Adult autism test: Getting tested for autism as an adult
Autism in adults? Yes! Well, technically you can’t develop Autism as an adult. In fact, the DSM-5 or the Diagnostic and Statistical Manual of Mental Disorders created by the American Psychiatric Association explains that the onset of the disorder is in the early developmental stages. Most children show symptoms of autism by 12-18 months of age or earlier. Nonetheless, the disorder can be hidden away inside you. Let us explain. The DSM-5 further indicates that symptoms of autism may take time to fully manifest. Consequently, adults starting to show autistic symptoms or being tested and diagnosed with autism is not unlikely at all.
If you are an adult who suddenly started to show symptoms of autism or know someone who did, it’s not because of a sudden development in the disorder. It’s because the condition was already there but the symptoms were subtle. Alternatively, you may even have been misdiagnosed when you were a child. Yes, that is possible. For instance, have been a lot of cases where autism was misdiagnosed as ADHD (Attention Deficit Hyperactivity Disorder) because of similarities in symptoms.
Now to the central point of this article: getting tested for autism as an adult. Testing autism in adults is far more complicated than children’s tests. Most medical professionals who do autism diagnoses are used to seeing children and are not really trained to diagnose adults. Furthermore, we still don’t know much about how adult autism differs from the children’s variant. Keep on reading to find out how testing is done and how a diagnosis is made.
With respect to the Australian Bureau of Statistics, there were 164000 Australians living with Autism in 2015 which is a 42.1% increase from the 2012 numbers. The prevalence of autism in men was higher than that of women, with every 4 out of 5 from the total number of cases being males. While no statistics on the number of adults with autism have been indicated, it is said that 3/4 of the total number were young. Hence, we could assume that 41000 of these cases were adults. These numbers would have (obviously) increased by now.
What is autism?
Autism Spectrum Disorder (ASD) or simply, autism is a complex developmental condition that is characterized by changes in social interactions, speech, and nonverbal behaviour, and restricted or repetitive behaviour. The complex part of autism comes from its many subtypes. Depending on these symptoms and severity are different in each person. In fact, when it comes to children, no two children show symptoms the same way. For instance, a child diagnosed with autism may have difficulty learning and show signs of lower intelligence whereas another would show high intelligence but have trouble communicating and behaving appropriately in social settings. Consequently, this is one of the reasons why the APA (American Psychological Disorder) modified the diagnostic name of autism in the DSM-5 to “Autism Spectrum Disorder” instead of the previously used sub diagnoses such as Autistic Disorder and Asperger Syndrome.
As mentioned early, the disorder begins really early in life and eventually starts disrupting normal social functioning in social settings such as schools and workplaces. Most children with autism show symptoms in their first year. However, a small percentage of children show normal development in the first year and then go through a period of regression between 18 to 24 months where they develop symptoms.
What causes it?
What causes autism? We are not really sure. What we do know is that there is no single one, instead, there’s a lot. Research over the last decades has indicated many risk factors for the disorder including combinations of genetic and nongenetic factors along with environmental influences. These many roots are also another reason why the disorder was renamed ASD. On the other hand, it is important to keep in mind risk factors may not necessarily cause the disorder, they simply increase the chance of development. For instance, some people with autism-related genetic components do not get the disorder.
Risk factors for autism
Autism may be hereditary. This means that you could get the disorder from certain genes that are passed on to you by your parents (even if parents don’t have the disorder). Some of these changes are a result of the fertilization process in the womb where genetic material from both parents gets together. However, these genetic components will not cause the disorder, instead, they only increase the risk of getting it.
Environmental risk factors
Certain environmental factors further increase the risk of the development of autism in children who are genetically predisposed to the disorder. Some of these factors include,
- Maternal diabetes or obesity
- High parentage
- Prenatal exposure to pesticides, mercury, and air pollution.
- Prematurity or low birth weight.
- Birth difficulties leading to oxygen deprivation in the baby’s brain.
The child’s sex is a risk factor for autism. According to a 2014 paper published in Current Opinions in Neurology, male children are four times more likely to develop autism than female children.
Can vaccines cause autism?
