Signs of autism in adults, and why they get missed

Why adults get missed

Adult Autism Assessment Perth arranges autism and ADHD assessments for adults and adolescents across Perth and WA. The diagnostic picture most people carry in their heads comes from research done largely on boys, decades ago. An adult who learned early that copying other people keeps them safe can present as sociable, employed and articulate, and still be autistic. That learned copying has a name — masking — and it is exhausting in a way that is hard to describe to somebody who has never done it.

What people describe

• Social interaction that works, but only by running a conscious process the whole time, followed by a need to recover in silence.
• Sensory load that others seem not to register: fluorescent hum, overhead light, a scratchy label, several conversations at once.
• Deep, sustained interests that are a genuine source of joy and are often dismissed as obsessive.
• A strong need for predictability, and a disproportionate cost when plans change late.
• Instructions that are perfectly clear to everyone else and ambiguous to you, and being told you are "too literal".
• A long file of near-misses: burnout, anxiety treatment that did not fit, jobs that went well until the social part, and a persistent sense of running a different operating system.

Why it surfaces in the thirties and forties

Usually one of three things. A child gets assessed and the description sounds like the parent's own life. Burnout arrives and the masking stops working. Or something at work changes — an open-plan office, a promotion into management — and strategies that held for twenty years stop holding.

Women, and anyone who learned to blend in

Autistic women are diagnosed later and less often, and the reason is not that autism is rarer in women. It is that the presentation is frequently quieter and the masking more practised, and clinicians looking for the textbook picture do not see it. Many are treated for anxiety, an eating disorder or a personality disorder for years first. If that paragraph describes you, you are not unusual — you are typical of who is being assessed now.

Sensory experience, which rarely gets asked about

Sensory difference is part of the diagnostic criteria and it is the thing adults most often fail to mention, because they assume everyone experiences it and simply copes better.

• Overhead fluorescent light, and the hum nobody else reports hearing
• Several conversations at once resolving into noise rather than speech
• Clothing labels, seams, particular fabrics
• Strong smells in a shared office
• Being touched unexpectedly, even lightly
• Interoception — not noticing hunger, thirst, needing the toilet or the onset of illness until it is acute

The last one surprises people. It is common, and it is why "I forget to eat when I am busy" turns up so often in assessments.

Autistic burnout

Distinct from depression and from ordinary work burnout, though it is regularly treated as either. It follows a long period of masking and unaccommodated demand, and presents as a loss of skills you previously had: speech becoming harder, executive function collapsing, sensory tolerance dropping to near zero, and an exhaustion that rest does not fix.

It is frequently what finally prompts an assessment in the thirties or forties, because the strategies that held for twenty years stop holding.

Things that are not on the stereotype list

Worth stating, because their absence makes people rule themselves out:

• You can make eye contact. Many autistic adults have learned to, and find it uncomfortable or effortful rather than impossible.
• You can have a sense of humour, including a sophisticated one.
• You can be employed, partnered and a parent. None of that rules anything out.
• You can be empathetic. The idea that autistic people lack empathy is wrong; many report feeling others' distress intensely and struggling to know what to do with it.
• You can be sociable and enjoy people, and still find it costly.

A screener is not a diagnosis

Online questionnaires such as the RAADS-14 or the AQ are screening tools. They are useful for deciding whether to take the question seriously, and they cannot diagnose anybody. A high score is a reason to ask. A low score does not close the question, particularly if you have spent your life learning the right answers to give.