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. Author manuscript; available in PMC: 2025 Dec 24.
Published in final edited form as: J Health Serv Psychol. 2024 Jun 24;50(2):103–111. doi: 10.1007/s42843-024-00108-0

Diagnosing Autism in Adults: Clinically Focused Recommendations

Antonio F Pagán 1, Daniel D Flint 2,3, Katherine A Loveland 4
PMCID: PMC12724529  NIHMSID: NIHMS2127044  PMID: 41446803

Abstract

Autism is sometimes missed in childhood and can be associated with co-occurring conditions (e.g., attention-deficit/hyperactivity disorder or anxiety) and lower quality of life in adulthood. The present paper seeks to provide concise and up-to-date information for practicing clinicians who are tasked with evaluating potentially autistic adults who were not diagnosed in childhood. For assessments of autism, practicing clinicians should consider many factors in adults, including “masking” symptoms, sex or gender differences, and family reports of developmental history when available. Treatment providers should tailor their interventions to include psychoeducation about autism symptoms for newly diagnosed autistic adults. Clinicians should utilize a multi-trait assessment method and provide evidence-based treatment recommendations to manage possible co-occurring mental health needs when working with autistic adults.

Keywords: Autism, autism spectrum disorder, adulthood, clinicians, therapy, assessment

Vignette

Melanie, a 32-year-old engineer, was self-referred for a mental health evaluation to identify if she is an autistic adult. She reported watching several YouTube videos that discussed autism in adulthood and how females often enter adulthood undiagnosed due in part to a phenomenon called “camouflaging” or “masking.” She resonated with the descriptions provided in these videos, which ultimately led her to the current evaluation. Overall, Melanie described her social life as “unsatisfying” and when asked how socializing feels to her she stated she felt others were given the “book on how to socialize” but she never received it. Melanie is not currently taking medication or receiving any treatment for these symptoms. At Melanie’s request, her mother attended the evaluation with her to provide a detailed description of developmental history. The evaluator utilized self-report measures, informant-report measures, a semi-structured observation interview, and an interview with Melanie’s mother after Melanie signed the appropriate release.

In order to get a clearer picture of her development, Melanie’s mother provided background information regarding Melanie’s childhood. Specifically, she reported that when Melanie was between the ages of 4 and 5 years old, she would rarely talk with her mother just to be friendly, did not spontaneously copy others, rarely utilized gestures, did not smile if others smiled at her, had some self-stimulating behaviors such as hand flapping, and would rarely socialize with other children. However, Melanie’s mother reported Melanie was “bright” and did very well in school. She stated Melanie “always had straight As and loved math.”

Melanie stated she struggled with socialization all of her life. She never had a best friend and struggled to form close relationships with peers. After high school, Melanie completed her college degree in mechanical engineering and graduated with honors. However, Melanie endorsed significant depression and anxiety symptoms throughout college. She stated she was isolated and could not connect socially with her roommates. She also reported executive functioning difficulties, including difficulties with organization and planning. She endorsed sensory sensitivities to certain sounds and textures (e.g., tags on clothing) and certain focused interests (e.g., collecting rare Pokémon cards). She stated she is not currently satisfied with her social life. Melanie said she would like to identify if a diagnosis of autism would help her receive treatment from a specialist who understands her needs and can help improve her quality of life.

Background and Challenges

Autism, or autism spectrum disorder, is a lifelong neurodevelopmental condition that is typically diagnosed in childhood but can be diagnosed later in life (Huang et al., 2020). While the diagnosis of autism is increasing in prevalence in the United Stated overall (Maenner et al., 2023), autistic adults remain an understudied and undertreated group. Specifically, experts estimate that for every three diagnosed cases of autism, there are two additional undiagnosed cases (Lewis, 2018). The diagnosis of autism can be validating given that it can bring a sense of validity to lifelong challenges (Micai et al., 2023). Moreover, the cost of masking (i.e., hiding social difficulties in order to “blend in”) one’s autistic traits in adulthood can lead to anxiety and depression (Hull et al., 2021). However, social support from a community of other autistic adults shows promise in offsetting these difficulties (Crompton et al., 2022). In addition, autistic adults are more likely to experience co-occurring medical conditions, including sleep problems, immune conditions, and gastrointestinal disorders (Croen et al., 2015). Thus, awareness of an autism diagnosis is an important step for adults seeking to better understand their functioning across social, psychological, and medical domains.

