Often, autism is recognized early in childhood—parents, teachers, or healthcare providers recognize symptoms or areas of difficulty and refer a child for testing, which results in the child getting a diagnosis of Autism, which then enables them to benefit from supports and services. 

But sometimes it isn’t.

This is especially true for people who grew up before autism became more well-known by the general public. Older teenagers and adults who might easily be recognized as autistic if they were young children now may have fallen through the cracks if their parents or doctors were not familiar with signs of autism. Especially if they were pretty high functioning, or learned how to get along or appear as if they were getting along with others. 

Many psychology clinics and specialists are overloaded and have significant waitlists for evaluations—but what is worse, many of these clinics are for children only. For older adolescents or adults, they simply cannot be seen in these centers. This creates a real dilemma for adults who suspect they may have undiagnosed autism, or who may need an updated evaluation for autism. 

There are three main reasons why getting an autism evaluation as an adult is more difficult.

First, many psychologists who do adult assessment do not focus on autism—and their reference for what autism is maybe based on severe and more stereotypical cases, which have been identified early in childhood due to severe needs. Though it would be incredibly rare to find a psychologist who “didn’t assess” for conditions like ADHD or mood disorders like anxiety and depression, many psychologists do not get the training on more complex or subtle presentations of autism and simply do not address it. This is a significant problem, since an individual could be assessed by a psychologist like this and the issue of autism would not be examined or in many cases, even brought up to the family. 

Adults who are wondering about an autism diagnosis and seeking an evaluation for the first time have often learned many “tricks” to get by socially, which is often described by “masking” or “camouflaging” symptoms. Many of these individuals may have people-watched or watched television shows in attempts to learn how to be successful socially, to the point where many of the “autistic” symptoms are less visible or obvious.

The second reason why autism diagnosis for adults is more challenging than for children, is that some providers focus only on what they can see and miss the opportunity to ask about the internal experience that individuals have, such as social discomfort or attempts to mask and minimize symptoms. Due to this, they may not appear to meet criteria for autism spectrum disorder.

While some people may feel that if they are able to manage these symptoms, they do not need a diagnosis, I disagree. Just as medical conditions such as diabetes and high blood pressure can sometimes be improved and managed successfully with a combination of diet and exercise, these conditions need to be continuously monitored; if a person needs to constantly remember what they have trained themselves to do and needs to use logic and “tricks” to be socially successful, I believe a diagnosis of autism is often warranted and helpful. 

Third, many autism clinics focus on children, and most standardized assessment measures are centered on childhood. Training programs which focus on autism tend to work exclusively with children, leaving many professionals to learn how to extend this knowledge to adults on their own. Even now, some pediatricians advise parents to wait until their child is 2 or 3 for evaluation. Parents who follow this guidance miss out on early opportunities to change the trajectory of their child’s future, and when they do attempt to schedule an evaluation, they often look at a waitlist of up to a year before they can get answers. Sometimes parents are the ones delaying an evaluation. They may fear the answers an evaluation would provide, or their priorities are on other areas.

Some parents may not recognize the importance of a formal diagnosis and the doors it can open in terms of therapies and accommodations in and out of school. With children, a report is almost always necessary to help justify a child’s participation in supports and services, such as various types of therapy and school accommodations. With adults, this may not be necessary, so the need for autism evaluation in adults is sometimes not recognized or understood by all providers.

Overall, I believe that in many cases there are adults who would benefit from evaluation for autism spectrum disorder. If you are looking for a psychologist who understands autism in older adolescents and adults, ranging from those with severe needs to those who have been able to teach themselves to be successful despite their brain differences, consider reaching out to me for assistance.

Dr. Jessica Myszak has had over 10 years of experience evaluating children and adults with autism. She has recently transitioned into offering telehealth evaluations. She is able to work with families who reside in Arizona, Colorado, Delaware, Georgia, Illinois, Missouri, Nebraska, New Hampshire, Nevada, Oklahoma, Tennessee, Texas, Utah, Pennsylvania, Virginia, and North Carolina (effective 3/1/2021). If you are interested in learning more about potentially working with her, you can visit her website here or email her here to get the process started.