Autism in adulthood: Understanding, recognising and rethinking high-functioning autism

Introduction: Autism in adulthood

How does it feel when everything you thought you knew about autism is suddenly called into question?

For many adults with autism, new research findings mean exactly that: insights that emphasise diversity, strengths and individual differences. Autism is no longer seen as a deficit, but as a natural form of human development.

High-functioning autism describes a form of autism spectrum disorder (ASD) in which those affected have average or above-average cognitive abilities and often function independently in everyday life. Nevertheless, symptoms such as limitations in social interaction, special interests, difficulties with nonverbal communication or a need for clear routines are clearly evident. High-functioning autism in adults often goes undiagnosed for a long time, as external adaptability can mask potential social or emotional distress.

What it's all about:

• What autism and autism spectrum disorders (ASD) mean in adulthood

• Why high-functioning autism in adults is often overlooked

• The role of an autism diagnosis in adulthood

• How new scientific findings are influencing diagnosis and treatment

What does autism spectrum disorder mean in adulthood?

Autism spectrum disorders (ASD) describe neurological characteristics that affect social interaction, communication, perception and behaviour and can manifest themselves in very different ways.

Important to know: Autism covers a broad spectrum of characteristics, including Asperger syndrome and atypical autism. People with autism develop individual strengths, coping strategies and needs.

In the ICD-10 classification system, autism spectrum disorders are considered profound developmental disorders. Typical characteristics include abnormalities in social interaction, repetitive behaviour patterns and special interests. These characteristics are present from early childhood but may change over the course of a lifetime or appear less noticeable due to compensatory mechanisms.

A study published in Nature Reviews Disease Primers in 2020 emphasises that autism in adulthood encompasses a wide variety of conditions, ranging from high-functioning autism to atypical autism and various manifestations of Asperger syndrome. Why this perspective is crucial:

Only when the diversity of autism symptoms is recognised can accurate diagnosis and individually tailored therapeutic support be provided.

Recognising symptoms of autism in adults

Many people associate autism with stereotypes: oddballs, uncouth, taciturn, shy, extremely dependent on routines. However, this image falls far short of the mark.

Current research shows that

• Symptoms of autism appear very differently – especially in adulthood

• Autism can manifest differently in girls and women than in men

• People with high-functioning autism often mask symptoms, making clinical diagnosis difficult

Typical symptoms can include

• Difficulties with non-verbal communication (e.g. eye contact, facial expressions)

• Overstimulation by noise, light or touch

• Strong attachment to routines and fixed procedures

• Intense preoccupation with special interests

• Problems interpreting social rules or unspoken expectations

Real-life effects:

People with autism often face particular challenges in social interactions, at work and in sensory-stimulating environments.

Particularly common in adults:

Autism often goes undiagnosed, even though symptoms such as social anxiety, difficulties with non-verbal communication or sensory overload were present in early childhood.

Masking autistic traits – known as ‘camouflaging’ – is particularly common among women and high-functioning autistic individuals. This can lead to exhaustion, depression or anxiety disorders.

Causes and development of autism

The exact causes of autism are still not fully understood. Research findings point to a complex interaction between genetic and environmental factors.

• Genetic influences are considered one of the strongest risk factors.

• Neurobiological characteristics primarily affect neural connectivity and signal processing in the brain.

• Environmental factors during pregnancy, such as infections or metabolic disorders, can increase the risk, but are not decisive on their own.

Autism is not the result of parenting mistakes or traumatic experiences, but reflects an innate neurodiverse development.

Why these findings are important:

A better understanding of the biological basis helps to reduce prejudice and feelings of guilt and to strengthen social acceptance of neurodiverse ways of life.

Common additional diagnoses in adulthood

Autism often does not occur in isolation. Many adults with autism have additional mental or neurological diagnoses:

• Anxiety disorders (e.g. social phobia, generalised anxiety disorder)

• Depression

• ADHD (attention deficit/hyperactivity disorder)

• Eating disorders

• Obsessive-compulsive

These so-called comorbidities often make it difficult to make a clear diagnosis, as they can overlap with or mimic autistic symptoms.

Special feature:

A differentiated diagnosis and treatment that takes into account both autism and comorbidities is crucial for a lasting improvement in quality of life.

Diagnosis and therapy for autism in adulthood

The diagnosis of autism in adults is based on a comprehensive medical history, structured interviews, standardised tests and behavioural observations.