Due in part to recent changes in awareness, professional understanding, and diagnostic updates, more adults than ever are undergoing evaluations for autism (Huang et al., 2020). As specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5-TR), a diagnosis of autism has two requirements: (1) persistent deficits in social communication and interactions and (2) restricted, repetitive patterns of behavior, interests, or activities (p. 56; American Psychiatric Association, 2022). Currently, it is estimated that 2.26% of U.S. adults are diagnosed with autism (Dietz et al., 2020), which can include those identified with autism in childhood as well as those who received diagnoses of autism for the first time in adulthood.

For those seeking an evaluation in adulthood, there exist challenges in being correctly identified, including previous misdiagnoses (Crucitti et al., 2018), or a fear of not being believed by professionals (Lewis, 2017). A subset of autistic adults who are diagnosed with what was formerly known as Asperger’s syndrome (i.e., those with verbal abilities in the average range) may be functioning above the cutoff to qualify for developmental disability services, yet their communication and social impairments make it difficult for them to develop needed social relationships (Friedman et al., 2013). Unfortunately, most previous research suggests that autistic adults who are intellectually average or above still experience significant difficulties achieving independence, gainful employment, and postsecondary education despite their apparent capacity to work (Lounds Taylor et al., 2017).

Autistic adults often have symptoms related to social and communication difficulties, self-stimulating or repetitive behaviors, sensory processing difficulties, and issues with executive function and theory of mind (Howlin & Magiati, 2017). Autistic adults may require varying levels of psychosocial support to achieve independence, up to and including continuous care (Campisi et al., 2018). Regarding psychological functioning, autism commonly co-occurs with internalizing difficulties like anxiety and depression (Micai et al., 2023), which can persist into later adulthood (Roestorf et al., 2022). There are also correlations between autism and externalizing symptoms, including those pertaining to attention-deficit/hyperactivity disorder (ADHD). Autistic adults report consistent subjective difficulties in key executive functioning domains, in addition to difficulties with cognitive flexibility and working memory (St. John et al., 2022). Therefore, careful assessment and identification of key issues warranting intervention is paramount.

Why Do Some Enter Adulthood Undiagnosed?

One reason for missed diagnosis in childhood is that individuals who are intellectually average or above may require less educational support in childhood, where autism symptoms are commonly noticed. Another reason a diagnosis of autism may not be detected in childhood is that symptoms can converge with other conditions such as ADHD symptoms or obsessive-compulsive disorder (Pehlivanidis et al., 2020). Furthermore, girls in particular may have learned behavioral coping strategies that help “camouflage” or “mask” symptoms (e.g., mimicking small talk, feigning eye contact, and practicing conversations ahead of social situations; McQuaid et al., 2022), which may have contributed to being overlooked for diagnosis in childhood despite having challenges in social or other domains of functioning. Accordingly, autistic individuals who are not referred until adulthood present a complex diagnostic task, which requires sensitive measures to detect the subtle and unique presentation of autism within this population. For Melanie in the vignette, adaptive school behaviors were not a problem. It was not until adulthood when her workplace social impairments became notable that she wisely sought an evaluation.

The Assessment of Autism in Adults: Current Strategies

Crucial to any assessment is the purpose of the evaluation. Clinicians must inquire from adults seeking a first-time evaluation for autism as to the purpose of the evaluation (e.g., wanting to clarify their diagnosis, better understand themself, or receive treatment recommendations that would improve their quality of life). Guidelines for the assessment of autism in adults indicate that inclusion of perspectives across disciplines (e.g., psychologists, psychiatrists, and social workers; Hayes et al., 2018) and using multiple methods and sources is ideal (Pagán et al., 2023).

