What is Autism in Adulthood?

What is Autism in Adulthood?

People do not grow out of autism. Autistic children become autistic adults. However, research continues to focus heavily on children, and as a result, few people have a concept of how autism manifests in adults. Recent population-based studies estimate that 40% of primary-school age children who need to be diagnosed with autism go unrecognised, resulting in many reaching adulthood without a diagnosis (Lehnhardt et al., 2013). Mental-health professionals often lack the skills or experience to distinguish autism in adults from diagnosed disorders with which they are more familiar (Lehnhardt et al., 2013). Therefore, many adults on the autism spectrum grow up without understanding their “difference.”  A distinct feature of that difference is that many adults with autism have a higher intellectual capacity together with a lower social capacity (Deisinger, 2011).  Consequently, they have spent much of their lives struggling to fit in without knowing why, with the wrong diagnosis, consigned to psychiatric institutions, or overmedicated for disorders that were non-existent (Wright, 2015). These and other aspects, such as inadequate services and insufficient professional assistance and information (Hagland, 2009), have meant that whether an adult suspects that they may have an Autism Spectrum Condition (ASC), or whether a diagnosis is gained or not, many adults with ASC may not achieve the understanding or specialised help that they require. The result is that they, and their families, are often obligated to bear the responsibility of this lack of awareness.

There is also considerable evidence to indicate that autism has existed throughout human history (Deisinger, 2011). It has been said that many famous historical figures would probably have been diagnosed with an ASC if they had lived today. Albert Einstein, Amadeus Mozart, Sir Isaac Newton, Charles Darwin, and Michelangelo are among many celebrated and brilliant figures who have exhibited considerable behaviours suggestive of autism (Elder & Thomas, 2006; James, 2005). Therefore, there are most likely countless adults with an ASC throughout the world, of all ages, who largely continue to be unknown.

Adults with moderate to high intellect are not only more likely to have partners and children, but are also more proficient at hiding their symptoms (Attwood, 2015). Often, adults with ASC have learnt from an early age to compensate for their underlying difficulties by camouflaging, that is modifying their behaviour in order to blend in, or appear neurotypical, by using their intellect to mask deficiencies in public (Livingston, Colvert, Bolton, & Happé, 2019). The verbal IQ abilities of many adults on the spectrum have meant that they are often able to mask their deficits in social communication, to some extent, by learning social rules and scripts, in order to suppress autistic behaviours (Lehnhardt et al., 2013; Livingston et al., 2019). An appearance of being socially skilled can hide impairments, to a degree (Lingsom, 2008). The special abilities, talents, and interests that adults with ASC often display, means that they have the potential to do well in their vocational pursuits and frequently rise to the top of their field (Howlin, 2000).

However, within relationships, it is a different story. Due to their camouflaging abilities, first impressions of the communication abilities of adults with ASC often can be inaccurate (Aston, 2003). Many are quite articulate, especially when they are talking about their work or interests and since they do not disclose their difficulties, the courtship stage may not provide an indication of actual communication problems (Aston, 2003; Attwood, 2015). After a relationship moves to a deeper level, whereby compensatory strategies cannot be maintained over time (Attwood, 2015; Lingsom, 2008), difficulties with social interaction, social reciprocity, and social imagination (American Psychiatric Association, 2013), may impact on the capability to do well within the everyday interaction requirements of close relationships. Due to the hidden nature of adults with ASC, regularly others do not see the struggles, they, and their families confront. Consequently, these difficulties impact on the quality of life for those with ASC, and their significant others (Pallathra et al., 2018). As a result of the lack of awareness or understanding of the particular difficulties associated with ASC for adults, the responsibility to cope is placed on the adults with ASC, and their significant others (Attwood, 2015; Hendrickx, 2009; Mendes, 2015).

Dr. Bronwyn Wilson

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (Fifth ed.). Arlington, VA: APA.

Aston, M. (2003). Aspergers in love. Couple relationships and family affairs. London and Philadelphia: Jessica Kingsley Publishers.

Attwood, T. (2015). The complete guide to Asperger’s Syndrome (Revised ed.). London and Philadelphia: Jessica Kingsley Publishers.

Deisinger, J. A. (2011). Chapter 10 History of autism spectrum disorders. In A. Rotatori (Ed.), History of Special Education (Vol. 21, pp. 237-267): Emerald Group Publishing Limited.

Elder, J., & Thomas, M. (2006). Different like me: my book of autism heroes. London: Jessica Kingsley.

Hagland, C. (2009). Getting to grips with Asperger Syndrome: Understanding adults on the autism spectrum: Jessica Kingsley Publishers.

Hendrickx, S. (2009). The adolescent and adult neuro-diversity handbook: Asperger syndrome, ADHD, dyslexia, dyspraxia, and related conditions. London;Philadelphia;: Jessica Kingsley Publishers.

Howlin, P. (2000). Outcome in adult life for more able individuals with autism or Asperger syndrome. Autism, 4(1), 63-79. doi:10.1177/1362361300004001005

James, I. (2005). Asperger’s Syndrome and high achievement : Some very remarkable people [1 online resource (226 pages)]. Retrieved from https://ebookcentral.proquest.com/lib/ECU/detail.action?docID=290867

Lehnhardt, F.-G., Gawronski, A., Pfeiffer, K., Kockler, H., Schilbach, L., & Vogeley, K. (2013). The investigation and differential diagnosis of Asperger Syndrome in adults. Deutsches Ärzteblatt International, 110(45), 755-763. doi:10.3238/arztebl.2013.0755

Lingsom, S. (2008). Invisible impairments: Dilemmas of concealment and disclosure. SCANDINAVIAN JOURNAL OF DISABILITY RESEARCH, 10(1), 2-16. doi:http://doi.org/10.1080/15017410701391567

Livingston, L. A., Colvert, E., Bolton, P., & Happé, F. (2019). Good social skills despite poor theory of mind: exploring compensation in autism spectrum disorder. Journal of Child Psychology and Psychiatry, 60(1), 102-110. doi:10.1111/jcpp.12886

Mendes, E. (2015). Marriage and lasting relationships with Asperger’s Syndrome (Autism Spectrum Disorder): Successful strategies for couples or counselors. London, UK: Jessica Kingsley Publishers.

Pallathra, A. A., Calkins, M. E., Parish-Morris, J., Maddox, B. B., Perez, L. S., Miller, J., . . . Brodkin, E. S. (2018). Defining behavioral components of social functioning in adults with autism spectrum disorder as targets for treatment. Autism Research, 11(3), 488-502. doi:10.1002/aur.1910

Wright, J. (2015). Autism’s lost generation. Retrieved from LinkedIn: http://www.theatlantic.com/health/archive/2015/12/the-lost-adults-with-autism/419511/?utm_source=yahoo

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