No. Not at all. This is actually a myth. There has been a lot of research on this and none of them has indicated any link between the two. However, there was a 1998 paper by a physician names Andrew Wakefield and 12 others that suggested a link between autism and measles, mumps, and rubella vaccine. This paper was later deemed questionable and exposed for scientific fraud.
Autism symptoms along with severity differ from person to person, consequently, it is difficult to put together a lift of symptoms to look out for. Nonetheless, there are some that have been seen frequently among adults with the disorder.
- Having a hard time interpreting what others are thinking or feeling.
- Problems in interpreting facial expressions, body language, or social cues.
- Getting anxious about social situations.
- Social withdrawal and difficulty making friends.
- Sticking to a very strict routine and not wanting any changes.
- Not participating in a lot of activities.
- Repetitive behaviour patterns.
Getting tested for autism as an adult
We mentioned in the introduction that getting an autism test as an adult was complicated. This is in fact true. At the moment there are no standard diagnostic criteria for adults with ASD. However, with advancements in research and awareness for the disorder growing, we can expect to see one in the near future. That being said, most medical health professionals who diagnose autism do not stick to one type of test, instead, they use a series of in-person interactions and observations.
Furthermore, if you were to do a simple google search on autism testing for adults, you will probably find so many online tests that claim to provide a diagnosis. However, the accuracy of these tests is questionable. We recommend that you see an expert if you are convinced that you have autism or if you have any symptoms.
Who can diagnose you?
The first step must be to visit your general practitioner and tell them about any symptoms you are experiencing or why you think you could be autistic. Your GP then will refer you to someone who could make a diagnosis and treat the condition. This would most likely be a psychiatrist, psychologist, or neurologist.
Types of tests
Interviews will be the main type of assessment used by your medical professional. However, they will not be interviewing you, instead, they will interview a parent, sibling, close friend, or someone you have a close interpersonal relationship with. The questions asked on these interviews usually cover your full developmental history from when you were small. Two examples for diagnostic interviews are the Developmental, Dimensional, and diagnostic Interview-Adult version (3Di-Adult) and the Autism Diagnostic Interview-Revised (ADI-R).
ADI-R is a structured interview of 93 questions that covers three main behavioral areas, each of which focuses on current behavior or behavior at a certain point of the patient who is suspected of having autism. The entire interview takes around 2 hours to administer. Questions of the interview are further grouped into five more sections: opening questions, communication questions, social development and play questions, repetitive and restricted behavior questions, and questions about general behavior problems. After the interview, the clinician rates the answers to each question on a rating scale (present below) and calculates a total score.
- 0: “Behavior of the type specified in the coding is not present”
- 1: “Behavior of the type specified is present in an abnormal form, but not sufficiently severe or frequent to meet the criteria for a 2”
- 2: “Definite abnormal behavior”
- 3: “Extreme severity of the specified behavior”
- 7: “Definite abnormality in the general area of the coding, but not of the type specified”
- 8: “Not applicable”
- 9: “Not known or asked”
The 3Di-Adult is also a structured interview of 69 ordered questions, developed from the childhood/adolescent version of the 3Di. These questions are separated into two different scales: the A scale and the B scale which are again separated into seven subscales. Questions in the A scale are designed to measure a patient’s social communication and interactions whereas questions in the B scale measure restricted, repetitive patterns of behavior, activities, or interests. Each question is scored on a three-point scale (0 = Often, 1 = Sometimes, 2 = Never) or a four-point Likert scale (0 = No, 1 = Yes, minimal, 2 = Yes, persistent, 3 = Yes, persistent with functional impairment) and only takes around 40 minutes to complete. To get the scores for the subscales, the scores of responses for each question are averaged.
These are other types of assessments that can help your clinician get an overview of your condition. Eg: The social communication questionnaire (SCQ). Much like the interviews, you won’t have to fill these. Instead, they will also have to be completed by a parent, sibling, close friend, or someone you have a close interpersonal relationship with.
The social communication questionnaire (SCQ)
The SCQ is designed to measure the communication skills and social functioning in children who may have autism. Nevertheless, it can be used for adults as well. There are 40 yes-or-no questions in the questionnaire, such as “Gets hyperactive, angry, screams, yells often” and “difficulty in expressing needs or desires”. Your loved ones could expect to complete this survey in around 10 minutes.
