The teen years can bring a lot of ups and downs emotionally. Handling the daily challenges, such as sensory and social communication issues, brings stress that impacts mental health as well as physical health. Finding ways to manage that stress and feelings like anxiety and depression are vital for your teen to feel their best physically and mentally.

Puberty and hormones impact the ability to self regulate (handle) their emotions. Changing bodies bring different viewpoints. They may feel conflicted about their body and how they view their body image.

Your teen's brain is still developing which impacts their behavior, emotions and executive functioning. Many autistic teens have challenges with what are called executive function skills. Executive functioning refers to a set of brain functions for managing your daily living including working memory, organizational skills, flexible thinking and self control.

This is why teens are more likely to get in traffic accidents, act impulsively, engage in risky behavior and have frequent mood shifts. Learning to understand and handle their emotions will help them enjoy life and deal with the natural stresses of life that can feel more intense during this stage.

To learn more about executive functioning, visit the Education section of the Milestones Autism Planning (MAP) Tool.

Additional Resources on Brain Development and Teens

What's Going On in the Teenage Brain? from American Academy of Pediatrics HealthyChildren.org

Understanding the Teen Brain from the University of Rochester Medical Center

The Evolutionary Advantage of the Teenage Brain from the University of California

Advice for Parents

By this time it should not just be you talking to your teen about issues. Your teen should be discussing these feelings with other trusted people. Your mental health team may include the counselor at school, private therapist, other close relatives or your clergy.

Helping Your Teen Learn How to Express Their Feelings

Encourage your teen to express how they feel. Help them understand and connect their emotions including what more nuanced feelings mean. For example, the difference between being angry and frustrated. Sometimes the emotions your teen expresses may not match the feelings they experience.

Ask questions that encourage them to share more but respect when they do not want to. Turn to a therapist or contact the Milestones free autism Helpdesk if you are concerned your teen is struggling and needs more help or if you are seeking more strategies.

If your teen is more impacted, they may need more support in identifying when they feel happy, sad, disappointed or angry. Teach them that everyone has different emotions and has a right to feel how they feel. And that those feelings will not last forever and that those feelings will pass.

Asking for Help

It is important for your teen to learn how to ask for help when something is difficult and that it is OK to say no to something that they do not want to do or that is uncomfortable for them. Especially with autistic teens, we want to be careful not to inadvertently imply they must say yes or be too compliant, putting them at risk for victimization or bullying. You can have your teen practice saying “No” for example, while blocking the door when someone tries to come in at an inappropriate time. You can teach your teen to say, “I need my privacy” as a concept in their bedroom and in the bathroom.

Dealing with Loss or Change

Big changes or loss can have a huge impact and be hard for your child to express and deal with. Grief is tough for anyone but it is such an abstract idea. Big changes can be as traumatic as someone they love dying or parents divorcing to losing a pet to having to change a provider.

Allowing Your Teen to Try without Stepping In

It can be tempting to help our teens if we think they’re having a hard time or not doing something correctly. But if we always step in and “fix” it for them they don’t learn how to handle frustration and to feel confident that they can figure it out. For example, they’re working on a homework project, and you or a sibling steps in to “fix” it for them when they weren’t done. This can impact a teen’s feeling of self-worth, and learned helplessness.

This is a gradual process. Especially in the beginning it may just be giving your teen a short amount of time to try to do something for themselves. If they’re really struggling you could give them a time frame you think is appropriate based on the problem or skills they’re working on and their developmental level. For example, give them 5 to 15 minutes and you can set a timer. Then after that if you still see they are very frustrated and not successful, you could offer some different ideas of how you might approach it. And then you could do it with them or for them (if appropriate) or help them come up with and implement a plan to advocate for themselves around the challenge.

If your teen is using a lot of self-defeating language like “I can’t do it,” “I don’t want to,” “Why bother,” or “No matter what I do it’s not going to work” it’s important to help them. Work on building confidence.

You can also start with something that your teen knows how to do and then introduce an element of complication to start to build in opportunities to ask for help or problem solve. This approach is called "sabotage."

Your teen will make mistakes. Listen to what they express before jumping in. Be an ally without necessarily fixing it for them. You could ask, “Do you want me to listen or do you want me to help you problem-solve?” We all learn best from the mistakes we make.