Contact points such as the Autism Outpatient Clinic for Adults at Charité-Universitätsmedizin Berlin offer specialised diagnostic procedures. Unfortunately, the waiting times for an assessment are absurdly long for patients with statutory health insurance, if new patients are accepted at all.

Therapy approaches:

• Psychoeducation: Acquiring knowledge about autism and developing strategies

• Cognitive behavioural therapy measures adapted to autistic thinking and perception styles

• Social skills training in small groups

• Support with professional integration and stress management

Why a diagnosis is important:

A diagnosis enables those affected to understand themselves better, re-evaluate their life story and find targeted support.

Note:

The earlier tailored therapeutic support begins, the better comorbid stress can be mitigated.

Vocational integration of adults with autism

People with autism have valuable skills for the workplace:

• Precision

• Perseverance

• Systematic problem solving

• Analytical thinking

Nevertheless, they often encounter barriers:

• Difficulties with small talk and informal communication

• High demands on flexibility and multitasking

• Sensory overload in open-plan offices

Supportive measures can include:

• Clear task descriptions

• Structured, low-stimulus working environment

• Raising awareness among colleagues and managers

• Option to work from home or have quiet rooms

People with autism have valuable skills that make them a great asset to the workplace. They often work with exceptional precision, show impressive perseverance and impress with their systematic approach to problem solving. Analytical thinking is also one of the particular strengths that many of them bring to teams and projects.

Despite these resources, people with autism encounter structural barriers in many professional environments. Difficulties with small talk and informal communication make it hard for them to feel confident in unstructured social situations. In addition, the high demands for flexibility and multitasking that are often expected in modern workplaces pose particular challenges. Open-plan offices, where there is constant sensory overload from noise, light and movement, often lead to rapid overload.

This makes supportive measures that enable sustainable professional integration all the more important. These include clear and unambiguous job descriptions, a structured, low-stimulus working environment and raising awareness among colleagues and managers of the specific characteristics of autistic people's experiences and behaviour. Flexible working models, such as home office or the provision of quiet rooms, can also make a decisive contribution to ensuring the long-term employability and well-being of autistic employees.

The goal of an inclusive workplace is not only to break down barriers and promote individual strengths – it also benefits significantly from the diverse perspectives, exceptional problem-solving skills and creative thinking that many people with autism bring to companies.

The media must update its portrayal of autism

Autism is often misrepresented in the media:

• As a tragedy (‘victims of autism’) – often linked to anxiety disorders

• As exceptional genius (‘Savant syndrome’)

• As a pure source of inspiration (‘successful despite autism’)

Modern reporting should:

• Portray people with autism authentically and respectfully

• Make everyday experiences visible

• Avoid stereotypical portrayals

• Actively include autistic voices

Authentic portrayals promote social acceptance, support early diagnosis and counteract prejudice.

In public portrayals, autism is still often presented in a misleading or distorted way. Media reports often focus on extreme representations: either autism is portrayed as a tragedy associated exclusively with suffering and anxiety disorders, or individuals are portrayed as ‘geniuses’ who achieve extraordinary feats. Another stereotypical narrative depicts autistic people as ‘heroes’ who achieve social recognition despite supposedly insurmountable obstacles.

These simplified narratives do not do justice to the complexity and diversity of autistic realities. Rather, they contribute to reinforcing prejudices, raising unrealistic expectations or exacerbating existing uncertainties in dealing with those affected.

Modern, responsible reporting on autism should therefore observe several basic principles:

It should portray autistic people authentically and respectfully – without idealising or pitying them. It should make everyday life and individual experiences visible, rather than focusing one-sidedly on special achievements or deficits. Above all, however, those affected should have their say and their perspectives should be actively incorporated into the public portrayal.

Why this is so important:

Differentiated, realistic reporting promotes social acceptance, facilitates early and accurate diagnosis of autism in adults, and helps to break down existing prejudices in the long term.

Conclusion: Rethinking autism in adults

Autism in adulthood is diverse, dynamic and deeply human.

New scientific findings are breaking with old deficit models and emphasising strengths, individual needs and opportunities for development.

For many affected individuals, a diagnosis in adulthood means the first complete understanding of their own biography.

For therapists, doctors, the media and society as a whole, it means the task of further developing diagnostics, therapy and public representation.

It is time to stop viewing autism as a condition that needs to be ‘cured’ and instead see it as part of the natural diversity of human development.

FAQ: Frequently asked questions about autism in adults

Basics of autism

What is autism in adults?

Autism in adults describes a neurologically based difference in perception, communication and social behaviour that is often only recognised at a late stage.

What is an autism spectrum disorder?

