We often hear, oh she is married, she definitely does not fall under the autism spectrum! Oh, he makes eye contact and enjoys close relationships. How can he be autistic? If he was autistic surely in childhood his physician would have known or his teachers would have said something.
It is high time that professionals develop a full understanding of the autism spectrum better so that many adults do not get undiagnosed or misdiagnosed.
In this article, the following topics have been discussed
DSM-V defines Autism concerning two broad domains of behaviour
Difficulties with social communication and
Presence of restricted and repetitive behaviours.
Autistics find it hard to understand what others are thinking or feeling. They get very anxious about social situations, find it hard to make friends, or prefer to be on their own. They seem blunt, rude, or not interested in others without meaning to.
“I had failed miserably trying to connect with human beings,” an Autistic female says. “They do not make sense to me.”
There's a lot of variability with respect to the presentation we know that adults with Autism have. The actual difficulties or behaviors that we use to diagnose Autism are really diverse. There are high rates of psychiatric conditions and health problems, and many autistic adults need support in terms of their adaptive skills and executive functioning.
Autism is not simply the behaviors but also an individual's language, intellectual abilities as well as emotional functioning. These put together are really what contribute to the various heterogeneity and the diversity that we see within the Autism spectrum disorder.
Symptoms of Autism in Adults
It varies by context, type of environment, or the level of support surrounding the individual. Someone can have more difficulties in different contexts and less or very subtle in places with more structure, adaptations, and support.
Autism symptoms really vary depending on the person's age and language abilities.
These symptoms in adults are different than what's seen in children because of the cognitive development and language development that has happened in two decades. Adults report learning different strategies or sometimes what's referred to as camouflaging to mask their difficulties. This tells us that Autistic adults are making active attempts to self-monitor and sometimes mask behaviors that they have learned are not viewed as socially acceptable. So the presentation of an Autistic adult may look quite different than someone who is younger or maybe less aware of the behaviors.
It's really essential that we recognize that the absence of the childhood red flags like limited eye contact or the ability to have conversations should not be mistaken as evidence that an adult does not have autism spectrum disorder. Classic childhood Autism symptoms might not be the best markers for Autism in young adults or older individuals. Many of our diagnostic tools and questionnaires might not actually capture the range of symptoms or difficulties in Autistic adults.
It isn't right to define an autistic adult just by the impairments. They all have strengths and difficulties.
When we're thinking about interventions or different accommodations that we might provide for #Autistic adults it's important that we remember that this isn't about changing who they are and not every area of difficulty has to be a target for intervention. We need to really think about what's meaningful to them and what is impeding their participation in the community at the level that they want. It can be simply increasing adaptability or flexibility to allow participation in different settings like the workplace, college, or family get-togethers.
If we focus on the strengths of the autistic individual and find the right job, a suitable environment, and both co-workers as well as employers to support them then we can help them be successful.
Assessment of autistic adults
Usually, the reason for assessments is because
First-time diagnosis,
Second opinion/Reevaluation
Planning for a transition or
Forming treatment of a specific challenge and
Struggling with depression or anxiety and need support.
Also, it is important to note who is going to contribute information for the assessment.
Is it the caregiver? If yes, since when do they know the adult?
Is it just the autistic individual who is wanting to know information for themselves?
Is it the spouse who is referring them? That's important because often that sort of details into what are the concerns or what's driving the need to clarify a diagnosis.
Assessments are an opportunity to understand different patterns of strengths and identify potential comorbid medical or psychiatric conditions.
Why are autistics looking for a diagnosis?
They are struggling with depression, anxiety, or social isolation.
There is a desire to have clarification on whether autism is causing difficulties in different social situations and contributing to mental health concerns.
Also, they are wondering if an autism diagnosis will help explain some of the difficulties in their relationships and interpersonal dynamics.
Components of assessment
If we know about the purpose of the referral it will help in understanding the strengths and challenges of the adult.
In the assessment, we ask the adult for their own perspectives on what are they good at and what they find challenging.
We ask adults to share feedback with other people. This is useful to understand some of the strengths and difficulties acknowledged by other people.
We find out about appropriate and challenging behaviors.
We directly interact with the adult to observe social and communication skills. We assume that the adult is being honest and is comfortable disclosing information like if they're just uncomfortable in the situation or if they don't understand a question and are not masking anything. We observe how the adult navigates the clinical assessment interaction.
We assess current functioning as well as developmental history. Adult completes at least some kind of basic cognitive assessment. We might also conduct language assessments and adaptive functioning to know how they're able to use skills in everyday life and self-reported questionnaires to make sense of other mental health diagnoses.
We see the education level and support like individualized education plans in school. We see the kinds of jobs they've had as adults, and job satisfaction with the kinds of jobs that they've engaged in.
