Autism Across the Life Span: What Gets Better, What Gets Worse, and What to Expect

Originally published on 3/17/23 and updated on 10/27/25

Every day we are learning how autism affects development in ways that differ from person to person. Some of those differences remain constant across the life span; others change.  

Researchers at the University of California, Davis, looked at how the brain changes over the course of a lifetime. They identified close to 200 gene differences between autistic and neurotypical individuals. Some of those genes were linked to differences in the brain’s immune response, inflammation, and neural connectivity—all of which can affect how a person changes with age (Zhang et al., 2023).  

Here's a brief look at how autism traits can evolve as people mature from childhood to adulthood.  

Autism in Early Childhood 

The Centers for Disease Control and Prevention (CDC) encourages clinicians and caregivers to look for these early indicators of autism as children grow and develop: 

• avoids eye contact 
• doesn’t respond to name or show emotion in facial expressions (by 9 months) 
• doesn’t play interactive games or use a variety of gestures (by 1 year) 
• doesn’t share interests or attention with others (by 15 months) 
• doesn’t seem to notice when someone else is hurt or upset (by 2 years) 
• doesn’t seem to notice or want to interact with other children (by 3 years) 
• doesn’t use imaginative or imitative play (by 4 years) 
• has strongly preferred interests  
• repeats certain words or phrases (a behavior sometimes called echolalia) 
• prefers a predictable order for events, activities, and objects 
• prefers to follow routines exactly or carefully 
• moves in ways that are not neurotypical (spinning, stimming, hand flapping) 
• responds to sensory stimulation in ways that are neurodiverse 

Every autistic child won’t have all these characteristics (CDC, 2022). How autism looks and feels can also be shaped by culture, trauma histories, language differences or delays, and intellectual disabilities.  

Download the infographic: Early Childhood Development and Beyond 

Other Developmental Considerations  

As you evaluate each child, it’s important to keep these factors in mind.  

Use of “Motherese”

A study published in 2023 found that autistic toddlers between the ages of 1 and 2 years were less attentive than neurotypical toddlers to use “motherese”—a voice tone mothers often use with very young children. Researchers tracked eye movements to measure children’s attention. Autistic toddlers who focused more on motherese tended to have more developed social and language abilities, researchers said (Pierce et al., 2023).   

Age at Identification 

Universal autism screening aims to identify autism in infants and toddlers so intervention and support can begin at a young age. Early interventions have been linked to better outcomes. In at least one study, researchers found that when autism is identified between 25 and 41 months, toddlers had greater developmental delays in several key areas than when it was identified between 12 and 18 months (Miller et al., 2021).   

Autism in the School Years   

Traits that emerge in the toddler years may continue during later childhood. For some people, new behaviors, experiences, or co-occurring conditions may develop as school interactions present new challenges. For example, autistic students may  

• not feel confident that they’re accurately interpreting social cues with peers; 
• take the lead in determining what to talk about in conversation;  
• speak in literal or concrete terms rather than figurative language; 
• do better when instructions are clear and straightforward; and
• become overwhelmed with the stimuli and social demands in classroom settings.  

Learn more about assessing social communication and pragmatic language. 

It’s important to share information about co-occurring conditions with families.  Data shows the following:  

• Nearly 40% of autistic children have an anxiety disorder (Lai et al., 2022). 
• Close to 35% also have attention-deficit/hyperactivity disorder (ADHD) (Brown et al., 2021). 
• Approximately 27% have sleep difficulties (Mutluer et al., 2022).
• Gastrointestinal issues such as diarrhea, constipation, and feeding problems are more common among autistic children than in the wider population (Krigsman & Walker, 2021) 

Autism in Adolescence  

The core features of autism are the same in teens as they are in children. Even so, as social relationships become more important, and as puberty places new demands on the mind and body, core features may intensify. Here’s what to know about some of the unique challenges autistic teens may encounter while navigating adolescence. 

Puberty 

Some studies suggest that puberty may arrive earlier in autistic teens than it does in the general population—a phenomenon known as precocious puberty. This is especially true for girls (Liu et al., 2024). Other studies show that while the onset of puberty may be earlier, its full development may take longer in autistic teens (Groenman et al., 2024).  

Menstruation can be an extra challenge for autistic girls and women. Social taboos make it harder to talk about periods, so people may not have a good sense of what’s normal. Pain, bloating, and skin changes can bring on sensory overload.  

For girls and women, autism has been linked to a greater risk of endocrine dysfunction, including conditions such as polycystic ovary syndrome, premenstrual syndrome, and some reproductive cancers (Simantov et al., 2022). And social communication differences may make it difficult to seek help from or describe symptoms to healthcare professionals (Gray & Durand, 2023).  

For some teens, gender identity can come into better focus in adolescence. Autistic individuals are more likely to experience gender dysphoria, to vary from gender norms, or to be transgender than people in the general population (Cooper et al., 2022). Understanding these needs can give you the extra awareness you may need to provide appropriate support. 

