Recognizing Autism Indicators in Adulthood: When to Get an Assessment

If you've spent your life feeling like you're operating from a different playbook than everyone else—working harder to understand social situations, managing overwhelming sensory experiences, or carefully rehearsing conversations—you might be among the millions of adults with undiagnosed autism. Recent research indicates that many autistic adults, particularly women and individuals from marginalized communities, often reach adulthood without receiving an accurate diagnosis (1). This delay in recognition can profoundly impact mental health, self-understanding, and access to appropriate support.

Understanding autism indicators in adulthood requires looking beyond stereotypical presentations. Many adults have developed sophisticated coping strategies that mask their autistic traits, making identification more complex but no less important. Whether you're questioning your own experiences or supporting someone you care about, recognizing these often-hidden signs can be transformative. An autism assessment provides more than just a label—it offers a framework for understanding yourself, accessing tailored support, and connecting with a community that shares similar experiences.

The Hidden Face of Adult Autism: Understanding Masking and Camouflaging

Masking, also known as camouflaging, represents one of the most significant yet overlooked aspects of autism in adults. This unconscious or deliberate strategy involves suppressing natural autistic behaviors while mimicking neurotypical social patterns (2). While masking can help autistic individuals navigate social situations and professional environments, research shows it comes at a considerable cost to mental health and authentic self-expression.

The Camouflaging Autistic Traits Questionnaire (CAT-Q), developed by researchers to measure these behaviors, identifies three core components of masking: compensation (developing workarounds for social difficulties), masking (hiding autistic characteristics), and assimilation (trying to fit in with non-autistic people) (3). Adults who engage in high levels of masking often report feeling exhausted, anxious, and disconnected from their true selves. This constant performance can lead to autistic burnout—an overwhelming state of physical and emotional exhaustion that significantly impacts daily functioning.

Women and gender-diverse individuals are particularly likely to engage in masking behaviors, which partially explains why they're often diagnosed later than men (4). These individuals may have spent years observing and copying social behaviors, creating elaborate scripts for different situations, and suppressing their natural responses to sensory stimuli. If you find yourself mentally rehearsing conversations, forcing eye contact despite discomfort, or hiding self-soothing behaviors like fidgeting, you might be experiencing masking without realizing it.

Sensory Sensitivities: More Than Just Preferences

Sensory processing differences are now recognized as a core feature of autism, included in the diagnostic criteria since 2013 (5). These aren't simply preferences or quirks—they represent fundamental differences in how the nervous system processes and responds to sensory information. Adults with autism may experience both hypersensitivity (over-responsiveness) and hyposensitivity (under-responsiveness) to various stimuli, often simultaneously across different senses.

Common sensory sensitivities in autistic adults include:

• Overwhelming reactions to fluorescent or LED lighting

• Difficulty filtering background noise in conversations

• Strong aversions to certain textures in clothing or food

• Becoming overwhelmed in crowded or busy environments

• Needing pressure or movement to feel regulated

• Not noticing hunger, pain, or temperature changes

These sensory differences can significantly impact daily life, from workplace productivity to social relationships. Many adults develop elaborate strategies to manage their sensory environment—wearing noise-canceling headphones, choosing specific fabrics, or avoiding certain spaces entirely. While these adaptations can be helpful, understanding the root cause through proper assessment and diagnosis can lead to more effective support strategies and workplace accommodations.

Social Scripting: When Conversations Feel Like Performance

Social scripting—the use of pre-learned phrases, responses, or entire conversations—is a common but often misunderstood aspect of autism in adults (6). This isn't simply being prepared or having good manners; it's a fundamental strategy for navigating social interactions that don't come naturally. Adults who rely on social scripts often describe feeling like actors playing a role, carefully selecting appropriate responses from their mental database rather than responding spontaneously.

