Autism in Adults: The Cost of Masking and Why Diagnosis Matters
More and more people are talking about autism or ASD (Autism Spectrum Disorder). Today, more young children are being diagnosed than in the past, and society is gradually becoming more inclusive. But what happens when it comes to autism in adults? Are there any differences? Why would someone get diagnosed later in life?
Contrary to what some people believe, autism is not a disease. It is a neurodevelopmental condition that begins to manifest quite early in human development. Autism is not something that needs to be cured. Rather, support focuses on helping individuals understand their needs and adapt their environment to improve wellbeing.
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What Is Autism in Adults?
Autism in adults meets the same diagnostic criteria as in children. In essence, it is the same condition. However, because the social demands placed on us change throughout different stages of life, autism may present itself in differently.
For example, when children are young, they play. Children with autism may show repetitive play and or reduced symbolic or imaginative play or might stand out due to not playing with other children. In adults, however, all this is much harder to observe.
The same applies to social interaction. People with autism often experience difficulties with social skills. However, these are developed over time. Perhaps a child will avoid eye contact, won’t greet others or might struggle with sustaining conversations. In contrast, the same child, as an adult possibly will have learned social communication rules and may therefore go more unnoticed, even though following these social communication rules might be very draining.
It is also important to highlight that autism does not present in the same way for everyone. Each person has different strengths, interests and challenges, which is why autism is described as a spectrum. Some individuals might show a lot of repetitive behaviours but less social and communication difficulties. On the contrary a different person might present a higher language impairment but not so many repetitive behaviours. Everyone will have different levels of difficulties in different symptoms or areas.
A few years ago, what we now know as Autism Spectrum Disorder (ASD) was not a unified concept. We could find for example, professionals talking about Asperger’s Syndrome. However, in 2013, Asperger’s Syndrome, was included within the autism spectrum. This change reflected the scientific understanding that autism is a spectrum with varying levels of symptom severity and support needs, rather than different conditions.
Symptoms of Autism in Adults
Difficulties with social interaction
People with autism may experience differences in:
- Maintaining conversations that feel reciprocal
- Interpreting social cues
- Eye contact
- Non-verbal communication
Some people may be expressive and use many gestures and maintain socially effective conversations, but experience difficulties keeping eye contact. Another person, might find difficulty maintain conversations that are reciprocal, asking questions, or talking about something they are not as interested about without doing a conscious effort
Stereotyped or repetitive movements
Stereotyped or repetitive movements can appear in autism, especially during stressful or emotionally intense situations. They can create a sense of control and relief. Examples include rocking, hand flapping, clapping or small jumping movements.
Many autistic adults suppress them in social situations because they realise that others do not display these behaviours. However, this suppression can lead to frustration and anxiety.
Cognitive rigidity
Cognitive rigidity appears as difficulty adapting to change, a strong need for routines and an insistence on sameness. While some degree of rigidity exists in many people, the rigidity associated with autism may appear more extreme, interfering greatly with daily life on some cases.
Difficulties in social relationships
Sometimes adults with autism may not adjust their behaviour according to social expectations, which can lead others to perceive their behaviour as inappropriate.
Autism in adults may also manifest in difficulties with what is known as “Theory of Mind“. This ability allows us to understand how others have emotions, thoughts and intentions different than ours. Adults with autism may find it harder to interpret what is occurring in social situations, and knowing how they should respond.
Restricted interests
These refer to interests that that are experienced with unusually high intensity. These interests can be over several topics. For example, marine animals, steam engines, or even common topics such as football. But they are also uncommon in this occasion, as the person might do very extensive research about the topic, knowing information about it that is unusual (e.g. knowing the birthdays of all the football players of the Champions League). These interests may vary over time, but individuals often dedicate a significant amount of time to them.
Sensory hypersensitivity
For some autistic individuals, certain stimuli may be perceived very intensely, leading to anxiety and emotional distress. Examples include sensitivity to noise, clothing or foods textures, bright lights, colours, smells or tastes.
On the opposite side, some people may experience sensory hyposensitivity, such as reduced sensitivity to pain or temperature.
Autism can also coexist with other conditions, such as Attention-Deficit/Hyperactivity Disorder (Autism and ADHD or AuDHD), high intellectual abilities (Autism and High IQ) or intellectual disabilities (autism and LD).
Masking
So why does autism really go unnoticed in adults? We already explained how autistic individuals might learn how to follow communication rules and social cues. This is related to the concept known as “masking”.
Masking refers to the camouflage strategies used by many autistic individuals. It is a learned ability to fit in socially by hiding autistic traits.
Masking may occur consciously or unconsciously, and it can be exhausting. Over time, it can contribute to emotional difficulties such as stress, anxiety and other mental health struggles. Masking is particularly common in autistic women and individuals diagnosed later in life.
Autism in Adult Women
Autism often goes unnoticed in women. Some women today receive their diagnosis in their 40s or even later. This can be problematic, because earlier access to psychological support can significantly improve quality of life.
This occurs due to several reasons:
- Women often show stronger social motivation and social skills than boys, and therefore they tend to mask their autistic traits more.
- Autism has traditionally been considered more common in males.
- Women may present more emotional difficulties, which are sometimes misinterpreted as other conditions such as depression, anxiety, shyness.
Types of autism in adults
Contrary to common belief, there are no different “types” of autism. Autism is simply autism. However, some individuals may not meet the full diagnostic criteria and may fall within a broader autism phenotype. As explained earlier, autism is now conceived as a spectrum, and therefore each individual presents different strengths and difficulties. This means they share some characteristics of autism, but at a level that does not meet the criteria for a formal diagnosis.
How can I know If I have Autism?
Assessment for autism in adults usually involves gathering information from several sources to build a full picture of the person’s experiences. This often includes a direct observational assessment, such as the ADOS-2 (Autism Diagnostic Observation Schedule), which helps clinicians evaluate social communication and behaviour in a structured way. It is typically combined with a neurodevelopmental history interview, such as the ADI-R, exploring early development, childhood behaviours and patterns across life. Additional information may also come from questionnaires, previous reports or people who know the person well. Clinicians then bring all this information together and consider it alongside the DSM-5 diagnostic criteria, helping them carry out a careful differential diagnosis and determine whether autism or other condition best explains the person’s profile.
A diagnosis can help the person and those around them better understand their needs and strengths, making daily life easier to navigate and reducing the risk of anxiety, depression and burnout.
In summary, autism in adults can often go unnoticed, and many people receive a diagnosis later in life. This delay can negatively affect quality of life, as individuals may not receive the support they need. For this reason, awareness and genuine inclusion are essential.
At Clement Mind, we aim to support individuals with neurodivergent presentations in Cambridge following a neuro-affirmative approach.
