How Do I Know if I'm Autistic in Adulthood?
Do you know what I find fascinating (but not surprising)? The fact that last week on Google, the question, “How do I know if I have autism in adulthood” was trending. We’re living amidst a boom of Autistic education and discovery as more Autistic advocates talk about their lived experiences. We’re realizing the spectrum is much more wide and diverse than we historically thought. Additionally, in the medical field, there is now valuable research exploring how autism presents differently in women, BIPOC, and genderqueer individuals. We are in the midst of an Autistic awakening.
While, thankfully, progress has been made in identifying and supporting BIPOC children and girls on the spectrum, there remains a lost generation of Autistic adults who have navigated life without a diagnosis. Many of them are seeking answers to what is often a life riddled with social confusion, chronic mental health conditions, and a pervasive feeling that something just isn’t quite right. So if you are an adult wondering if you belong to this lost generation of Autistic adults, welcome; you’re in the right place!
Autism in Adults
Over the next few months, I'll be diving deeper into the topic of autism in adulthood. As an Autistic psychologist who discovered my own autism at the age of 37, it’s a topic I have some invested (and special) interest in. In today's article, we will cover a lot of ground, including:
Understanding what autism is
Exploring the unique brain style differences in Autistic people
Unpacking the concept of autism masking
Non-stereotypical presentations of autism and how they differ from the traditional paradigm
Examining stereotypical presentations of autism
Steps to take if you suspect you might be Autistic
In my own journey of discovering autism in adulthood, understanding non-stereotypical presentations of autism was a crucial first step. That's why we'll begin this series by exploring the different ways autism can manifest in adults. But before we delve into the various presentations, let's make sure we're all on the same page by providing some introductory information about what autism actually is. From there, we'll navigate through the fascinating world of autism in adults and the various ways it can present.
What is Autism?
What is Autism? It's a question that elicits diverse responses depending on who you ask. From a traditional medical perspective, you might hear that "autism is a neurodevelopmental disorder characterized by challenges in communication, social interactions, obsessive interests, and repetitive behaviors." However, as an Autistic person in the medical profession, I find this definition inadequate. Instead, I view autism as a form of neurodivergence, diverging from the norms and culture of neurotypicality. It represents a neuro-minority, as only a minority of people have an Autistic neurotype.
Autism as a Form of Neurodivergence
Neurodivergence refers to a brain that processes cognitive, social, and sensory information differently from the neuronormative majority. It encompasses the experiences of people whose unique processing style may lead to challenges, prejudice, ableism, and systemic barriers in accessing education and work. Identifying as neurodivergent acknowledges and embraces these differences in brain functioning and the diverse ways of experiencing and navigating the world.
Autistic people often navigate a world that is primarily designed around neurotypical norms and the experiences of the non-Autistic majority. This can lead to various challenges and stressors, including being misunderstood by others, having our unique social-communication style undervalued, and facing misinterpretations of our actions through an allistic (non Autistic) lens. These experiences highlight the divergences between our Autistic way of being and the mainstream culture we are a part of.
Autism as an Identity
As the neurodiversity movement gains momentum and a shift towards viewing neurotypes through a diversity lens emerges, we are moving away from perceiving conditions like autism and ADHD solely as pathological disorders and embracing them as identities. In my writing, you'll notice my use of identity-first language, referring to being Autistic rather than having autism. This reflects the incorporation of Autism as a significant part of my identity, something I celebrate and take pride in. By expanding our understanding to recognize autism as a neurotype, a distinct way of being, and an identity, we create space to celebrate Autistic culture and embrace the Autistic brain style differences. Speaking of, let's delve into the specific brain style differences that characterize autism.
Autistic Brain Style Differences
The Autistic brain exhibits distinct styles and differences that set it apart from the allistic brain. Dr. Marilyn Monterio has made valuable contributions in categorizing these differences into three main areas: Language-Communication, Social Relationships, and Emotional Responses, and Sensory Use and Interests.
Language-Communication
The Autistic brain demonstrates a distinct approach to language and communication. Our communication style emphasizes sharing information, facts, and intricate details related to our areas of interest. We thrive in conversations centered around our passions, while social-based conversations can present more frustrations and challenges for us.
Interest-Based Conversation
We feel most at ease when engaging in conversations related to our areas of special interest. Object-based conversations, which explore outside ideas, concepts, or areas of interest, are more comfortable for us compared to social-based conversations. Social-based conversations typically involve questions like "How are you?" or "Tell me about yourself,” while object-based conversations might focus on a favorite book, interesting idea, project, or area of interest.
High-Context Verbal Communication
Context holds great importance for us. Our brains naturally think in associations and ecosystems, rather than isolated ideas and linear thought. As a result, we tend to use high-context speech, which means we value providing the full context and may go into great detail to explain the backstory, including relevant facts and details. For example, every time I share a quote or idea, I feel the urge to share how I came across that quote or idea, or who it came from. I often find myself explaining the context of how I learned the idea over just stating the idea itself!
