Autism Spectrum Disorder (ASD) is often misdiagnosed or undiagnosed during the adult years, especially if the individual’s level of functioning is at the higher end of the ASD symptom distress continuum and if the individual has developed and utilized effective coping strategies. In 1980, the DSM (Third Edition) established specific criteria for diagnosing Autism but categorized this diagnosis as a childhood disorder. During the 2000’s, research studies began focusing attention on symptoms of Autism in adults, and, in 2013, the American Psychiatric Association (APA) changed the diagnostic name of Autism, which was perceived as primarily a childhood disorder, to Autism Spectrum Disorder (ASD), which is classified as a neurocognitive disorder. During the past ten years, there has been a dramatic increase in social media posts about being “neurodivergent” and a subsequent effect of young adults self-diagnosing as “on the spectrum.” It is very important to focus on the DSM criteria, as opposed to others’ personal stories, when trying to figure out what, if any, disorder you may have. Autism Spectrum Disorder is actually a continuum of mild (or high functioning) to moderate to severe symptoms. Asperger’s is included in the ASD diagnostic category and represents the mild, or high functioning, end of the ASD continuum.
ASD has four main diagnostic criteria areas: social interaction difficulties, nonverbal communication deficits, hyper- or hypo-reactivity to sensory stimuli, and preoccupation with a limited number of interests. The first criteria cluster, social interaction difficulties, can have a range of related symptoms, such as not being able to determine when to respond and when to listen during two-way conversations, not speaking at all or very little in the workplace and in social situations, and having a monotone voice due to challenges with identifying and expressing a range of emotions. An adult with ASD can appear aloof, disinterested, or even rude during interpersonal communication, and this deficiency can result in further avoidance of integrating with others. In fact, it is often difficult to determine if an individual’s primary diagnosis is ASD, Social Anxiety Disorder, or Generalized Anxiety Disorder. The second criteria cluster, nonverbal communication deficits, is characterized by a lack of eye contact, low ability to recognize the emotional component of others’ body language or facial expressions, and the tendency to focus only on others’ words without being able to perceive nuances, sarcasm, or implied meanings of someone’s words. Adults with ASD tend to struggle with small talk, maintaining conversations, and developing and maintaining friendships.
The third criteria cluster, hyper- or hypo-reactivity to sensory stimuli, can cause distractibility and frustration when too many people are in one’s immediate physical space and when there are loud noises or bright lights, often causing the “ASD meltdown.” In my professional experience, the sensory processing difficulties are strong indicators that a client DOES have the primary diagnosis of ASD, rather than Social Anxiety Disorder or Attention Deficit Hyperactivity Disorder. The final criteria cluster, preoccupation with limited interests, is also characterized by restrictive or repetitive behaviors and/or hyperfocusing on the small details of a project rather than the overall process necessary for completing the project in a timely manner. Although much more research is needed on ASD, neuroscientists have made statistically significant correlations between executive functioning skills deficits(task completion, capacity for divided attention, verbal communication skills, and managing a diverse range of information which is often needed in academic, work, and other group environments) and the f-MRI results showing less activity in the brain areas which process these executive functions. These executive functioning skills deficits and inconsistent focusing ability are more reasons for confusion when making a diagnosis. In this case, the confusion again occurs between ADHD or ASD as an individual’s primary diagnosis.
More research is needed to better correlate the executive and emotional dysfunctions which contribute to an ASD individual’s difficulty with understanding social cues and with maintaining satisfying and appropriate two-way conversations or group-based discussions. Social interactions can become extremely threatening to ASD individuals, and they can be easily overwhelmed when in the presence of too many sensory stimuli. For these reasons, there’s a high percentage of comorbidity (co-existing) of an individual being given multiple diagnoses, such as ASD, ADHD, and sometimes PTSD (just to name a few!)
Cognitive Behavioral Therapy (CBT) and Applied Behavior Analysis (ABA) have been found as the most effective approaches for teaching strategies aimed at anxiety management, behavioral regulation, improved management of negative expectations and emotions, and dealing with the behavioral patterns that interfere with these strategies. The goals and session agendas of CBT center on scenarios and challenges that the individual has encountered and, more importantly, expects to encounter, particularly between sessions. The therapist uses take-away reminders, follow-up check-ins, and other ways of applying new coping skills so that they are used outside of the counseling room. Mindfulness training and distress tolerance training, which are Dialectical Behavior Therapy (DBT) strategies, are becoming more popular for ASD adults. A supplement to cognitive and behavioral approaches has increasingly been grounding techniques, which are excellent tools for focusing attention away from overwhelming thoughts, feelings, or memories. When grounding, you shift your focus from the internal stressor (thought/emotion) to the external environment. You can do this by staying in the present moment, rather than projecting into the future or past.
To determine if you or someone you know is on the continuum of Autism Spectrum Disorder symptoms, it is imperative to not only look at the symptoms but how much each symptom affects your daily functioning ability. The Ritvo Autism and Asperger Diagnostic Scale-Revised (RAADS-14) is a diagnostic tool specifically designed to assist in the identification of Autism Spectrum Disorder (ASD). The RAADS-14 evaluates symptoms across four domains: language, social relatedness, sensory-motor, and circumscribed interests. A final, and most important, point about adult ASD is that these individuals tend to excel in specific, detail-oriented careers, are straightforward and honest in their words, and value their friendships on a genuine level.
