Many older adults have symptoms of autism spectrum disorder (ASD) but remain undiagnosed. The reason? They reached adulthood before public and clinical awareness of ASD increased and before the current diagnostic criteria for ASD were formulated. Additionally, mild or high-functioning autism is particularly easy to overlook by loved ones and medical professionals alike, as symptoms are not always obvious and misdiagnoses are common.
Since those on the autism spectrum often exhibit comorbid or co-occurring disorders and illnesses, and since they have unique needs across their lifespan that require specialized care, it’s important that their ASD is recognized and diagnosed. A diagnosis of autism in adults is the first step to finding support and services in one’s community.
Autism is a neurodevelopmental disorder thought to be predominantly genetic or heritable, and is currently diagnosed in roughly one in 68 children in North America. Since ASD is a lifelong disorder it would be expected that one in 68 older adults would also have the disorder, yet a majority of these individuals are not receiving their ASD diagnosis until after the age of 55.
Common Signs of Mild Autism in Adults
Do you suspect that you or a loved one might be on the autism spectrum?
What follows are some of the common signs and symptoms of mild or high-functioning autism in adults. This autism checklist cannot be used to make a diagnosis of autism spectrum disorder, but may suggest the need to seek a formal diagnosis from a professional who specializes in diagnosing autism in adults.
1. Avoidance of Social Situations
The main diagnostic criterion for autism spectrum disorder in the DSM-5 (the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) is: “Persistent deficits in social communication and social interaction across multiple contexts.”
This can manifest as not understanding the unspoken rules of reciprocity when engaging with others or not knowing what information is appropriate to share in a conversation. The individual may talk over others or not at all, and may share too little or too much information at inopportune times. Feeling socially inadequate, many with ASD will avoid social interaction, and will especially stay away from settings where they must meet or interact with new people. In older adults, especially those who are widowed or have never been married, this can manifest as almost complete social isolation.
2. Restricted or Intense Interests
Those with ASD frequently exhibit a few intense or fixated interests related to their favorite topics or activities and can become agitated when they’re not able to pursue these interests. Their pursuit of these interests is abnormal in intensity and the individual can spend hours collecting information on train schedules or computer hardware, for example, all while shutting out the world — or the loved ones — around them.
3. Alexithymia
Occurring in less than 10% of the general population, alexithymia has been identified in 85% of those with autism and refers to the marked difficulty in identifying and recognizing one’s own emotional states and the emotional states of others. This does not mean that those with ASD do not experience emotions, but it does mean that they often lack insight into what they’re feeling and why they’re feeling a certain way. They’re also unable or less able to decipher nonverbal cues that might allow them to know what another person is thinking or feeling. In this way, they often display low emotional empathy or an inability to put themselves in another’s shoes. Alexithymia also manifests as a focus on the external world as opposed to inner experiences.
4. Chronic Depression or Anxiety
ASD carries a high risk of co-occurrence with other disorders throughout the lifetime of the individual. In adulthood, the most common comorbid disorders include depression, anxiety, ADHD and schizophrenia.
5. Inappropriate Eye Contact
Those with ASD often make little eye contact while conversing with another, or they make too much eye contact and may inappropriately stare.
6. Insistence on Routine
This often presents as difficulty accepting change to one’s schedule and may manifest as extreme frustration or anger when confronted with unexpected disruptions to routines.
7. Lactose Intolerance
A majority of individuals with ASD have lactose intolerance caused by lactase deficiency, and many have additional enzyme deficiencies, food intolerances and chronic gastrointestinal tract problems. Keep in mind that autism is a heterogeneous disorder, meaning no two cases of ASD look the same. There are key characteristics that must be present in order to receive an autism diagnosis, but there are also endless variations to how adults can present with the disorder.
It Might Be High-Functioning Adult Autism…Now What?
Consider taking the Autism Spectrum Quotient and Empathy Quotient tests. Both tests were developed by Simon Baron-Cohen and his colleagues at the University of Cambridge’s Autism Research Centre. If scores on these tests indicate autistic traits, speak with a medical professional who specializes in autism spectrum disorder in adults.
Depending on where you live and what medical coverage you have, you may decide to either book an appointment directly with a psychologist or social worker who specializes in ASD, or go to your family doctor for a psychiatric referral. Also, the Autism Speaks organization has a helpful toolkit for adults who believe they may be on the autism spectrum.
