Today, a child being diagnosed with autism spectrum disorder is common. A few decades ago, it was a much rarer occurrence.
One in 36 children in the United States are diagnosed with autism by age 8, according to the Centers for Disease Control and Prevention. In 2000, just 1 in 150 children had been diagnosed with autism by age 8. Before that, numbers were even lower.
One reason for the increase is that we know much more about autism now. Medical providers, teachers and others who work with children are more aware of the symptoms, leading to an increase in referrals, comprehensive evaluations and ultimately the diagnosis of autism, says Laura G. Klinger, PhD, executive director of the UNC TEACCH Autism Program, which provides services for people with autism and training for professionals who work with them.
Another reason is that over time, the diagnostic criteria have changed and people with higher intellectual ability and milder symptom presentations are also diagnosed with autism.
This means that people who were children decades ago might have had autism, but nobody checked or the diagnosis was missed. (There’s evidence that many people who weren’t considered autistic in the 1980s would be today.)
“One of the things we think about as we see the rates of autism increase is whether some people who are now adults were just never diagnosed as children,” Dr. Klinger says.
As more is known about autism spectrum disorder, adults are becoming more aware of their symptoms and asking to be evaluated. Some learn about symptoms when their own children are diagnosed.
“It’s a more common request than it used to be,” Dr. Klinger says. “We’ve recognized that you can be very smart and have autism. Autistic adults can have good language and communication skills. However, in the ’80s and ’90s, most of the people who had been diagnosed with autism also had intellectual impairment, so autistic individuals without intellectual impairment may not have received a diagnosis.”
UNC TEACCH serves autistic people across the life span. In 2022, the youngest person treated in the UNC TEACCH Autism Program was 17 months old, Dr. Klinger says. The oldest was 71 years old.
Symptoms of Autism Spectrum Disorder
The symptoms of autism are the same in adults and children, Dr. Klinger says. They include:
- Challenges with making friends or knowing what social behaviors are appropriate at work, school or in the community
- Less use of gestures, eye contact and facial expressions when communicating with others
- Difficulty with back-and-forth social interactions, such as conversation
- Difficulty initiating with or responding to others socially
- Narrow range of interests
- Difficulty with changes
- Repetitive movements
“The same symptoms can look very different in a 4-year-old and a 40-year-old,” Dr. Klinger says. “A lot of adults we see tell us they thought all their lives that they were introverts or very shy. They may have been diagnosed with attention problems such as attention-deficit/hyperactivity disorder or anxiety as children. They may have been labeled as anxious, shy or depressed.”
Diagnosing Autism Spectrum Disorder
When a child is being evaluated for autism, psychologists and other trained medical professionals will measure developmental behavior and observe children as they play. Often, examiners will use standardized measures, such as the Autism Diagnostic Observation Schedule (ADOS) or the Childhood Autism Rating Scale. The ADOS is a standardized assessment of communication, social interaction, play, and restricted and repetitive behaviors.
For adults, the ADOS or another standardized assessment is conducted through an interview. The examiner asks the person questions about social interactions and observes their behavior.
“It’s a series of activities and questions to find out about social interactions, interests, challenges and strengths,” Dr. Klinger says. Typically, children are screened for symptoms of autism by their pediatrician as toddlers. Screening is important because early diagnosis and intervention can help children receive the help they need as soon as possible.
Adults typically get diagnosed by talking to their primary care provider or a medical or mental health specialist, who can then refer them to a psychologist for diagnosis.
Why an Adult Might Seek an Autism Evaluation
Adults who are struggling in some area of their lives may be looking for answers—and help.
“Some adults tell us that a diagnosis is reassuring,” Dr. Klinger says. “It gives them a framework for understanding what’s going on with them, and what’s been going on their whole lives.”
A person who is doing well in life and not facing any particular challenges, even if some autism symptoms are present, probably doesn’t need to be evaluated, she says.
But for others who are struggling to find or maintain employment or relate to other people, an autism diagnosis may provide access to services that can help.
Various local, state and national organizations provide support services for people with autism. Group behavioral therapy sessions can help adults with autism improve their communication, social and organizational skills.
“Therapy sessions at UNC TEACCH focus on social awareness and how to recognize social errors and emotions,” Dr. Klinger says. “It’s psychotherapy we have adapted to help autistic adults. We also provide employment supports through our employment services program.”
In many places, employment support is available. In North Carolina, for example, LiNC-IT is a partnership among government agencies, nonprofit organizations and employers that offers employment experience, paid internships and on-the-job training for students and professionals with autism. The program provides employers with a pipeline of talent that might be missed during conventional hiring processes.
“People are starting to realize that a neurodivergent workforce can be very productive,” Dr. Klinger says. “There’s an awareness now that a diagnosis of autism doesn’t mean intellectual disability. Autism can bring unique strengths.”
Autism Is a Lifelong Condition
There is no “cure” for autism, although behavioral psychotherapy may help people better interact with others. With about one-third of autistic people also having an intellectual disability, many adults need significant supports, including residential facilities. Adults without an autism diagnosis would not qualify for some important services for autistic adults.
“Our goal is to help people handle the challenges they face in life because of autism,” Dr. Klinger says. “The first step may be to get evaluated. If autism is diagnosed, help is available.”
If you have symptoms of autism, no matter your age, talk to your doctor, or find one near you.