In addition to assessments administered by a trained clinician, practitioners may also distribute self-report and informant-report measures of autism, which are useful not only as a means of accurately identifying whether an adult client meets diagnostic criteria but also for examining strengths and opportunities for intervention or support. These measures may be particularly useful for autistic adults who are not intellectually impaired (and may not qualify for services from developmental disability or vocational agencies) but whose communication and social skills limit their ability to successfully navigate work or social relationships effectively (Friedman et al., 2013). In the case of Melanie, both self- and informant-report measures were utilized.

Standardized Measures of Autism in Adults

Below are eight measures of autism symptoms and related difficulties that can be used in assessing adults. Most of the measures are to give to the individual being assessed. Measures that are for a parent/caregiver are specifically indicated.

The Social Communication Questionnaire Lifetime (SCQ-L; Rutter et al., 2003) consists of 40 items in a yes/no format. The Lifetime Form focuses on developmental history and behavior consistent with autism. The SCQ-L cutoff of >15 provides an indication of increased risk for autism, and the SCQ-L has demonstrated strong psychometric properties (Chesnut et al., 2017). The SCQ-L is filled out by a trained clinician and a parent/family member.

The Autism-Spectrum Quotient (AQ; Baron-Cohen et al., 2001) is a brief, self-report measure focused on examining traits of autism in adults with average cognitive abilities. The AQ consists of 50 items and includes a Likert scale ranging from 1 (Definitely Agree) to 4 (Definitely Disagree). The AQ is intended to assess five domains associated with autism: social skills, attention switching, attention to detail, communication, and imagination. Autistic individuals score 32 or higher 80% of the time.

The Empathy Quotient (EQ; Baron-Cohen & Wheelwright, 2004) is a brief, self-report measure used to screen for challenges with perspective-taking and empathy, a difference often observed in cognitively able autistic adults. The EQ consists of 60 items and includes a Likert scale ranging from 1 (Definitely Agree) to 4 (Definitely Disagree). Autistic individuals score 30 or lower 80% of the time.

The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R; Ritvo et al., 2011) is a self-report measure used to identify cognitively able autistic adults. The instrument consists of 80 items, measured on the following scale: 0 (True now and when I was young), 1 (True only now), 2 (True only when I was young), and 3 (Never true). Items assessing three domains (Social Relatedness, Language and Communication, and Sensorimotor and Stereotypical Behavior) produce a total score. The cutoff score associated with a clinical diagnosis of autism is 65.

The Camouflaging Autistic Traits Questionnaire (CAT-Q) evaluates common camouflaging (masking, social compensation, and assimilation) associated with autism (Hull & Mandy, 2021). The CAT-Q has 25 items filled out by the adult, which results in a total score from 25–175, with higher scores representing greater levels of camouflaging. A word of caution to clinicians is that the CAT-Q may result in a higher rate of false positives if utilized as the only indicator of autism because there are other factors that can impact camouflaging (e.g., anxiety).

The Social Responsiveness Scale-2 (SRS-2) is a self-, parent-, and other-report measure that is sensitive to features of autism (Constantino, 2013). Scores are presented as T-scores where 50 is average and scores of 60 and above indicate areas of concern across several scales (e.g., Social Awareness, Social Cognition, Social Communication, Social Motivation and Restricted Interests and Repetitive Behavior). The SRS-2 has demonstrated strong psychometric properties in autistic adults (Chan et al., 2017).

The Adult Repetitive Behaviors Questionnaire-2 (RBQ-2A) is a self-report measure of repetitive behaviors and restricted interests (Barrett et al., 2015). Restricted and repetitive behaviors are not typically assessed in self-report measures of autism, making the RBQ-2A an important measure for clinicians.

Last, the Modified Girls Questionnaire for Autism Spectrum Condition (GQ-ASC) - Scale for Adult Women is a screening questionnaire designed to identify autism symptoms in females. Autistic women score 56 or greater 80% of the time (Brown et al., 2020).

