Tackling autism in adults: How to manage and diagnose the condition in older patients


By Ankur Biplav

Autism is sometimes diagnosed in adults. Does it develop in later stages or only childhood? Dr PN Renjen, senior consultant, neurology, Indraprastha Apollo Hospitals, says autism spectrum disorder (ASD) is typically diagnosed in early childhood, usually by the age of two or three. However some individuals may receive a diagnosis later in life. This can occur for several reasons:

  • Late recognition: Some people may exhibit subtle signs of ASD that go unnoticed or are misinterpreted during childhood. As they grow older, these signs may become more apparent or have a greater impact on their daily lives, leading to a diagnosis in adulthood.
  • Masking or compensation: Certain individuals with ASD may develop coping mechanisms to navigate social situations and mask their difficulties. This can make it difficult to identify ASD earlier in life. But the demands of adulthood, such as increased social expectations and stress, may lead to the masking breaking down, making the symptoms more apparent.

Improved awareness and diagnosis: Over the years, awareness of autism has increased. This has resulted in improved diagnostic tools and increased recognition of ASD signs in adults. Hence, more individuals are getting accurate diagnoses later in life. Notably, the core characteristics of autism do not typically emerge in adulthood if they were absent in childhood. Instead, the delayed diagnosis is often a case of recognising and understanding the symptoms that were present but not fully recognised or assessed earlier. If an adult receives an autism diagnosis, it does not mean that the severity of their symptoms has suddenly increased. Rather, it indicates that their symptoms and difficulties align with the criteria for an autism diagnosis, which may have been overlooked or undiagnosed during childhood.

In adults, the signs of autism can vary widely, as individuals with autism spectrum disorder (ASD) can have different strengths, challenges, and coping mechanisms. However, some common signs are:

  • Social difficulties: Adults with autism may have difficulty understanding social cues, maintaining eye contact, interpreting facial expressions, and engaging in reciprocal conversations. They may struggle with social interactions, finding it difficult to make and keep friends.
  • Communication differences: Adults with autism may have difficulty with verbal and nonverbal communication. They may have limited speech or struggle with understanding and using gestures, facial expressions, or tone of voice. Some individuals may have a formal and literal style of communication.
  • Sensory sensitivities: Many adults with autism experience heightened sensitivity or hypo-sensitivity to sensory stimuli. They may be sensitive to loud noises, bright lights, or strong smells. Alternatively, some may have a reduced sensitivity to sensory input.
  • Restricted interests and repetitive behaviours: Adults with autism often display intense or narrow interests in specific topics, objects, or activities. They may engage in repetitive behaviours. They may also follow strict routines and become distressed by changes in their environment.
  • Difficulties with executive functioning: Executive functioning involves skills such as organisation, planning, problem-solving, etc. Adults with autism may struggle with these abilities.


Diagnosing autism in adults typically involves a comprehensive assessment by a healthcare professional or specialist, such as a psychologist or psychiatrist. The diagnosis process may include:

  • Evaluation of medical and developmental history: The clinician will review the individual’s personal and family medical history, developmental milestones, and any previous assessments or interventions.
  • Clinical interviews: The clinician will conduct interviews with the individual and, if possible, with their family members or close associates. It helps get information about the individual’s social and communication skills, sensory sensitivities, behavioural patterns, etc.
  • Autism-specific assessments: Various standardised assessment tools may be used to evaluate symptoms and functioning. These often include self-report questionnaires, observations of behaviour, and structured interviews.
  • Medical and psychological evaluation: The clinician may conduct medical examinations or order additional tests to rule out other conditions with similar signs.

Psychological assessments may also be administered to evaluate intellectual abilities, adaptive functioning, and any co-occurring mental health conditions.

Are severity and symptoms different if onset is in later stages of life?

When autism spectrum disorder (ASD) is diagnosed later in life, the severity and symptoms can differ from those typically seen in individuals diagnosed in early childhood. It is important to note that the impact and severity of symptoms can still vary widely among individuals with late-onset autism. Some individuals may experience significant challenges and require support in various areas, while others may have milder symptoms that primarily impact specific aspects of their lives.


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