While the term “Asperger’s Syndrome” was replaced with the DSM-5 updated term of Autism Spectrum Disorder (ASD), colloquially, the term still applies to a subsection of those who are on the spectrum. Our collaborative network of providers is fortunate to include Stuart Robinson, PhD, a local expert on ASD and its presentation in adulthood. When we asked Dr. Robinson to help us define the differing characteristics between a childhood presentation of ASD and how this manifests in adulthood, he gave us some great information, that we are now passing along, to you!
Dr. Robinson shared that adults have the same set of symptoms and criteria of ASD, but that you may need to look harder, or “ask the right questions” to identify the symptoms. He added that, “Adults make eye contact, or they appear to. Really they are focusing on something to appear like they are making eye contact, like the other person’s forehead, or a spot between someone’s eyes instead of into their eyes, or the wall behind the person speaking. Unlike children, adults have heard other adults telling them that not looking people in the eye is considered impolite throughout their childhood and teen years, or have been continuously accused of not paying attention. Therefore, they eventually learn to appear as though they are looking people in the eyes, or ‘Masking.”
To elaborate more on masking, Dr. Robinson shared that adults on the spectrum will hide their nervousness or repetitive movements in more subtle ways than a child may, such as tapping their foot, or chewing the inside of ones’ mouth. When asked, an adult will freely admit that they are hiding their anxiety in this way. Adults also hide their social anxiety and use social skills and attempts that have been learned throughout the years to “get by.” When asked, an adult on the spectrum will describe near daily intense social and communication difficulties.
Resistance to change is often considered a hallmark feature of an ASD diagnosis. In children, it is more readily apparent, a child who resists day to day changes, or within a week. An adult may have their ASD resistance to change manifest in resistance to leaving a dysfunctional marriage, or career. While children will have visible meltdowns, an adult tends to withdraw, and may take a day off of work, or need to sleep more than usual after a few days of intense social interactions. While a child with ASD is often described as having “inappropriate facial expressions,” an adult may appear more natural in their expression, particularly smiles. However, when asked, many adults with ASD will admit that they have rehearsed specific smiles and laughs for different situations.
Restricted interests are another symptom that may be more apparent in children, as opposed to adults. While there are many adults who are outspoken in their intense interest for Harry Potter, Doctor Who, or anime, others may have their restricted interests channeled into politics, individual rights and freedoms, a strong sense of justice and right and wrong, along with some concrete or black-and-white thinking. They may also report having more obsessive thoughts about their interests, as opposed to children who may act out their interests.
Growing up on the spectrum includes a lot of trial and error. This is particularly true of self-care – while this is something that parents lament their child or adolescent on the spectrum struggles with, after years of embarrassment and efforts to fit in, an adult on the spectrum likely has better hygiene than a child. Dr. Robinson added that there are “hundreds more examples,” but as with all things ASD, individual differences tend to be the most informative. If you’ve met one person with ASD, you’ve met one person. This does explain why having a detailed childhood history is important for diagnosis, but as Dr. Robinson put it, asking the right questions can offer up valuable information about the inner world, and thought process, of the adult mind.