If you feel upset or angry, it can be helpful to say, “I need to think about this situation and talk about it later.” Take some time to calm down and think through the situation and options and come back. You might find it helpful to discuss it with a trusted therapist, guidance counselor or clergy. You may want to have a therapist of your own who you can discuss issues with. The Milestones Helpdesk is here to support you.

Finding Inclusive Communities and Social Groups

Having a community or being a member of various communities is important for social connections, networking and friendships. Look for inclusive communities and social groups that include people who have special needs as well as neurotypical people.

Be open to different types of people including those who have different ways of communicating. Your teen’s communication will not be negatively impacted by being around teens who do not have communication skills on the same level as theirs. They will still learn in different ways such as empathy and leadership. It is part of teaching your teen to be welcoming and open to people who are different from them, and how each person is unique and special.

For parents of teens who are more impacted, it’s important for them to have the opportunity to have friends, to be with people and build their skills. Reflect on your own views as a parent and how you can learn and grow.

For Parents of More Impacted Teens

If your loved one is more impacted, they may still need more support in identifying when they feel happy, sad, disappointed or angry. Teach them that everyone has different emotions and has a right to feel how they feel.

Friendships and Social Challenges

Friendships bring companionship and fun but also hurt feelings. Since our teens tend to think literally and struggle with social skills, they may not understand the nuances and steps in friendship. This includes levels of friendship from an acquaintance like a classmate who says hi to them to a real friend who wants to hang out with them after school or text with them. Or being romantically interested in someone or someone being interested in them.

It’s hard dealing with a friendship ending or someone being mad at them. They may have a hard time understanding the other teen’s perspective. For example how the other person is feeling. They may not pick up cues from other teens, such as facial expressions, language (especially jokes or comments that are subtle or puns) or body language that a neurotypical teen might naturally grasp.

Bear in mind that girls tend to mask more than boys, trying to fit in and act like their neurotypical peers. They may mimic who they perceive as friends or people who are friendly. For example if they see a group of girls they like, they may try to copy what those girls are into (even if it isn’t something you would want them to) and lead to burnout and stress.

Handling Puberty

Make sure your teen understands what puberty is and the changes they are experiencing. Help them handle the emotions and know that changing hormone levels may affect their feelings and perceptions.

Teens may question their sexuality or gender preference at a young age including which bathroom they want to use. They may be exploring what pronouns they want to use and parents should make an effort to honor those. There is a higher percentage of teens in the autism community who identify as LGBTQ. You can get support and learn more about it from your teen’s psychologist, social worker, pediatrician or school nurse. Organizations like Milestones can help you find someone in your community to support you.

More information is available in the social skills/communication and friendship sections of the Milestones Autism Planning (MAP) Tool. We will be adding articles about sexuality, dating and relationships to the MAP later in 2022.

Bullying

Bullying is a worry many parents have for our teens. Bullying takes many different forms such as

• Social isolation, like inviting everyone in the class but the autistic teen to a party.
• A teacher making a teen uncomfortable focusing on a behavior they may not understand is part of their being autistic.
• Teens making fun of them on social media or as minor as a negative emoji on their Instagram post.

Watch for changes in your teen’s behavior that could be from emotional issues or something happening at school or other places that are difficult for your teen. Warning signs include, does your teen

• Seem more emotional than usual?
• Come home from school and go right to bed?
• Refuse to go to school?
• Leave a class or school without permission when it wasn’t common before?
• Have more meltdowns in school than usual?

Work on figuring out what is happening that is causing these signs. It’s likely something is overwhelming them, whether a situation, environment or people. Whether it’s as simple as the wrong kind of food at lunch or something more serious like kids made fun of them or a substitute teacher who didn’t know something important about how to work with your teen.

Emotional issues should be addressed in their Individualized Education Program (IEP) or 504, as it is impacting your teen’s ability to get their educational needs met. Get professional help from your teen’s counselor, therapist or if school has a guidance counselor that your teen relates to.

