What ASD In Adults Can Look Like
Autism spectrum disorder (ASD) is considered a neurodevelopmental disorder and form of neurodivergent, meaning autism traits often become apparent in early childhood. On search engines, the term “autism” may yield multiple results on recognizing the condition in children and providing support systems for Autistic children navigating school and social situations. However, because ASD is a form of neurodiversity, Autistic people’s brains function in different ways from neurotypical individuals. These individuals cannot change, and there is no cure for autism. Autistic children grow up to be Autistic adults.
Autism in adults may be less discussed than autism in children, but it is still significant. Autistic adults may continue to experience symptoms that negatively impact their ability to navigate day-to-day life, so it can be crucial to implement support systems in society that do not only accommodate children with autism but adults experiencing the condition or identifying as Autistic or neurodivergent.
Symptoms of autism in adults
Symptoms of autism can be similar in children and adults, though adults may have become more adept at camouflaging or “masking” their symptoms. Adults may also develop systems to regulate the emotional distress that can result from some symptoms, such as sensory sensitivity. However, many adults still struggle in ways similar to children with autism, and their challenges are no less significant. Below are ways ASD may manifest in adult populations:
- Social and communication difficulties like facial expressions and gestures that inaccurately reflect feelings
- Difficulty maintaining friendships and high levels of social anxiety
- Repetitive or routine behaviors, interests, or actions
- Distress if one’s routine or repetitive behaviors are interrupted
- Non-typical body language, such as avoiding eye contact or fidgeting
- Sensory sensitivity or a decreased reaction to sensory stimuli
- Masking behaviors like self-stimulation (stimming) or attempting to mimic others to appear more “neurotypical” or non-autistic
The Centers for Disease Control and Prevention (CDC) estimates that 2.21% of the adult population in the United States is living with ASD.
Why some people aren’t diagnosed with ASD until adulthood
There are various reasons autism might not be diagnosed until someone is an adult, including but not limited to the following.
“High-functioning” labels
If a child was able to navigate social situations and the constraints of daily life without accommodations or additional support systems, they might not have received an ASD diagnosis because their caregivers might not have thought there was any need for further developmental assessment. Some Autistic children without severe symptoms may be labeled as “odd,” “shy,” or “a loner” by their peers, teachers, parents, medical providers, and community. Such Autistic people diagnosed in adulthood may be retroactively labeled as “high functioning.”
“High-functioning” can also be viewed as a reductive way to describe a mental health condition with a wide range of associated experiences. Autistic people can be “high-functioning” in some areas, such as language, and “low-functioning” in other areas, such as sensory sensitivity. To assign an Autistic person a blanket high- or low-functioning label could be minimizing part of their experience and reducing their chance to receive support.
However, it may still be beneficial to consider that some Autistic individuals may not be able to communicate their preferences due to being non-verbal or living with symptoms that cause significant distress and potentially physical harm to themselves. These individuals may require more medical and mental health support to manage daily life and may struggle with independence. Understanding that autism is a spectrum and has various levels of functioning can be a way to understand the full range of identities within this label.
Gender, race, and sexuality
If a person belongs to a marginalized gender, racial, or identity group, they may not have been diagnosed with ASD as a child because their presentation of symptoms didn’t fit the “conventional” idea set by outdated materials on autism. Some estimates indicate that cisgender boys and men are diagnosed with ASD at four times the rate that cisgender girls and women are diagnosed. There are a variety of theories about what is causing this discrepancy, including the following.
Gender gaps in research
Early research on Autistic children almost exclusively studied the condition in male children, and some early researchers theorized that autism was unique to the male brain and that female children couldn't have the disorder. While this theory has since been disproven, a diagnostic bias towards a stereotypically male expression of autistic symptoms may remain.
Societal gender expectations of girls and women as more sociable than men and boys may cause Autistic girls and women to mask their symptoms and learn to imitate socially successful behavior.
Some autism symptoms may manifest in girls and women in more socially appropriate ways. For example, shyness may be considered more appealing in little girls than in little boys, who may be expected to be loud and rambunctious. Additionally, the special interests of girls and women with autism may be seen as more socially acceptable, such as celebrities, TV shows, pets, etc.
Marginalized identities and bias
Some research demonstrates that people of color and LGBTQ people may also be diagnosed with ASD at lower rates. This potential gap could be due to the early research bias of studying autism primarily in straight white cisgender male subjects, but more research is needed to understand this link.
It can also be beneficial to note that people in BIPOC and LGBTQ+ communities are at a higher risk of many mental health conditions and have a lower rate of seeking support due to a lack of access to gender-affirming, race-informed, and LGBT-friendly support. More therapists trained in diversity, identity, and culture may be beneficial to support and diagnose Autistic adults with these identities.
Misdiagnosis
Understanding of ASD has evolved, as evidenced by the consolidation of different conditions that were previously listed as separate in the DSM and are now all under the umbrella of autism spectrum disorder. These conditions include early infantile autism, childhood autism, high-functioning autism, atypical autism, Kanner’s autism, pervasive developmental disorder, childhood disintegrative disorder, and Asperger’s syndrome. These diagnoses are no longer used, and there is controversy surrounding the “Asperger’s” label, as it has been linked to harmful historical events.
However, much about autism is still misunderstood. Because ASD can present in such different, individual ways, some people with symptoms of ASD may have been misdiagnosed in childhood as exhibiting signs of another mental health condition. Some common conditions that may cause symptoms like those of ASD and potentially lead to a misdiagnosis include:
- Attention-deficit hyperactivity disorder (ADHD)
- Rett syndrome
- Social anxiety disorder
- Selective mutism
- Language disorders
- Intellectual developmental disorder
- Social (pragmatic) communication disorder
- Stereotypic movement disorder
- Anxiety disorders
- Schizophrenia (usually with childhood-onset)
- Phobias
- Depressive disorders
- Developmental coordination disorder
- Avoidant-restrictive food intake disorder
- Personality disorders, particularly borderline personality disorder (BPD)
- Separation anxiety disorder
Support options for adults with ASD
If you were not diagnosed with ASD until adulthood, you may have complicated thoughts about your diagnosis. You may experience resentment due to not being diagnosed as a child and given adequate support, or you may feel afraid of experiencing the stigma that can be associated with autism. For some Autistic adults, receiving a diagnosis can be a validation, a realization that they are not somehow “defective” or “broken,” but that they are neurodivergent.
It may be beneficial to process these thoughts and feelings with a therapist. However, some Autistic adults may not be comfortable attending traditional in-person therapy sessions. They may have a sense of distrust toward the medical system for not accurately diagnosing them as children. In some cases, navigating the social conventions and sensory stimuli of a therapist’s office and waiting room may also be overwhelming.
In these instances, online therapy through a platform like BetterHelp may be a more accessible option. Attending therapy online can allow you to speak to your therapist from the comfort of your home. You can also control how you communicate with your therapist, meaning you can choose between phone, video, or live chat sessions with your provider.
Current research indicates that online therapy can be as effective as traditional in-person therapy at helping people support their mental health, including adults with autism spectrum disorder. One study found that a group of people with ASD who completed online therapy reported improved mental health outcomes and more significant levels of functionality when sessions ended. Online therapy may be a helpful option if you are an adult navigating an ASD diagnosis.
Takeaway
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