Autism in adults

Autism spectrum disorder (ASD) is a neurodevelopmental condition that can affect social abilities, speech, movement, and cognitive functioning. Generally, a diagnosis of ASD is received in childhood, although many adults experience symptoms and do not have a diagnosis. Understanding and managing autism in adulthood can be improved with professional advice.

What is adult autism?

Autism is a neurodevelopmental disorder that impacts social abilities, behaviors, and learning. Symptoms of autism present on a spectrum of severity. It is believed that around 1.5% of the population has ASD, and the development of the condition is affected by genetic and environmental factors ^[1][2].

Autism is a lifelong condition, often diagnosed in early childhood. However, sometimes it is not diagnosed until adulthood if symptoms are not recognized. For some people, the severity of the condition reduces with age. In contrast, for others, symptoms may become more noticeable as the demands of adulthood increase and highlight impairments in cognition or functioning ^[3][4].

Signs of autism in adults

Some symptoms of autism in adults can appear similar to those experienced in children, such as impaired social abilities and an intense focus on a particular interest. However, in some cases, adult symptoms are less severe as the individual learns to adapt and manage their behaviors ^[5].

There may also be gender differences in the presentation of ASD amongst both children and adults. For example, females tend to be more able to mask their symptoms, leading to more cases of misdiagnosis ^[4][6].

Symptoms of ASD in adults can include ^[1][3][6][7]:

• Being unable to recognize or understand other people’s feelings
• Difficulties in expressing emotions
• Issues with maintaining eye contact with others
• Taking things very literally, so not understanding idioms or sarcasm
• Struggling to make or maintain friendships, leading to social isolation
• Feeling anxious around others
• Being blunt in tone and affect, potentially coming across to others as rude
• Masking or hiding behaviors in an attempt to appear ‘normal’ or ‘fit in’
• Obsession or excessive interest in a specific topic or field
• Requiring strict routines and becoming anxious or agitated if plans are changed
• Being very sensitive to or unusually unaware of sensory stimuli, such as noises, smells, and touch

Can you develop autism in later life?

Autism is a neurodevelopmental disorder that begins in early life, so it cannot develop in adulthood ^[7]. However, it can go undiagnosed or unrecognized throughout childhood, thus contributing to a diagnosis later in life ^[3].

Diagnosis in adulthood could happen if symptoms are not recognized in childhood. Similarly, some people mask or camouflage their symptoms, adapting their behaviors by learning from the actions of others. As such, someone with mild symptoms of ASD can enter adulthood without receiving a diagnosis ^[2][8].

Furthermore, the understanding of autism has developed considerably in the last few decades. This may have resulted in many people’s symptoms going unnoticed due to a lack of awareness of the condition. Thus, as awareness later increased, these individuals may have sought and received a diagnosis in adulthood ^[3][4][5].

Some conditions share similar symptoms to ASD, such as attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders. As such, if an adult experienced no signs of ASD in childhood, it may be that their current symptoms are due to another condition ^[1][7].

Adult autism diagnosis

Benefits of a diagnosis

As the understanding of autism grows with increasing research into the condition, more adults are now recognizing symptoms and seeking diagnoses. ASD is highly genetic, so it may be that parents or older family members who have lived experience of ASD notice symptoms in children ^[9].

If an adult has gone through life without a diagnosis of ASD, they may feel it is unnecessary to seek a diagnosis in adulthood. However, a diagnosis can be helpful in providing context and an understanding of childhood experiences. Similarly, it can help the individual and their loved ones better understand symptoms and behaviors and how to manage them ^[1][9].

Furthermore, an ASD diagnosis can provide an opportunity to receive accurate support or treatment ^[5][6].

Receiving a diagnosis

Diagnostic criteria for autism have been regularly reviewed and changed over the years since the first inclusion of the condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 ^[5][10].

Currently, the DSM-5 contains criteria for autism spectrum disorder (ASD). ASD now encapsulates individual diagnoses of autism, atypical autism, Asperger syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS). As such, the criteria now include a broader range of symptoms within this spectrum ^[4][7].

Criteria for ASD in the DSM-5 include ^[7]:

Aspects relating to social abilities, all of which must be present for a diagnosis of ASD.

