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In this post, you will read about changes in the experience and expression of autistic behaviors that may occur during puberty. In order to support each ASD individual, it is critical that autism characteristics are recognized to be "persistent" (as noted in the DSM-5 criteria) but also somewhat changeable in expression across life seasons. (also see Let's Bust the Myth that Autism Looks the Same Across the Lifespan)
PUBERTY AND AUTISTIC BEHAVIORS
Autistic behaviors are an expression of how the brain has connected and developed. The brain is part of the body and can change as the body changes. Hormone changes are one aspect of physical function that may impact behaviors in autism.
PUBERTY AND EMOTIONAL/BEHAVIORAL REGULATION
In addition to physical changes in height, muscle mass, etc., teens also experience notable changes in emotional and behavioral regulation. This term refers to the ability to stay calm and centered (to regroup when upset, to calm down when angry, to refrain from hitting or punching people/property). Many an adolescent can switch from laughing to crying to shouting within minutes (and often not understand why).
AUTISM AND REGULATION
Individuals on the autism spectrum are prone to emotional and behavioral dysregulation (even at an early age). According to research by Samon (2013), "children and adolescents with ASD showed more emotion dysregulation and had significantly greater symptom severity on all scales [of a behavior profile than neurotypicals]. Within ASD participants, emotion dysregulation was related to all core features of [autism]."
AUTISM, PUBERTY, AND REGULATION
It should come as no surprise, then, that the changes in emotions and behaviors are apt to appear even more dramatic within (than outside) the spectrum during puberty.
As noted by the Lurie Center for Autism at MassGeneral for Children, "New behaviors can surface—such as emotional outbursts, aggression, property destruction, self-injury, and increased anxiety. Even the most stable family can feel challenged."
CLINICAL OBSERVATIONS
In my clinical practice, patients and families do seem to report frequent struggles around the age of 14 years and through the early 20s. The difficulties may take the form of agitation, anxiety, increased sensory reactivity, reduced sleep, repetitive behaviors, or sometimes restless fixations on interests that appear somewhat "manic."
In-depth research about this topic continues to be lacking. Studies are needed to capture the frequency of behavioral escalation in ASD during puberty. Because I see individuals in a clinical setting (those who are presenting because of difficulty), my observations of struggle may represent a minority subset of ASD adolescents.