ASD is a developmental disability that can be caused by genetic, environmental, and/or biological factors (CDC, 2022; Drake Institute, 2024). It begins before 3 years old due to atypical brain development. As adults already have a mostly developed brain (Drake Institute, 2024), it is not possible to develop ASD in later life.
However, later life diagnosis is possible as a large number of people simply remain undiagnosed or may even get misdiagnosed with another condition, such as anxiety or depression (Alms, 2020). Diagnosis may also be tricky in higher-functioning individuals who do not present obvious symptoms, as there are no lab tests for ASD (CDC, 2022; Drake Institute, 2024). According to Alms (2020), girls, children of color, and children from low-income families are more likely to go undiagnosed.
In fact, boys get diagnosed four times as often as girls (Drake Institute, 2024). Does this mean that the prevalence of developing ASD is lower in girls? Maybe, maybe not. It’s not clear, but here are some relevant factors as to why it may not be the case.
Firstly, we may be less aware of the ways in which ASD presents in girls as early autism research was mostly focused on boys (Hoxworth, 2022). Secondly, women with higher-functioning ASD are found to be more adept at masking their tendencies and feelings, mirroring peers’ behaviors, coping with social situations, and show fewer signs of repetitive behaviors (Drake Institute, 2024; NHS, 2022). Hence, they are able to hide the signs of their condition better.
Signs of ASD in adults
According to Drake Institute (2024) and National Health Service (NHS; 2022), adults with ASD may struggle with:
Understanding other people’s thoughts and feelings
Making friends or preferring solitude
Expressing their feelings
Understanding social rules
Making eye contact with others
Anxiety about social situations
Anxiety about changes or disruptions in routines
Taking everything literally
Coming off as blunt, rude, or disinterested
Being unaware, or overly aware of their physical boundaries.
In fact, many adults find out about their undiagnosed condition by accident, after seeking help for other mental health and social problems. Most feel different from others – even to the extent of “being an alien” – and have experienced rejection by peers or social circles (Alms, 2020; Stagg & Belcher, 2019).
On a more positive note, other signs of ASD in adults can also include:
Having a strong and consistent interest in specific things
Having a keen sense for patterns, details, smells, and sounds that others might not notice.
(NHS, 2022)
Getting a diagnosis
Adults with high-functioning ASD are able to work and survive in the world as neurotypical individuals do. However, it may not come as naturally to them, as evident from the things that they often struggle with. Late diagnosis - after 12 years of age - has been linked to affected mental health and well-being (Hoxworth, 2022). Not only do they lack access to intervention and support services but they may also not understand why they have such problems.
For example, Michael John Carley (diagnosed at 36 years old) and Walters (diagnosed at 30 years old), said that his diagnosis “explained a lifetime of puzzles” and helped make sense of his life, respectively (Alms, 2020; Hoxworth, 2022). Adding on, Walter’s diagnosis helped him see that his troubles were not from being “not good enough”, but because he was simply “unaware and unsupported of [his] needs” (Hoxworth, 2022).
A late diagnosis may be beneficial as it helps individuals who were unaware of their condition view their struggles from another perspective and understand why they may have certain traits or behaviors that are not commonly shared or appreciated by others (Alms, 2020; Stagg & Belcher, 2019). This allows for positive reconfiguration of their self-concept. It provides control over how they can manage and seek intervention for themselves, which plays an important role in improving overall well-being.
For readers who may be interested to know more; Sue Nelson’s (2022) article – linked in the references – nicely illustrates her own experience as someone who received a late ASD diagnosis at 60 years old!
Written by Leong Jia Hui
References
Thirdman. (n.d.). Crop psychologist taking notes during appointment [Photograph]. Pexels. Retrieved January 10, 2025, from https://www.pexels.com/photo/crop-psychologist-taking-notes-during-appointment-7176026/
Alms, S. (2020, January 7). When autism is diagnosed in adulthood. Organization for Autism Research. https://researchautism.org/oaracle-newsletter/when-autism-is-diagnosed-in-adulthood/
Centers for Disease Control and Prevention (CDC). (2022, December 9). ASD diagnosis, treatment, and services. U.S. Department of Health & Human Services. https://www.cdc.gov/ncbddd/autism/facts.html
Hoxworth, L. (2022, October 20). Solving the problem of late autism diagnosis. University of Virginia. School of Education and Human Development. https://education.virginia.edu/news-stories/solving-problem-late-autism-diagnosis
Drake Institute of Neurophysical Medicine. (2024). Can autism develop later in life? https://www.drakeinstitute.com/can-you-develop-autism-later-in-life#:~:text=However%2C%20autism%20symptoms%20can%20show,be%20later%20diagnosed%20in%20adulthood.
Nelson, S. (2022, April 6). The onset of the coronavirus pandemic took its toll on journalist Sue Nelson. Exhausted by covering the crisis, she received a life-changing diagnosis at 60- she was autistic. BBC. https://www.bbc.com/future/article/20220405-the-life-changing-diagnosis-of-autism-in-later-life
National Health Service. (2022, November 11). Signs of autism in adults. https://www.nhs.uk/conditions/autism/signs/adults/
Stagg, S. D., & Belcher, H. (2019, November 6). Living with autism without knowing: receiving a diagnosis in later life. Health Psychology Behavioural Medicine, 7(1), page 348-361. doi: https://doi.org/10.1080%2F21642850.2019.1684920
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