Diagnostic Interviews

Here are three diagnostic interviews that can be used for potentially autistic adults. Clinicians should take care to ensure that they have the correct training and supervision, if applicable, before administering a diagnostic interview for autism symptoms. Some of the diagnostic interviews, such as the Autism Diagnostic Observation Schedule listed below, have trainings that qualified clinicians can attend as a step toward becoming proficient in administering that interview.

The Autism Diagnostic Interview – Revised (ADI-R) is a clinical diagnostic interview that can be used in assessing adults with suspected autism (Lord et al., 1994). The interview must be conducted with a parent/family member. The interview focuses on behaviors across three areas: qualities of reciprocal social interaction; communication and language; and restricted and repetitive, stereotyped interests and behaviors.

The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2; Lord et al., 2012) is a semi-structured assessment of social communication used to gather information on how individuals with possible autism may interact. The ADOS-2 Module 4 is used to assess children and adults with strong verbal language abilities and was administered to Melanie. The ADOS-2 module 4 has shown to have adequate psychometric properties in predicting autistic adults; however, a word of caution for clinicians is that the ADOS-2 was normed disproportionally on males, which may lead fewer autistic females to reach cut off scores on this measure (Libsack et al., 2021).

The Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Edition (MIGDAS-2) is a sensory-based, semi-structured interview to gather and organize information that can help to diagnose autistic adults (Monteiro & Stegall, 2018). More research is needed to understand the clinical utility of the MIGDAS-2. The MIGDAS-2 and various self- and informant-report measures were utilized for Melanie’s evaluation presented in the vignette.

Limitations in the Assessment of Autism in Adults

There are significant gaps in training and interpretation of self- and informant-report measures of autism by mental health professionals (e.g., psychiatrists, psychologists) in the unique features of autism in adulthood. For example, clinicians have yet to fully understand the gender differences in the presentation of autism, co-occurring conditions, and psychosocial characteristics (e.g., socioeconomic status) of autistic adults (Huang et al., 2020). Furthermore, questions have emerged regarding the validity of measures currently used to identify characteristics related to autistic adults (Ashwood et al., 2016) especially in clinical samples (Bezemer et al., 2021). Many current measures for the diagnosis of autistic adults utilize symptom examples from children. Additionally, there exists concerns about population norming procedures, such as in the standardized measure presented earlier, the Autism-Spectrum Quotient, which was normed using a ratio of 5:1 males to females. Recent research suggests a ratio of 3:1 males to females more accurately represents the distribution of autism, and that even that number may underestimate the true number of females with autism (Loomes et al., 2017). The implementation of telehealth has provided avenues for completing diagnostic evaluations with underserved populations, but insufficient evidence exists on the validity of diagnosing autistic adults with this method (Alfuraydan et al., 2020).

Clinicians should also keep in mind the limited information available on how each of the above referenced measures compare across diverse racial, sexual and gender identity, and language groups. The following recommendations are provided for clinicians working with diverse clients who face significant barriers in the assessment and treatment of autism (La Roche et al., 2018). When conducting evaluations with patients from diverse backgrounds, clinicians should prioritize cultural humility and sensitivity. This entails participating in relevant training, recognizing intersectionality of identities, and utilizing culturally adapted assessment tools and language services when available. Clinicians should employ culturally responsive interviewing techniques, engage with community organizations, and engage in ongoing self-reflection to understand the perspectives they are bringing into an evaluation. Continuing education, supervision, and consultation are essential for staying informed and addressing challenges related to practicing with diverse populations. Ultimately, clinicians must advocate for considerations of individual differences, which lead to more accurate assessments and better outcomes for patients from diverse backgrounds.

