Understanding Less Obvious Signs of Autism

In recent times, there’s been a noticeable increase in requests for autism evaluations, especially among teens and adults. Historically, autism was largely identified in children who exhibited clear traits, such as challenges in communication, unique repetitive behaviors like hand-flapping or organizing toys, and heightened sensitivity to changes in their environment. However, as awareness grows, we now recognize that even individuals who seem neurotypical can experience daily struggles due to more subtle manifestations of autism.

So, what exactly are the core features of autism? 

To help us understand these subtler presentations, we can look at the two primary areas where individuals with autism face challenges:

• Social Interaction and Communication: This includes ongoing difficulties in social engagement across various settings, such as difficulties with nonverbal cues, forming relationships, and understanding social dynamics.

  
  

• Restricted and Repetitive Behaviors or Interests: This can manifest as intense or niche interests, repetitive actions or speech, and heightened sensory sensitivities or a strong resistance to change. Interestingly, these behaviors don't always have to present themselves currently; a history of these traits can suffice for diagnosis. 

  
  

Now you might be wondering about terms like “high-functioning” or “high-masking” autism. Autism exists on a spectrum ranging from mild to severe, and many individuals with milder forms may function quite well in daily life. They may appear neurotypical at first glance, but this often involves concealing their autistic traits, leading to struggles in forming authentic relationships. Unfortunately, these individuals sometimes receive misdiagnoses, such as anxiety or ADHD, simply because their challenges have been overlooked due to their high intelligence or social aspirations. 

So what are some common signs of subtle autism in teens and adults? 

Let’s break it down:

1. Social Interaction and Communication Issues

• Less obvious difficulties in nonverbal communication may include trouble picking up on subtle changes in the tone or facial expressions, missing the subtext or intent in conversation that is not clearly stated, such as sarcasm, envy, or irritation. Speaking too quietly, too loudly, or with little change in tone can also constitute difficulties in nonverbal communication.

• Difficulties in social reciprocity can make it hard to know when it is one’s turn to speak or how to respond in conversation. This can make “small talk” or talking in a larger group particularly challenging.

•  Difficulty in developing and maintaining relationships – may be seen in close relationships, such as struggles in making friends or dating. Yet others may struggle to interact in more casual settings, perhaps with their classmates or co-workers.

2.       Behaviors, Interests, and Activities that are unusual, intense, or repetitive

These do not have to be currently present; however, if present, they can manifest in subtle ways:

• Repetitive movements or speech – less apparent behaviors can include subtle, repetitive movements, such as foot tapping, or hair twirling. Pet phrases frequently used in speech, or humming the lines from a song repeatedly, are some examples of repetitive speech and language.

•  Preference for routines and difficulty with change – these preferences can manifest as having the same meal for breakfast every day, purchasing the same type of shoes, or taking the same route to work every morning. It may be difficult to consider different solutions to a problem or understand others’ perspectives, which requires mental flexibility.

• Intense, restricted, or unusual interests - just about any interest that occupies a great deal of someone’s time and focus may fit these criteria. These can include childhood obsessions with dogs or horses, listening to the same favorite songs, or rereading the same series of books many times over. Even autism itself can be an area of intense interest. These interests are not necessarily always maladaptive; a strong passion can lead to great expertise and accomplishment in that area.

• Sensory sensitivities – these include both over- and under-responsivity to sensory input. While sensitivity to noise is perhaps one of the most common sensory differences in autism, any area of sensory functioning can be affected. Examples are a strong preference for or aversion to certain lights, smells, textures, types of clothing, or touch. On the other hand, unawareness of one’s own bodily sensations, like hunger or thirst, an unusually high threshold for pain, or extreme temperature, are some examples of under-responsivity. 

Now, you might ask, why diagnose autism if the signs are subtle?

For many, these less obvious symptoms can significantly impact their daily life. Having an official diagnosis can unlock access to valuable services, resources, and support that enhance one’s quality of life. The diagnosis often brings relief and validation, fostering a deeper understanding of one’s unique challenges and capabilities. Realizing you’re not alone and connecting with the broader neurodiverse community can be incredibly empowering.

Finally, consider the role of a neuropsychological evaluation. 

This comprehensive assessment goes beyond making a diagnosis for Autism Spectrum Disorder (ASD); it delves into cognitive and emotional strengths and challenges, identifying any co-occurring conditions like anxiety or learning disorders. Tailored recommendations resulting from such evaluations can offer strategies for daily living, academic guidance, and accommodations in work or school settings. Ultimately, with the right support and a solid understanding of their unique qualities, autistic adolescents and adults can lead enriching lives, embracing both their challenges and strengths.