The Autism Diagnostic Observation Schedule (ADOS)
Your clinician or mental health professional would ask you to perform a stream of structured and semi-structured tasks which involve some amount of social interaction between you and them. For instance, creating a story, describing a picture, and telling a story from a book. The process takes around 30 to 60 minutes to complete and the clinician will finally calculate a score based on certain observations they make.
You may have to go through an IQ test before a diagnosis is made. This can be a complex process and you may be wondering why you even need an IQ test. The reason is that verbal skill deficits are a main symptom of autism. Most IQ tests are built to access age-dependent language skills and since most autistic patients have problems in verbal communication development, these tests could identify them as less intelligent. This of course doesn’t necessarily mean that your IQ is low, it just indicates the presence of autism. Two common specialized IQ tests that you may have to go through are the Wechsler Abbreviated Scales of Intelligence (WASI) and the Test of Premorbid Functioning (TOPF).
Wechsler Abbreviated Scales of Intelligence (WASI)
The WASI scale measures a person’s verbal, nonverbal, and general cognitive functioning to determine how intellectually gifted or impaired they are. It produces three final scores including, verbal, performance, full-scale IQ.
Test of Premorbid Functioning (TOPF)
TOPF enables clinicians to estimate a person’s level of cognitive and memory functioning before the onset of injury or illness. This test is quite small and only takes around 10 minutes to complete and can be used for people aged 16 to 89 years.
What if you get an autism diagnosis?
Your clinician will most likely tell you the results on the same day or a few days after your initial appointment. If you don’t get diagnosed with autism, that’s great but you might need to get yourself for other conditions that are related to autism such as ADHD. However, if you do get diagnosed with autism, that’s great too! You may have a lot of questions. You may want to get to know more about your condition or learn about the services and treatment available to you.
There is no cure for autism. Well, not right now at least. Don’t be discouraged. There is a range of interventions that have been studied for use with autistic patients. These interventions can reduce symptoms, improve cognitive ability and daily living skills, and maximize the ability to function and participate in the community. However, it is important to keep in mind that most of these interventions are specifically designed to treat children and then effectiveness on adults has still not properly been established.
Types of treatment
The types of currently available treatment can be generally taken apart into four approaches: behavior and communication approaches, dietary approaches, medication, and alternative treatment.
Behavior and communication approaches
These interventions are a combination of both behavioral and communication approaches which are administered simultaneously to provide patients with structure, direction, and organization. Behavioral issues of most patients with autism disappear once they learn to communicate their wants and needs effectively.
Applied Behavior Analysis (ABA)
ABA is the most commonly used behavior and communication approach used to treat adults and children. There is a high chance that your clinician will recommend this to you. These include a series of techniques designed to encourage positive behavior by using a reward system. The progress of the patients is tracked and measured. ABA comes in a few forms including,
- Discrete trial training: uses a sequence of trials to teach a positive behavior step-by-step. Correct answers or behavior are rewarded and incorrect ones are ignored.
- Pivotal response training: a learning strategy used in a patient’s everyday environment that teaches them pivotal skills such as motivation to learn or initiate communication.
- Verbal behavior intervention: is a strategy that is directed by a therapist. They will help a patient understand why and how people use language to communicate effectively and get what they want.
- Positive behavior support: making environmental changes to the home, work, or classroom environments to make positive behavior feel more rewarding.
Cognitive Behavioral Therapy (CBT)
CBT is a type of therapy that can help manage a patient’s problems by changing the way they think and behave. In more technical terms, CBT therapy focuses on identifying a patient’s negative or destructive thought patterns that influence their behavior negatively and changing them. Consequently, for autistic patients, it can be an effective form of treatment which will help change their negative behavior and thought.
In a 2018 study published in the Journal of Developmental and Physical Disabilities, participants with ASD who were treated with CBT started to show improvements in symptoms and decreased symptom severity.
Social Skills Training (SST)
SST interventions are used to teach patients social skills. This is important because some of them find it really hard to interact with others. Through this process patients learn basic social skills such as keeping a conversation going, understanding humour and reading emotional cues. Additionally, they also learn problem-solving skills, communicating non-verbally, and accepting and giving compliments.