Scripting can manifest in various ways:

• Memorizing conversation starters and responses for different situations

• Borrowing phrases from movies, books, or other people

• Creating detailed mental flowcharts for social interactions

• Rehearsing phone calls or meetings extensively beforehand

• Struggling when conversations deviate from expected patterns

While scripting can be an effective coping mechanism, it requires significant cognitive resources and can be exhausting to maintain. Many adults report that their scripts work well for routine interactions but break down in unexpected situations or during emotional conversations. This disconnect between scripted responses and genuine expression can contribute to feelings of isolation and imposter syndrome, even in seemingly successful social situations.

Different Presentations: Why Autism Often Goes Unrecognized

Autism presentations in adults can vary dramatically from traditional diagnostic expectations, which were historically based on studies of young boys (7). This diversity in presentation means many adults, particularly those who are highly intelligent or have developed effective coping strategies, may not fit the stereotypical image of autism. Understanding these varied presentations is crucial for accurate identification and assessment.

Adults with undiagnosed autism often share certain experiences:

• Feeling fundamentally different from peers since childhood

• Developing intense, focused interests that provide comfort and structure

• Struggling with implicit social rules and unwritten expectations

• Experiencing anxiety or depression that doesn't respond well to traditional treatments

• Finding comfort in routines and predictability

• Having a history of being labeled as "quirky," "intense," or "too sensitive"

Many adults discover their autism after their children receive a diagnosis, recognizing similar patterns in themselves. Others may have been misdiagnosed with conditions like social anxiety, ADHD, or borderline personality disorder before finally receiving an accurate autism diagnosis. The intersection of autism with other neurodevelopmental conditions is common—research shows that 50-70% of autistic individuals also have ADHD (8).

When to Seek Professional Evaluation

Determining when to pursue a professional autism assessment is a personal decision that depends on individual circumstances and needs. However, certain indicators suggest that an evaluation could be beneficial for understanding yourself and accessing appropriate support. Consider seeking an assessment if you experience persistent challenges in multiple areas of life that seem to stem from fundamental differences in how you process information and interact with the world.

Key indicators that an assessment might be helpful include:

• Chronic exhaustion from social interactions despite appearing successful

• Long-standing difficulties with changes in routine or unexpected events

• Sensory sensitivities that significantly impact daily activities

• Feeling like you're constantly translating between your internal experience and external expectations

• Mental health concerns that haven't improved with standard treatments

• Relationship difficulties stemming from communication differences

An autism assessment for adults involves comprehensive evaluation by qualified professionals who understand how autism presents across the lifespan. At ScienceWorks, we use modern, neurodiversity-affirming assessment tools including the MIGDAS-2 and DIVA-5, which are specifically designed to identify autism in adults who may have been missed by traditional screening methods. Our approach recognizes that many adults have developed sophisticated masking strategies that can obscure autistic traits during brief clinical encounters.

Diagnostic Considerations for Adults

The diagnostic process for adult autism requires specialized expertise and a comprehensive understanding of how autism manifests across different life stages and contexts (9). Unlike childhood assessments, adult evaluations must account for decades of learned coping strategies, co-occurring mental health conditions, and the absence of early developmental records. This complexity underscores the importance of working with clinicians who specialize in adult autism assessment.

Modern diagnostic approaches emphasize:

• Detailed exploration of current and historical experiences

• Recognition of masking and camouflaging behaviors

• Assessment of sensory processing patterns

• Evaluation of executive functioning and daily living skills

• Consideration of how gender, culture, and other identities influence presentation

• Screening for common co-occurring conditions

The diagnostic criteria themselves focus on persistent patterns in social communication and interaction, along with restricted, repetitive patterns of behavior, interests, or activities (10).

However, experienced clinicians understand that these criteria can manifest subtly in adults who have spent years adapting to neurotypical expectations. What might appear as social competence could actually represent exhausting scripting efforts, and special interests might be hidden or channeled into socially acceptable careers or hobbies.

Moving Forward: The Value of Understanding

Receiving an autism diagnosis as an adult can be profoundly validating and transformative. Many adults describe it as finally having an explanation for lifelong struggles, a framework for understanding their strengths and challenges, and permission to stop forcing themselves into neurotypical molds. Beyond personal validation, a formal diagnosis can provide access to workplace accommodations, specialized therapy approaches, and communities of support.

