Firsttime Diagnosis of Adults on the Autism Spectrum

First-time Diagnosis of Adults on the Autism Spectrum Janet Miller, Ph. D, JD Clinical Psychologist Department of Psychiatry and Behavioral Sciences Stanford University, School of Medicine 1

Adults Seeking First-time Diagnosis of Autism Spectrum Disorder (ASD) q Trend of adults seeking first-time ASD diagnosis q Tend to be verbally-fluent, with average or aboveaverage cognitive abilities q Possible reasons for not being diagnosed in childhood: - “Flew under the radar” Inaccurate diagnosis Unconscious bias Lack of awareness

Why now? ? ? q Access to appropriate treatment and services › Effective treatment and autism-specific supports › Accommodations and governmental services q May help answer questions about their life and experiences › Sense of relief and perspective › Awareness of strengths and challenges › Increased sense of belonging and decreased loneliness q May improve relationships (increased empathy, understanding and support)

AUTISTIC SPECTRUM DISORDER DSM-5 Hyperactivity/ Impulsivity Inattention Anxiety Depression Two Core Domains Lack of socialemotional reciprocity Sensory aberrations Deficits in nonverbal communication Stereotyped or repetitive behaviors Difficulty developing & maintaining relationships Insistence on sameness; rituals Obsessions and/or compulsions Sleep & eating problems 4 Language development delay Adapted from slide by Lawrence Fung, MD Irritability & emotional dysregulation Aggression towards others Self-injurious behaviors Executive functioning deficits Restricted interests Deficits in independent living skills Intellectual disabilities Lack of central coherence

DSM-5 Criteria for ASD (cont. ) q Past: At least some symptoms must have been present in early childhood q Present: Must have significant impairment in important areas of current functioning q Very heterogeneous! - Different etiologies and treatments - Individual presentations vary widely - Important to assess for co-occurring conditions

Elements of ASD Assessment with Verbal Adults q Parent/caregiver clinical interview based on DSM-5 - Current behavior and level of impairment - Detailed development history q Adult diagnostic assessment - Clinical interview and observation of social, communication and repetitive behaviors (e. g. , ADOS-2) - Cognitive testing - Self-report questionnaires q R/O medical conditions, if suspected (e. g. , seizures, genetic abnormalities, etc. )

Co-occurring Mental Health Conditions in ASD q Prevalence is significantly higher in adults with ASD q Having co-occurring psychiatric conditions is associated with poorer long-term outcomes q Most common in adults with ASD: • • Anxiety disorders Depressive disorders ADHD Obsessive-compulsive disorder (OCD)

Challenges in Diagnosing Adults with ASD q Autism symptoms of adults with first-time ASD diagnosis tend to be more subtle q Complicated by co-occurring mental health conditions • Can mask or mimic ASD symptoms (e. g. , bipolar disorder, depression, ADHD, psychosis, eating disorders, etc. ) • Differential diagnosis vs. co-occurring conditions q Lack of reliable, detailed early developmental history q Barriers to access q Assessment tools and diagnostic criteria

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