Autism can present differently in adults than it does in children, making it important to understand and recognize its common symptoms and signs. Doing so allows individuals with ASD to lead more fulfilling lives and find healthy ways to manage some of the challenges they face along the way.
What Is Autism Spectrum Disorder (ASD)?
Autism Spectrum Disorder (ASD) is a neurological disorder characterized by difficulties in verbal and non-verbal communication, social interaction, and restricted behavior patterns. While autism is typically diagnosed in early childhood, it may also be recognized by an individual as they enter adolescence or adulthood. While there are challenges associated with ASD, there are also many strengths that can be cultivated as an autistic person grows and develops.
Symptoms of Autism in Adults
According to the CDC, ASD affects about 2.0% of children. The number of diagnosed adults is predicted to rise to as high as 3%-5% by 2025, given current pediatric prevalence rates and trends.1 Adult autism is both under-studied and misunderstood due to a lack of research interest and funding, despite the fact that impacts of the condition may increase after the age of 18.1
Adults with autism are often overlooked, largely because symptoms can vary greatly depending on a person’s age. As such, adult autism diagnosis is often more difficult than in children, thus limiting the opportunities an adult may have for support. However, there are common behaviors or social differences an autistic adult may experience, although symptoms of autism in women may vary slightly from symptoms in men.
Common symptoms of autism in adults include:
- Increased need for sensory stimulation
- Difficulty with identifying emotions
- Difficulty understanding others’ perspectives
- Repetitive motor movements or sounds (echolalia)
- Problems with verbal reasoning
- Sensory overload
Signs of Autism in Adults
Autism is a complex neurological disorder that affects the way a person interacts with their environment. To help identify the early signs of autism, it is important to recognize how autism may manifest in adults. Being aware of this can help autistic individuals take steps towards obtaining a diagnosis and finding support.
Common signs of autism in adults include:2
Social Communication & Interaction
People with ASD may have difficulty understanding social cues, engaging in conversation with others, and expressing themselves. They may also struggle with sensory processing which can impact their ability to handle certain situations or environments. What may seem like emotional disconnect from others typically stems from difficulties in understanding another person’s feelings, reading facial expressions, or the tendency to take things very literally.
An autistic person may exhibit communication differences such as:
- Extreme focus on special interests
- Speaking in a monotone voice
- Struggles with forming and maintaining relationships
- Difficulty reading facial expressions and body language
- Difficulty understanding others’ experiences and perspectives
- Directness that may present as being rude or insensitive
- Issues with expressing emotions
Some autistic people behave differently than neurotypical individuals. They may become overstimulated easily, sometimes resulting in autistic burnout. Autistic adults also engage in repetitive behaviors to cope with overstimulation and express emotions (whether positive or negative), commonly referred to as stimming. Autistic individuals tend to rely heavily on the structure of daily routines and may become visually distressed when these are disrupted.
An autistic person may exhibit behavioral differences such as:
- Repetitive speech or behaviors
- Preference for more alone time in comparison to neurotypical people
- Utilizing sensory stimulation to decompress
- Meticulous planning to decrease anxiety or uncertainty
- Autistic scripting
- Rigid routines
Autistic individuals may exhibit other signs of autism such as food sensitivities, special interests, or a lack of eye contact. It’s important to remember that just because these behaviors may differ from what is typically expected by neurotypical society, this does not mean that they need to be changed. Rather, these may indicate that an autistic person has found peace in their own life, routine, and hobbies.
A person may exhibit other signs of autism such as:
- Challenges regulating sensory input
- Emotional sensitivity or insensitivity
- Dislike of change
- Knowledge about certain books, movies, etc.
- Intense sensitivity to sensory input
- Preference to work alone, rather than with others
How Is Autism Diagnosed in Adults?
Because autism can affect everyone differently, it is sometimes difficult to diagnose a person during one evaluation. The first step in assessing the level of severity of symptoms typically involves a thorough examination of a person’s family and medical history.
While many individuals may receive a diagnosis in childhood, others may not be aware of their autism until adulthood. This may be due to a person becoming accustomed to their symptoms because they don’t recognize them as being different from neurotypical behaviors. Therefore, this can lead to problems with diagnosis as someone may not see the need for one.
A diagnostic examination for autism may include:2
Reviewing History of Symptoms
Many clinicians performing a diagnostic exam will first inquire about a patient’s developmental history. They may also request that family members, friends, or teachers provide information regarding the person’s symptoms. A physician may ask about certain behaviors, such as repetitive movements, insistence on routine, a lack of empathy, or difficulty with social interactions.
Additionally, clinicians will review a person’s family health history to determine if conditions, such as specific genetic syndromes or brain injury, may have predisposed them to developing ASD. Certain physical symptoms associated with autism–such as sinus infections, sleep problems or gastrointestinal issues–may be explored as well.
Ruling Out Other Causes
Autistic adults may experience comorbid mental or physical health conditions. Because of this, a clinician will be sure to rule out other possible causes of a person’s symptoms. They may be on the lookout for conditions such as ADHD, which is believed to run in families. A doctor will also look for signs of a brain injury or a substance abuse disorder as these can share similar symptoms with autism.
