Adults with ASD: diagnosis, symptoms and treatment

Autism Spectrum Disorder (ASD) is a neurological and developmental condition that has been extensively studied and documented in children. However, understanding and support for adults with ASD remain areas that require more attention and resources. Although symptoms of ASD manifest from childhood, many individuals reach adulthood without a formal diagnosis. This can present significant challenges in their social, educational and working lives.

The issue is that diagnosing ASD in adults presents particular obstacles, mainly because symptoms may overlap with those of other psychological issues or be misinterpreted due to the personal adaptations that individuals develop over the years. In addition, there is a general stigma and lack of knowledge about how ASD presents in adulthood, which can result in inadequate support and limited opportunities for those living with the disorder.

 Diagnosis of ASD in adults

The process of diagnosing autism spectrum disorder (ASD) in adults is complex and multifaceted, mainly due to the variability in the manifestation of symptoms and the lack of awareness of how the disorder affects individuals beyond childhood.

With this in mind, we look at the main challenges and the specific diagnostic process for adults below.

Difficulties and challenges in diagnosis

Identifying ASD in adults involves overcoming multiple barriers that can hinder accurate diagnosis. These challenges range from insufficient training of health professionals to cultural biases surrounding ASD. These are the main obstacles:

• Lack of recognition and specific training. Many health professionals are not sufficiently trained to recognise the signs of ASD in adults. This can lead to misdiagnosis or failure to diagnose.
• Stereotypes and prejudices. There is a stigma attached to ASD, often seen only as a childhood condition. This can negatively influence public and professional perception, leading to a reduced likelihood of ASD being considered a viable diagnosis in adulthood.
• Coexistence with other conditions: Adults with ASD often have comorbid conditions, such as anxiety, depression, obsessive-compulsive disorder or attention deficit hyperactivity disorder, which may mask or complicate the diagnosis of ASD.

Diagnostic process of ASD in adults

The path to an accurate diagnosis of ASD in adults is painstaking and requires a comprehensive assessment that considers both the individual’s past and present. Let’s look at the critical steps in this process:

• Initial assessment. This begins with a detailed review of the individual’s medical history, including childhood development and current behaviours. It is crucial to consider accounts from family members or partners who can provide important observations about unusual social and communicative behaviours.
• Use of specialised diagnostic tools. Tools such as the Diagnostic Interview for Autism Spectrum Disorders-Revised (ADI-R) adapted for adults and the Autism Diagnostic Observation Scale-2 (ADOS-2) are commonly used to assess the presence of ASD-related behaviours.
• Multidisciplinary assessment. Effective diagnosis of ASD in adults often requires a multidisciplinary approach that includes psychologists, psychiatrists, occupational therapists and sometimes speech and language specialists. This team collaborates to gain a full understanding of the individual’s abilities and challenges.

Recognition of ASD in adults is a basic step in accessing appropriate interventions and targeted support that can significantly improve the quality of life of adults with ASD. This process is vital not only to provide the necessary treatment but also to validate the experiences of those who have lived without a diagnosis for many years, thus allowing them to understand better their own lives and how they interact with the world.

Symptoms of ASD in adults

ASD in adults can manifest in various ways, which often differ from the symptoms seen in children. This is because many adults have developed compensatory techniques that can mask the more obvious symptoms. Below, we look at the most common symptoms of ASD in adults and how they may differ from those seen in childhood.

The main symptoms to observe

 Symptoms of ASD in adults can be subtle and vary widely, sometimes complicating recognition. Here are some of the most common signs that may indicate the presence of ASD in adults:

• Difficulties in social communication and interaction. Includes problems understanding gestures, facial expressions, and the tone of voice of other people, as well as difficulties in holding two-way conversations.
• Restrictive and repetitive patterns of behaviour, interests or activities. This may manifest in specific routines or rituals, a resistance to changes in daily routine, or intense interest in particular subjects.
• Atypical sensory responses. Heightened or reduced sensitivity to sensory stimuli such as sounds, lights, and textures, which may be overwhelming or unnoticed.

Differences in the manifestation of symptoms between children and adults

While children with ASD often show easily identifiable symptoms, adults may have learned to camouflage or manage these signs, sometimes leading to misinterpretation or late diagnosis. Let’s look at how these symptoms may change with age:

• Personal adaptations. Many adults with ASD have developed non-conscious strategies to adapt to social and occupational norms, which may make their symptoms less noticeable.
• Changes in symptom intensity. With age, some people experience a decrease in the severity of certain behaviours, such as restrictive interests, while others may see an exacerbation of social anxiety and communication difficulties in new or stressful situations.

An understanding of these symptoms and their variations is indispensable for providing appropriate support and interventions for adults with ASD. This knowledge is also essential for those who regularly interact with adults on the spectrum, as it allows them to create a more supportive and facilitating environment.

Treatments and strategies for adults with ASD

Treatment of ASD in adults requires a personalised and flexible approach that considers the individual needs, abilities, and challenges specific to each person. In any case, treatment strategies for adults may differ significantly from those used for children, focusing not only on mitigating symptoms, but also on improving quality of life and independence.

The following are the recommended therapies and most effective management strategies for adults with ASD.

Recommended therapies and their effectiveness

 Treatments for adults with ASD should be multidimensional, encompassing behavioural, emotional and social aspects. Here are some of the most effective therapies:

• Behavioural and cognitive-behavioural therapy (CBT) helps manage the challenges associated with ASD, such as difficulties in social interaction, anxiety, and repetitive behaviours. CBT is tailored to address how adults with ASD process information and respond to their environment.
• Interventions based on communication and social skills. These specialised programmes teach and reinforce communication and social skills, which are vital for improving personal and professional relationships.
• Medication to manage associated comorbidities. Although there are no specific medications for ASD, medications may be prescribed to treat co-existing conditions, such as anxiety or depression, which often accompany ASD in adults.

Necessary adaptations in everyday life

Beyond formal therapies, adults with ASD must implement adaptations in their daily lives that can help them manage their symptoms better and improve their overall functioning.

The first step is to integrate strategies to manage sensory overload. These may include using headphones to reduce noise in overwhelming environments or special clothing that is comfortable for tactile sensitivities.

In addition, modifications are needed in the workplace and at home. Here, adjustments such as adequate lighting, organised and quiet workspaces and structured routines can greatly affect an adult’s ability to function effectively.

Emotional support and support networks

 Emotional support is critical for adults with ASD, as they face unique challenges that can affect their emotional and mental well-being.

Of particular relevance here are online support groups and communities. These spaces not only provide a place to share experiences and advice but also help to reduce the sense of isolation that many adults with ASD may feel.

In addition, there are services and resources available. For example, occupational therapy services, counselling, and employment programmes designed for adults with ASD can significantly improve their independence and quality of life.

The importance of implementing a holistic approach that combines effective therapies, practical adaptations and robust emotional support is essential to help adults with ASD navigate their world more confidently and successfully.

The importance of improving detection and support for adults with ASD

Improving detection and support for adults with ASD is essential to ensure that these individuals can lead full and satisfying lives. Early detection is vital to provide tailored interventions to help manage the specific challenges of ASD, such as difficulties in communication and social interaction. Proper diagnosis also allows access to resources and specialised therapies vital for developing essential daily living skills.

Strengthening support for this population not only improves the quality of life of individuals with ASD, but also promotes inclusion and acceptance within the community. This translates into greater social awareness and sensitivity, key elements in fostering an environment that supports diversity and mutual respect.