An autism spectrum disorder (ASD) encompasses various manifestations characterised by social interaction problems, limited interests and stereotypical behaviours.

Are there different types of autism?

Yes, these include early childhood autism, atypical autism, Asperger syndrome and high-functioning autism.

How does autism develop in adults?

Autism does not develop in adulthood, but is a congenital neurological developmental variation.

Are there signs of autism before birth or during pregnancy?

Research suggests that genetic and neurobiological factors may play a role even before birth.

Early signs and symptoms

How early can signs of autism be detected?

The first signs often appear in early childhood in the form of limited eye contact, delayed speech development or a lack of interest in social interaction.

What are the typical symptoms of ASD?

Typical symptoms include limited social communication, stereotypical behaviour patterns and intense, often unusual interests.

What are autistic traits in adults?

Autistic traits include directness in communication, a strong need for structure and sensory sensitivity.

How does autism manifest itself in adults?

In adults, autism often manifests itself in difficulties with spontaneous social interactions, a strong need for routine and special areas of interest.

What is typical for adult autistic people?

Typical characteristics include a high degree of attention to detail, special interests and challenges in social interaction.

How does an autistic adult behave?

Many autistic adults prefer direct, clear communication and find casual small talk exhausting.

How does autism manifest itself in adult women?

Women are more likely to mask their symptoms, adapt to social expectations and are therefore diagnosed less often or later in life.

Why do men sometimes have different symptoms than women?

Men tend to show more direct symptoms, while women develop stronger social strategies to compensate.

Diagnosis of autism in adulthood

How can you recognise autism in adults?

Through persistent difficulties in social situations, sensory sensitivities and a strong need for routines.

How can you recognise autism in adults?

Through social insecurity, intense special interests and non-verbal communication difficulties.

How can I recognise autism in adults?

Through a different way of dealing with social situations, special perception processing and fixed habits.

How can autism be recognised in adults?

Through observation of social interactions, analysis of communication patterns and standardised testing procedures.

Why does autism often remain undetected in adults?

Because many affected individuals have learned to mask their symptoms in adulthood or they are misinterpreted.

Why were affected individuals not diagnosed in childhood?

Previous knowledge about autism was limited, and high-functioning forms and female individuals were often overlooked.

How is autism diagnosed in adults?

Through a detailed medical history, standardised interviews (e.g. ADOS-2) and observations in a social context.

How is autism diagnosed in adults?

By specialist psychiatrists or psychotherapists after a comprehensive examination.

How is autism tested in adults?

Through structured diagnostic tools, observation of behaviour patterns and discussions about the person's own life history.

How is autism tested in adults?

Through questionnaires, diagnostic interviews and behavioural analyses.

Who diagnoses autism in adults?

Psychological psychotherapists, medical specialists in psychiatry or specialised outpatient clinics.

Who is allowed to diagnose autism in adults?

Only licensed professionals such as psychiatrists and psychological psychotherapists.

Which doctor diagnoses autism in adults?

Specialists in psychiatry or specialised centres such as autism clinics.

Which doctor tests for autism in adults?

Psychiatrists or specialised psychologists carry out tests and diagnostics.

Who diagnoses autism in adults?

The diagnosis is made by interdisciplinary teams or specially trained professionals.

Living with autism in adulthood

Living with high-functioning autism: what does the diagnosis mean?

The diagnosis brings understanding of one's own personality and opens up specific therapeutic and social support options.

What characteristics do people with high-functioning autism display?

They display strong interests, structured thinking and often intense focus on details.

What strengths do people with high-functioning autism benefit from?

High levels of concentration, analytical thinking, honesty and deep specialist knowledge.

What challenges do autistic people face in everyday life?

Sensory overload, difficulties in social interaction and high demands for adaptation.

Autism in adults: What those affected suffer from in the workplace

Above all, unclear communication structures, frequently changing requirements and sensory overload.

Treatment and therapy

How is autism treated in adults?

Treatment includes psychoeducation, cognitive behavioural therapy, social skills training and, if necessary, medication for comorbidities.

Are there therapies for people with autism?

Yes, such as behavioural therapy programmes, coaching for coping with everyday life and specialised social training.

Are there treatment options for people with mild autism?

Yes, especially therapy programmes that focus on social skills and stress management.

Is autism curable?

Autism is not a disease and therefore cannot be cured. However, supportive therapies can significantly improve quality of life.

Other common questions

What can I do if I think I have autism?

Talk to a medical specialist or specialised psychotherapist to get a proper diagnosis.