The journey toward autism assessment and diagnosis is deeply personal. Some adults choose to pursue formal evaluation immediately upon recognizing autistic traits in themselves, while others take time to explore and reflect before seeking professional assessment. There's no wrong approach—what matters is finding the path that feels right for you. Whether you're just beginning to question whether you might be autistic or you're ready to take the next step toward formal evaluation, understanding these adult autism indicators can guide your journey toward self-discovery and support.

If you recognize yourself in these descriptions and feel that an assessment could provide clarity and direction, we encourage you to reach out. Our comprehensive assessment process is designed to honor your lived experience while providing the thorough evaluation needed for accurate diagnosis and effective support planning.

About the Author

Dr. Kiesa Kelly is the owner and lead psychologist at ScienceWorks Behavioral Healthcare, bringing over 20 years of experience in neuropsychological assessment and autism diagnosis. As both a clinical psychologist and the parent of an autistic individual, Dr. Kelly combines professional expertise with personal understanding to create assessment experiences that are thorough, respectful, and affirming. Her training includes specialized certification in modern autism assessment tools designed to identify previously undiagnosed adults, particularly women and non-binary individuals.

Dr. Kelly's approach emphasizes the importance of recognizing autism across diverse presentations and life experiences. She has completed extensive training in neurodiversity-affirming assessment practices and maintains active involvement in autism research and advocacy communities. Her commitment to accessible, comprehensive assessment has helped countless adults finally understand themselves and access the support they deserve. Learn more about Dr. Kelly's background and approach.

Disclaimer

This content is for informational and educational purposes only and is not intended as medical advice or a substitute for professional healthcare services. Every individual's experience with autism is unique, and what applies to one person may not apply to another. If you suspect you may be autistic, please consult with qualified healthcare professionals who specialize in adult autism assessment. The information provided here reflects current understanding as of the publication date and may not include the most recent research developments. Always seek the guidance of qualified health providers with any questions you may have regarding your mental health or neurodevelopmental concerns.

References and Citations

1. Lai, M. C., & Baron-Cohen, S. (2015). Identifying the lost generation of adults with autism spectrum conditions. The Lancet Psychiatry, 2(11), 1013-1027. DOI: 10.1016/S2215-0366(15)00277-1

2. Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M. C., & Mandy, W. (2017). "Putting on My Best Normal": Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519-2534. DOI: 10.1007/s10803-017-3166-5

3. Hull, L., Mandy, W., Lai, M. C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V. (2019). Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819-833. DOI: 10.1007/s10803-018-3792-6

4. Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281-3294. DOI: 10.1007/s10803-016-2872-8

5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. DOI: 10.1176/appi.books.9780890425596

6. Fiebich, A. (2017). Pluralism, social cognition, and interaction in autism. Philosophical Psychology, 30(1-2), 161-184. DOI: 10.1080/09515089.2016.1261394

7. Lockwood Estrin, G., Milner, V., Spain, D., Happé, F., & Colvert, E. (2021). Barriers to autism spectrum disorder diagnosis for young women and girls: A systematic review. Review Journal of Autism and Developmental Disorders, 8(4), 454-470. DOI: 10.1007/s40489-020-00225-8

8. Hours, C., Recasens, C., & Baleyte, J. M. (2022). ASD and ADHD comorbidity: What are we talking about? Frontiers in Psychiatry, 13, 837424. DOI: 10.3389/fpsyt.2022.837424

9. Huang, Y., Arnold, S. R., Foley, K. R., & Trollor, J. N. (2020). Diagnosis of autism in adulthood: A scoping review. Autism, 24(6), 1311-1327. DOI: 10.1177/1362361320903128

10. Lord, C., Brugha, T. S., Charman, T., Cusack, J., Dumas, G., Frazier, T., ... & Veenstra-VanderWeele, J. (2020). Autism spectrum disorder. Nature Reviews Disease Primers, 6(1), 1-23. DOI: 10.1038/s41572-019-0138-4