Navigating Identity and Autism in a Teenager

A 16-year-old, Vee, is attending a comprehensive evaluation with a team of specialists. Vee was assigned female at birth and uses they/them pronouns. Vee's journey with potential autism began in pre-kindergarten. Teachers flagged concerns, leading to an Individualized Education Plan (IEP) for autism services. However, by first grade, Vee no longer met the criteria for an IEP. Ten years later, Vee is still grappling with social skills and identity questions, wondering if they might be on the autism spectrum. Vee has a history of various diagnoses, including obsessive-compulsive disorder (OCD), anxiety, depression, attention-deficit hyperactivity disorder, and specific learning disabilities. None of these fully explain Vee's long-standing feeling of not fitting in. Vee's struggles with mood and anxiety persist, despite improvements in OCD symptoms through therapy. Vee's anxious habits include hair pulling and storing the hair in boxes. Vee's dislike for school has grown, especially since starting middle school. Vee's school attendance has worsened significantly. Upon entering high school, Vee shared their nonbinary identity with parents, close friends, and the school counselor. Social interactions, particularly in new situations, pose challenges for Vee. They have experienced bullying and have only two close friends, both of whom recently moved away. Most of Vee's friends are part of an online community. Vee enjoys independent activities, loves anime, and is passionate about rescuing animals. They are highly imaginative and artistic. Vee has a history of lining up items, toe-walking, and sensitivities to loud noises, room aesthetics, clothing aesthetics, and textures. Vee can become aggressive toward their mother when frustrated, even punching walls, but is not aggressive with others. Vee's mother struggles to distinguish between nonbinary identity, neurodiversity, and typical teenage behavior. During the evaluation, Vee used minimal eye contact and spoke in a flat tone with reduced, stiff gestures. Vee narrated their thoughts using "vocal stim, " which includes silly voices, catchphrases, and occasional swearing. Vee uses vocal stim to manage nervous energy, entertain friends, and cope with difficult situations. Vee and their family are eager to understand why Vee feels so different from peers. The evaluation team ultimately diagnosed Vee with autism spectrum disorder, providing much-needed clarity and relief for Vee and their family. The team must now focus on supporting Vee and their family moving forward.