From the Guidelines
Adults suspected of having autism spectrum disorder (ASD) should undergo a thorough diagnostic evaluation, including a comprehensive assessment by a healthcare professional with expertise in autism, using standardized tools such as the Autism Diagnostic Observation Schedule (ADOS-2) or the Autism Spectrum Quotient (AQ), as recommended by the most recent guidelines 1. When it comes to adult autism screening, the process typically involves a multi-step approach.
- The first step is to consult with a primary care physician who can refer the individual to a specialist, such as a psychiatrist, psychologist, or neuropsychologist with expertise in adult autism.
- The screening process usually includes interviews about the individual's developmental history, current behaviors, social interactions, and communication patterns.
- The individual may be asked to complete questionnaires, and sometimes family members who knew them as a child might provide additional information.
- Many adults seek diagnosis after recognizing patterns in themselves following a family member's diagnosis or after learning more about autism characteristics.
- Getting diagnosed as an adult can provide clarity, access to appropriate supports, workplace accommodations, and a better understanding of personal strengths and challenges.
- The process may take several appointments and can be expensive, though some insurance plans cover diagnostic evaluations.
- Self-assessment tools available online can provide initial insights, but they cannot replace professional evaluation for a formal diagnosis, as emphasized by the American Academy of Child and Adolescent Psychiatry 1. It is essential to note that biological diagnostic markers are not available, and diagnosis rests on careful examination and consideration of DSM-5 diagnostic criteria, as highlighted in the practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder 1.
From the Research
Adult Autism Screening
- Adult autism screening is a complex process due to the heterogeneity of autism spectrum disorder (ASD) and symptom overlap with other conditions 2.
- The diagnostic procedure for ASD in adults should be carried out in a specialized assessment unit, based on behavioral observation and a careful evaluation of developmental history 3.
- A clinical framework for diagnosing ASD in adults can be based on the DSM-5 criteria, starting with an evaluation of childhood symptom onset and persistent manifestations of the core criteria - social and communication impairment, along with restricted, repetitive behaviors 2.
Challenges in Adult Autism Screening
- Existing tools for ASD screening often miss subtle or atypical presentations, particularly in underdiagnosed groups like women and older adults 2.
- Conditions with overlapping presentations, including personality disorders, anxiety, depression, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, and schizophrenia, can make it difficult to differentiate ASD from other conditions 2.
- Skewed public perception or misinformation spread on social media can also complicate the diagnosis of ASD in adults 2.
Screening Tools and Methods
- The Autism Spectrum Quotient (AQ) is a widely used tool to measure ASD symptoms and screen for ASD, and has been shown to have convergent validity with the Social Responsiveness Scale (SRS) 4.
- A combination of genetic factors and environmental factors around birth contribute to the etiology of ASD, and a comprehensive diagnostic assessment should consider a wide range of potential differential diagnoses 3.
- Promising advances in machine learning and artificial intelligence may improve diagnostic precision in the future, but up-to-date clinician training and large-scale research remain paramount for refining adult ASD diagnosis 2.