August 10th, 2022
Diagnosing autism can be tricky at times, and when we think of this, we are usually evaluating children to screen for and rule out autism. Generally, this happens when the child is about two or three, but what would happen if a child with autism was never evaluated or diagnosed? Do they go their whole lives not being able to explain why they think, feel, and behave differently than others?
Well, that is certainly one option. The other option is to get an evaluation to determine whether an autism disorder is present.
Diagnosis in adults, while a bit more complicated, is possible. Pediatricians diagnose children with autism spectrum disorder (ASD) following screening questions and assessments. Psychiatrists or psychologists specializing in ASD use the same screening questions and evaluations but modify them to verify an autism diagnosis.
The assessor often uses direct observation to understand barriers to communication and social interactions, repetitive behaviors, and sensory issues. Questions about childhood development also play a part in an adult autism diagnosis.
Another resource utilized may include reports from parents or family members recounting childhood behaviors and mannerisms. Adults with higher functioning may be able to recall aspects of childhood in detail, making it easier to gather information. In contrast, lower-functioning adults may not be able to understand specific questions or remember memories of their upbringing, which is where statements from other relatives can help. Knowing these things can assist the process of differentiating between autism and other mental health disorders.
Autism symptoms in adults can occasionally look like those we see in children. Adults with autism may have trouble establishing and maintaining eye contact, conversing with others, understanding social cues, recognizing someone’s body language or tone of voice, and engaging in repetitive behaviors such as stimming (flapping arms, foot tapping, rubbing hands and fingers together).
Some of the other symptoms include preferences for consistent routines and tight-knit schedules. Other executive functioning areas such as emotion regulation, IQ, memory, and senses can be impacted by autism. For example, an adult with autism may have an eidetic memory, meaning they can vividly recall shown images once the image is gone. Many adults with autism also have sensory processing issues, so something such as vacuuming may be louder than to someone not on the spectrum.
I mentioned social symptoms earlier as well, but what are social symptoms? Socialization in autism is challenging due to processing issues. Adults with ASD process things differently than most; things said can be taken literally when not intended, and languages such as sarcasm are not understood. Returning to the eye contact piece as well- maintaining eye contact with autism is complicated for adults with autism simply because it is uncomfortable for them. Between this and added social discrepancies, many adults with autism can find it challenging to build and preserve different types of relationships, including friendships.
So, if an adult suspects that they have autism or recognize signs and symptoms, what should they do? The first thing they can do would be to research autism in adults. After that, a few options are available, including reaching out to a psychiatrist, psychologist, or general practitioner if a referral is needed. Thankfully there are many valuable resources and services for adults with autism, including the Autistic Self Advocacy Network. Mental health counselors, psychologists, psychiatrists, pediatricians, and special education teachers are also knowledgeable about ASD.
For all the fans of the TV show The Big Bang Theory, if you have ever seen it, then you are familiar with the character Sheldon Cooper. There is speculation that Sheldon is on the autism spectrum because of his mannerisms, behaviors, and lack of social construct. Sheldon fails to recognize sarcasm on many accounts and is unaware of when he has hurt others’ feelings, come off as condescending, or take a joke or phrase out of context. Sheldon also has an extremely high IQ, limited interests, and issues with emotional regulation. He also adheres to a strict schedule and becomes upset when disrupted.
Living with autism looks unique for everyone on the spectrum, and many people with autism lead whole and successful lives. They get married, have children, work, and do everything other people can do. The difference is that people with ASD may have to work harder than many people worldwide.
Higher functioning adults on the spectrum will likely need to learn how to communicate and interact with the world around them. They may even need to make accommodations for themselves to navigate daily life. These accommodations can include seeking education or assistance regarding communication and social situations, living alone to avoid disturbing their schedule and lifestyle, or keeping a small circle of friends.
Lower-functioning adults, such as those who are non-verbal or immobile, may need more assistance with speech, movement, toileting, and other activities of daily living. Many higher-functioning adults with autism may not appear on the spectrum at all, especially if they were diagnosed as a child and learned early on to examine the world around them to fit in. Others will learn over time to cope by either accepting or masking symptoms.
Autism is referred to as autism spectrum disorder, or ASD, because of its diversity. Different levels of functioning and diagnoses are considered a form of autism. No matter their place on the spectrum or level of functioning, those living with autism will view the world in a way that no one else will ever understand, which is truly beautiful.
Written by: Emily Shelton, LCPC, CADC, CRSS.
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