Written by: Amy K. Izuno-Garcia, PhD NCSP, Katherine A. Loveland, PhD
Autism Spectrum Disorder in Adulthood
April is Autism Acceptance month. Autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by differences in social communication and interaction as well as the presence of restricted, repetitive patterns of behaviors and interests (American Psychiatric Association, 2013). The prevalence of ASD in children has increased, now impacting 1 in 36 children in the United States (Maenner et al., 2023), which could be due to an actual increase in the incidence of the condition, an expanded definition of the disorder, or an improvement in access to evaluation and intervention services. Less is known, however, about the prevalence of autism in adulthood, with only one study to date finding that approximately 2% of the US adult population has an ASD diagnosis (Dietz et al., 2020). As the understanding of ASD has improved and expanded in clinical work, research, and media, more individuals are seeking a first-time diagnosis of ASD in adulthood.
Research suggests that adults with ASD are at-risk for a number of co-occurring internalizing difficulties (e.g., Hofvander et al., 2009). Social challenges associated with ASD may lead to reduced self-esteem and increased social anxiety among this population. For instance, camouflaging or masking social and behavioral differences is associated with increased generalized and social anxiety as well as depression (Hull et al., 2021). In addition to co-occurring internalizing problems, many individuals on the autism spectrum also experience attentional and other executive functioning difficulties; there are strong correlations between ASD and symptoms of attention-deficit/hyperactivity disorder (ADHD; St. John et al., 2022). Further, both groups may experience challenges with learning and memory, attention, and theory of mind that persist into adulthood (Nydén et al., 2010). Neurocognitive challenges associated with executive functioning in childhood may also correlate with internalizing difficulties in adulthood (Owens & Hinshaw, 2016), further illustrating the unique vulnerabilities to mental health conditions associated with a neurodivergent population.
Despite these difficulties, many bright, verbally able individuals may be able to compensate for some of their challenges for much of their lives. Adults seeking evaluation for possible ASD may want help understanding their long-term experience of problems. They may accrue years of stress from sources such as rejection from peers, difficulty with school and job performance, sensory sensitivities, and loneliness. As adults, these individuals may have few, if any, peer relationships that are more than superficial, although this is not always the case. However, adults who are wondering if they may be on the autism spectrum, may pursue a comprehensive psychological evaluation in order to receive the best recommendations for treatment and long-term support.
An evaluation for autism in adulthood at UTHealth Changing Lives through Autism Spectrum Services (CLASS) Clinic consists of an initial appointment during which a comprehensive developmental history is gathered, in addition to areas of current concern and functioning. Following this appointment, a second evaluation appointment is conducted during which a client participates in a standardized behavioral assessment that helps clinicians specifically observe the traits associated with ASD. In addition, the client and an informant (i.e., parent, spouse, close friend, etc.), if available, complete questionnaires regarding the client’s social skills, emotional and behavioral functioning, and personality. An integrated report is then written using the findings from the evaluation, which also includes appropriate diagnoses and recommendations for support and care.
Taken together, individuals of all ages on the autism spectrum are at-risk for increased difficulties socially, emotionally, behaviorally, and adaptively. In the spirit of Autism Acceptance month, non-autistic people should strive to make the world a more inclusive and accepting place for neurodivergent folks. People on the autism spectrum are a unique population with their own challenges as well as strengths, and all types of development and people are needed in this world.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi-org.ezproxy.frederick.edu/10.1176/appi.books.9780890425596
Dietz, P. M., Rose, C. E., McArthur, D., & Maenner, M. (2020). National and State Estimates of Adults with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 50(12), 4258–4266. https://doi.org/10.1007/s10803-020-04494-4
Hofvander, B., Delorme, R., Chaste, P., Nydén, A., Wentz, E., Ståhlberg, O., Herbrecht, E., Stopin, A., Anckarsater, H., Gillberg, C., Rastam, M., & Leboyer, M. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry, 9(1), 35. https://doi.org/10.1186/1471-244X-9-35
Maenner, M. J. (2023). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2020. MMWR. Surveillance Summaries, 72.
Nydén, A., Niklasson, L., Stahlberg, O., Anckarsater, H., Wentz, E., Rastam, M., & Gillberg, C. (2010). Adults with autism spectrum disorders and ADHD neuropsychological aspects. Research in Developmental Disabilities, 31(6), 1659-1668. https://doi.org/https://doi.org/10.1016/j.ridd.2010.04.010
Owens, E. B., & Hinshaw, S. P. (2016). Pathways from neurocognitive vulnerability to co-occurring internalizing and externalizing problems among women with and without attention-deficit/hyperactivity disorder followed prospectively for 16 years. Development and Psychopathology, 28(4pt1), 1013–1031. https://doi.org/10.1017/S0954579416000675
St. John, T., Woods, S., Bode, T., Ritter, C., & Estes, A. (2022). A review of executive functioning challenges and strengths in autistic adults. The Clinical Neuropsychologist, 36(5), 1116–1147. https://doi.org/10.1080/13854046.2021.1971767