Recognizing Undiagnosed Adult Autism in Your Clients

I got a clue that Clark might have undiagnosed adult autism during my first couple’s therapy session with Clark and Shelly, his wife of 20 years.

“The problem is that you never come out of your room!” Clark yelled.

“You know I have anxiety!” Shelly yelled back.

Both had the disheveled and tired look I had seen on dozens of strained couples in my office over the years. He was an IT professional, and she was a stay-at-home-mom.

The Initial Clue My Client May Have Undiagnosed Autism

Shortly before Shelly and Clark arrived in my office for their first session, both of my young boys had been diagnosed with autism.

And I was suddenly intensely aware of the autism spectrum everywhere around me.

During our first conversation Clark said something that made my ears perk up.

“The last time we had sex was four months and 22 days ago. And before that, it was eight months and nineteen days ago. And, the longest time we ever went without sex was four years, six months, and twenty-three days, and we are not going back to that!”

When Shelly turned beet-red in embarrassment, Clark puffed his chest—and something clicked in my head.

My Client’s Additional Signs of Adult Autism

By week three with Clark and Shelly, I highly suspected Clark had adult autism.

There were additional early clues. The memory for dates, obviously. His rigidity. His robotic vocal pattern, and tendency to dominate conversation. The inflexible habits—all highly logical—around which he organized his life. The way he noticed fascinating numerical patterns no one else would.

But Clark had great eye contact. A twenty-year marriage. A successful career. Children he adored—and all this despite being raised by a volatile and abusive alcoholic mother.

I spoke privately with Clark about my hunch that he may have adult autism. 

As a result of our conversation, he saw an autism spectrum disorder specialist who diagnosed him with autism.

Clark found an adult autism support group, read books on adult autism, and he discovered a new understanding of his personality and personal history.

Shelly was able to understand more of his behaviors and quirks, as well, and it helped our couples therapy and their relationship.

Had I not yet learned so much about autism from my own sons’ being diagnosed, I could have easily made the mistake of attributing Clark’s particular personality quirks to the psychological impact of his childhood.

He’s rigid and controlling? Well, life was so unstable with his alcoholic mother.

He’s annoyingly needy? How can you blame him, after all the rejection he’s experienced?

You begin to understand the dangers of clinicians missing the symptoms of autism spectrum disorder.

Clark had had many previous therapists in his life who were not aware of the signs of autism.

If we lack basic skills to recognize adult autism, we will never refer clients to the resources they need.

Signs and Symptoms of Autism in Adults

So, what are the signs and symptoms of adult autism we need to be aware of?

This list is not exhaustive, but any combination of these signs could indicate adult autism:

• A monotone way of speaking or a manner of speaking that doesn’t feel conversational
• Reporting feeling “different” or “alien” throughout life
• History of social awkwardness or being a loner
• Reporting sensory overwhelm in crowded, loud, or bright environments. (Many people with autism spectrum disorder learn to manage and mask these feelings through the use of headphones, sunglasses, fidgets, and other tools.)
• Difficulty with eye contact. A side note: In conversation with Clark, I mentioned that he had great eye contact. “Aha!” he said. “What’s the first thing I do when I sit down? I take my glasses off. I can look right at you but I can’t really see your eyes. That’s the only way I can handle it. I figured that out years ago.” (Talk about a brilliant coping mechanism.)
• Ritualized behaviors—which might make you lean diagnostically towards OCD
• Fixated, obsessive interests
• Difficulty in social interactions. (One ASD woman I counseled used to attend a church group for singles and lamented that socializing was like speaking another language: she could not keep up quickly enough in conversation to react appropriately in time.)
• Difficulty with empathy. (After a terrifying incident at their children’s school in which teachers thought there was an active shooter, Shelly called to thank the teacher for her bravery. “Why would you do that?” asked Clark, genuinely annoyed. “You don’t thank people for doing their job.”)
  If You Suspect Your Client May Have Autism Spectrum Disorder
  The symptoms of ASD listed above are not an exhaustive list, and an autism spectrum disorder diagnosis must be made by a psychologist or psychiatrist who specializes in adult autism.For some adults, an ASD evaluation and diagnosis from a psychologist or psychiatrist can provide comfort, relief, and a clearer path forward. 

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