Emotion and Social-Based Conversation
Our verbal skills tend to decrease when discussing emotions or engaging in social-based conversations, especially in spontaneous and unscripted situations. These encounters can be sensory demanding, and the resulting sensory overwhelm can impact our verbal and spoken skills in those moments.
Social Relationships and Emotional Responses
Social Initiation
Autistic people often prefer to initiate social interactions on their own terms. Personally, I find that when someone else initiates social contact, it can feel intrusive or overwhelming. Small talk and unplanned social interactions can be challenging for me, as they require quick sensory processing and may lead to me shutting down. I feel most socially engaged and comfortable when I have initiated the interaction myself.
Peer Interactions
Building and maintaining peer relationships can be difficult for many Autistic people, especially during childhood and adolescence. While we may desire social connections with our peers, we often struggle to establish them. Many Autistic children and teenagers find more comfort in interacting with adults or younger children rather than their peers. In adulthood, some Autistic people may still find it easier to connect with children or may feel more at ease in intellectually rigorous environments like academia or science-oriented industries, while finding it challenging to connect with peers outside of these specialized areas.
Preference for Intimate Relationships
Many Autistic adults prefer having a small circle of close friends or one or two trusted individuals in their lives, rather than a large social network.* We tend to navigate social groups with more difficulty, as they involve spontaneous and unpredictable interactions. We often prioritize deep and meaningful conversations over small talk, which typically occurs in one-on-one settings. This preference for smaller social settings may also be influenced by sensory issues.
We also tend to be more comfortable with alone time and don’t need as much socializing as allistic people seem to need. Clinically, this is referred to as "low social motivation." Many Autistic people have rich inner worlds, strong interests, and a capacity to entertain ourselves. This reduces the need for frequent socializing. For example, I would much prefer to be writing this article right now than engaging in a social interaction!
*Note this may not apply to Autistic-ADHDers.
Emotional Responses
Autistic people tend to have more difficulty in developing a cohesive narrative around our identity and emotions. We also tend to have more difficulty talking about our emotions. However, that doesn’t mean we don’t struggle with them! We tend to experience higher levels of anxiety, irritability, and anger, which can often be linked to sensory sensitivities, or routine disruptions. Disruptions in our routines or sensory overload can trigger intense emotional responses. Additionally, many of us have difficulty identifying our emotions until they reach a heightened level, which further complicates our ability to recognize and regulate our emotions.
Sensory Use and Interests
Interests
Our brains excel when exploring areas of interest. Due to the hyperconnectivity of certain parts of the brain, we become passionately interested in our interests and derive a great deal of pleasure, motivation, and energy from our areas of interest. Our interests are often integrated into our sense of self and identity. When Autistic people begin speaking about our interests, we often become emotionally animated, and our verbal fluency increases. Additionally, we may have developed exceptional skills within an area of interest.
Sensory Overload
Autistic people tend to have differences in how our brain processes and filters sensory information resulting in frequent sensory overload. When this occurs, we have a reduced ability to access verbal and spoken skills and will become more dependent on our routines for safety and comfort.
Sensory-Based Routines
Repetition and routines serve a sensory function. Whether it’s a repetitive routine, a ritual, or getting absorbed in an area of interest, these serve the function of blocking out unwanted sensory experiences. For the Autistic brain, routines, rituals, familiarity, and interests serve a regulating function in an unpredictable and overstimulating world.
Stimming
Stimming is one example of a repetitive act that serves to block out sensory input. Stimming simply refers to repetitive body movements. When we move any part of our body repetitively, it provides sensory input that we are controlling. This helps to block out the sensory input coming from the outside world and helps us to self-soothe and regulate our sensory system.
Now that we’ve unpacked some overarching brain style differences that all Autistic people share, let’s get a bit more focused and talk about how autism can present differently and how this can lead to diagnostic confusion and difficulty identifying autism in adults.
Stereotypical vs. Non-Stereotypical Autism
Our understanding of autism has expanded significantly, recognizing that it can present in diverse and varied ways beyond traditional stereotypes. Historically, autism research primarily focused on affluent, cisgender, white boys, leading to assessment tools and criteria biased towards this demographic. This bias perpetuates the identification of individuals with stereotypical autism, reinforcing the existing stereotypes.
We now know that autism often manifests differently in BIPOC individuals, girls and women, and genderqueer people, many of whom have developed camouflage strategies to mask their Autistic traits. It's important to note that the distinction between stereotypical and non-stereotypical presentations is not always clear-cut. For instance, some women, BIPOC, and trans individuals can exhibit stereotypical autism traits, while some cisgender white men may present in non-stereotypical ways. While the stereotypical presentation of autism has been associated with white boys in early research, it is important to recognize that autism's manifestations are not strictly categorical. Additionally, a person may have aspects of both stereotypical and non-stereotypical presentations of autism.