After receiving a detailed medical history, a doctor may recommend blood and urine tests, imaging studies, and genetic testing. The most common method for identifying autism in adulthood is a screening test. However, this can yield unreliable results due to variations in symptoms and behaviors over time.
Tests & Examinations
The best diagnostic test for autism is a comprehensive clinical evaluation. However, blood, imaging, and other laboratory tests may be used to rule out other possible explanations for symptoms. The most commonly used test is the Autism Diagnostic Interview-Revised (ADI-R), which takes approximately one hour to complete. It focuses on different areas of social interaction, communication, and play behaviors.
A standardized behavior rating scale, such as the Autism Diagnostic Observation Schedule-2 (ADOS-2) Module 4 or the 3Di Adult, may also be useful when assessing specific behaviors that are difficult to quantify from a single interview. Other assessments designed specifically for older adults include activities such as games involving pretend play or dialogues with a clinician about past events. These can help explore how well the individual interacts with others.
Benefits of Receiving an Autism Diagnosis
If you’ve recently received an autism diagnosis, you may be feeling a mix of emotions, such as anxiousness, relief, or even gratitude. A diagnosis of any kind does not define a person, but it can help them navigate symptoms that may be impacting their life. This can include seeking support services or developing skills for handling sensory overload. One of the greatest benefits of obtaining a diagnosis is that you will now have access to valuable resources that are otherwise not accessible.
Support for Autism in Adults
While some autistic adults do not need support, some may need a lot of assistance with day-to-day living. They may need additional help at home, school, or work settings. A person may be interested in seeking support if they feel they are being negatively impacted by their autism. Regardless, it’s important to remember that everyone–whether neurotypical or not–requires unique levels and forms of support. Asking for help never equates to weakness.
Support options for autistic adults include:3
We are all ever-growing and evolving as humans–the more we know, the more we can develop. Education about autism is key when finding life satisfaction as an autistic adult. It is important for both the person diagnosed and their loved ones to continuously learn more about the condition and healthy symptom management. There are formal and informal ways to do so, such as taking local classes, watching YouTube videos, reading blogs, or hearing others’ personal stories.
Autistic individuals may consider therapy if they are having difficulties interacting with others or finding success in their careers and personal relationships. They may be looking for ways to help them manage anxiety, depression, or other mental health concerns that could be impacting their overall well-being. Either way, therapy can help someone find ways to cope with daily stressors like unemployment or financial difficulties. A therapist can also sometimes recommend certain lifestyle changes, dietary modifications, or supplements that may be helpful for autistic adults.
When seeking formal treatment, you should look for a provider who has a neurodiversity affirming approach. There are many in-person and online therapy options to choose from, so focus on finding a therapist who you can trust and feel comfortable with.
Therapy options for autistic adults may include:
- Social development: This approach can help people build their confidence in social interactions, as well as better express their emotions and perspectives.
- Speech and language therapy: This method of therapy can help autistic adults learn how to articulate their needs and feel comfortable and confident in their communication.
- Cognitive behavioral therapy (CBT): CBT can be beneficial as it helps clients understand how their thoughts, actions, and experiences are all connected
- Sensory integration therapy: This therapy method can help autistic adults understand how to fulfill their sensory needs, manage sensory input, and receive sensory stimulation.
- Narrative therapy: Narrative therapy teaches people how to rewrite their internal narratives in order to take control of their lives and experiences
- Motivational interviewing: Motivational interviewing can help a person take ownership of their willingness to receive support and their growth process.
- Expressive arts therapies: Art therapy and music therapy are both therapeutic interventions that have healing properties beyond our conscious cognitive abilities. They can support sensory and unconscious needs, as well as aid in emotional and social expression.
Autistic adults may have a harder time finding support through traditional channels than autistic children. Therefore, it is beneficial for autistic individuals to connect with others who “get it,” especially when navigating the adult world. Support groups can provide a person with useful guidance, knowledge, and friendship during the critical period of transition into adulthood. Social media and online group therapy options can be a great asset for those looking to meet like-minded peers.4
Social Work Resources
Being in touch with local community organizations, businesses, and social groups is important when finding support outlets. Knowing what is available in your area, and what is both inclusive and accessible, is helpful. Social work resources can help you or an autistic loved one learn more about autism and find ways to actively engage in advocacy.
Vocational Rehabilitation (VR)
Due to social and communication challenges, adults with autism often struggle to find meaningful employment. Vocational rehabilitation can help a person address and overcome certain difficulties in order to open up new opportunities.3
Federal guidelines mandate that vocational training must be based on rigorous outcome measurements, not merely intuition or anecdotal evidence. The success of these programs is measured by their impact on quality of life metrics such as income and job satisfaction. VR can be a wonderful support when entering the workforce.
Medication is considered a frontline treatment for autism, but it may be helpful for some. Certain prescriptions may be recommended by doctors for autistic individuals with comorbid anxiety disorders, ADHD, or depression.3
Medications that may be prescribed to autistic adults with comorbid conditions include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Psychoactive or antipsychotic medications
- Anti-anxiety medications
Diagnosis may feel daunting and even shocking to some at first. However, the increasing education and awareness to decrease stigma associated with autism is helping to create a more inclusive supportive community.