Autism in adults
Autism is a neurodevelopmental disability that lasts lifelong. It causes differences in communication, social skills and behavior and it shows up in many ways. The term autism spectrum disorder describes the full range of symptoms and behaviors, from mild to extreme. People have a wide range of challenges and strengths that can vary with age and over time.
These are some common traits found in autism in adults.
In social situations, adults with autism can:
- avoid eye contact, or feel uncomfortable with eye contact
- find it hard to make or keep friends, or prefer to be on their own
- be very honest and transparent, which people may misinterpret as them as being blunt, rude, or not interested in them
- find it hard to understand what others think or feel. They may even have a hard time understanding how they feel.
- miss cues within conversation, such as body language, or whose turn it is to talk
- find it hard to say how they feel
- have difficulty understanding sarcasm, figures of speech, or take things literally.
Autism in adults also presents in the following ways:
- have repetitive behaviors or urges to move that seem unrelated to what is going on — this may increase if they are stressed, anxious, or excited
- prefer order, rules, and routines, and finding it hard to cope with change
- experience sensations such as smell, touch, taste, texture, hearing, and pain at a different level to others
- are able to focus on certain tasks or passionate interests very closely, and understand them in great detail.
Reasons for Delayed Diagnoses
Parents and doctors knew much less about autism and its presentation when you were a child. As the diagnostic criteria have evolved and education efforts have been made within the medical, educational, and psychological communities, and with parents, children as young as 3 months can now be diagnosed. Records of milestones a child has or has not met are recorded at every well child checkup and assessing children for signs of autism has become pretty standard. Back when you were a child, only those with significant difficulties were recognized—and even they were sometimes misdiagnosed.
Lifespan Developmental Changes in Autism
Autism traits change and evolve as children grow into adults. The results is a different presentation of symptoms, challenges, and strengths.
Children with Autism are largely unaware of how autism sets them apart from their peers. They act following their inner preferences and challenges without a conscious effort to conform to societal norms.
In contrast, adults with mild to moderate levels of autism are typically more aware of their differences and societal expectations. This heightened self-awareness allows adults to adapt to social norms and environments, albeit sometimes at the cost of their comfort and authenticity.
Overall, the primary ways in which Autism evolves throughout development include:
- Difficulties with Personal Relationships: As individuals develop over time, the nuances of personal communication become more complex. Autistic children might have difficulties reading facial expressions and making friends. Adults face more demanding relationship situations as they have to navigate romantic relationships, workplace friendships, and even parent their own children.
- Difficulties with Social Interactions or Environment: Autistic children often show a diminished interest in talking to others and making friends; preferring solitary activity. This is not a universal truth. Many autistic children and adults desire friendships and can struggle with loneliness. Adults continue to find social situations challenging as well.
- Development of Coping Mechanisms and Masking: Children are often quite open about their difficulties as they are less inhibited. As children grow into adults, they often become skilled at camouflaging or masking their difficulties to fit into societal norms.
- Development of Focused Interests: Autistic children usually have intensely focused interests, which might seem restrictive in scope but provide comfort and a sense of order. As individuals with autism transition into adulthood, these persistent interests can evolve into areas of expertise or specialized career paths, offering significant opportunities for employment and personal fulfillment.
Understanding these key differences highlights the importance of a life-span approach to autism support. Tailoring interventions and support to the changing needs of individuals with autism as they grow ensures that every person on the spectrum has the opportunity to lead a fulfilling and productive life.
