Getting a Diagnosis

Diagnosis for adults

Autism Spectrum Disorder is a neurological condition typically identified in childhood, which may raise questions among adults about the possibility of developing autism later in life, particularly if they've observed symptoms resembling autism.

Due to the basic nature of the disorder, it is not possible for adults to acquire autism. Autism arises from atypical brain development, and by adulthood, the foundational neurodevelopmental processes are already complete. Thus, it is impossible to develop autism later in life. However, autism symptoms can start to show up/ affect later in life and the diagnosis of Autism can happen late for some individuals due to a variety of reasons:

  • Masking and Camouflaging: Many individuals, especially those with higher-functioning forms of autism, may develop coping strategies to mask their autism traits and fit in socially. This masking can make it challenging for professionals to recognize the signs of autism.
  • Gender Differences: Autism is often underdiagnosed in girls and women, as the diagnostic criteria were historically based on male presentations. Girls with autism may exhibit different social and behavioral traits that are less recognizable as typical autism symptoms.
  • Mild or Subtle Symptoms: Some individuals with autism have milder or subtler symptoms that may not be as noticeable in childhood but become more apparent as social demands increase in adolescence or adulthood.
  • Co-occurring Conditions: Individuals with autism may have co-occurring conditions, such as anxiety, depression, or attention deficit hyperactivity disorder (ADHD), which can complicate the diagnostic process and delay recognition of autism. They are often secondary conditions that occur when the autism is left untreated. It takes a keen eye and specialist who is well-versed in the nuances of autism to identify autism symptoms in adults.
  • Late Recognition of Differences: Some families and individuals may not recognize autism traits until later in life, especially if they have limited exposure to autism or were unaware of the spectrum's diversity.
  • Change in Life Circumstances: Life transitions, such as moving to a new environment, starting a new job, or entering college, can highlight social and communication challenges, prompting individuals to seek assessment and diagnosis.
  • Access to Services: Limited access to healthcare or diagnostic services can delay the identification of autism. In some regions, diagnostic resources may be limited, leading to later diagnoses.
  • Stigma and Misunderstanding: Social stigma or misunderstanding of autism can deter individuals and families from seeking diagnosis or support until later in life. “He/she will start talking when she is 5 or 6 years old. Their uncle/dad also started talking late only. Let’s wait.”

In most cases, it could be a combination of these reasons. The family is not aware of Autism and its symptoms, the child is bright academically and somehow manages to mask the symptoms.

As Samriddhi Malhotra, an individual on the autism spectrum, diagnosed in her 30s, shares: “My family couldn’t understand this because I was considered academically bright. Because of these ‘odd’ behaviours, people would say things like ‘she’s so careless and haphazard’ or ‘she’s lazy’. As an adult, I wouldn’t always understand social cues, the dynamics in a friend circle and the subtext and subtleties of what people say. But, over the years, I learnt to master them almost like a science. Piecing it together logically, like, oh, this is what people mean when they say this or that, and I learnt to adapt.”

Signs to look out for

Symptoms of autism in adults closely resemble those in children, such as difficulties in social situations, obsessive interests, and strict adherence to routines. Key symptoms that are often observed in adults with autism include:

  • Difficulty understanding other people’s feelings or reactions
  • Social anxiety
  • Trouble making and keeping friends
  • Coming off as brutally honest and not realizing they’re offending others
  • Not being interested in others’ points of view or feelings
  • Difficulty expressing how they feel
  • Interpreting things very literally or in black and white
  • Stuck in having the same routine every day and being uncomfortable if it is interrupted or threatened to be changed

Diagnostic tools

Since symptoms are not very different from what we observe in a child, the diagnostic process would be more or less similar. In most cases of adolescents, it would be the school that first reports concerns and then with the help of a psychologist one may undergo the diagnostic process. In adults, it could pose some challenges because symptoms of other disorders could be overlapping with autism symptoms. Either ways, a combination of assessments and clinical judgements could be used to diagnose older people. Some tools are:

  • Autism Diagnostic Observation Schedule (ADOS) - (ADOS; Lord, Rutter, DiLavore, Risi, 1999) The Autism Diagnostic Observation Schedule (ADOS) is considered the 'gold standard' for assessing and diagnosing autism and pervasive developmental disorder (PDD) in individuals of all ages, developmental stages, and language abilities.
  • Autism Diagnostic Interview, Revised (ADI-R) - (ADI-R; Couteur, Lord, Rutter, 2003) The Autism Diagnostic Interview, Revised (ADI-R) is a structured interview employed for the purpose of diagnosing autism, planning treatment strategies, and distinguishing autism from other developmental disorders.

Receiving an autism diagnosis according to a recent study with 9 adults over the age of 50, was seen as a positive development that enabled them to redefine their sense of self and gain a deeper understanding of their unique requirements. Before the diagnosis of autism, they had undergone treatment for anxiety and depression. They also reported experiencing behaviors associated with Autism Spectrum Conditions (ASC) during their childhood and often feeling isolated and aloof from others, growing up.

Although most people feel relief, it may also be accompanied with a feeling of guilt or grief over their life thus far, for they have to redefine themselves and their lifestyle. Therefore, it could be helpful to continue receiving psychological support while processing the diagnosis for themselves.

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