Autistic teens can have mental health illnesses as well, such as depression and anxiety and at a higher rate. How depression or anxiety is expressed in autistic teens may be different than neurotypical children. For example, depression or anxiety in neurotypical teens is often expressed by social isolation and a decrease in communication with their peers. Since these are already struggles for autistic teens those typical symptoms may not be as noticeable. It’s important to get help from a counselor or therapist with experience treating autistic teens.

Just as we don’t want our teens to be bullied we need to watch that our teens are not the one bullying others. It is important to monitor their social media.

Additional Resources on Bullying

An Autism Perspective on Bullying: Creating a Culture of Acceptance

Bullying Prevention Resource Guide

Legal Rights Around Bullying

The Difference Between Life Stress and the Need for Outside Help or Diagnosis

It’s important to weigh the difference between common manageable challenges and ones that need outside medical or therapeutic help. Manageable behaviors as opposed to signs that your teen may have a mental health condition like anxiety, depression or self-injuring behavior that should be assessed by a professional.

There are various conditions like these that can be common in autistic people or their families. It’s vital to get professional help and support. They are often treated with therapy and/or medication.

While some people may hesitate to go to a therapist, sometimes teens need a neutral, objective person to talk to who understands your situation. When people have a medical challenge like diabetes, they see a doctor and may take medications like insulin. The brain is a vital organ that needs support, too. Seeing a therapist is a way to get that support to help you through.

Bear in mind that many mental health conditions have biological causes like chemical imbalances in the body that can be helped with medications and therapy. An outline of different co-existing mental health conditions is in the Physical and Mental Co-existing Conditions page.

The Milestones Helpdesk can connect you with resources. The service options and recommendations may also change at different ages and stages of their life.

The Milestones Mental Health Tool Kit provides an overview of mental health services available for autistic individuals as well as professional roles and forms of therapy. The Mental Health page also offers information and tips.

Getting Help If You Suspect Self Harming or Suicidal Thoughts

We know these are very difficult topics, but it is vital to get help if you suspect your teen may be hurting themselves through self-harming behaviors such as cutting (repeatedly, purposely making cuts or marks on themself) or are having suicidal thoughts. Your sensitively discussing these issues with your teen or asking questions will not give them ideas. Find a professional such as a therapist with experience treating autistic people.

Self harming is a sign that someone is in distress. They are not able to access other ways to communicate at that point to express what is bothering them. It often involves sensory issues, meaning they may experience touch, sound, light/seeing, smell or taste in a much more intense or much lower degree than neurotypical teens. Self harming may happen when they are not able to handle that stress or experience it in other ways.

If your teen expresses wanting to hurt themself or attempt suicide, don’t be dismissive or assume it’s not serious. Don’t be afraid to ask questions. You’re not going to give them ideas. If they express having a plan or specific ideas for how they might hurt themselves that is an urgent call for help. Call the National Suicide Hotline at 800-273-8255 or visit them online at Lifeline (suicidepreventionlifeline.org).

If you have a mental health provider you can ask for a crisis appointment but if they do not have one immediately available, find out if your community has a mobile crisis center. You can also take your teen to the Emergency Room at your hospital.

Make a safety plan right away, especially if there are guns or knives in the house, making sure they are properly locked and stored away, locking up medications, household cleaners, etc.

Suicidal autistic teens tend to attempt suicide at a younger age. If you sense depression or anxiety in your teen it is important to seek help from a trained counselor or therapist. While not all suicide attempts are an intent to die, they can end up in a life threatening situation without meaning to.

Trauma-Informed Care

Trauma-informed care is very helpful for autistic teens. The idea of trauma-informed therapy is that painful things happen to people and when that trauma happens it impacts the brain and sensory system. This type of therapy is based on how the brain processes trauma, especially important for autistic teens who already usually have sensory challenges. They know how to help your teen share their story and pain and handle it using what is meaningful for your teen. Ask for a Trauma-Informed Counselor and ask any potential therapist if they have this type of training and that they specialize in autistic patients.

Additional Resources

Department of Developmental Disabilities (DODD) Trauma Informed Care Guide

FrontLine 24/7 Crisis Hotline - 216.623.6888

National Suicide Prevention Line - 1-800-273-8255

Crisis Text Line - Text HOME to 741741 to connect with a Crisis Counselor

Ohio Addiction Hotline - 888-796-5986