Non-Stereotypical Autism
My introduction to understanding non-stereotypical presentations of autism came when I came across Laura Hull's article on the Female Autistic Phenotype. I found this article in the aftermath of my daughter’s diagnosis and in the fast and furious two-week period where I was reading everything I could get my hands on about autism and was in the process of discovering my own autism.
Discovering the Female Autistic Phenotype was a significant moment for me, but I soon realized that this phenotype extends beyond just females. It includes many genderqueer individuals, BIPOC males, and even many white cisgender men who exhibit similar characteristics described by Hull. When I provide trainings on this topic, I adapt Hull’s work and have started using my preferred term, “the High-Masking Autistic Phenotype.” Following are some of the key characteristics associated with this phenotype.
High-Masking Autistic Phenotype
While not an exhaustive list, high-masking Autistic people tend to:
Have developed sophisticated methods of socially blending in (i.e., masking, people-pleasing, scripting, rehearsing)
More likely to be hyper-empathetic
Special interests culturally blend in
More internalization of repetition (less externalization)
More commonly seen among Autistic people without a co-occurring intellectual disability.
Socializing
One of the primary reasons high-masking Autistic people don’t get identified is that many of us have adapted to our social differences by becoming studious observers of people. Many of us have become keen observers of social cues, studying how people move, talk, and interact. This may stem from our innate social motivation or through social conditioning, such as the societal expectations placed on girls to socialize or the need to conform to social norms for safety in a racist and transphobic society.
As a result, many of us have honed sophisticated strategies to socially blend in. These strategies can include suppressing or hiding stimming behaviors, meticulously studying and imitating social behaviors, analyzing body language, scripting, and rehearsing conversations, and displaying excessive accommodation and helpfulness towards others. This process is commonly known as camouflaging or masking.
Autistic Camouflaging Explained
Autistic camouflaging encompasses three distinct features: Compensating, Masking, and Assimilation.
Autistic Camouflaging: Autistic Compensation Explained
Compensation involves mimicking and copying allistic people. Many people with the high-masking Autistic phenotype observe and catalog phrases and mannerisms from television, movies, or their friends and peers. I often refer to this process as having a "working Google doc in my head." Whenever I observed someone doing or saying something that I admired, I would mentally catalog it and incorporate it into my own communication style. It was like curating a collection of behaviors and phrases that I could draw from in social situations.
Compensation can also manifest in the form of pre-prepared scripts that we rely on during social interactions. I used to practice conversations and develop scripts in advance. Whenever I knew I would be engaging in a particular conversation, I would rehearse different iterations of that exact conversation in private, ensuring that I had my conversational plugins or scripts ready to go. However, when I found myself in conversations that deviated from my rehearsed scripts, I would often feel awkward and struggle to cohesively put my words together.
Autistic Camouflaging: Autistic Masking Explained
While Autistic compensation is about copying allistic communication, Autistic masking involves actively suppressing Autistic traits. This might involve things like repressing stimming or finding more socially acceptable forms of stimming (picking nails, playing with hair).
Masking might also involve developing a vigilant and critical self-monitor that alerts you when you're about to engage in info-dumping or behavior that others might find odd or off-putting. This is why I refer to my inner critic as "the mask." Prior to discovering my Autism, my inner critic was quite severe, consistently berating me for things I had said or done and cautioning me whenever I approached what it perceived as socially risky situations. My inner critic, “the mask,” used shame as its tactic in its attempt to help me conform to allistic norms. This aspect of masking becomes deeply ingrained in our psyche, often to the extent that we are unaware of its presence or assume that everyone else experiences the same inner dynamics.
Furthermore, masking involves being hyper aware of our body language during conversations. I used to consciously coach myself on appropriate body movements, reminding myself to nod to show engagement and to uncross my arms to avoid appearing defensive. These intentional body coaching techniques were aimed at conveying interest and engagement in social interactions.
Autistic Camouflaging: Autistic Assimilation Explained
Assimilation entails an act of pushing ourselves to engage in behaviors that don't come naturally to us and often cause significant discomfort. This may involve forcing ourselves into small talk or social interactions. It also involves an element of feeling as if you are pretending or acting during social interactions.
Another aspect of assimilation is finding socially acceptable ways to avoid socializing. For instance, as a young mother, I would frequently use my newborn as an excuse to extricate myself from conversations in group settings. At other times in my life, I would keep myself busy with tasks such as cleaning or assuming other designated roles that allowed me to appear engaged and helpful in the group without the need for extensive socializing.
Beyond Autistic camouflaging, there are additional factors that contribute to our tendency to more easily blend into social environments. Next, we’ll explore some of these reasons.
Autistic Special Interests: Blending In with Cultural Relevance
Special interests, also known as "restricted interests," are a defining characteristic of autism. However, among non-stereotypical presentations of autism, our special interests often align more closely with mainstream culture. While the stereotypical image of autism portrays obscure or niche interests that few people connect with, non-stereotypical presentations often involve special interests that culturally blend in.
