Autism in Adults

Why do I struggle to make eye contact?
Why do I get lost in certain topics for hours?
Why do I feel overwhelmed by loud music?

If these sound familiar, it’s possible that you have at some point wondered: Could I have autism? For many adults, the question of whether they might have autism doesn’t emerge until later in life, often after years of navigating challenges in social settings, at work, and in relationships. While autism is frequently associated with childhood, it can remain undiagnosed into adulthood.

This article will explore how autism in adults manifests, the benefits of receiving a diagnosis, and the unique strengths many adults with autism bring to their personal and professional lives.

What is ASD?

Autism, or Autism Spectrum Disorder (ASD), is a neurodevelopmental condition that affects how individuals communicate, interact, and experience the world around them. In adults, this might show up as difficulty with social interactions, like finding it hard to understand non-verbal cues or participating in group conversations. Many adults with ASD may also have intense interests in specific topics and engage in repetitive behaviours or routines.

The “spectrum” aspect of autism means that experiences can vary widely. While some adults may navigate social situations and work environments with minimal challenges, others may face more significant difficulties. Support needs vary too, with some individuals requiring targeted strategies for coping, while others might need more comprehensive assistance in daily life. Ultimately, autism is about understanding and embracing how each person experiences the world in their own unique way.

What causes autism?

Adults with autism, not unlike children with autism, are born with the condition. Research suggests that autism is the result of a complex interaction of genetic and non-genetic factors. Some adults have inherited genes that make them more likely to develop autism, influencing how their brain develops and how different brain regions communicate with each other.

But autism is not solely determined by genetics. Environmental factors can also play a role in increasing the risk of autism. These include:

• Advanced parental age at the time of conception
• Exposure to air pollution or certain pesticides during pregnancy
• Maternal obesity, diabetes, or immune system disorders
• Extreme prematurity or very low birth weight
• Birth complications that may cause oxygen deprivation to the brain

It’s essential to clarify that autism is not something an individual “catches” through vaccines or parenting style. It’s a lifelong condition shaped by genetic factors and influences during pregnancy and birth. 

Do I have ASD?

Across the world, 1 in 100 adults have autism. If you’ve ever wondered, “Am I autistic?” or looked up signs of autism in adults, you may resonate with the following:

Autism symptoms

According to the DSM-5, ASD symptoms fall into two categories:

1. Persistent difficulties in social communication and interaction in different settings, like at home, school, or in social situations, including:

• Social-emotional reciprocity: Struggling to start or respond to social interactions. (e.g. not initiating conversations or having difficulty responding to others.
  
• Nonverbal communication: Body language and eye contact might feel uncomfortable or unnatural. (e.g. avoiding eye contact or having difficulty reading others’ facial expressions)
  
• Building and understanding relationships: Difficulty adapting their behaviour to fit various social contexts. (e.g. struggling to understand social cues like personal space or misinterpreting sarcasm or humour.)

2. Restricted and repetitive behaviours, such as:

• Repetitive movements or speech: Engaging in repetitive behaviours, such as repeating certain phrases when feeling stressed or movements (e.g. tapping or rocking) to self-soothe.
   
• Need for sameness: Having a strong preference for routine and resistance to change, such as needing to take the same route to the office every day and getting upset when they fail to do so.
  
• Intense, focused interests: Developing deep, narrow interests in specific topics or activities, such as having extensive knowledge about a hobby. This can make it tough to engage in conversations outside that area of focus.
  
• Sensory sensitivities: Overreacting or underreacting to certain sensory experiences, like sounds, lights, or textures. This might look like feeling overwhelmed by loud noises and bright lights, or being extremely sensitive to certain fabrics.

How adults may experience autism

As a result of the above symptoms, adults with autism may require additional support in the following areas:

• Securing employment: Difficulties in making conversation, speaking with inflection, maintaining eye contact, and understanding facial expressions and body language make job interviews a stressful affair for individuals with ASD.

• Adjusting to work environment: Workplaces designed for neurotypicals (e.g. open-concept offices) may trigger sensitivity to stimuli, such as noise and touch.

• Managing change: Working life is full of changes, and individuals with ASD who value routine may feel exceptionally anxious in the face of events such as organisational restructuring. They may not be able to negotiate for support when needed.

• Building relationships: Individuals with ASD may prefer to keep to themselves and find it hard to read others or express themselves. In the workplace, this can lead to anxiety about social situations (e.g. team-bonding), misunderstandings, and feelings of isolation. In their personal lives, this can likewise lead to feelings of loneliness.

• Self-esteem: Individuals with ASD may not have processed negative past experiences (e.g. being bullied in school). Continued difficulty in nurturing professional and personal connections can lower their self-esteem. 

• Emotion regulation: Working life is difficult as it is. Individuals with ASD may struggle with feelings of stress and burnout more than others, especially as masking ASD symptoms—however mild—can take a lot out of them.

• Mental health conditions: People who aren’t diagnosed with ASD until adulthood are almost three times as likely to be diagnosed with a mood, anxiety, or personality disorder than those who were diagnosed in childhood.

Although adults with autism may encounter difficulties in a world designed for neurotypicals, research shows that they possess unique abilities that can be incredibly valuable in various aspects of life. These include:

• Cognitive strengths: Adults with autism often excel in attention to detail, pattern recognition, and logical thinking, which can be beneficial in various industries such as IT, creative fields, and research.

• Personal qualities: Many adults with autism demonstrate high levels of honesty, dedication, and reliability, making them trustworthy employees and colleagues.

• Empathy: Contrary to common stereotypes, many individuals with autism possess a strong capacity for empathy, especially towards others with similar challenges, such as fellow autistic individuals or those with disabilities.

