When To Consider An Autism Diagnosis: Real World Examples Of Diagnostic Criteria

Do you physically struggle when a motorcycle or loud car whizzes by? Are you often obsessive when it comes to your interests and hobbies? Do jokes or sarcasm go right over your head? It’s possible autism spectrum disorder (ASD) may be the answer to some of your lifelong, confusing, and unexplained challenges and quirks.

Connection

Difficulties with social connections are one of the most, if not the most, widely discussed and researched struggles for those on the Autism spectrum, and a neon sign within the therapeutic relationship that a client may be on the spectrum. Those on the spectrum often find themselves feeling out of place socially, as though something is “wrong” or “awkward” about them when interacting with the general public. For those with high-masking ASD, it may be difficult to specifically identify such instances, so don’t discount a vague sense of being different.

Folks who are autistic often engage in scripting and imitation, although again this isn’t always obvious. While some with autism will repeat lines from media or others to use in their own conversations, high-masking individuals are more likely to spend time mentally preparing for conversations and practicing social behaviors as a way to prevent potential challenges and bring about greater success with connection. 

While struggling with jokes and sarcasm is a widely experienced concern for those on the spectrum, it’s not always the autistic individual who misses the joke. Many ASD individuals have a great sense of humor and may be especially drawn to puns and delivering jokes in a deadpan manner.

Additionally, many autistic individuals, especially those who are high-masking, may be capable of mirroring eye contact, tone of voice, and posture; however, internally they find these tasks difficult and draining to monitor, and near impossible to manage when they are experiencing increased stress. It’s not uncommon for folks to find that this monitoring becomes more and more challenging over time, and this may partially account for why many folks are looking at an autism diagnosis late in life. 

Some other examples of connection challenges include:

• Difficulty understanding dishonesty and avoiding lying to others
• Preparing for future conversations and having a continuous inner dialogue about what to say and how to act socially
• Tending to overshare or monopolize conversations

Capacity

Cyclical periods of burnout and the consistent feeling that one can’t “keep up” with adult life are a telltale sign that one may be autistic, particularly for those who are considering a later-in-life diagnosis. The expectations surrounding Western work culture and adulting in the modern age take a significant physical and mental toll for autistic individuals, and it’s not unusual for them to feel they can either work or manage the household, but not both.

This stress often leads to the autistic individual needing a sacred period of isolated recharging following work, school, or even social interactions. It’s not uncommon for folks to switch jobs often or engage in repeated periods of unemployment due to burnout. In the most extreme cases, these struggles with capacity due to autism can result in ongoing economic and housing instability.

The limited capacity that those on the autism spectrum experience also can lead to a limited social life due to the demands new experiences and connections often require. As shared earlier, those who are autistic find it especially challenging to balance social connection, work, and

instrumental activities of daily living (IADLs) as the recovery time for each can be vast.

More examples of common capacity struggles are:

• Dreading upcoming events or appointments
• Making social plans and then cancelling them
• Avoiding mundane tasks, like chores and errands
• Feeling relief when one can stay home and engage in hobbies

 

Sensory

Sensory challenges are another notable daily struggle for those on the autism spectrum. Sensory issues are not specific to autism, but frequently co-occur. Some of these sensory challenges include, but are not limited to, eating the same foods/meals repeatedly, only wearing specific fabrics or styles of clothing, sensitivity to certain smells, sounds, lighting, and textures, being easily startled, and becoming overwhelmed and fatigued by many sensory experiences occurring at once.

Sensory sensitivity is why many autistic individuals dislike crowded, loud, and well-lit spaces. Many avoid concerts and festivals, or also grocery stores and malls. Some can tie their overwhelm back to specific sensory triggers, while others may simply have an intense urge to leave without really knowing why.

When talking about sensory issues, most people think of external experiences. Many of those who are autistic struggle with interoception, or internal body signals. They may find they are clumsy or bump into things a lot, or also have challenges with gross motor skills, like throwing a ball. You’re also more likely to struggle with noticing the subtle signs that tell you that you need to eat or go to the bathroom.

Other sensory signs include:

• Buying multiples of the same outfit or shoes
• Sensitivity to sensory input when trying to sleep
• Retaining use of comfort items as an adult, such as plushies
• Heightened hearing, esp. of background noises
• Auditory processing disorder
• Avoidant/Restrictive Food Intake Disorder (ARFID)
• Sensory seeking (spinning, rocking, stimming)

 

Special Interests and Hobbies

We all know the autistic stereotype of an individual obsessed with certain topics, like trains, certain periods of history, or fandoms. It’s not just the topic of obsession, but the nature of the obsession itself that may suggest someone is in fact on the spectrum. For autistic folks, their entire world, personhood, and even routine can be dictated by their interest or interests. These obsessions also work as an escape mechanism when overwhelmed, lonely, or when needing a place to lay their head.

Sometimes it’s obvious that a hobby is in fact a special interest; however, for many, including those who are AFAB or BIPOC, it may be less clear-cut. Many individuals born and raised female or who are BIPOC have special interests that align with gender-stereotyped and culturally expected hobbies, which can be easily missed if providers only look at the topic of the hobby rather than the intensity. Some examples of such special interests include pop culture, psychology, reading/writing, art, and social justice themes. For high-masking individuals, special interests can also intertwine with what one does for a living, and when this happens, the intensity can be overlooked completely.

Some relatable experiences of this could be:

• Not only watching, listening, or reading the same shows, artists, and books over and over again but immersing oneself fully in the fictional world or being an expert on the creators
• Using one’s special interest to help emotionally regulate
• Accumulating an “encyclopedic” amount of information about specific topics
• Hobbies are limited and change infrequently
• Finding it challenging to move one’s attention away from the current hyperfixation, even to do work or care tasks

 

Emotions

Within the autistic brain, emotions are often a difficult and overwhelming experience. Alexithymia, a comorbid experience in about 50% of autistic individuals, is a condition where individuals find it difficult not only to verbalize how they are feeling but to even register the emotion itself. Many who are autistic can identify when they are feeling good or bad and not much in between, making it difficult not only to understand one’s emotional responses but to effectively regulate them.

Those on the spectrum also often have emotional processing delays, making understanding and expressing emotions an even more uniquely challenging experience. It’s not uncommon for autistic individuals to seem fine during an interaction and hours or days later feel the full weight of their nervous system reacting to what is already done and over with.

Examples of emotional concerns include:

• Having difficulty identifying emotions unless they are extreme
• “Overreacting” to situations others think aren’t a big deal
• Experiencing feelings of confusion and overwhelm frequently
• Frequent meltdowns or shutdowns

 

Sense of Self

For folks on the spectrum, masking can make it challenging to have a clear, strong self-understanding. This weakened sense of self creates a need to try out different personas, and it’s not unusual for autistic individuals to be “chameleons”, imitating others as a means to fit in. Although it may work socially for a while, pretending to be someone you’re not is not only unsustainable, but it also takes a toll emotionally.

In addition to the effects of masking, for many on the spectrum, the messages they received throughout their lifetime from the allistic and neurotypical world is often negative. Being the recipient of this negative messaging over and over again can lead to challenges in cultivating a healthy sense of self-esteem and self-worth.

Some examples of these experiences are:

• Feeling “not human,” misplaced, and chronically misunderstood
• Imitating and basing one’s personality on public figures, fictional characters, or those within their social group
• Feeling trapped between being authentic and wanting to “fit in”