Autism criteria in the DSM-5-TR and manifestations in adults
The DSM-5-TR specifies diagnostic criteria for autism. The following table summarizes the DSM-5 criteria, with examples of how these criteria may manifest in adults.2
| DSM5-TR Criteria for Autism | Examples of how criteria may manifest in adults | |
|---|---|---|
A. Persistent deficits in social communication and social interaction across multiple contexts. (Diagnosis requires person meets all three criteria.) |
1. Deficits in social-emotional reciprocity | Difficulty initiating or maintaining back and forth conversation; reduced sharing of interests and emotions; tendency to monologue without attending to listener cues; unusual response to greetings or other social conventions. |
| 2. Deficits in nonverbal communicative behaviors used for social interaction | Lack of eye contact; facial expressions are not easy to identify; difficulty understanding non-verbal communication; unusual tone of voice or body language. | |
| 3. Deficits in developing, maintaining, and understanding relationships | Challenges adapting behavior to match different social settings such as when interacting with family, friends, authority figures, or strangers; difficulty developing or maintaining friendships; needing to spend a lot of time alone. | |
B. Restricted, repetitive patterns of behavior, interests, or activities. (Diagnosis requires person meets at least two of four criteria.) |
1. Stereotyped or repetitive motor movements, use of objects, or speech | Repetitive movements or “stimming” (e.g., rocking, flapping, pacing, or spinning for enjoyment or as a coping mechanism); arranging objects in a very precise manner; echolalia; continuously repeating sounds, words, or phrases. |
| 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior | Greater than expected degree of distress with changes in routines or expectations; difficulty transitioning between activities at home and work; need to do the same thing in the same way each time; greater than usual reliance on rituals for accomplishing daily tasks. | |
| 3. Highly restricted, fixated interests that are abnormal in intensity or focus | Intense special interests (e.g. becoming an expert in seventeenth century art) while having significant difficulty attending to topics outside of one’s areas of special interest. Interests often interfere with sleep, work, and socializing. Interests may be less stereotypical and may involve topics that at first glance do not appear uncommon. | |
| 4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment | Being hyper- or hypo-sensitive to sounds, lights, smells, or textures; having an abnormally high or low pain threshold; difficulty processing more than one sense at a time (e.g., not being able to understand spoken language while looking at someone’s face); tendency to become confused or overwhelmed by sensory stimuli; challenges with body awareness or separating different types of sensations. | |
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life) |
Though characteristics should have been present throughout one’s lifetime, a change in circumstances can disrupt coping strategies and make characteristics more pronounced; alternatively, environmental facilitators, supports, and coping strategies may make characteristics less noticeable. | |
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. |
Characteristics lead to difficulty obtaining or sustaining employment, doing basic or instrumental activities of daily living, maintaining social life, or integrating with community. For example, there may be significant mismatch between educational attainment and occupational history. | |
| E. These disturbances are not better explained by intellectual disability or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level. | N/A | |
Diagnosis of Autism in Adults
Before committing to a formal diagnostic process, you may want to take some online quizzes that are not diagnostic, but may inform your choice to pursue a formal diagnosis. Save a copy of your results. The mental health provider who goes through the formal diagnostic process with you may be interested in reading your results.
To get a formal diagnosis of autism, you will need a detailed assessment by a qualified mental health professional. They will also ask for information from someone who knew you when you were younger whenever possible. You should expect to fill our questionnaires, have a clinical interview, undergo diagnostic testing, and have a final feedback session. It’s important to know that there is not one single assessment tool for Autism. Some clinicians use the ADOS-2. The Migdas-2 is also a well-known assessment and is able to be used over telehealth.
At Therapy Dynamics, I specialize in adult assessments and use the MIGDAS-2. It is an interactive method for evaluating autistic individuals that stands apart from traditional standardized tests by focusing on sensory play and discussions centered on personal interests, providing rich, qualitative insights into language, communication, social relationships, emotional responses, and sensory use. It is also strengths based, helping people to learn about abilities and potential.
What kind of sensory play is involved in the MIGDAS-2 for adults?
Sensory play during the MIGDAS-2 can take various forms. Adults might bring a blanket to touch or rub, play with a fidget toy or two and share it, they may share objects of special interest and experience the feeling of touching them. These experiences encourage participants to be fully present in the moment, promoting mindfulness and reducing stress.
