While autism spectrum disorder (ASD) is often associated with childhood, some people with autism are not diagnosed until adulthood, even if they had signs and symptoms in their early years.
Autism has characteristics that include challenges in social communication and social interaction, as well as restricted and repetitive behaviors and interests. Adults living with autism face unique challenges that can affect work, daily life responsibilities, and relationships with family and other people.
Sergei Dubrovskii / Getty Images
1. Challenges in Social and Emotional Give and Take
One of the most well-recognized signs of autism is a pattern of social interactions that do not flow as is typical for people without autism. Many autistic adults talk or contribute much more or much less than others in social settings.
Over the years, adults with autism may develop a level of comfort only in specific types of social interactions. For example, some autistic adults are more comfortable spending time with family and lifelong friends, while others may feel more comfortable socializing with unfamiliar people.
Some adults living with autism may feel comfortable only in one-on-one conversations, while others only feel comfortable in larger groups.
Adults living with autism who have a self-awareness about their comfort level might have a strong preference for the type of interactions where they feel confident and secure.
2. Challenges in Nonverbal Communication
Autism can cause challenges with nonverbal communication, such as eye contact, facial expressions, and gestures. Autistic adults may have an unusual pattern of nonverbal communication and/or might not understand other people’s nonverbal communication.
Adults who have lived with these challenges for many years may learn to ask questions to clarify communication and avoid misunderstanding nonverbal cues.
3. Challenges in Understanding and Making Relationships With Other People
Autistic adults may have trouble forming relationships with peers. They often do not have an age-appropriate understanding of nuances or jokes. Autism can make it difficult for adults to comprehend diverse cultural norms of different groups—such as the difference between coworker and family interactions.
Sometimes, adults living with autism may be able to develop friendships with people who are much older or much younger, rather than people of their same age. This may be because people who are not peers do not have the same expectation of give and take, shared humor, or social cues as peers.
Adult Females and Subtle Signs of Autism
Some people with autism use a strategy described as camouflaging or masking to behave in ways that are more socially accepted. Research suggests that females who have autism are more likely to use this strategy, which can lead to a mismatch between the internal experience and the external behavior—and may play a role in delaying diagnosis.
4. Repetitive Movements and Speech
Adults with autism may have repetitive physical behaviors, such as fidgeting, lining up objects, or repetitive motions that don’t have a purpose. Many people who do not have autism also have these habits, but people with autism can spend excessive time with these behaviors or are often unaware of the way these habits appear to others.
5. Depending on Routines
One of the characteristics of autism is an extreme comfort with routines and feeling exceptionally stressed when routines are disrupted. Adults who have autism may feel strong urges to repeat certain tasks in a specific order or with a consistent timetable, even if changing the pattern will not cause any harm.
6. Intense and Limited Interests
Adults who are living with autism may have unusually strong attentiveness to obscure topics, potentially to a degree that interferes with work, life, or family responsibilities. Sometimes adults who have autism may keep unusual collections or hold extreme attachment to specific objects.
7. Unusual Reactions to Sensations
Often, adults with autism have intense responses to sensations, such as fabrics, food, or smells. Many people with autism have an increased response to sensations, while others have a decreased response.
Diagnosis
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines the diagnostic criteria of adult autism. An autism diagnosis is a clinical diagnosis based on a person’s history of symptoms and characteristics, and it is not verified by any imaging test or blood test.
An adult may be evaluated through an interview with a neuropsychologist, a psychologist, a psychiatrist, or a neurologist. In some instances, their primary care provider may also evaluate and diagnose them.
Challenges of Autism in Adulthood
Autism creates many challenges for adults that involve family relationships, friendships, work, and task management. Individuals who have autism might unintentionally upset or alienate other people, potentially causing others to avoid them. This can lead to loneliness and isolation.
The interpersonal difficulties and unconventional interests can make it hard for adults with autism to connect with others in school, at work, and socially. If you are living with autism, you might have a hard time getting a job or getting promoted to a position that requires a strong appreciation of nuance and interpersonal skills.
Reasons for a Delayed Diagnosis
It is common for an autism diagnosis to be delayed until adulthood. The diagnostic criteria have been refined over the years, and there’s an increase in awareness among parents, teachers, and healthcare providers.
Many adults who had signs of autism during childhood or adolescence were not diagnosed because the diagnostic criteria were not well developed or widely available.
Additionally, some characteristics of autism fall into a gray area and are displayed by almost all children until mature and become more socially aware. For some people, it’s only after the symptoms persist into adulthood that an individual may start to wonder if they have autism.
Sometimes, characteristics of autism might be dismissed as just part of a person’s personality, not prompting the pursuit of a diagnosis. Additionally, several mental health conditions can cause symptoms that are similar to autism, which can further delay diagnosis.
Conditions with features similar to autism include:
It’s important to distinguish autism from these conditions because the management or treatment are not the same.
Treatment to Manage Adult ASD
Adult autism can be classified into the following levels that correlate with the severity and degree to which the condition affects a person’s ability to function independently:
- Level 0 describes a person who’s been diagnosed with autism but does not require any support to be able to achieve appropriate social interactions and independent self-care.