• Issues with communication and interactions, particularly initiating conversation.
• Difficulties sharing emotions, interests, and attention.
• Issues managing relationships, including a lack of interest in others or being inappropriate.
• Impaired expression and understanding of nonverbal communication, including eye contact, facial expressions, and gestures.

Aspects relating to behavior, of which at least two must be present for a diagnosis of ASD.

• Repetitive behaviors involving speech or movements.
• Compulsive adherence to routines, schedules, or patterns of behavior.
• Intense focus on one or more specific interests.
• Abnormal sensitivity to or excessive interest in sensory information and stimuli.

Assessment tools may be used to help ascertain the presence of these symptoms. This might include the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) ^[4].

When making a diagnosis, the medical professional will ask about the individual’s physical and mental health history, family medical history, early development, behavior, and levels of functioning in educational or professional aspects ^[4][9].

The DSM-5 states that symptoms must have emerged in childhood, although they may not be recognized until later ^[7]. As such, gathering information about the individual’s early behavior, speech, and development is vital. It can be helpful for a parent or family member with knowledge of the individual’s early development to attend this assessment ^[1].

As there is an increased risk of comorbidities amongst those with ASD, the clinician will also likely assess the individual’s physical and mental health. This may involve further questionnaires, tests, and examinations ^[2][4].

How to manage adult autism

Currently, there is very little research and evidence relating to the treatment of ASD in adults. Because of this, there are no FDA-approved medications or evidence-based treatments for the condition. Additionally, ASD can cause a wide range of symptoms, so different people may require different treatments ^[4][11].

Medication

Sometimes clinicians prescribe medication to someone with ASD to manage a comorbid condition, such as ADHD or depression, or specific symptoms, such as poor sleep or irritability. Therefore, although there are no approved medications specifically for adults with ASD, an individual may be able to manage co-occurring symptoms with off-label prescriptions. This might include ^[1][4]:

• Antidepressants
• Antipsychotics
• Stimulants
• Sleep medications

If medication is prescribed, it will be started on a very low dose and gradually increased to an effective dose. The individual’s physical and mental well-being will be carefully monitored during this process due to the increased risk of side effects in people with ASD ^[4][8].

Therapy

Various types of therapy can be helpful for some adults with ASD, although the effectiveness of these interventions may vary depending on the individual. As many adults with ASD experience comorbid mental health conditions, such as anxiety disorders, depression, and obsessive-compulsive disorder (OCD), therapy can help manage symptoms ^[8].

Types of therapy might include ^[1][4][8]:

• Cognitive behavioral therapy (CBT) may help adults with ASD learn how to recognize and express their emotions and manage symptoms of depression, anxiety, and OCD.
• Mindfulness therapy has been found to be effective for some adults with ASD in reducing symptoms of depression and anxiety.
• Group therapy can be helpful for some adults with ASD if appropriate and manageable. This can help reduce social isolation, improve communication and social skills, and discuss difficulties with others with shared experiences.
• Other types of psychotherapy can also help improve social skills, communication, confidence, and motivation.

Professional support

Social workers or other professionals can help adults with ASD improve their functioning and quality of life. They may be able to provide support relating to education or employment opportunities, financial or housing difficulties, and accessing resources and groups. Furthermore, they can also help provide mental and physical health care ^[1][5].

What is the outlook for adults with autism?

The outlook for adults with ASD tends to vary depending on the severity of their symptoms. For some people, symptoms become much less severe in adulthood, so the impact on functioning and quality of life is minimal. For others, symptoms can cause difficulties with employment, relationships, and general functioning and well-being, significantly reducing their quality of life ^[4][5].

It is possible for people with ASD to have success in their careers. This can be related to the fact that some find jobs around the specific areas of interest for which they have an intense focus and passion. However, despite this, these individuals may still encounter difficulties due to their particular support requirements ^[5][8].

Some people with ASD can adapt and manage their social impairments, learn to reduce sensory sensitivity or ritualistic behaviors, and gain skills in independence and functioning. This can help to improve quality of life and general well-being, as well as to reduce social isolation ^[5].

However, for some, ASD can increase the likelihood of unemployment, social isolation, and issues with physical and mental health. As such, some people with ASD experience a reduced quality of life, particularly those with limited support ^[2].

Therefore, outcomes for adults with ASD can be significantly improved with ongoing mental and physical health treatments, support around vocational and functional skills, positive interpersonal relationships, and opportunities for employment and income ^[2][8].