Clinicians should also consider a recently identified experience of autistic adults called “autistic burnout,” which has only recently begun to be addressed in autism research. Defined as chronic periods of exhaustion, difficulty utilizing skills, and difficulty tolerating stimuli in the environment, autistic burnout can lead to withdrawal from social settings, additional executive function difficulties, and increased depressive and suicidal ideation. This phenomenon may not be captured by existing screening measures (Higgins et al., 2021).

Finally, few measures incorporate several components of autism into one, including group social interactions, emotional regulation, masking, and executive functioning. Thus, current best practice continues to depend on clinical judgment when diagnosing autistic adults (Hayes et al., 2018), especially given that many adults seeking an autism evaluation may not have parents/family members available, leaving clinicians with the burden of evaluating the individual’s recollections of early childhood. It is also important to note that most measures of autism (e.g., the ADOS-2, ADI-R) have not been validated in those older than 39 years old so consideration should be made for older adults.

Evidence-Based Treatment Considerations

When discussing evidence-based practice for autistic adults, it is important to consider that mental health services may not adequately support autistic adults and may even cause additional harm (Brede et al., 2022). In fact, autistic adults have been reported to prefer therapies such as cognitive behavioral therapy (CBT) to other approaches (e.g., transcranial magnetic stimulation, antidepressant medications; Benevides et al., 2020). Clinicians and stakeholders should be wary of services apparently focused on “curing” autism instead of providing skills that may enhance the lives autistic individuals.

Surveys of autistic adults indicate that treatment outcomes are predicted by the practitioner’s knowledge of and consideration for common characteristics of autism (e.g., sensory sensitivities, communication style, preference for routine and sameness; Lipinski et al., 2019). Unfortunately, a recent survey of mental health practitioners found that most providers did not have adequate training in recognizing, understanding, and adapting interventions for autistic adults (Cooper et al., 2018). Further, many service care providers have misunderstandings, lack of experience, and implicit biases that impede their ability to provide accurate assessment and quality intervention services for many autistic adults (Maddox et al., 2019). The psychologists who are equipped to provide appropriate evaluations for autistic adults typically have long waitlists for their services (Huang et al., 2020).

Clinicians working with autistic adults can provide environments that are more sensory friendly. This tailoring of the environment could involve providing sensory accommodations such as noise-cancelling headphones or quiet workspaces to reduce auditory distractions while patients are filling out questionnaires. Clinicians can also consider adjusting lighting conditions by using natural light or providing adjustable lighting options to minimize sensory overload in their waiting rooms and clinic spaces.

Most interventions for autistic adults are tailored to unique presentation and focus on treating co-occurring conditions when applicable. For example, psychotropic medications can help mitigate depression and anxiety in autistic adults (Houghton et al., 2017). Cognitive behavioral and mindfulness-based interventions in both individual and group formats also demonstrate strong efficacy for autistic adults and co-occurring mental health needs (Hartley et al., 2019; Spain et al., 2015). These interventions may include making space for common symptoms experienced by autistic adults (e.g., difficulty with change, sensory sensitivity, rigidity, black and white thinking; Gadke et al., 2016). Other areas to consider with intervention include challenges identifying internal experiences (e.g., physiological sensations and emotions; DuBois et al., 2016) cognitive inflexibility, and difficulty with theory of mind (Brunsdon & Happé, 2014). Finally, other symptoms of autism (e.g., sensory sensitivities, restricted behaviors or interests) or difficulties with executive functioning (e.g., planning and completing homework) should be addressed as needed based on the symptoms of the autistic adult (Hwang et al., 2020).

Importantly, telehealth has grown into a popular modality to deliver interventions to individuals who do not have access to mental health care in their city and can be an appropriate and effective modality for treating autistic adults (Ellison et al., 2021). Given that Melanie has been recently diagnosed with autism, her intervention should include a psychoeducational module, providing an overview of the unique presentation of autism in adulthood and why her diagnosis may have been missed during her childhood. Melanie was also provided with information about treatment providers who have expertise in applying evidence-based interventions for autism in adulthood.

