Signs of autism in adults: Symptoms, diagnosis and treatment

  • The signs of autism in adults include difficulty making friends, preferring to be alone, and anxiety.
  • Appearing lethargic and having ritualized behavior patterns can also be symptoms of autism.
  • Occupational therapy, speech therapy and psychotherapy can also ease the symptoms.

People with autism spectrum disorder (ASD) may behave and interact differently from most people. They often have repetitive behavior, difficulty communicating, and strong or intense interests in specific subjects or objects.

However, this does not mean that having autism is always debilitating or that people with autism cannot lead independent lives. The term “spectrum” means that there is a wide range of symptoms, skills and levels of functioning among people with autism, and it is not the same for everyone.

Signs of autism usually appear before the age of three, but some people with autism may not be diagnosed until they reach adulthood, making it challenging to get the support they need.

Today, more than five million adults in the United States have ASD. There aren’t good estimates of how many people with autism reached adulthood without a diagnosis, said Dr. Christopher Hanks, medical director of The Center for Autism Services and Transition (CAST) at Ohio State University Wexner Medical Center.

Here are the signs of autism in adults and how health professionals generally diagnose it.

Signs of autism in adults

The signs that lead to a diagnosis of ASD are the same for children and adults, says Wayne Fisher, director of the Rutgers University Center for Autism Research, Education, and Services (RU-CARES).

Some signs of autism in adults include:

  • Difficulty understanding what others are thinking or feeling
  • Having very ritualized patterns of behavior and becoming anxious if these rituals are interrupted
  • Coming across as blunt or rude without meaning to
  • Not understanding social cues
  • Difficulty making friends
  • Prefers to be alone
  • Having high levels of focus or interest in particular subjects or activities
  • Not knowing how to express yourself
  • Anxiety in social situations

Why some people are not diagnosed until adulthood

People with autism are usually diagnosed in childhood. However, some people are not diagnosed until adulthood due to various factors.

1. Behavioral signs were not evident

Sometimes signs of autism may not become apparent until much later in childhood or adulthood when certain demands increase.

For example, if you struggle to interpret subtle communication cues, the symptom may only become more recognizable later in situations like employment or dating, says Hanks.

2. Autism in women often flies under the radar

The diagnostic criteria for autism are the same for males and females.

However, the knowledge and conceptualization of autistic traits was largely obtained from male samples, which may lead to a distorted understanding of the autism spectrum.

Compared to men, women with autism tend to have:

  • Lower likelihood of externalizing behavior such as breaking rules, disrupting activities or interrupting others
  • Higher social motivation, meaning their social experiences can sometimes be more similar to individuals without autism than men with autism
  • A greater capacity for traditional friendships
  • Lower measures of repetitive behaviour
  • Better non-verbal communication

In other words, women may express their autism differently and not meet the diagnostic criteria. This may explain why autism is underdiagnosed in women and is more likely to be identified late, mislabeled or missed altogether.

3. Lack of access to health services

In the US, autistic traits are underrecognized in racial or ethnic minority groups and people with low socioeconomic status, says Hanks.

These groups of people face several potential barriers to an autism diagnosis, which include:

  • Lack of access to health services due to non-citizenship
  • Lack of access to health services due to low income
  • English is not their main language

“I’ve seen adults with undiagnosed ASD more often in rural areas without easy access to autism experts,” says Fisher.

How to diagnose autism in adults

A psychologist or psychiatrist will often interview you to learn about the history of your autistic traits and observe how you react, says Fisher. They will ask about the way you communicate with others and whether you have any strong, specific interests, repetitive behaviors or sensory issues. These questions will help them see if you meet the criteria for ASD.

Diagnostic tools such as the Autism Diagnostic Observation Schedule — which is considered the gold standard for diagnosing ASD in adults — are often used to structure and guide the assessment, adds Fisher. This diagnostic test takes approximately 40 to 60 minutes to administer.

The diagnostician may also want to interview family members to gain insight into your childhood experiences, says Hanks.

Ultimately, the decision to get diagnosed is up to you. If you’re concerned about certain aspects of your behavior and you question whether you might have ASD, getting a diagnosis can lead to appropriate treatment, support and services, says Fisher.

“Many adults who have been diagnosed with autism report that it helps them understand themselves and become more self-aware of their challenges,” says Hanks.

How to treat autism in adulthood

There is no one-size-fits-all treatment plan because people with autism have different experiences. Treatments are often aimed at reducing challenges that interfere with their quality of life or daily functioning.

According to Hanks, the following therapies may be helpful for adults with autism:

  • Talk therapyfor people who have problems communicating or interacting with others.
  • Psychotherapyto help with mental disorders.
  • Occupational therapyfor people who have difficulty processing sensory information such as sounds and textures or those who struggle with independence.

“Unfortunately, the availability of treatment, support and services for adults with ASD is significantly less than for children,” says Fisher.

There are many interventions for children with autism because their brains are still forming compared to older ages, therefore treatments are more likely to be effective.

“Our field has become increasingly aware of the need to expand and improve services for adult autism, and the situation is improving, but much more needs to be done,” says Fisher.

Insider’s takeaway

Although the signs of autism are the same for children and adults, some people may have a delayed diagnosis because they did not have access to health services or their autistic traits were not recognized.

For people with autism, getting a diagnosis can lead to a better understanding of themselves and better access to different forms of treatment.

“We still have a lot to learn about those diagnosed as adults. This is an understudied group,” says Hanks.

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