- Level 1 describes a person with autism who needs some support with social interactions and responsibilities. This could include help from family, school, workplace accommodations, or specialized professionals.
- Level 2 describes a person who requires substantial support to maintain interactions and manage responsibilities.
- Level 3 describes a person who depends on substantial support and still might not be able to have healthy relationships, manage responsibilities, or maintain self-care.
Professional and Community Support
If you are an adult living with autism, you may be able to receive assistance and accommodations in your community, at your school, or in the workplace. It’s important to ask for guidance from your healthcare team. Support groups and government agencies, such as the following, may also recommend resources:
Summary
People diagnosed with autism in childhood do not outgrow the condition as they age. And sometimes, autism is not diagnosed until a person is an adult. Reasons for delayed diagnosis include lack of recognition and awareness or misdiagnosis with another condition.
Signs and symptoms of autism center around challenges with social interactions, unusual behaviors, and interests. Autism can be classified into levels, which correlate with a person’s level of independence and need for support.
Understanding Autism Spectrum Disorder in Adults
While autism spectrum disorder (ASD) is often recognized in children, many individuals may remain undiagnosed until adulthood despite exhibiting symptoms during their early years. Understanding autism in adults is crucial as it encompasses various challenges related to social interaction, communication, and daily living.
Key Challenges Faced by Adults with Autism
1. Social and Emotional Interaction Difficulties
One of the hallmark signs of autism in adults is the challenge of engaging in typical social interactions. Autistic individuals might find themselves speaking more or less than others in various situations. Over time, many develop comfort in specific types of social settings, preferring interactions with family or acquaintances over unfamiliar social environments.
2. Nonverbal Communication Barriers
Nonverbal communication, including eye contact and body language, can pose significant challenges for those with autism. Many adults may struggle to interpret or replicate nonverbal cues and might resort to asking questions to clarify communication, thereby mitigating potential misunderstandings.
3. Building Relationships
Forming and maintaining relationships can be difficult for adults with autism, who often lack an understanding of social nuances, humor, and differing interaction dynamics among various social groups. They may find more comfort in friendships with individuals from different age groups, where the expectations and social cues differ from those of peers.
Women and Subtle Signs of Autism
Research indicates that women with autism often engage in “camouflaging” behaviors to fit societal norms, which can lead to internal experiences that do not align with their external presentations—sometimes delaying their diagnosis.
4. Repetitive Behavior Patterns
Adults on the autism spectrum may display repetitive behaviors, such as fidgeting, arranging objects, or engaging in specific routines. These behaviors can sometimes consume significant amounts of time and might be performed unconsciously.
5. Need for Routine
A strong preference for routines is common among autistic adults, with disruptions to these routines often leading to significant stress. Many individuals feel compelled to follow specific patterns even without any apparent consequences from changing them.
6. Intense Focus on Specific Interests
Some individuals on the spectrum cultivate profound interests in niche topics, which can distract from daily responsibilities or social obligations. They might develop collections or deep attachments to certain objects related to these interests.
7. Sensory Sensitivities
Autistic adults often experience heightened or diminished sensitivities to sensory stimuli, such as textures, flavors, and odors. These unusual reactions can significantly affect their daily experiences and engagement with their surroundings.
Diagnosis of Autism in Adulthood
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines the criteria for diagnosing autism in adults. Diagnosis is conducted through a comprehensive evaluation that may include interviews by mental health professionals. There are no blood tests or imaging techniques to confirm autism; it is based on assessed behavioral symptoms and personal history.
Challenges Associated with Adult Autism
Adults with autism encounter multifaceted challenges in their family dynamics, friendships, and workplace interactions. Their interpersonal difficulties, coupled with unique interests, can lead to social isolation and feelings of loneliness. Autistic individuals may struggle to secure employment opportunities or promotions that demand nuanced social skills.
Delayed Diagnosis: Reasons and Implications
Many individuals receive an autism diagnosis only later in life due to evolving diagnostic criteria and limited recognition among healthcare providers. Symptoms can sometimes be mistaken for personality traits or misdiagnosed due to overlapping symptoms with other mental health conditions.
Managing Autism: Treatment and Support
Autism in adults is categorized into levels based on the severity of the condition and the individual’s need for support:
- Level 0: Individuals who do not require support for social interactions or self-care.
- Level 1: Individuals needing some assistance with social responsibilities.
- Level 2: Individuals requiring substantial support for interactions and managing responsibilities.
- Level 3: Individuals who depend on significant support to function effectively in social and personal domains.
Resources for Support
Adults living with autism can access various support resources in their communities, workplaces, and educational environments. Consulting professionals in healthcare and exploring support groups can be beneficial in navigating challenges associated with autism.
Conclusion
While diagnosis often occurs in childhood, autism is a lifelong condition that adults continue to navigate. Increased awareness and improved diagnostic methods are essential in supporting individuals who may not have been recognized during earlier years. Symptoms feature significant social interaction challenges and behavioral patterns and require a tailored approach for management and support.