Risky Behavior 

Studies have consistently shown that autistic teens are no more likely to engage in generally risky behavior or in substance abuse than their neurotypical peers. However, there does seem to be a higher chance that autistic teens will put their health at risk with behaviors like these: 

• Unprotected sex  
• Self-injury 
• Unhealthy eating patterns 
• Exercise avoidance 

These health-related risky behaviors are more common among autistic teens who are having symptoms of depression (Sun et al., 2021).  

Mental Health 

Depression symptoms and certain autism traits may overlap in the teen years. Both can increase irritability, withdrawal, and negative rumination. Depression can also keep people from taking good care of themselves, can intensify inflexibility, and can decrease the pleasure people usually find in their focused interests (Pezzimenti et al., 2020).  

When autistic teens experience depression, they may not show their feelings openly, and their executive function skills may not function as well. There’s some evidence that the risk of developing an eating disorder such as anorexia and binge eating is higher for autistic individuals (Numata et al., 2021).

Intellectual Disability 

If you’re working with an autistic teen with an intellectual disability, you may have an opportunity to help with a few additional challenges.   

When an autistic teen also has intellectual disability, it can increase the likelihood of aggression, weight changes, bathroom accidents, and self-injury (Pezzimenti et al., 2020). While many autistic students have an education transition plan in place, it’s less likely among autistic teens with an intellectual disability (Hughes, et al., 2024). 

Higher Education 

At least one study found that autistic traits were linked to some social and academic difficulties in college or university. In a study that involved students from 14 different colleges and universities, researchers used surveys to find connections between three traits associated with autism (mentalizing deficits, social anxiety, and sensory reactivity) to see which traits were linked to these academic outcomes: 

• Academic difficulties 
• Course failure 
• GPA 

Mentalizing skills enable people to understand their own emotions and intentions, as well as the emotions and intents of other people. Researchers also explored the links between autistic traits and social outcomes such as:  

• having a confidant 
• having a positive assessment of their friendship experiences 
• having a sense of social exclusion 

Researchers found that mentalizing skills were linked to overall GPA, and all autistic traits were associated with academic difficulties and a higher likelihood of failing a course. Social findings were a bit more nuanced. If a student had autistic traits and an autism diagnosis, they were more likely to have a confidant. Similarly, students who had autistic traits without a diagnosis were more likely to have felt a sense of social isolation (McLeod & Anderson, 2023). These findings support the value of autism evaluations, even when they take place in adolescence or young adulthood.  

Autism in Adulthood    

Autism is a lifelong condition. Whether it’s identified early in childhood or later in life in adulthood, autism presents new physical, adaptive, and mental health challenges in each stage of life.  

Increasingly, autism is being identified in adults. That doesn’t mean that adults develop the condition in adulthood; it means people may not have had access to services in their youth, when the pathway to a diagnosis and a support plan might have been more easily accessible. 

Meaningful Participation in a Multidisciplinary Approach 

For some adults, an autism evaluation is precipitated by: 

• Long-lasting difficulties with social interaction and communication 
• Difficulty getting or keeping a job 
• Care for a mental health condition or another neurodevelopmental condition, such as ADHD or dyslexia 
• Identification of autism in a child or other family member 

Experts recommend that practitioners work in respectful partnership with adults who are being evaluated for autism. Trust, empathy, and a non-judgmental stance are vital. It’s also important to take a close look at adaptive behavior to see whether social demands, sensory demands, or co-occurring mental health concerns may be interfering with daily functioning (NICE, 2021). 

Respectful partnership includes creating physical spaces where the unique needs of autistic individuals are considered.

Learn more about how to design autism friendly spaces here.  

Economic Exclusion 

The Centers for Disease Control & Prevention (CDC) reports that the adult years often carry these additional concerns for autistic people:  

• unemployment or underemployment,  
• limited post high school education, and  
• continued living with family members (CDC, 2025).  

When autistic adults have difficulty with employment, it may be related to problems managing, interpreting, or responding to emotions and social situations. These difficulties can also make personal relationships more challenging. Difficulties may exist, in part, because it can be so challenging for autistic adults to access mental health services, allied health services, and healthcare transition services (Maddox et al., 2021).  

Experts recommend that the evaluation team include professionals who can offer or coordinate support for finding housing, education, and career services. It may also benefit your client to get involved with local support groups.

Parenting

Being an autistic parent can present unique challenges. Here are a few to be aware of: 

• Some parents describe a “near constant sensory overload” that could occasionally result in a parental meltdown—though they expressed no regrets in becoming parents (Smit & Hopper, 2023). 
• Some parents feel frustrated by a support system that feels “broken.” It’s common for parents to feel dismissed, unsupported, and judged when seeking services for their children. Many feel they have to “scream” or “fight” to get appropriate care for their autistic children, only to face a lack of follow-through on promises made (Radev et al., 2024). 
• Some parents worried that disclosing their autism diagnosis would reduce the respect they received and might jeopardize their child getting appropriate care (Radev et al., 2024). In a 2019 study, researchers noted that autistic parents were four times more likely to have a professional question their parenting ability (Griffiths et al., 2019).  
• Some parents feel their autism traits were stigmatized by school officials, especially difficulties with sensory processing and social communication. Better training of school officials would help, they say (Radev et al., 2024). 

