peers and begun to change from a slim pre-pubertal shape to a more mature shape with
additional body fat may feel embarrassed and have negative feelings about weight gain.
How can we help?
Just as in the past parents have prepared their children for change, now is also a time to help
adolescents with an ASD to be prepared for the changes in him/herself over the next few
years. Preparing adolescents for the changes that will occur can be very helpful and also
minimize confusion and fears about their changing body. Ideally, education about puberty
needs to start well before it is actually occurring to be most beneficial to each young person.
Keeping in mind the great variation in physical growth and development throughout
adolescence, it will be still relevant to some families when their sons and daughter are aged
between 11-15 to be teaching them about change in body shape, size, and looking and feeling
different. It is probably best to initially teach adolescents about changes occurring for their
own sex at this stage rather than complicating the issue by discussing the other sex; so
relevant information about boys for boys and girls for girls is necessary at this stage.
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Activity sheets with photographs to describe physical changes, picture and visual
matching activities, sequencing cards, step by step instructions will all be helpful for
teaching information about physical development and bodily changes
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Photographs that cover different ages and stages can help the adolescent to look back
on the changes and growth that have already occurred in themselves
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Teach by pictures, social stories and actual demonstration about changes to hygiene
routines. How to use deodorant, shaving facial hair, managing menstruation and
wearing a bra, are some of the new skills that are necessary for adolescents to learn.
Boardmaker© and some other visual communication systems can be used to develop
teaching materials about growth and development issues. (Boardmaker© is a computer
program which uses the Mayor- Johnson Picture Communication Symbols and other line
drawing clip art. The program is used to create communication boards. There are symbols to
represent many nouns, verbs, and adjectives).
Diet, exercise and sleep
Adolescence can be a time when parents and teachers are concerned about the young
person’s eating and exercise habits and their sleeping patterns. This applies to those with an
ASD as well as typically developing teenagers. Weight may become a problem because
adolescents often enjoy foods that are high in fat, sugar and salt and may eat beyond their
needs at this time. The rules for a healthy diet are moderation, variety and balance and eating
fresh food daily from the major food groups (Bennett and Rowe, 2003). Breakfast is important
and should never be missed. Ideally, breakfast should comprise of a variety of foods such as
milk, cereal, toast, eggs and fruit for a good start to the day and provide some of the calcium
and iron needs. Growing bones need calcium during adolescence and good sources of this are
milk, yoghurt and cheese. It may be easier to not have junk food and sugary drinks at home
and at school if you have a teenager who has a passion for sugar, salt and fat.
Does the teenager you know eat daily from each of the food groups?
(Cereals, fruit and vegetables, dairy, meat and fish)
How can we help?
When an adolescent with an ASD wants to eat unhealthy food or has a restricted diet it can be
difficult to make changes. It may be that the adolescent has continued with food preferences
and sensitivities that were established during early childhood. They may be sensitive to
textures, temperature, appearance taste and colour of food. They may be distressed by
change and so prefer the same food each day or the same packaging of familiar food. These
suggestions are worth trying:
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There is no point in getting into a battle over food. Offer a balanced meal and healthy
food choices for every meal.
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A food diary can be helpful for parents and it may be that the young person has a
better and more stable diet than you thought. Record what he/she eats and when if
you can. The weekends might be a better time for parents to do this because of school
canteen or shopping choices you may not know about.
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Encourage the adolescent to be involved with food preparation and cooking. Watching
TV cooking shows might inspire them.
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At school opportunities to eat in a quiet place or in a small group of peers away from
social stress may be able to be arranged
At home it can be difficult to get teenagers moving! Adolescents spend a lot of time watching
TV, playing computer games and are often driven to destinations rather than have to walk.
Inactivity will increase the likelihood of weight gain in this age group. There is no doubt that
about 30 minutes of exercise a day (the sort that raises a sweat) will be of benefit to overall
improvement in health.
Bennett and Rowe (2003) list the following benefits of regular physical exercise:
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effective muscle control will improve posture
as physical endurance increases fatigue decreases
exercise can be an effective way of coping with stress and anxiety because tension
decreases with physical activity
weight is more easily controlled
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can ward off strokes and heart attacks in later life (p.90)
How can we help?
Does the teenager with an ASD do any of the following daily? Encourage them or join them in
these activities - play a team sport, jump on a trampoline, walk for more than 15 minutes, ride
a bike, swim, go for a run, walk the dog, ride a scooter.
Some adolescents with an ASD have a history of poor sleeping. This may have settled during
middle childhood only to return in adolescence. Adolescents who are going through their
“growth spurt” may complain of tiredness and seem to need more sleep. Growth hormone is
secreted during sleep and therefore your son/daughter may have literally grown overnight.
You may have had a bedtime routine for your children when they were little. Adolescents can
also benefit from a structured bedtime routine in which they go to bed to sleep so that they
will settle more easily and have a good night’s rest.
How can we help?
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Get homework finished about one hour before going to bed so that
there is time to unwind
Dim, or no lights
Have some quiet music playing
Listen to a story tape
Read a favourite book
Drink a glass of milk
Do some relaxation exercises
Do not watch a screen
References and further reading:
Bennet, D. & Rowe, L. (2003). What to do when your children turn into teenagers. Sydney:
Doubleday.
Berger, Kathleen S. The Developing Person Through the Life Span. New York, New York: Worth
Publishers, 2001.
Brereton, A., Tonge, B, Kiomall, M. (August 2009). Outcome of a parent education skills
training programme for adolescents with autism. Paper presented at the Australia Pacific
Autism Conference, Sydney, Australia
Erikson, E. H. (1968). Identity: Youth and crisis. New York: Norton.
Hoffman, L., Paris, S., Hall, E. & Schell, R. (1988). Developmental Psychology, 5th Ed. Random
House: New York.
Piaget, J. (1952). The Origins of Intelligence in Children. New York: International University
Press.
The NAS website has ideas about managing diet. http://www.autism.org.uk/living-withautism/understanding-behaviour/dietary-management-for-children-and-adolescents/dietarymanagement-restricted-diet.aspx