By now, you may have read about the increase in prevalence of children being diagnosed with Autism Spectrum Disorder (ASD). Though ASDs originate in childhood, and are most frequently diagnosed in people under eight years old, there has been an increase in adults seeking out mental health services for difficulties consistent with an autism diagnosis.
Since ASD is diagnosed in three main areas, I will focus on how the areas of social-emotional skills, communication, and relationships can appear as symptoms of autism in someone who isn’t diagnosed with autism as a child.
For people with “high-functioning autism” (a term I don’t really like, as it doesn’t really provide all that much information to the individual client or to professionals to indicate where the problems might be), social interactions become more complex as we get older. Behaviors that are acceptable in small children that are not as acceptable in adults include:
- Inappropriate sharing of information. I remember when my friend’s daughter stood up in a group of adults and announced, “I have new panties!” while lifting her dress over her head. While this is not all that socially acceptable (even in small children), we give preschoolers a little leeway, because they’re still learning the social rules. However, if you find yourself in a meeting about how you shouldn’t discuss your intestinal complaints with your co-workers, it might be an indication that you are having trouble distinguishing what’s appropriate based on the setting.
- Difficulty regulating emotion. One of the tasks we have to learn as we go out into the wider world is to manage our own emotions. If you find you are having extreme difficulties managing your emotions, or that you’re experiencing emotional extremes that interfere with your life, it might be time to talk to a therapist.
When I meet with an adult who thinks they might have a missed autism diagnosis, I ask about their development. Often adults who could be diagnosed with autism will have had significant delays in speech, or will have had past interventions in speech therapy. This is a good time to talk about how communication isn’t just what we say to others (the talking part), but it’s also how we take in what others say. This may lead to:
- Struggling to communicate. Adults who have a missed autism diagnosis will often report that when they are in intensely emotional situations, they cannot communicate. This on its own does not indicate autism, but if any heightened emotional situation, positive or negative, leaves you struggling to make your needs, wants, and preferences known, it could be indicative of an autism diagnosis.
- Not being able to “read a room.” It’s fairly typical for children to over-estimate an adult or peer’s interest in their preferred topic, whether it’s Pokemon or sharks. However, if you often find people staring at you blankly, or walking away from you while you’re talking, you may be dealing with some social communication impairments. Therapy can assist you with learning the “cheat codes” to knowing when someone is interested in what you’re talking about, knowing how long to talk about something, and learning the give-and-take of a conversation.
For many adults on the spectrum, they didn’t realize that their brains were wired a bit differently until they entered into relationships with others. Note that there is a significant difference between “can’t” and “won’t.” There are individuals for whom romantic or sexual relationships are not a priority, or not even desired, and that’s okay. But if someone wants to have romantic and/or sexual relationships with others, but has difficulty making connections, (outside of the typical “being a human is difficult and messy sometimes”) they may benefit from seeing a therapist who specializes in working with adults with ASD. Some challenges in relationships for people on the spectrum include:
- Difficulty interpreting the actions, thoughts, or feelings of others. As we age, our actions, thoughts, and feelings become more complex. Depending on the setting, someone’s actions may not match their feelings, and unfortunately what people say doesn’t always match what they do. Dealing with this dialectic can be very difficult for people with ASD and can make other parts of the work day more challenging.
- Difficulties with sensory input. For many people on the spectrum, typical physical interactions with others or their environment can be filled with landmines. It’s not unusual for an adult on the spectrum to have adverse responses to specific sounds or textures, require high levels of sensory input, to be touch-aversive to certain areas of the body (the face is very common), or to have an apparent indifference to pain or temperature extremes. Having an explanation and open communication with a partner can make the difference in the success of a relationship.
But why now?
You may wonder what would lead to an adult having a missed diagnosis. The best way for me to describe how features of autism can become more apparent as we age is by using an internet metaphor. Our brains have a certain bandwidth. Everything we do takes up some of that bandwidth. If we have 100 megabits per second in our processing speed, and processing sensory input (visual, auditory, tactile, and olfactory) takes up 30% of your bandwidth (for example), you only have 70% left to work with. That 70% now has to deal with:
- Work (the actual work, organizing your work, prioritizing, etc.)
- Social interactions (talking to your supervisors and co-workers about work, engaging in polite chitchat, navigating any office politics or difficult situations)
- Executive functioning (impulse control, emotional control, flexible thinking, working memory, self-monitoring, planning and prioritizing, task initiation, and organization)
- Fine and gross motor skills
And all the other things our brains do without us even being aware of it! As all of those tasks become more challenging, the bandwidth gets narrower to the point where something has to give. This is often where those difficulties with social-emotional skills, communication, and relationships come in.
Why get a diagnosis?
Receiving a diagnosis of any psychological or neurological disorder can be overwhelming, but it can also be an enormous relief. A great book for adults with attention deficit is entitled “You Mean I’m Not Lazy, Stupid, or Crazy?” The same could be said for adults receiving an autism diagnosis. Having the explanation for years of experiences can be affirming. It can also mean access to the right kind of help, and that can make all the difference.