Mental health would include previous diagnosis and previous assessments or evaluations as well as you know what types of treatment have they engaged in throughout their lives
adaptive functioning focuses on understanding how free time is spent and to what extent an individual you know splits their time across multiple things versus staying focused and kind of specific areas how independent are they in terms of self-care
finances as well as
personal aspects like hygiene and then you
relationships look like families peer professional relationships and then you
gathering other informant's reports and this is really consistent with sort of broader views and multiple viewpoints certainly can provide a better understanding of the individual
Sometimes we mistake and view autism as a childhood disorder and make our assessment based on that.
Why is it important to do a comprehensive assessment?
To know an individual's cognitive and language abilities
To know their age and understanding of the areas that are difficult for them
Helps us recommend types of accommodations and adaptations for them.
An autistic can then communicate his strengths and difficulties.
Many times autistic adults with good verbal skills, and average cognitive abilities, who have made accommodations to use eye contact and gestures and consciously monitor many of their behaviors are questioned by people that you don't seem to have autism. In that situation, autistics can highlight the specific areas that are difficult for them.
For individuals who were diagnosed as children often don't want an updated assessment because they know they have autism but it is important to know the skills and behaviors that have changed or developed over time.
We can help identify and understand risk factors or potential risks on how an individual person's difficulties put them at risk. For example: Being misunderstood. So someone who has good verbal skills and no apparent physical differences may make a comment to someone or engage in a certain type of interaction and that other person might misunderstand and think the person is being rude or there's something inappropriate about their behavior when really it's in the context of autism and so that can put them at risk for being misunderstood certainly for being underestimated and in some cases increased risk for physical harm.
If we know the specific areas that might put someone at risk for these factors we can try to be proactive about ways to reduce risk. In some cases, it's disclosure or education of people in certain settings about autism. Sometimes it's documenting again the strengths or teaching really specific skills to help mitigate those risks.
I think a reason to really understand the full picture of a person at multiple points in their life and not assuming that an assessment that was done as a younger child would necessarily inform the specific supports that are needed in adulthood.
Some people are happy self-diagnosing or just relating to the things that they are reading. There are many autistic self-advocacy communities and resources like chat rooms and groups and they're very open and welcoming to people who don't necessarily have a diagnosis.
Is an autism diagnosis important for adults?
A diagnosis can help provide context around why treatment maybe has been difficult in the past but it's a personal decision of getting a documented diagnosis.
There's a little bit of research to support that autistic adults feel that a diagnosis can help to validate their experience and help them to better understand why certain things are difficult sometimes provides a social network and you know hopefully will import treatment or different kinds of support.
There are not a lot of positive things being said about autism in the media. There's a lot of research where many individuals report stigma and discrimination, particularly by communities who do not have a good understanding of autism in adulthood or autism in general.
There is a lack of services in general available for individuals. An autism diagnosis isn't going to provide insight into all of life's challenges or necessarily improve relationships or make people more understanding. It certainly doesn't define who a person is and I think it's up to you as an individual how you integrate this diagnosis into your sense of who you are. Some individuals feel very much that it's a part of their identity and others feel that it is more negative and not something that they want to relate to or share with other people. There's more research being focused on adults and understanding the unique needs of adults.
We encourage you to advocate for the best most comprehensive care possible. If you are not comfortable going to a clinic, you can do a self-assessment online.
For people who already have a diagnosis, it's important to think about and find your own meaning in autism.
Try to educate yourself about what you know and don't know about autism, how it fits with your own perceptions, and ways in which maybe it doesn't make sense for you.
In the diagnostic criteria, there are a lot of examples but not all of them are intended to capture everyone. Some adults report that getting a diagnosis is positive and helpful but then at other times, it feels very negative whether it's because of their own outlook on what that diagnosis means or just their experiences with other people and their reactions to the diagnosis.
After you pursue an assessment, you should have some guidance about what the next steps will be and make sure that you know your priorities as adults are part of that plan and you know that many of the professionals who are providing support for individuals with autism are really used to working with children and so you know sometimes the recommendations that come out of assessments are kind of very similar to what we might think is important for children and I think we have to be really careful that those recommendations don't always generalize to what an adult might need
Some examples of areas that adults sometimes might consider as treatment targets and things that will improve their ability to participate in different settings like employment or college or family contexts.
Disclosure again is a personal choice. Some research suggests that knowledge of a diagnosis can result in more positive impressions of autistic adults.
Autism may look different in adults and we need to increase awareness of this because people and unfortunately some professionals might not recognize autism in adulthood and that really affects understanding and acceptance. Assessments are important for more than just informing diagnosis and limited understanding of strengths and challenges.
We work with a range of adult clients, from individuals who struggle to develop vocational and community skills to senior executives at well-known companies. We have a passion for working with adults and helping them change their lives for the better! Learn about the complexities of the social mind and how these thinking processes related to social skills, social academic tasks, and personal problem-solving. We continue to learn throughout our lifetime and our social learning is no exception. We find that adult clients can be strong social learners. They have more social awareness and socially-based experiences, and they do well discussing and applying social concepts in real-world settings. They are also less likely to blame their challenges on a peer, a teacher, or a parent.