Some examples of these interests may include:
✦ Bands, celebrities, and popular shows
✦ Well-known book series or movies
✦ Social justice causes
Additionally, special interests may not culturally blend in but be topics or areas that are generally admired by a person’s community. For example
✦ Books and reading Religious topics
✦ Identity theories/activities (Queer theory, Intersectionality, and more)
✦ Religious topics
During my childhood, my special interests revolved around Jesus and Christianity (due to my upbringing in a fundamentalist tradition), and social justice issues. Within the context of the fundamentalist culture, my passion for these topics was highly regarded, making me appear as a devoted and enthusiastic Christian.
As a teenager, I delved into researching the child sex trade in Thailand, studying its economic, social, and religious aspects; my dedication seemed to be that of a passionate advocate for social justice. However, upon closer observation, it becomes apparent that I would consistently steer conversations back to either Jesus or the sex trade in Thailand. I would spend hours studying and researching these subjects.
While Christianity can be a common interest, it was my level of intensity that was atypical for a 14-year-old. While most 14-year-olds were spending time with friends, learning instruments, or exploring multiple hobbies, I was at home studying Bible commentaries and memorizing the book of Romans. Yet, it didn’t look like me being Autistic; it looked like me being a good Christian girl passionate about social justice issues.
Autistic Special Interests: Intensity and Immersion
You might be thinking, "But wait, doesn't everyone have their own interests? How can you differentiate between an Autistic interest and an average person's interest?" Well, the answer lies not in the content of the interest, but in its intensity and depth. While it's true that everyone has things they enjoy, Autistic people often display an unparalleled level of passion and immersion in our specific areas of interest. It is this exceptional intensity and profound engagement that distinguishes Autistic special interests from ordinary hobbies or interests.
So when distinguishing between Autistic special interests and typical interests or hobbies, it's important to consider the intensity of the interest rather than the content itself. Autistic people often create an ecosystem around our special interests. For instance, when my daughter was deeply invested in a particular show as a young child, she would want her entire room decorated in alignment with that show, dress like the main character, and engage in imaginative play based on its storyline. Her whole world became about the show.
When I develop a special interest, it becomes a lens through which I perceive and filter reality. Whenever I encounter new information, I naturally connect it to my special interest in order to make sense of it and encode it in my memory. For instance, if my husband shares something about European football, I may link it to concepts related to autism or ADHD (my current special interest). By connecting his idea to my area of interest, it provides me with a conceptual map to understand what he is telling me.
When I share this connection, it might appear as though I am attempting to steer the conversation back to my special interest. In reality, I am simply sharing how I am integrating and making sense of the new information he provided. For me, a special interest is not just an interest; it becomes my lens for understanding and making sense of the world around me. When given new information, my brain will automatically connect it or associate it with some parallel idea embedded within my area of interest. By linking the new idea to an idea from my area of interest, I can make sense of the incoming information. In this way, my interest becomes the medium by which I process and metabolize new information in a meaningful way.
Internalized Repetitions in Autistic Adults
Another reason why high-masking Autistic adults are less likely to be identified is because of our tendency to internalize repetitions. This can manifest as internalized stimming, where we repeat the same sentence, or phrase, or engage in internal counting. It may also involve listening to a song on repeat for several hours.
Repetitive behavior can extend to other areas, such as having a strict and repetitive meal routine, eating disorders, or more. Because these repetitions are internalized, they are not readily visible to others, requiring an understanding of the person's internal experience to recognize these as repetitions. This can make it more challenging to identify these repetitive patterns. In fact, many of us may not even realize that our experience of internalized repetition is unique, often assuming that everyone engages in similar mental repetitions.
The Fawn Response: Internalization of Stress in Autistic Adults
Autistic people who mask have often adapted to the stress and trauma of not fitting in by becoming exceptional people pleasers. Another way to consider this is through the body’s stress response. Many of us have adapted by engaging the fawn response and attempting to appease those around us so that we don’t stand out.
We are also more prone to have sensory shutdowns over sensory meltdowns (a form of the freeze/dorsal vagal shutdown response). A sensory shutdown socially blends in more than a sensory meltdown, so many high-masking Autistic adults tend to veer toward more freeze/fawn responses when in public. This is yet another way that high-masking Autistic people have internalized the stress of being Autistic. We have taken external stress and turned it inward. Our bodies suffer, but we look calm to the outside observer.
Navigating Hyper-Empathy as an Autistic Adult
Perhaps one of the most common reasons non-stereotypical presenters of autism are doubted is due to their heightened empathy, which stands in stark contradiction to autism stereotypes. While traditional research linked autism with hypo-empathy (low empathy) recent studies, suggest that this is better attributed to alexithymia rather than autism itself. Brain scans have shown that empathic brain activity correlates with alexithymia, not autism, indicating that there are no inherent group differences in empathy between autistic and non-autistic individuals once alexithymia was accounted for (Bird et al., 2010).