Actionable Steps for Clinicians

Clinicians who are interested in improving their competence in the assessment and treatment of autistic individuals in adulthood have several steps to take and may need more based on training and clinical setting. Many clinicians can start by familiarizing themselves with the diagnostic criteria outlined in the DSM-5-TR and the ICD-10 (International Classification of Diseases, 10th Revision). This diagnostic background will provide them with a foundational understanding of the characteristics and behaviors associated with autism. Clinicians may also wish to read Keller et al.’s (2020) descriptive research on a large cohort of autistic adults. In addition, clinicians may wish to attend workshops and webinars specifically focused on adult autism assessment and diagnosis. Organizations like the Autism Research Institute (ARI) and Autism Society often host events and training sessions tailored to professionals working with adults on the spectrum. Moreover, clinicians may identify and complete online courses and certifications. The University of California at Davis offers a certificate program in autism spectrum disorder that covers assessment, diagnosis, and treatment across the lifespan. Fourth, several books can be helpful, including “Unmasking Autism” by Devon Price (2022) and “Assessment of Autism Spectrum Disorders” edited by Sam Goldstein and Sally Ozonoff (2020). Of importance, as is required for clinicians pursuing goals to specialize in an unfamiliar area, seek out supervision and consultation with experienced clinicians who specialize in adult autism assessment. It is also critical to stay up to date with the latest research and advancements in the field of adult autism assessment and diagnosis by regularly reading peer-reviewed journals (e.g., Autism in Adulthood) and following reputable autism research organizations (e.g., the Organization for Autism Research).

A Brief Note on Language

We acknowledge there are several terms for the population of autistic individuals and alternates between them (e.g., individuals with autism, autistic individuals). This paper opted for the term autistic adults/individuals for continuity in the present work. A useful rule of thumb for clinicians is to ask clients whether they prefer to utilize either diagnosis-first language (autistic individual) or person-first language (individual with autism). We refer the reader to more indepth discussion on this topic with Singer et al. (2023).

Conclusions

The present article provides an overview of important considerations for practicing clinicians when assessing and treating autistic adults. Specifically, not only does autism persist into adulthood but the condition can be missed in childhood. Delayed diagnosis until adulthood can contribute to complex challenges for adults who have been coping with undiagnosed autism for decades. In terms of assessment approaches, the present study acknowledges that no perfect measure or battery of measures exists that can perfectly identify autism in adults. Best practice is an assessment strategy that builds on multiple informants and modalities and includes good clinical judgment from clinicians who are well-trained in the presentation of potentially autistic adults. Furthermore, clinicians should assess for co-occurring problems including depression, anxiety, and other diagnoses (e.g., ADHD), and make medical referrals as indicated. Clinically, interventions ought to be developed that are tailored to the unique needs of autistic adults. Finally, clinicians should continue educating themselves regarding the newest interventions and assessments for autistic adults so that those who are seeking care for the first time or coming in for additional help receive the care they deserve.

Vignette Wrap-Up

Melanie presented appropriately casually dressed. She exhibited at times fleeting eye contact and some use of what could be interpreted as overly emphatic and descriptive gestures. She often smiled and yet exhibited dysthymic affect with depressed and anxious mood. There were several instances when Melanie became tearful throughout the evaluation. Overall rapport with examiners was easily established.

Her speech was clear with normal volume and normal prosody, rhythm, and rate. She did not demonstrate any evidence of thought disturbances, hallucinations, or delusions, nor evidence of deficits in receptive or expressive language. She described her difficulties with good insight and expressed motivation for seeking help. She appeared engaged and responsive during the evaluation. There were no obvious signs of fine or gross motor difficulties.

After a thorough examination including self- and parent-report measures, diagnostic interview, and clinical observations, it was concluded that Melanie met criteria for autism. The following symptoms and related characteristics were identified as impacting her quality of life through the comprehensive examination: discomfort with eye contact, highly focused interests, difficulty with transitioning from one task to another, discomfort with small talk, lifelong sensory sensitivities, difficulty making long-term friendships, and making offensive or inappropriate jokes.