Sensory integration therapy
Autistic patients are sometimes strangely affected by sensory input. Sensory integration therapy is a form of occupational therapy that involves certain sensory activities which can help patients respond suitably to light, sound, touch, and smell. Some of these activities include art therapy and crafting. The goals of this form of therapy are to help patients focus better, improve their behavior and reduce anxiety.
Occupational Therapy (OT)
This is a therapeutic intervention that teaches children and adults basic skills they need in everyday life. For example, adults will be taught how to live independently, cook, clean and handle money.
Speech therapy is used to help patients communicate better. For adults with autism, this kind of therapy and helps develop their speech, language, and cognitive communication. Two exercises incorporated into speech therapy are oral muscle strengthening exercises and learning to use conversational tactics.
There are no medications that are designed to treat autism specifically. However, medication is often used to treat other medical and psychological conditions that can arise with autism.
- Antipsychotics: Often used to treat aggression, behavioral problems, and self-harm that can surface in both adults and children with autism. Eg: risperidone (Risperdal) and apripiprazole (Abilify).
- Antidepressants: Depression and anxiety are rather common in autistic patients. Research suggests that these rates may be higher in teens and young adults with the disorder. In consequence, antidepressants are used to treat these conditions.
- Stimulants: A type of drug that can temporarily increase mental and physical functioning. They are mainly used to treat ADHD patient’s but they can also be useful in treating symptoms such as impulsivity, hyperactivity, and attention difficulties in autistic patients. Eg: Ritalin, Attenta and Concerta.
- Anticonvulsants: About one-third of people with autism can develop epilepsy. Anticonvulsants are anti-seizure drugs that are useful in treating these patients. Eg: Valproic acid (Depakote) and Phenytoin (Dilantin).
For people with autism, special diets or changes in the food they eat may help reduce symptoms. After all, what we wat can affect our bodies in many ways. A study published in Nutritional Neuroscience stated that gluten and casein-free diets can help reduce the severity of symptoms in autistic patients.
However, there are a few issues with these approaches. To illustrate, there’s not much research on their effectiveness for one thing so it is hard to say if they work with everybody with the disorder. On the other hand, there is no research to show if they are effective on adults with autism. This doesn’t mean that you should completely ignore this approach. There’s a chance you will see results, besides, a good diet can be really good for your health and body. Here are some dietary options that you could follow,
- Yeast-free diet.
- Feingold diet (eliminates additives and chemicals).
- Casein-free diet (Casein is a milk protein).
Complementary and alternative treatment (CAM)
These types of treatment aren’t entirely backed by science. Some of them may be effective but some may even be harmful, it is really hard to say. What is concerning about these novel off-label treatments is that a lot of families actually go out of their way to try them out. Reports say that around 30 to 95% of children with ASD have been given some type of CAM treatment. If you ever consider one of these approaches to treatment it is important to talk to your doctor first and get their opinions. In the meantime, here are some common CAM treatment approaches,
- Dietary supplements: supplements such as magnesium and B6, dimethylglycine, amino acids, omega 3 fatty acids are given to patients.
- Melatonin: ASD patients often experience trouble sleeping and restlessness. Melatonin can help with this. It is a naturally occurring brain hormone that can also be taken in the form of a pill or even inhaled. When absorbed into the body it can improve sleep.
- Chelation therapy: Designed to flush heavy metals such as lead and mercury out of your body. There’s no proof this treatment works and it may even be harmful to some people.
- Relaxation techniques: Techniques such as Jacobson’s relaxation technique which involves tightening and relaxing certain muscle groups in a sequence can be a helpful stress relief technique.
An Adult autism diagnosis isn’t the end of the world
Autism is not a disease or illness, it just means that your brain works slightly differently from other people. You may, however, need support with certain things in your life. It may at first be a little hard to adjust to a new lifestyle and treatment. You just have to be patient and work with your health professional to get the maximum benefit out of treatment.
A word of farewell
If you feel like you have any symptoms of autism or want to clear any doubts please feel free to reach out to us. All you have to do is click the “chat with us” option available on our web page. We have a well-experienced and qualified team of psychologists and psychiatrists available full-time to assist you and help you out.