Bird and his research team have done several studies that show that alexithymia rather than autism explains several of the emotion and empathy traits typically associated with autism (difficulty reading facial expressions, difficulty with recognizing emotion, and low empathy). This suggests the diagnostic criteria for autism have historically conflated alexithymia and autism and failed to tease out the difference. It’s therefore reasonable to assume that non-stereotypical presentations of autism are partly explained by the presence of Autistic people who don’t have alexithymia.
Furthermore, more and more Autistic people are speaking out about their experiences of hyper-empathy, with some identifying as empaths who have a tendency to catch other people’s emotions.
For those of us with hyper-empathy, this is one of the factors that make socializing difficult. Personally, socializing becomes a full-body sensory experience for me. I find myself absorbing the energy of those around me. In the presence of extroverted individuals exuding positive energy, my body vibrates with an overwhelming intensity that feels intrusive. When encountering sadness, I melt into the heaviness alongside them. Interacting with someone who is dissociating causes my senses to dull, and my mind becomes foggy. I experience muscle tension and stress when around people experiencing stress and anxiety. These sensory experiences make socializing challenging for me. The difficulties that come with absorbing people’s emotions far surpass the difficulties I experience in navigating small talk! As a result, I am selective in choosing who I spend my time with!
The Existential Thinking of Non-Stereotypical Autistic Adults
One of the reasons I initially struggled to identify myself as Autistic is that my thinking style is deeply existential, theoretical, and metaphorical. I had a limited understanding of what "concrete and literal" thinking meant. Although I do have a visual and concrete thinking style in many aspects (my husband needs to explain his jokes to me), I am also highly engaged with existential concepts and thoughts.
Interestingly, this tendency appears to be more common among non-stereotypical Autistic presenters. Many of us have a special interest in spirituality, philosophy, existentialism, or humanitarianism, and we often find ourselves contemplating the nature of existence. It's worth noting that some of us may also experience existential OCD, which involves obsessive and intrusive worries about the fundamental aspects of life and existence.
The Cost of High-Masking: A Diffuse Sense of Self
When a person becomes a high-masker, it’s like their antennas for the people around them become heightened, and their self-antenna becomes muted. The volume for other people’s stuff becomes heightened while we turn the volume on our own bodies down. We absorb and adapt to the energy, behaviors, and intentions of those around us, effectively mutating our own sense of self.
We become professional chameleons and learn how to adapt and blend in. Although this adaptive strategy helps us to socially blend in it comes at a significant cost—the development of a distinct social identity. Many high-maskers find their sense of self shaped by external influences, leading to a diffuse sense of self or a pervasive feeling of emptiness. This diffuse sense of self can be mistaken for instability and may result in misdiagnoses such as Borderline Personality Disorder or other personality disorders.
The Challenges of Obtaining an Autism Diagnosis for High-Masking Adults
A notable pattern among high-maskers is their increased likelihood of actively seeking a diagnosis in adulthood, yet paradoxically, they are less likely to receive one. Many of us have experienced a lifetime marked by mental health challenges, such as depression, anxiety, and potentially PTSD, often accompanied by a perceived presence of personality disorders. We are actively seeking an accurate lens from which to understand ourselves driven by the confusion around our persistent mental health struggles, the confusion we face in social and relational contexts, and the fragility of our self-perception. Ironically, although non-stereotypical presenting Autistic adults are more likely to desire and seek out a diagnosis than stereotypical presenters, we are less likely to be identified as Autistic precisely because we have internalized so many of our Autistic traits!
Common Misdiagnoses for High-Masking Autistic Adults
High-masking Autistic adults often face a range of misdiagnoses, which can further complicate their journey toward accurate self-understanding. Mislabels such as Borderline Personality Disorder, Bipolar disorder, complex PTSD, Avoidant Personality Disorder, or Obsessive-Compulsive Personality Disorder are frequently encountered. Additionally, it is common for us to have co-occurring conditions such as ADHD, OCD, depression, anxiety, social anxiety, and PTSD, which further contribute to the complexity of our diagnostic landscape.
Stereotypical Autism
Before delving into the topic of stereotypical autism, let me first address a concern I had about creating this Venn diagram and writing this article. In the Autistic advocacy space, there is a growing trend where individuals like me, who were diagnosed later in life and exhibit non-stereotypical presentations of autism, work hard to educate and promote recognition of Autistic experiences beyond the stereotypes. While this is valuable for educational purposes, it can inadvertently create an "us vs. them" dynamic, potentially dismissing those who align more with stereotypical presentations.
It is crucial to remember that stereotypes exist for a reason. Many Autistic people indeed face challenges with perspective-shifting, exhibit reduced activation in the insula resulting in hypo-empathy, and have painful and significant struggles with socializing. While it is essential to emphasize the diversity of autism experiences, it must be done in a way that respects and acknowledges those who present in more stereotypical ways. The reality is that our experiences, struggles, and support needs can vary greatly across the spectrum.
