Autism in Adults: Recognizing the Signs, Living with a Diagnosis
Even if you weren’t diagnosed as a child, you may notice the symptoms of high-functioning autism in later life. Here's what to look for and how to deal with a diagnosis.
Understanding autism in adults
We all have our quirks. But if you've noticed that your way of thinking, feeling, or doing things isn't quite the norm, you may suspect that you have autism spectrum disorder (ASD), even though you never received a diagnosis as a child.
Perhaps your body language, social skills, interests, behaviors, or general preferences don't seem to match those around you? Or maybe you have a child who was recently diagnosed with autism and you recognize some of the same issues in your own way of behaving?
In recent years, more people are embracing the idea of neurodiversity—the concept that some people have neurological differences and those differences should be valued rather than “corrected”. Still, a diagnosis of autism as an adult can come as an unwanted surprise. You may even experience denial or anxiety over the diagnosis. On the other hand, if you’ve long suspected that you have ASD or some other condition that sets you apart from your peers, a diagnosis can come as a relief. Suddenly, a lot of your past experiences and interactions make sense and you’re afforded a sense of clarity.
No matter how you feel after a diagnosis, keep in mind that, just like everyone else, you have unique strengths and weaknesses. You can always take further steps to better understand your own thoughts and behaviors and grow as a person.
Why weren’t you diagnosed earlier?
Parents and doctors sometimes miss the symptoms of autism in children who are “high functioning”—meaning they're able to move through the world without assistance. You may hear this referred to as Asperger’s syndrome, a formal diagnosis that is now categorized under the broader umbrella of ASD.
It’s also common for autism in children to be misdiagnosed as attention deficit hyperactivity disorder (ADHD) since ADHD can also cause difficulty with communication skills and repetitive behavior.
While it’s possible to have both conditions, over the years, experts have become better at distinguishing the symptoms of ADHD from those of ASD.
Signs and symptoms of autism in adults
Autism has a wide range of symptoms, even if you narrow the scope down to “high functioning” autism. Autism symptoms in adults tend to be most prominent in your communication skills, interests, emotional and behavioral patterns, and sensitivity to stimuli, such as noise and touch.
Problems with communication
If you’re an adult with ASD, you might have a hard time reading social cues. This can encompass everything from another person’s facial expressions to their gestures or tone of voice, making it difficult to maintain back-and-forth conversations or tell what another person is feeling. Sarcasm and figures of speech can be especially tricky to detect.
In addition, you might also use a monotone voice or limited facial expressions, which makes it difficult for others to interpret your thoughts and feelings. Eye contact may be another important social cue that you struggle with. Perhaps you’ve been told you look away too often during conversations, or even stare.
Everyone has their own interests. But adults with ASD often focus on one or two subjects that they find highly fascinating. You may have an encyclopedic knowledge of a historical event or movie series, for example.
While it’s often impressive to others, it may limit the amount you feel you can contribute to conversations beyond your favorite subjects. Trying to relate to people who don’t understand your interests may feel tedious or incredibly challenging. It might even lead you to avoid social interactions.
Maintaining a consistent routine or keeping items organized can help you feel that your life is secure and predictable. You may experience discomfort when your daily routine and rituals are interrupted, such as having to take a new route to work or someone moving your belongings so they’re now out of place. You might feel so upset that you have an outburst of strong emotion such as anger.
To someone with ASD, certain sensations can be unbearable. You may feel pain if someone taps you on the arm. for example, or certain sounds, smells, or textures may elicit a similar unpleasant reaction. In some cases, you may do everything you can to avoid that discomfort.
How gender affects the signs of autism
Men are about four times as likely to be diagnosed with ASD than women. Some researchers theorize this may be because women in general are better at imitating socially acceptable behavior. Unlike children with ASD, adults with autism (even when undiagnosed) have had plenty of time to practice their social skills. Women especially often learn to “mask” certain behaviors that seem to draw the attention of other people.
It’s also possible that women with ASD have repetitive behavior tendencies and narrow interests that aren’t seen as unusual. For example, a woman with ASD who feels the urge to neatly organize dishes or who is only fascinated with music theory may pass as “neurotypical”.
Diagnosis and causes
In some cases, you might only recognize your own ASD symptoms when you have a child diagnosed. Experts haven't yet decided on standard criteria to diagnose adults who believe they have ASD. However, a clinician may borrow some of the criteria used to diagnose children, such as experiencing problems with social communication, exhibiting restricted, repetitive behaviors, and any sensory issues.
To diagnose ASD as an adult, a clinician will likely talk to you about your interests, emotions, and childhood. They may also want to talk to your family members. This can be especially useful because symptoms—even subtle ones—likely developed when you were a child.
What causes autism?
Scientists aren’t entirely sure yet if autism is the result of biological or environmental factors. But the answer could be both. Some of the possible causes they’re exploring include:
Genetics. Gene mutations might link to specific ASD symptoms, make a person more susceptible to developing ASD, or determine the severity of symptoms.
Environment. Certain environmental factors, such as air pollution or low birth weight, may cause ASD in a child who was already susceptible to it.
Other biological factors. Abnormalities with the immune system, metabolism, or brain development may also play a role.
Living with a diagnosis
Feel caught off guard by your adult autism diagnosis? It may help to look at your diagnosis as a path to better understanding yourself. You can gain insight on challenging moments from your childhood or teen years, for example, or any relationship problems you’ve experienced as an adult.
Every adult with ASD has both unique challenges to overcome and unique strengths to draw upon. However, there are some common challenges to address, including difficulty building or maintaining relationships, social isolation, managing mood disorders, and staying organized.
Even if you haven’t received a formal diagnosis, if you suspect you have ASD, you can begin to take steps to improve your life. The following tips and strategies can help.
