SIGNS OF AUTISM IN ADULTS

You may have spent your entire life not recognizing the signs of autism, or not realizing that some of the issues and feelings you have dealt with were related to autism. Here are what the three hallmark symptoms of ASD might look like:

SOCIAL INTERACTIONS

COMMUNICATION DIFFERENCES

REPETITIVE BEHAVIORS

Read more in our Autism Speaks Adult Autism Diagnosis Tool Kit: autismspeaks.org/AdultToolkit

A study from Autism Research7 shows that age of diagnosis can have a major impact on mental health. People who were diagnosed over age 21 were 2.7 times more likely to have co-occurring mood, anxiety, personality or eating disorders than people who were diagnosed in childhood. These conditions greatly impact quality of life and can increase the complexity and cost of healthcare.

"Experts have claimed for a long time that autistic people are more prone to anxiety and depression, and that it's somehow caused by their brains. But the fact is, that the world looks a lot different from the perspective of people with autism. If you don't fit in, it makes sense that you're going to be more anxious and depressed, because being social takes so much of your energy that you don't get to live your life," says Dr. Levin.

THE PATH TO A DIAGNOSIS

Screening for autism in adults can be challenging. Currently, there are few clinicians who specialize in adult autism, so it can be difficult to find someone who is comfortable with (and skilled in) diagnosing and treating autism in adults.

Dr. Cathy Lord, Ph.D., George Tarjan distinguished professor of psychiatry in the David Geffen School of Medicine at UCLA, recommends that adults seeking a diagnosis start by going to a general therapist, psychologist or psychiatrist.8 While these specialists will take self-referrals, a referral from a primary care physician could help speed up the process.

Another approach is contacting a clinician who specializes in autism in children. A developmental pediatrician, child psychiatrist or pediatric neurologist may be open to seeing older patients.

Though there are established diagnostic tests for ASD in adults, autism looks different for everyone, and many older adults learn how to mask their symptoms, making an autism diagnosis based on observation challenging. Over the course of multiple appointments, adults are typically asked to speak with the clinician about their childhood and present life, do various activities, and fill out questionnaires. 

At Dr. Lord’s clinic, the process begins with a conversation about what the adult is seeking from the assessment. Then, clinicians speak with someone who knew the patient as a child. “That is very useful, because autism is a developmental disorder, so we are looking for something that has always been there but may not have caused difficulty until later in life,” she explains. 

After the initial interviews, patients are asked to do a full assessment to test their cognition, executive functioning, and ability to make judgments. Lastly, clinicians do a social-emotional functioning interview to measure people’s ability to hold a job, make friends, and other social activities, as well as an adaptive behavior scale to measure independent living skills. They also screen for depression, anxiety and ADHD – common cooccurring conditions that accompany autism. 

A formal diagnosis will come with a written evaluation that explains which autism criteria was met, the level of diagnosis, as defined in the DSM-5, and other diagnoses and suggested supports. This document could open the door to benefits or services from state, federal and other public agencies. 

THE WORK AHEAD 

While the medical profession has made huge strides in early diagnosis, much work remains in the field of autism and aging. There is a shortage of research into issues that affect autistic individuals across the lifespan, and a shortage of mental health professionals who are trained to provide support to autistic adults. 

“We’ve made huge strides in early diagnosis, but we also need to do a much better job of training our general practitioners in the mental health field, to be prepared to see autistic adults,” says Dr. Bal. “We simply do not have the capacity as a specialty field, to assess and diagnose all the people who need to be seen. So we need to find other ways. Some people will continue to benefit from specialty care, but there ought to be a subset of people who can go and get a diagnosis from a more general mental health professional, who has enough training to help them map out their path forward.”• 

ABOUT THE AUTHOR: 

Marta Chmielowicz is the Content Manager of Mission Delivery at Autism Speaks, where she leads science communications to advance the mission of Autism Speaks to create an inclusive world for all individuals with autism throughout their lifespan.