Furthermore, it is important to recognize that even within stereotypical autism, there is a wide range of experiences. For instance, an Autistic person with level 3 autism, an intellectual disability, and who is non-speaking will have a different experience compared to an Autistic person diagnosed with level 1 autism who holds a full-time job in the technology sector. As Autistic advocate, Dr. Stephen Shore famously said, "If you've met one individual with autism, you've met one individual with autism." So while there are patterns and clusters of experiences that tend to hang together, there is a lot of diversity in how these will be experienced.
The Social Landscape of Stereotypical Autism
In the stereotypical presentation of Autism, social-communicating differences are more pronounced and apparent to the outside observer. People with this presentation may exhibit the following characteristics:
✦ Will often bypass small talk and gets straight to the point in the conversation (high maskers will typically attempt small talk, but it costs us a lot of energy).
✦ Back-and-forth conversation is more difficult (note when talking in an area of special interest and with other Autistic people, this gets easier for the Autistic person)
✦ Communication style tends to be straightforward and concise, and they tend to struggle more with understanding or decoding non-direct speech (high maskers have typically learned to decode non-direct speech when they have time and space to do so).
✦ Initiating friendships and deepening from acquaintance to friendship is more difficult however becomes easier if connecting with other Autistic people (non-stereotypical presenters will often have one close friend, and struggles are more apparent in groups).
✦ They may say things that others consider inappropriate for the given context, either because they are unaware of the discomfort it causes or because they struggle to adjust their communication based on different contexts and social norms.
✦ Context-shifting can be more challenging, as they may not grasp the concept of changing their tone, conversation topic, or behavior to fit different situations. Autistic brains value authenticity no matter the context, so we don’t fully comprehend the idea of changing tone, conversation topic, and mode of being for different situations (high-maskers may analyze social norms and sort out which social equations work for which context). Stereotypical presenting Autistic adults will likely get more feedback that their comments are inappropriate for the context.
Due to their difficulty socially blending in, Autistic people with stereotypical presentations may face a higher degree of bullying, teasing, and negative reactions from peers. This can lead to feelings of isolation and contribute to mental health conditions such as depression and anxiety.
On the flip side, some people with a more stereotypical presentation may exude self-confidence and be less emotionally impacted by others' negative perceptions, which on one hand, can be protective, and on the other, can result in a disregard for others that can look similar to narcissistic personality disorder and may lead to different kinds of social-communication struggles.
The Role of External Repetition in Autistic Stereotypical Presentations
Stereotypical autism is associated with a range of external repetitive behaviors, which are often expressed as outward movements or actions. These behaviors may include hand-flapping, finger flicking, body rocking, toe-tapping, pacing, repeating certain phrases or sounds, and engaging in repetitive body movements or gestures. These external repetitive behaviors can serve various purposes, such as for the purpose of sensory regulation, or communication. As discussed above (Autistic Brain Style Differences), these behaviors function to help block out unpleasant sensory input and to self-soothe.
The Impact of Alexithymia on Autistic Social Experiences
People with stereotypical presentations of autism often experience high to severe alexithymia, which refers to difficulty identifying and describing emotions. The presence of alexithymia intensifies social difficulties and makes it even more challenging to understand and perceive shifts in emotional tone, contributing to a dysregulating and anxiety-provoking social experience.
When an Autistic person has severe alexithymia, the social world is disorienting and confusing as it becomes much more difficult to interpret people’s actions, emotions, and words. They are confronted with non-literal and non-direct language (Autistic differences), while also experiencing difficulty in perceiving and understanding changes in emotional expression (alexithymia struggles). This can make the social world a highly dysregulating and anxiety-provoking experience!
Disentangling Alexithymia and Empathy in Autism
As discussed earlier (in the section on High-Masking Autism), reduced activation in the insula and perceived hypo-empathy is associated with alexithymia, rather than autism itself. Individuals with more stereotypical presentations of autism often experience severe alexithymia, which can lead to challenges in identifying and expressing emotions. Consequently, they often experience reduced activation in the insula and report lower levels of empathy. However, it is important to recognize that this is primarily linked to their alexithymia and not autism per se.
Thinking Styles in Stereotypical Autism
Autistic people tend to be concrete and pragmatic in our thinking style, which is particularly pronounced in stereotypical presentations of autism. Moreover, people with alexithymia often demonstrate an externally-oriented thinking style, prioritizing the concrete aspects of the external world over their internal realm of emotions and thoughts. The presence of an external-oriented thinking style, often associated with alexithymia, can intensify the already concrete and pragmatic thinking style found in Autistic individuals. This combination of alexithymia and Autistic thinking style, characterized by a focus on the concrete world, is what is often portrayed in media in shows such as Atypical or The Good Doctor.
