By Dr Michelle Garnett & Prof Tony Attwood
If you live with, teach or work with an autistic teenager, it is very likely that you have noticed that many days seem to be characterised by struggle. They often experience very strong emotions, including anxiety, stress, depression, and anger. On some days even the smallest trigger, for example, looking at the person, can trigger a meltdown. They come home from school catastrophically tired, seeming to need hours in the bedroom lying on the bed to recover, or disappearing into a computer monitor, only to emerge in a worse mood than they went in with. What is going on? Why are our autistic teenagers struggling so much with life? In this blog we cover 10 likely challenges your autistic teenager faces every day, with a hope to increase your understanding of why your teenager is struggling so much. We find that when we can understand the reasons for the struggle, that understanding can provide a roadmap of how to better assist our teenagers.
10 Challenges your autistic teenager likely faces every day
- Being different.
An autistic person often experiences that they are different from other people from an early age, but commonly does not understand why they are different. Within this gap of understanding they can insert many self-derogatory labels, like “weird,” “psycho,” or “stupid.” It is very difficult to be different at school, especially socially. You will remember from your own experiences of high school just how critical, rejecting and punishing teenagers can be to each other. One of the developmental milestones of adolescence is to individuate, that is to become an individual separate from your parents, to gain a sense of self. The individuation process is often characterised by trying to fit in with peers. It is very difficult to fit in with peers when you are socially different. The other kids know you are different, you know it, but you have no idea what to do about it. The result can be very low self-esteem, a poor sense of self and a sense of hopelessness, leading to depression and suicidality. Some teenagers react by denying that there is a problem, and overcompensate with an inflated self-esteem, or arrogance, and blame others. They often have anger problems.
Autism is a frontal lobe condition, which means that it affects the frontal lobes of the brain, which are responsible for executive functioning. In fact 3/4 of people with autism also have attention deficit hyperactivity disorder (ADHD), a condition characterised by poor executive functioning. Executive functioning abilities include the capacity to focus on the right thing at the right time, transition between events, organise ourselves and our time, plan and prioritise, hold a problem in our mind while we are solving it, and to inhibit first responses. An autistic teenager is often struggling with each of these abilities, which truly impairs their ability to regulate their emotions and behaviour. They often ricochet between emotions, acting impulsively, becoming defensive, and avoiding situations that make them anxious. This pattern allows no space to sense themselves, to process what is happening, to learn, or to problem solve. Without self-regulation, your teenagers feels out of control, and increasingly anxious. When someone cannot control themselves, they usually start to try to control other people.
- Sensory challenges.
One of the defining features of being autistic is that there are sensory challenges. Often noises are too loud, light is too bright, and the person can be very distressed by certain aromas, textures and tastes. Having a different sensory system can also affect the person’s ability to register pain and temperature. The consequences of a different sensory system include persistent hypervigilance, exhaustion and sleep problems. There can be difficulty with concentration and focus during the day because of the background stress of trying to process sensory experiences.
If you ask an autistic teenager what is the biggest problem of their life, they often will tell you that it is people. What they mean is that people are confusing, it is difficult to read them and to know what they expect, and they can also be punishing and rejecting. Research tells us that over 90% of autistic teenagers will have received cruel bullying, including peer rejection, by the time they reach 14 years old. Often our autistic teenagers decide quite early that people are “toxic,” and they prefer to avoid them to stay safe. The problem with this is that they have overlearned the lesson. Not all people are toxic, and your autistic teenager needs people in their life, including friends, mentors, parents, siblings, professionals and teachers. As one autistic teenager said, “I would choose to be alone but I can’t stand the loneliness.” We know from research and clinical practice that having just one friend can protect an autistic teenager from poor mental health outcomes.
- Double empathy problem.
Autistic people struggle to read other people, to infer their expectations and intentions. This problem is called “theory of mind,” or cognitive empathy. It is important to point out that autistic people do not lack empathy, they usually have an abundance of affective empathy, as discussed below. However, they do struggle to “read” people, to have cognitive empathy. We now understand that the problem goes both ways. As much as autistic people struggle to read neurotypical people, neurotypical people struggle to read autistic people. The unique social communication style of an autistic person, which may include less eye contact, facial expressions and body gesture, can lead that person to be misinterpreted and even perceived unfavourably. Similarly, an autistic person can misperceive certain facial expressions, gestures and tones of voice as being negative, and thus perceive the person unfavourably. On each side, whenever an unfavourable impression is made, the person perceiving the unfavourable impression is less welcoming, leading to the autistic person to both reject other people and perceive that they themselves are not welcome (Mitchell, Sheppard & Cassidy, 2021).