Autistic parents also experience unexpectedly profound joy and love in parenting. Many said parenthood helped them feel “anchored” and “loved unconditionally.”  Having autistic children also gave many parents a sense of connection and solidarity because of their mutual understanding (Smit & Hopper, 2023). 

Perimenopause and Menopause 

When perimenopause and menopause occur in midlife, autism can make the transition more complicated. Here are some of the difficulties autistic women express in studies: 

• Autistic characteristics can interact with menopause symptoms and the symptoms of other co-occurring conditions to intensify emotions and worsen sensory sensitivities.  
• For some, menopause is when autism is finally identified, when “decades of being misunderstood, episodes of burnout and overwhelm, social isolation and bullying” culminate in an inability to cope (Brady et al., 2024).  
• Taboos around menopause, social communication difficulties, and “help-seeking fatigue” can make it harder for women to talk about their experiences and get needed care.  
• Dismissiveness and failure to listen can lead to insufficient or inappropriate care for mental and physical health related to both autism and menopause.  

As a practitioner, you are positioned to be able to offer empathetic support and guidance in this critical transition period.

Health Concerns 

Aging brings its own challenges to autistic individuals. In later life, autistic individuals may experience the following: 

• A greater number of chronic medical conditions, including metabolic, heart, and muscular-skeletal conditions 
• Decreasing adaptive skills 
• Higher risk of cognitive decline 
• Limited exercises 
• Higher risk of mental health conditions 
• Lower participation in the community life 

When autism co-occurs with intellectual disability, the chances of experiencing epilepsy, osteoporosis, gastro-intestinal conditions, respiratory infections, and thyroid disorders are also higher (Klein & Klinger, 2024).  

In early adulthood (20–39 years) and middle adulthood (40–59), sleep may continue to be a problem, especially for people who take certain medications or who have mental health conditions (Joveveska et al., 2020).  

Researchers think these elevated health risks may be related to genes, lifestyle habits, long-term use of medications, and less preventative care because of the unique challenges of autism (Klein & Klinger, 2024). As a practitioner involved in the life of an autistic adult, you may be able to help facilitate participation in community events, better lifestyle choices, and access to health care services. 

In adulthood, many autistic people—especially those who don’t have intellectual or language disabilities—learn to suppress repetitive behaviors in social situations. Adapting to neurotypical expectations can cause extra anxiety and even exhaustion. On the plus side, many autistic adults can leverage their preferred interests in their education, hobby, and career choices (Goldstein, 2019).   

The Role of Camouflage in How Autism Presents     

Camouflaging is a set of skills autistic individuals use to hide or change their own characteristics, preferences, or needs to fit in or feel more comfortable in neurotypical social settings. Those skills are usually categorized as  

• assimilation (strategies that help people fit into social environments);  
• compensation (strategies that help people learn and use social behaviors); and  
• masking (strategies that help people hide traits or behaviors).  

People of all backgrounds and identities camouflage from time to time. In one 2022 study, however, researchers found that autistic females tended to score higher on self-report scales measuring all three camouflaging skills. In that study, gender diverse autistic people had higher scores on the compensation subtest. Those who received an autism diagnosis as adults tended to use more assimilation and compensation behaviors (McQuaid et al., 2022).   

While camouflaging has perceived benefits, it also has costs. Children, teens, and adults can experience autism burnout, fatigue, and other mental health consequences because of the pressure to adapt to neurotypical expectations in their environments. And camouflaging can be so skillful that it keeps autism from being identified.   

Key Messages    

Autism characteristics and behaviors can change as people mature. While some or all core features of autism may remain present from early childhood onward, the degree of impairment or the outward appearance of some traits and behaviors may change. Understanding how and when these changes may occur can be helpful to those who support autistic individuals.  

Ready to learn more? Maximize your autism assessment process. 

AUTISM RESOURCES  

Further Reading on Autism 

• The WPS In-Depth Guide to Autism and ADHD  
• Why So Many Autistic Girls & Women Are Still Missing Out on Early Identification 
• Understanding the Complicated Interplay of Autism and ADHD 
• How Autism and ADHD Can Disrupt Interoception 
• How to Choose the Best Autism Assessment for Your Client 
• Best Practices in Autism Assessment 
• Autism Conversations: Individualizing Educational Interventions with the MIGDAS-2 Evaluation Process 

Videos and Webinars on Autism 

• How Cyberbullying Impacts Students On and Off the Autism Spectrum 
• Conversation Over Labels: A Better Way to Understand Autism 
• Autism Spectrum Brains 'Get Energy' from These Things