Stress Responses in Stereotypical Autism
Autistic people with a stereotypical presentation may be more prone to enter a state of hyperarousal rather than hypo-arousal. This can manifest in sensory meltdowns rather than shutdowns and may lead to a fight-or-flight response in challenging social situations. Additionally, some people with stereotypical presentations may also experience periods of shutdown and freeze. However, the fawn response, characterized by appeasing others to avoid standing out, is less commonly observed, while this is a primary defense often used among non-stereotypical presenters.
Special Interests More Obscure
The stereotypical depiction of autism often portrays a boy with a fascination for birds, penguins, trains, or dinosaurs. While non-stereotypical presenters are more likely to have a special interest related to people and culture, those with a more classical presentation of autism may have more interests in computers, technology, biology, and other scientific inquiry (this aligns with the more emphasized concrete and pragmatic thinking style) showcasing their passion and curiosity in the realms of the external world of science and technology.
Common Misdiagnoses in Stereotypical Autism: Exploring the Overlaps and Co-occurring Conditions
Autistic people with stereotypical presentations may also face misdiagnoses. Common misdiagnoses may include narcissistic personality disorder, schizoid personality disorder, schizotypal personality disorder, and in some cases, even antisocial personality disorder. These misdiagnoses can stem from the misunderstandings and complexities surrounding autism and its diverse manifestations. Additionally, co-occurring conditions such as anxiety, depression, and obsessive-compulsive disorder are commonly observed.
Shared Autistic Traits: Overlapping Characteristics in Stereotypical and Non-Stereotypical Presentations
While there are some distinct differences between stereotypical and non-stereotypical presentations of autism, there is also a great deal of overlap! Here are some of the ways our experiences commonly overlap.
Safety Through Routine and Structure: The Role of Predictability in Autism
Autistic people rely on routine and structure as a means to regulate our sensory systems. Due to struggles in processing sensory input and difficulties in predicting what will happen next, familiar routines and schedules provide a sense of safety and stability. By incorporating routine and structure into our daily lives, we can better manage sensory challenges and navigate the world with a greater sense of security.
Values Direct Communication: Autistic Preference for Clarity and Directness
All Autistic people appreciate direct and straightforward communication. Vague and indirect communication can be challenging to interpret and may lead to misunderstandings. Autistic people value clear and explicit communication, as it eliminates guesswork and promotes effective understanding. By embracing direct communication, interactions become more efficient and productive, fostering better connections and reducing potential miscommunication.
Sensory Processing Differences: Unique Experiences of Sensory Input in Autism
The majority of Autistic people experience sensory processing differences. Some may be hypo-sensory, perceiving sensory input in a dulled manner, while others may be hypersensitive, encountering an amplified experience of sensory stimuli. It is also common for Autistic people to exhibit a mix of hypersensitivity and hyposensitivity across different senses. These sensory processing differences contribute to the unique sensory experiences and sensitivities that greatly impact the way we navigate our daily lives.
Bottom-Up Thinking Style
Autistic people tend to have a distinct cognitive style when it comes to processing information. Known as bottom-up thinking, this approach involves starting with specific details or observations and gradually constructing a larger understanding or general conclusion. By analyzing individual components and synthesizing them, we form deep comprehension of the subject. Bottom-up thinking is characterized by its data-driven and evidence-based reasoning, but it also requires significant cognitive energy. This is why we may find busy environments, like group settings, overwhelming as our brains process numerous intricate details simultaneously.
Co-Occurring Mental Health Conditions: Understanding the Intersection of Autism and Mental Health
The majority of Autistic people will experience a co-occurring mental health condition at some point in their lives (Mosner et al., 2019). Anxiety, depression, OCD, and ADHD are among the common conditions that can coexist with autism. The presence of these mental health conditions can intersect with our Autistic traits in complex ways and can impact various aspects of our well-being and functioning.
Dislikes Small Talk and Prefers Substantive Conversation: Autistic Communication Preferences
Autistic people generally have a preference for substantive conversations over small talk. The unpredictable and superficial nature of small talk can be unrewarding, overwhelming, and challenging to navigate, particularly due to heightened sensory sensitivities. Engaging in meaningful and substantial conversations allows us to express our thoughts and interests more authentically, fostering deeper connections.
Struggles in Group Settings: Navigating Sensory Overload in Social Gatherings
Socializing in groups adds an additional element of unpredictability and spontaneity. So it is no surprise that group settings pose unique challenges for many of us due to the increased sensory input and sensory overload that can occur. Processing and responding to multiple stimuli simultaneously can be overwhelming and exhausting. As a result, many of us may find it easier to connect with others through one-on-one interactions or through online platforms that offer greater control over sensory input. For many Autistic people navigating social gatherings requires careful consideration of sensory needs and strategies to manage sensory overload effectively.