Because she was also diagnosed with co-occurring ADHD, generalized anxiety disorder, and major depressive disorder, she was provided with the following clinical recommendations. Melanie was encouraged to seek individual therapy services from a qualified clinician who has experience with autism and utilizes a cognitive-behavioral approach such as dialectical-behavioral therapy (DBT) or cognitive-behavioral therapy (CBT) to target cognitive and behavioral rigidity and related issues that are impacting her quality of life. It will be important that Melanie’s therapist understands and has experience with the social and behavioral differences associated with autism. Melanie was also provided with online resources and books to help her understand her new diagnosis and was provided with a feedback session to discuss the results of her testing with the clinician who conducted the assessment. Here are the resources that were provided to Melanie:

  • Recommended readings:
    • Autism Adulthood: Insights and Creative Strategies for a Fulfilling Life-Second Edition (Senator, 2018)
    • The Autism and Neurodiversity Self Advocacy Handbook (Cook & Purkis, 2022)
    • Autism in Adults (Overcoming Common Problems) (Beardon, 2021)
    • Autism for Adults: An Approachable Guide to Living Excellently on the Spectrum (Jones, 2023)
  • Online information about autism spectrum disorder:
    • Autistic Women and Nonbinary Network (https://awnnetwork.org): This organization was created to provide community, support, and resources for autistic women, girls, trans individuals, and all others of marginalized genders. Their website has welcome packets for newly diagnosed women.
    • Autistic Self Advocacy Network (https://autisticadvocacy.org): This organization was created to serve as a national grassroots disability rights organization for the autistic community. They provide information about autism, disability rights, and systems change to the public through different educational, cultural, and advocacy-related projects.
    • Asperger/Autism Network (https://www.aane.org/adults/women/): This organization provides resources and links to services and support for individuals diagnosed with Asperger’s or autism. There is also a page of essential resources specifically for women, which includes links to support groups, social activities, as well as additional information and education.

Key Clinical Takeaways

Arriving at an accurate diagnosis for adults presenting with autism is vital because of the ongoing challenges that undiagnosed autistic adults can experience, including difficulties with undiagnosed/untreated co-occurring psychiatric diagnoses.

Clinicians should consider conducting a comprehensive assessment using multiple methods (e.g., self-report, informant-report, diagnostic interview, observation), consider the role of sex and gender in presentation of autism as well as possible “masking” behavior, and make sure they have adequate clinical training before conducting an assessment or making the diagnosis of autistic adults.

Other factors that impact a lack of diagnosis of potentially autistic adults includes a lack of awareness for some clinicians on the symptoms of autism in adulthood, stigma, and/or anxiety related to fears of being misunderstood. Thus, clinicians ought to educate themselves and utilize the most current evidence-based assessments and treatment strategies for autistic adults.

Biographies

Antonio F. Pagán, PhD, is a clinical psychology postdoctoral fellow at UTHealth Houston. Dr. Pagán conducts research on neurodevelopmental disorders across the lifespan with a focus on how these disorders create difficulties during key life stage transitions.

Daniel D. Flint, PhD, is an assistant professor of pediatrics at Baylor College of Medicine and licensed clinical psychologist at Texas Children’s Hospital. Dr. Flint is interested in researching and disseminating empirically supported behavioral interventions for adolescents and young adults.

Katherine A. Loveland, PhD, is a professor and clinical psychologist at UTHealth Houston. Dr. Loveland is a foremost expert on the assessment and treatment of autism spectrum disorders across the lifespan. Throughout her career she has received many awards and honors, including receiving the Landmark Charities Professorship in Autism Research.

Footnotes

Declarations The authors have no relevant financial or non-financial conflicts of interests to disclose. Ethical approval was not needed for this narrative review. There is no relevant data for availability.

Contributor Information

Antonio F. Pagán, UTHealth Houston.

Daniel D. Flint, Baylor College of Medicine; Texas Children’s Hospital.

Katherine A. Loveland, UTHealth Houston.

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