The terms “people with autism/ASD” and “autistic” individuals and “on the spectrum” will be used interchangeably throughout this post. While people’s first language has become popular and politically correct in health care settings, as ASD is related to neurological differences, some individuals prefer identity first language as they feel it better represents them. When working with people I use their preferred term. This article is the first in a series.
As a psychologist who frequently works with people on the spectrum, I often encounter questions about autism spectrum disorder (ASD) in adults. Many people are familiar with childhood autism, but adult manifestations can be less understood. I have a number of relatives with autism and have seen first-hand the challenges of living with undiagnosed ASD and the benefits of ‘late’ diagnosis. Gaining clarity on the presence of ASD can be life- changing for individuals, particularly with the right supports. In this post, we’ll explore some common questions about autism in adults.
1. What are the signs and symptoms of autism in adults?
As a psychologist who supports ASD individuals, I’ve observed that autism in adults can manifest in various ways:
- Social communication challenges: Difficulty interpreting social cues, maintaining conversations, or understanding non-literal language.
- Restricted interests: Intense focus on specific topics or hobbies, and difficulties engaging with non-preferred topics.
- Repetitive behaviours: Adherence to routines or repetitive movements.
- Sensory sensitivities: Over- or under-sensitivity to sensory stimuli.
- Executive functioning issues: Challenges with planning, organising, and time management.
- Emotional regulation difficulties: Trouble managing emotions or understanding others’ feelings.
It’s important to note that these symptoms can vary widely between individuals. As a ASD focused psychologist, I always conduct thorough assessments to understand each person’s unique profile. It is also important to note that evidence is building regarding the physical health challenges associated with ASD. Often people with ASD have more complex health challenges (hypermobility or Elhers Danlos Syndrome, Dysautonomia, and immune system irregularities). These ‘spicy’ bodies of ‘spicy’ brains tend to be more sensitive to environmental stressors, including sensory factors, but also toxins. There is also overlap with other conditions such as ADHD, and the highly sensitive person construct (which is similar to ASD, and includes sensory difficulties, but not social difficulties). It is likely that the current diagnostic criteria are too narrow, and in time will be broadened.
Masking, also known as camouflaging, is a common phenomenon among adults with Autism Spectrum Disorder (ASD) that can significantly complicate diagnosis and assessment. As an psychologist working with ASD individuals, I’ve observed that many adults on the spectrum develop sophisticated strategies to conceal their autistic traits in social situations. This might involve mimicking neurotypical behaviours, suppressing stimming or other self-soothing behaviours, or scripting conversations based on observed social norms.
While masking can help individuals navigate social environments, it comes at a considerable emotional and cognitive cost. The effort required to maintain this facade can lead to extreme fatigue, anxiety, and even burnout. In particular, we find that many adults on the spectrum find that their difficulties become more prominent after major life transitions, such as having children, or transitioning from school to uni or uni to work. In these cases the additional load can exceed their ability to mask and they end up seeking support.
Masking can make it challenging for clinicians not specialising in adult ASD to accurately identify the presence and impact of autism. The learned behaviours and coping mechanisms can obscure typical autistic traits, leading to potential misdiagnosis or overlooking ASD entirely. This underscores the importance of comprehensive assessments by experienced ASD psychologists who are familiar with the nuances of adult autism presentation and can recognise the subtle signs of masking.
2. What is the difference between high-functioning autism and Asperger’s syndrome?
This is a common question I receive as a psychologist working with autistic individuals. Historically, Asperger’s syndrome was considered a separate diagnosis from autism. It was typically used to describe individuals with autism traits who didn’t have significant language delays or intellectual disabilities and who are more interested in having good social connections. However, in the current diagnostic manual (DSM-5), Asperger’s syndrome is no longer a separate diagnosis. Instead, it falls under the broader category of Autism Spectrum Disorder.
The term “high-functioning autism” is not an official diagnosis but is sometimes used informally to describe individuals with ASD who would have met the old “Aspergers” diagnosis. The term “high functioning” is rightly debated in the ASD community, and by neuro-affirming clinicians as while people with this profile are often less readily identified by others as having ASD, their challenges and support needs can be considerable and also vary over time. The “levels” of ASD are an attempt to determine the level of support needs that an individual experiences based on their ‘wiring’, but it does not capture the impact of the changing environmental demands on a person.
As a psychologist working in this area, I focus on understanding each individual’s unique strengths and challenges rather than using these older terms where possible. However, at times, such as when NDIS support is required, use of these terms is necessary. As a psychology clinic we tend to work with people who have lower support needs, as they benefit from psychological interventions more than people with higher support needs, who benefit more from direct, practical support. A great many of our clients are very successful in academics, or business and reflect the potential that many with ASD have in the right environment and with the right support.
3. Can autism be misdiagnosed as another condition?
Yes, autism can sometimes be misdiagnosed, especially in adults. As an ASD psychologist, I’ve seen cases where autism has been mistaken for:
- Anxiety disorders – such as social anxiety disorder or generalised anxiety disorder
- Depression
- Obsessive-Compulsive Disorder (OCD)
- Attention-Deficit/Hyperactivity Disorder (ADHD)
- Personality disorders, particularly BPD in young women
- Functional Neurological Disorder (due to unusual symptom clusters and extreme reactions)
Misdiagnosis can occur because many of the symptoms of these conditions can overlap with autism traits. Additionally, many adults with ASD have learned to mask their symptoms, making diagnosis more challenging. Furthermore, people with ASD who are undiagnosed and unsupported often end up with additional diagnoses as a function of their challenges, and they are also more likely to experience other co-occurring conditions such as Tourette’s, or tics, and eating disorders. They can also be more prone to manipulation and mistreatment by others, leading to traumatisation (including PTSD and cPTSD).
4. How do you differentiate autism from other mental health conditions?
As an ASD psychologist, differentiating autism from other mental health conditions requires a comprehensive assessment approach:
- Detailed developmental history: Understanding early childhood experiences and developmental milestones.
- Exploration of social skills: Assessing communication patterns and social skills.
- Evaluation of restricted interests and repetitive behaviours: These are hallmark features of ASD not typically seen in other conditions. They can be less obvious in adults and highly masked individuals.
- Assessment of sensory sensitivities: Often present in ASD but less common in other mental health conditions (other than ADHD).
- Consideration of co-occurring conditions: Many individuals with ASD also have other mental health diagnoses, and there are some conditions that can mimic elements of
ASD.
It’s crucial to remember that autism is a neurodevelopmental condition, not a mental illness. While it can co-occur with mental health conditions, the core features of ASD are present from early childhood and persist throughout life. I genuinely enjoy working with neurodivergent or ‘spicy’ brains, the overwhelming majority of whom are genuinely good humans. Helping people achieve more optimal functioning and an easier life is important, to both me and the greater Redman Gall team.
Understanding autism in adults requires careful assessment and consideration of an individual’s unique experiences and challenges. As an ASD psychologist, I’m committed to providing accurate diagnoses and tailored support for adults on the autism spectrum.
If you’re wondering about autism in yourself or a loved one, consider seeking an evaluation from a qualified ASD psychologist. Remember, an autism diagnosis can provide clarity, understanding, and access to appropriate support services.
Book an appointment with our ASD psychologist team at Redman Gall Psychologists on the Gold Coast for a comprehensive autism assessment.
Further Reading
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
And here’s a URL to information about the Highly Sensitive Person (HSP) construct:
This is the official website of Dr. Elaine Aron, who developed the concept of the Highly Sensitive Person. The site provides information about the construct, research, and resources related to high sensitivity.