Due to problems with both social confusion and executive functioning, the person tends to overthink many situations as a coping mechanism. Autistic people often highly value intellect and can utilise their intellect to overcome their problems. This is a very valuable skill, but when overused we call it overthinking. Overthinking one’s problems can lead to both exhaustion and “analysis paralysis,” where the person becomes overwhelmed and avoids the problem. You know your teenager is avoiding the problem when they spend a lot of time in bed or in front of a screen. This avoidance is called thought blocking and leads to much greater levels of distress. Overthinking is also associated with being disconnected from the body and hence from processing one’s emotions. We need to feel to heal.
- Empathy overarousal
We have talked about cognitive empathy and we mentioned affective empathy. Affective empathy is when the person feels other’s emotional distress as if it were their own. They may not be able to understand how to describe that distress, or why the distress is occurring, but they feel it as if it were their own. Research has shown that many autistic people experience other peoples’ pain more intensively than neurotypical people do. This has been called the “empathy over arousal hypothesis.” Autistic teenagers and adults describe that they often feel overwhelmed by other peoples’ emotional pain, and have no idea how to deal with it, either how to help themselves, or how to help the other person.
Up to 80% of autistic people also have alexithymia. Alexithymia literally interprets to “a” – a lack of, “lexi” – words for “thymia” – emotions. It also includes difficulty sensing bodily sensations associated with emotions, or problems with interoception. When someone cannot detect the early signs of an emotion, or find and words for that emotion, they are severely under equipped for managing the emotion. Alexithymia is one of the reasons many autistic teenagers rise from 0 to 100 in half a second on their Anger Thermometer. Unfortunately, having alexithymia is a risk factor for developing clinical levels of anxiety and depression.
- A different learning profile.
When an autistic person completes an Intelligence Quotient (IQ) test it is very common for them to show a great deal of variability between the various subtests that make up the IQ test. This means that they often have great strengths in their cognitive learning ability, but also areas of great difficulty. Because of their uneven learning profile they can really struggle with new learning tasks, even if they are very intelligent or even gifted. We call this the different learning profile of autism. Being a different learner can be very challenging in all contexts, including school, but also in social situations and within the family and community. Despite good intellect, your autistic teenager may feel that they are stupid, and can feel very depressed and hopeless about that.
- Trauma or the effects of past trauma.
It is unfortunately the case that autistic people are both more likely to experience a traumatic event and are more likely to have a traumatic stress reaction, for example, to develop PTSD, after trauma. It may be that your autistic teenager is suffering current trauma, for example, being bullied or abused, or has developed PTSD, but the condition is undiagnosed. A person with PTSD will experience high levels of hypervigilance throughout the day, distrust of people, flashbacks to the traumatic event, and nightmares that interrupt good quality sleep. If you suspect that your autistic teenager has developed PTSD or is suffering a current trauma, we highly recommend seeking professional assistance for them immediately. Fortunately, PTSD is treatable, and if we know about ongoing traumatic experiences, we can keep our autistic teenagers safe by stopping them.
The teenage years are challenging for typical teenagers, however our autistic teenagers face unique challenges that can amplify the typical challenges of the teenage years. Over the many years we have specialised in autism, we have discovered that understanding specific challenges that our autistic teenagers face is the most important first step in knowing how to support and assist our teenagers. The 10 challenges we list in this blog are ones that we commonly discover in our clinical practice, and have further understood with research and clinical practice. Hopefully your autistic teenager is not experiencing all of these challenges, but we encourage you to continue to explore and understand the challenges they face. It can be painful to tune in and listen, or to lean in and observe closely. We ourselves may have faced similar issues and have not yet healed. However, one of the most consistent findings across research on what helps to maximise the best outcomes in autism is support. When we provide ongoing support and understanding for our autistic teenagers, we give them the best opportunity to succeed.
If your autistic teenager, student or client is experiencing any of these challenges and you are uncertain about next steps, we encourage you to come to our next Succeeding with Autism in The Teens Live Webcast on Friday 22nd July, 2022.
More information is available on our website:
Mitchell, P., Sheppard, E. & Cassidy, S. (2021). Autism and the double-empathy problem: Implications for development and mental health. British Journal of Developmental Psychology, 39, 1-18. DOI: 10.1111/bjdp.12350