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Adults have to meet the same diagnostic criteria to be diagnosed as being on the spectrum that children do, but they may manifest differently. What do you need to know?

Sue, a 25-year-old single mother and junior accountant, wasn't in hospital for herself — she was there because her three-year-old son, Barry, suffered a severe asthma attack. She found the hospital environment stressful, loud, and bright, and kept trying to close the curtains around her son's bed in a bid to reduce the overwhelming sensory input. When staff kept telling her to stop doing that, she decided to ask for a side room. While her wishes were accommodated, nurses still repeatedly told her to not close the door.

Sue also noticed that nurses didn't show up to adjust her son's drip when they said they would, so she took this job on herself. Her son improved and would be able to go home soon, but hospital staff seemed to be focusing on Sue herself more than you'd expect. She was assigned a social worker because of her "odd" behavior and seeming coldness towards Barry, though staff said he appeared to be taken care of well. 

I have no idea if Sue and her son are real. This story — or case study — is my attempt to flip a scenario described in a document to help clinicians identify autism in adults around to the autist's perspective. The document, provided by the UK's National Institute for Health and Care Excellence (NICE), is a whole lot less, well, nice, in its description of this (perhaps fictional) woman. 

"Odd" behavior, an "odd" social communication style, and "odd" reactions to sensory stimulation can, the document says, offer initial clues that a previously undiagnosed adult may be on the spectrum.

This scenario, one in which others, perhaps medical professionals, notice something different about an adult and that eventually leads to an autism diagnosis, is possible. Many undiagnosed autistic adults, however, arrive at the conclusion that they are on the spectrum in a different way — through self-realization.

These people may always have felt a bit "quirky", "weird", "out of place", or "alien", but have adapted to the world around them through mechanisms they've self-taught with life experience. Their autistic features may have been more prominent in childhood, and have made way for neurotypical (non-autistic) masking behaviors with time. These people have never quite been able to be "themselves", and may have wondered what is different about them for a very long time. 

Some start reading up about autism because, well, we've got the internet now and there's lots of interesting stuff on there. Some may begin considering the possibility that they are autistic because someone suggested this option to them. It's also not unusual, however, for autistic adults to set off on a quest to discover whether they are on the spectrum after their child was diagnosed. In all these cases, the adults themselves will seek an evaluation, rather than having it pushed on them externally, as happened to "Sue". 

What are the signs of autism in adults?

To be diagnosed as being on the autism spectrum, adults have to meet the diagnostic criteria for autism spectrum disorder just like everyone else who is diagnosed. Research has shown that people diagnosed during adulthood tend to be more "high-functioning" (which, in this context, essentially means "able to pass as non-autistic without organized support in place"). This makes all the sense in the world, given that these people have been able to remain undiagnosed for a long time — more obviously autistic people would have likely ended up with a diagnosis much earlier. 

Possible traits or symptoms that may point you to seek an evaluation include:

  1. Disliking eye contact or finding it difficult and even painful to look into people's eyes. 
  2. An attention to detail that you have noticed others don't usually have.
  3. Being very passionate about particular subjects, with an ability to become totally engrossed in them and focus on them for many hours. 
  4. Being told you talk too loudly, don't wait your turn before speaking, that you're "odd" or rude, and misunderstanding jokes, metaphors, and subtle modes of communication such as body language. You may not know what to say to people, or how to start conversations.
  5. Being puzzled by other people. 
  6. Experiencing social anxiety.
  7. Difficulty discussing feelings or in some cases, identifying how you feel. Difficulty knowing how others feel, including because what they say and how they act doesn't always seem to "match up".
  8. A strong preference for set routines and an intense dislike of change. 
  9. Being overwhelmed by sensory stimulation — bright lights, crowds, loud noises, clothing textures, and smells, for instance. On the other hand, autistic people can also be under-sensitive to certain stimuli. 

Some of the interesting things researchers have observed in adult autistic people include:

  • Many are not in romantic relationships, and one study determined that a third of adults on the spectrum are asexual or not interested in romantic relationships. 
  • People diagnosed as adults function better in the workplace compared to those diagnosed as children. This can partially be attributed to age, or skills developed over time. 
  • Autists diagnosed in childhood and adulthood alike still have jobs well below their educational levels and intellectual potential, something attributed to social skills and sensory sensitivity. 

What if I think I'm autistic?

Keep on exploring the possibility. Depending on how you're feeling and functioning, you may decide to pursue diagnosis — or you may be content to make a tentative suspected self-diagnosis or just accept the fact that autism may explain everything you've been wondering about so far without taking it further. If you are doing well in all areas of life (something that you, ultimately, have to determine for yourself), you may not benefit much from a diagnosis of ASD, but still want an evaluation simply to get to the bottom of this suspected diagnosis. 

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