Autism symptoms in adults can be difficult to spot for a few reasons. For one thing, our media and society at large has presented stereotypical pictures of autism to us that rarely cover the nuances of the autism spectrum. This can be further complicated for patients with mental health disorders who may have symptoms or traits similar to autistic traits due to anxiety, depression, ADHD, or OCD.
To better understand autism symptoms and go over a few examples, Medical Director Dr. Rachela Elias and the Rivia Mind clinical team, spoke with Dr. Elizabeth Donovan, a psychologist specializing in autism and neurodivergent-affirming care.
“Often, unfortunately, in the media we have this Rainman image,” Dr. Donovan explained. “This white, cishet guy who is in some ways a savant. We don’t really think about the spectrum autism is and how it can present differently for adults.”
Symptoms of Autism
Autism spectrum disorder is just that: a spectrum. It can look different for everyone. Dr. Donovan broke down potential symptoms into five different categories: social communication differences, social awareness, sensory experiences, emotional processing, and executive functioning.
Social Communication Differences
One common autistic trait is the tendency to see language in black and white and to become frustrated with variances in language use. Autistic individuals tend to prefer direct conversations and may need more time to process conversations. They may have a stubbornness or rigidity in their language and arguments. They may also have a tendency to monologue about their interests, especially when in hyperfixation.
Social Awareness
Social awareness struggles may present as not knowing when to enter group conversations or when to change the topic. A disdain for small talk is also a common symptom. Many autistic individuals also feel misunderstood, “like everyone else knows what to do socially but they missed that day in school.”
“Anxiety is often present in my experience around social interactions,” Dr. Donovan explains. “Expectations that others might have, concerns about upsetting others, or even just the level of energy required in going out in the world. I like to explore when and where that anxiety is experienced.”
Sensory Experiences
Sensory symptoms can vary between hypersensitivity and hyposensitivity. Hypersensitivity around food such as certain textures of food can lead to rigid eating and, in some cases, to eating disorders. Autistic individuals who have strong sensory experiences may return to repetitive self-soothing comforts to soothe their senses.
Emotional Processing
Roughly 1 in 5 autistic people have alexithymia1, or a difficulty identifying and understanding emotions of themselves and others. They may struggle to show or even feel emotions. Importantly, alexithymia does not mean that the emotions aren’t there, but rather that someone with alexithymia might struggle to know how to engage with them.
Many autistic individuals also struggle with making or maintaining eye contact, which can lead to a difficulty with emotional processing.
However, emotional processing symptoms can sometimes be hidden or hindered by camouflaging or “masking.”
“As a kid, we present certain traits; but as people move through their lifespan, they often get a lot of messages about what’s appropriate, and they adjust themselves. Presenting in a clinical session doesn’t always represent the full self.”
Executive Functioning
We may think of executive functioning as a symptom of depression, but it can also be particularly present in autism. Symptoms such as difficulty losing track of time or struggling to manage interruptions are all common within autism.
Autistic individuals who struggle with executive functioning may feel jerked out of the moment when interrupted and struggle to return to the task. They can also become distressed or upset when they are unable to do the task the way they had planned it in their head. They can also struggle to understand processes other than their own, sometimes saying things like “That’s not how I would do it.”
Overlap Between Autism And Other Neurodivergent Conditions
In some cases, therapy patients receiving treatment for things like ADHD, anxiety, depression, or OCD may begin to question whether or not they’re autistic. But separating symptoms of mental illnesses or other neurodivergent conditions from autistic traits can sometimes be more complex than expected. Executive dysfunction could point to autism or to depression. Both ADHD and autism experience hyperfixation and rumination.
Substance use, such as drinking or marijuana intake as a way of dulling symptoms, are also often present in autism cases. “I don’t have the numbers or percentages,” Dr. Donovan admits, “but substances or things to numb the world and inputs or grease the wheels are often used.”
The key is to look at the larger picture rather than separating each individual trait. Someone with social anxiety may prefer direct conversation so that they don’t have to worry about what isn’t being said, for instance; but anxiety would not necessarily be linked to sensory hypersensitivity. For patients with autism, social anxiety can be a piece of it, but environmental anxiety can also be impactful. Things like schedule or sensory details can also be a cause of anxiety.
Some individuals may self-identify as autistic after doing their own research, which Dr. Donovan says is, “fine for many people.” But it can be helpful to talk to your therapist about your suspicions that you have autism and why symptoms of autism seem true for you. You can also discuss what an autism diagnosis would mean for you and whether you would like to go forward with testing.
Bringing Up Autism With Therapy Patients
While many therapy patients bring up autism themselves, sometimes the therapist may notice signs of autism and wonder how to approach it with the client. According to Dr. Donovan, the best step is simply to bring it up in specifics. Recall back to the patient the symptoms they brought up and ask for more detail. Ask if they have considered autism and if this is something they would want to look into. Obviously, it’s up to the patient whether or not they would take that further.
Preparing for Life Transitions As Adults With Autism
Life is full of transitions: forming new relationships, starting new jobs, adding to your family, or moving to a new city are just a few. But for individuals with autism, these life transitions may be a challenge — especially when it comes to sensory or executive function symptoms.
For example, someone who is hypersensitive to sound or crying may feel some anxiety about becoming a parent. “I wish there was more for autistic mothers, or even fathers,” Dr. Donovan says. It can help, however, to prepare with specific routines and schedules. If your partner is supportive, involve them in these plans, too.
Roleplay how you might react to certain situations that could be distressing and make a plan. Try to build interests and things to look forward to within the routine. You should also prepare for the possibility that you could still have a meltdown sometimes, even with these coping strategies. Be gentle and forgiving with yourself, focusing on moving forward rather than beating yourself up.
A Change For the Better
Neurodivergent conditions like autism have been shown much more in the media and discussed more prominently with the rise of social media compared to years past. To Dr. Donovan, that’s a good thing.
“I think it’s been a long time coming. There’s been a lack of awareness about invisible disabilities and expectations around what’s normal. I think this is an exciting time with a lot of shifting and changing ideas and evolution. It’s hard to predict where things will go, but I don’t think it’s a bad thing to be happening. At the very least, more people are hearing the word and expressing curiosity.
At Rivia Mind, we are committed to understanding more about autism and other neurodivergent conditions to provide the most neurodivergent-affirming care possible. Want to discuss autism with a clinician? Contact Rivia Mind today to schedule a consultation.
Resources:
- Alexithymia – Autistica