Speak to a Therapist Now
Living with adult autism tip 1: Improve communication and relationships
If other people have a hard time reading and understanding you—and you them—you’ll likely have difficulty with relationships. But you can still find ways to nurture a healthy social life.
Consider disclosing your diagnosis. Talking about your diagnosis can be difficult and the social stigma attached to ASD may make you shy away from doing so. While disclosure is entirely up to you and your comfort level, it may help improve some relationships. Letting close friends and family know about your diagnosis can help them understand why you have a hard time interpreting their sarcastic comments, for example, or why you’re distressed by sounds that seem normal to everyone else.
Note when you’re experiencing sensory overload. Perhaps you find it difficult to keep up with everything that’s going on in an intense group conversation. Or maybe something as simple as loud traffic or a barking dog is bothering you. Do what you can to minimize distractions. This might involve switching rooms or leaving a larger group for a one-on-one chat.
Look for common ground with the person you’re talking to. Establishing commonalities can lead to more relaxed and enjoyable conversations. If you have similar hobbies, that’s, of course, great news. Otherwise, you can look for other things you both like or dislike. This could be anything from a shared interest in cars to a shared dislike for loud noises.
Reach out to other adults with ASD. You might find that talking with others with ASD is less tiring than other interactions. Although every person with ASD is different, you share a common ground and can talk about your experiences. Additionally, neither of you will need to focus on reading or presenting social cues in a way that a neurotypical person might expect.
Support groups for adults with autism
If you feel isolated or feel like your neurotypical friends don’t “get” you, it can help to join a support group for adults with ASD. These may take place either online or in-person with groups of varying sizes.
Support groups can be a great way to meet people who have had similar life experiences. You might meet lifelong friends and become an important part of someone else’s social support network.
Group sessions can also help you gain a better understanding of the neurodiversity movement, which aims to erase the social stigmas associated with autism and neurodivergence in general.
Tip 2: Manage anxiety and depression
Some people find that anxiety and depression go hand in hand with symptoms of ASD. For example, difficulty relating to others can lead to feelings of anxiety. Increased anxiety can, in turn, make it even harder to communicate. You might even feel so flustered that you can't form sentences.
Feelings of isolation can also trigger depression. But there are steps you can take to manage your mood and improve how you feel.
Stay active. Exercise is good for the mind and eases stress. Some studies show that vigorous exercise can be especially useful for helping adults with ASD manage aggression. Find an aerobic exercise that fits neatly into your routine and won't potentially throw your schedule into chaos. It may be something as simple as going for daily walks or runs. Make sure it’s something you enjoy, so you’re more likely to stick to it.
Rely on close friends. Socializing can also be good for your mood, as long as the people you’re with don’t stress you out. Find people who share your interests. Thanks to the Internet, it’s easy to find people in your local area who share your interests. If possible, look for conventions or other gatherings where people who share your hobby come together and interact in person.
Practice relaxation techniques. You might find that techniques such as mindfulness meditation and deep breathing help you manage anxiety symptoms. These are also practices that you can easily incorporate into your daily routine. A 2020 study showed that self-guided mindfulness and cognitive behavioral techniques may be useful in reducing levels of anxiety in people with ASD.
Develop good sleep hygiene. Lack of sleep or poor sleep quality can affect your mood, making you more anxious, unhappy, and irritable. Unfortunately, insomnia is a common problem for adults with ASD. Some steps that might help include following a consistent, relaxing routine before bed each night. You should also consider if environmental issues, such as your bedroom temperature of texture of your blankets, are causing you discomfort.
Tip 3: Better organize your life
While many adults with ASD are extremely organized, others may become so fixated on certain interests that other aspects of their lives become disorganized. If this is a challenge you face, these tips can help you stay organized:
Use a timer to stay on track. This can be especially useful when you're working on a hobby that you're intensely passionate about. Once the timer goes off, you know it’s time to switch to an activity that is less intriguing, but nonetheless important, such as paying bills or grocery shopping.
Use a list or day planner. If remembering appointments and other responsibilities is a challenge, use a paper planner or an organizational app for your cell phone. You could also use anything from spreadsheets to a whiteboard to help you organize daily tasks.
Automate certain aspects of your life. For example, use online banking to track spending and automatic payment options to manage your bills. This can also help you avoid the clutter that tends to build up when you receive paper billing statements in the mail.
Treatment for adult autism
Although treatment is often recommended for children with ASD, adults with ASD may also find certain types of treatment to be beneficial. It’s important to understand that these treatments don’t aim to cure ASD. Instead, they help you address issues such as anxiety, rigid thinking, or depression.
As mentioned before, self-guided mindfulness and CBT can help adults with ASD. However, you can also visit a therapist for professional guidance. Prioritize finding one who specializes in ASD.
A therapist can offer personalized sessions that help you address specific issues. Perhaps you’re having trouble communicating your feelings in a relationship or frustrated with a coworker who refuses to accommodate your needs. Your therapist will help assess stressors in your life and develop adaptive solutions, such as reframing your thoughts and building more effective communication skills.
Vocational rehab is intended to help you address workplace-related difficulties. You may have specific challenges, such as discomfort with noise, that make it hard to work in a traditional setting.
Vocational rehab can help you find work that is accommodating and aligns with your interests and strengths. This can help to provide an opportunity to work to your fullest potential and enjoy a rewarding, successful career.
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Authors: Sheldon Reid.
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Helplines and support
UK: Find help and support at The National Autistic Society.
Canada: Find support and programs at Autism Canada or call 1-800-983-1795.
Australia: Find adult community services at Autism Spectrum Australia.
Last updated: November 23, 2022