• Unique perspectives: Their distinct way of thinking allows them to offer fresh insights and creative solutions, often excelling in tasks that others may avoid or struggle with.

• Focus and special interests: Autistic adults tend to be highly focused and can succeed in areas aligned with their intense interests. These passions, when incorporated into their careers, contribute to both personal fulfillment and professional success.

Can adults be diagnosed with autism?

Autism symptoms can be detected as early as 6 months and often become apparent to caregivers between 12 to 24 months. Yet, many adults with ASD remain undiagnosed because their autism symptoms are:

• Mild: In the absence of intellectual disability, individuals may only notice these symptoms when they encounter psychosocial difficulties in school and work.
  
• Masked: Individuals may have developed compensatory strategies to mimic neurotypical behaviours (e.g. creating a “script” for small talk).

Why should I get an ASD diagnosis as an adult?

You might be thinking, “If I’ve managed this far without an ASD diagnosis, what’s the point of getting one now?” It’s a valid question, and many adults with undiagnosed autism feel this way. But even if you’ve found ways to cope with life’s challenges, a formal diagnosis can still offer several important benefits:

• Clarity: Understanding that your challenges are linked to ASD can provide a sense of relief, paving the way for self-acceptance and compassion. It could also help correct misconceptions or other diagnoses you have lived with.

• Access to services and benefits: In Singapore, just like the Ministry of Education supports students with ASD, adults diagnosed with ASD can access programs and services designed to help. For example, tripartite guidelines in Singapore require employers to make reasonable accommodations for employees with conditions like ASD, which means adjustments at work can help you perform at your best.

• Access to psychotherapy: A diagnosis also opens the door to targeted psychotherapy, which can be invaluable in managing co-occurring mental health conditions, such as depression, which adults with ASD are four times more likely to experience.

How are adults diagnosed with ASD?

Getting diagnosed with autism spectrum disorder (ASD) as an adult in Singapore typically involves seeing a clinical psychologist or psychiatrist who is experienced in diagnosing neurodevelopmental conditions. The process generally includes several key steps to ensure an accurate and thorough diagnosis:

• Medical history: Your clinician will start by reviewing your medical history to understand any previous health conditions or concerns that may be relevant to your symptoms.
  
• Screening for other conditions: Since ASD often co-occurs with other conditions, your clinician will also screen for other possible diagnoses. If symptoms of ASD weren’t apparent in childhood but have emerged later in life, this could suggest another condition. Cognitive testing, which looks at attention, memory, processing speed, reasoning, and problem-solving, might also be used to rule out other cognitive or mental health conditions.
  
• Clinical interviews: To get a clearer picture of your development during childhood and adolescence, they may talk to your parents or siblings and review school records. They’ll also ask about your current social, personal, and professional life to assess how ASD symptoms may affect you today. 

Adult autism tests

While there are self-administered ASD tests, like the Autism Spectrum Quotient (AQ), these should not replace a formal diagnosis by a qualified clinician. A trained clinician is equipped to administer reliable and comprehensive autism assessments, such as the Autism Diagnostic Observation Schedule (ADOS). This is considered the gold standard for diagnosing ASD and typically involves an hour-long interview along with observations of your social behaviour to assess how you interact with others.

How therapy can help adults with autism

While autism is a lifelong condition, the right support can help individuals with Autism Spectrum Disorder (ASD) lead fulfilling lives. Psychotherapies, for instance, can address specific challenges that adults with autism face, such as emotional regulation and social interactions.

Cognitive Behavioural Therapy (CBT) and Mindfulness-Based Therapy (MBT), in particular, are especially helpful for managing emotional challenges that often co-occur with autism, such as anxiety and depression.

Cognitive Behaviour Therapy (CBT)

Cognitive Behavioural Therapy (CBT) is a structured, goal-oriented form of psychotherapy that helps individuals identify and modify unhelpful thinking patterns, emotions, and behaviours. For adults with autism, who often experience heightened anxiety, social challenges, , CBT can be an effective tool for improving emotional regulation, social understanding, and daily coping skills.

For example, if you find social situations daunting, you might work with a therapist to replace anxiety-provoking thoughts (e.g., “I won’t make friends”) with more balanced alternatives (e.g., “I can try talking to someone and see how it goes”). Your therapist may also guide you in increasing emotional awareness and understanding of others’ perspectives, and also help you develop practical strategies for managing anxiety.

Mindfulness-Based Therapy (MBT)

Mindfulness-based therapy teaches individuals to focus on the present moment in a non-judgmental and accepting way. For autistic adults, who often experience sensory overload, intense emotions, and repetitive thought cycles, mindfulness can be particularly grounding. It encourages the observation of internal experiences — thoughts, feelings, and bodily sensations — without immediately reacting or becoming overwhelmed.

For example, your therapist may guide you through exercises to facilitate mindfulness awareness of thoughts, emotions and bodily sensations, learning to notice them without being caught up in them or attempting to change them, thereby increasing psychological flexibility and potentially reducing psychological distress. 

Intellect Clinic: Navigating Adult ASD

Suspecting that you might have autism as an adult can stir up many feelings—overwhelm, confusion, or even relief. Navigating life and relationships can be frustrating when your view of the world seems out of sync with others’ experiences, but you don’t have to do it alone.

At Intellect, we offer individual therapy to help you navigate any challenges, including those related to adult autism. Our client-centered approach focuses on understanding your perspective, recognising your strengths, and adapting to your needs—building on what you do well and empowering you to thrive.

Reach out to us for an assessment today.