Case highlights diagnostic challenge when autism and functional neurological disorder overlap in adolescents

A recent case report underscores the complexity of diagnosing autism in adolescents presenting with functional neurological symptoms, emphasising the importance of thorough developmental history and caution in self-diagnosis, especially amid social media influence.

A new case report in Frontiers in Psychiatry highlights the diagnostic complexity that can arise when functional neurological disorder and autism spectrum disorder appear to overlap, particularly in adolescents whose understanding of their symptoms has been shaped by social media. The paper describes a 17-year-old girl with severe functional neurological symptoms, including weakness, functional seizures and tic-like behaviours, who came to believe she had autism after encountering autism-related content online. Yet a structured assessment, including standardised observation and a developmental history taken from her parents, did not support an autism diagnosis.

The authors argue that the case should not be read as proof that social media create autism-like symptoms. Instead, they say it illustrates a more subtle problem: genuine neurological disability can coexist with an autistic-style explanatory narrative that may fit a young person’s experience even when the formal developmental criteria for autism are not met. In this patient, the autism self-identification persisted despite negative findings on assessment, while her social difficulties, sensory sensitivity and emotional uncertainty were understood by the clinicians in the context of complex functional neurological disorder rather than a neurodevelopmental condition.

Functional neurological disorder is not a fabricated illness. It refers to disabling neurological symptoms that are real to the patient, but are thought to arise from altered nervous-system functioning rather than structural disease. The paper notes that autism and functional neurological disorder do overlap more often than chance would predict, although published estimates vary widely. Recent reviews cited by the authors suggest that around one in 10 people with functional neurological disorder may also have autism, but the figure depends on the group studied and on how autism is assessed.

That uncertainty matters because the overlap can cut both ways. Some people with autism, particularly girls and women, may be missed for years because they mask social difficulties or develop compensatory strategies that make brief clinical encounters misleading. Others may adopt an autism label after seeing relatable content online, even when their symptoms are better explained by anxiety, personality factors, trauma or functional disorder. The authors argue that clinicians should therefore avoid using either self-identification or a single screening tool as the final word. A careful developmental history remains essential.

The report also places the case within a wider discussion of how the brain interprets bodily sensation and emotion. The authors point to interoception, the ability to sense internal bodily states, and alexithymia, the difficulty of identifying and naming emotions, as possible bridges between functional neurological symptoms and autistic-like experiences. In their view, some patients may come to organise confusing bodily and social experiences into an autism narrative because that framework feels coherent, validating and less stigmatising. But they stop short of calling this a diagnosis in its own right. Their conclusion is that clinicians need to validate distress, look for a true developmental history of autism, and treat the functional symptoms directly when autism criteria are not met.