Special Interest Ecosystem: How Autistic Identity Is Shaped by Interests
Autistic people tend to orient our identities around their values and interests. Special interests play a central role in shaping our worldview and self-concept and influence how we engage with the world. Special interests extend beyond mere hobbies or fascinations and form a comprehensive world that we build. For this reason, I refer to special interests as a "special interest ecosystem." These intense and immersive interests provide us with a deep sense of purpose, meaning, and fulfillment.
Gets Absorbed in Our Interests: Hyperfocus and Deep Immersion in Autistic Experience
All Autistic people become deeply absorbed in our interests or activities (often referred to as hyper fixation). This state of intense concentration and immersion can lead to a distorted perception of time and a diminished awareness of the surrounding environment. For example, I started writing this article at 1 pm and just looked at the clock only to realize it is nearly 7:30 pm! Where did the time go? I could hardly say.
Before I knew I was Autistic, my spouse referred to this mode as “the vortex.” When I was in the vortex, I would often fail to register the kids or my spouse talking to me. Hyperfixation can also look like it can pull into overly focusing on little details of a project and becoming fixated on the small details. Hyperfocus allows us to delve into our passions with exceptional dedication, but it can also result in difficulties shifting attention and becoming fixated on specific details or aspects of a project.
What Should I Do If I Think I Am Autistic?
If you think you may be Autistic, this likely comes with a range of emotions. You may feel excited about the idea of having a framework from which to finally understand yourself more fully; you may feel terror and fear due to all the things you’ve heard about autism. You might be afraid about what this could mean for your primary relationships or your future. It’s normal to have a lot of complex emotions during the exploratory period. Here are some next steps you can do if you think you may be Autistic:
Self-Reflection
Engage in introspection and reflection on your own experiences, traits, and challenges. Consider keeping a journal to document your observations and thoughts, noting any patterns or behaviors that align with autistic characteristics.
Online Autism Screeners
Online screeners provide a helpful data point when exploring Autistic traits. Note, these are one data point and not conclusive in and of themselves. That said, they are an important data point. You can check out my top six favorite free screeners for Autistic people here. I also recommend Embrace Autism which is a great resource and has loads of screeners and information.
Educate Yourself: Seek Out Reliable Sources
Educating yourself by learning from reliable sources, such as reputable books, articles, and websites. Here are some common websites and research resources I frequently use:
Spectrum News (breaks down current research in relatable ways, more affirming that most sources)
Autism in Adulthood (a peer-reviewed journal that prioritizes inclusive research and makes its articles available for free online).
NeuroClastic (articles written by Autistic people, intersectional, advocacy, and education)
Educate Yourself: Learn From Autistic People
In addition to learning from reliable academic sources, it’s crucial to learn from Autistic people. There is a lot that is written about autism from the outside, but listening to people talk about autism from the inside will likely be most helpful for you. And congratulations, you just did that! By reading all the way through this article, you learned from an Autistic person as I talked about both external markers and internal experiences. By listening to Autistic voices and experiences, you gain valuable information that you may not be able to access by simply reading about autism.
Social Media
To find people on social media, use the hashtag #ActuallyAutistic to find Autistic people sharing their experiences on social media. Note, this hashtag is not referring to medically diagnosed over self-diagnosed. Rather it is in reaction to the fact allistic people have historically spoken for the Autistic community. So the hashtag is a way of stating the importance of listening to Autistic voices when talking about and thinking about autism.
Podcasts
However, there are a lot of voices out there on social media, and some are more reliable than others. Social media can also feel overwhelming to navigate, so you may consider starting with podcasts. Here are a few I recommend.
✦ Divergent Conversations: Okay, obviously, I’m biased because this is my podcast. Each week Patrick and I, both Autistic-ADHD therapists, explore a wide range of topics related to autism and ADHD. With a unique blend of professional expertise and lived experience, we provide insights and discussions that offer a unique perspective.
✦ Squarepeg podcast: Amy interviews women and non-binary people about their experiences with autism. This was one of the first podcasts I found in my journey, and I am forever grateful for the women and non-binary people who were willing to share their stories. I felt recognized for the first time by listening to their stories.
✦ The Other Autism: Kristen does a combination of research podcasts and interviews. Ideal for those who identify with non-stereotypical presentations of autism.
✦ Neurodivergent Women Podcast: Created by a clinical psychologist and neuropsychologist in Australia. They do fantastic research with deep dives into neurodivergence and women.
✦ Thoughty Auti: Autistic advocate and educator based in the UK. He talks a lot about mental health and has interviewed several well-known Autistic people.
Read Some Books: If you like learning through reading, here are some books that are valuable reads.
Divergent Mind: Great for women and covers several different forms of neurodivergence (ADHD, HSP, Autism, and more)
Unmasking Autism: Dr. Devon Price does a fantastic job unpacking Autistic masking. A great book if you relate to the non-stereotypical presentation of autism.
Is This Autism: A wonderful new release that walks through the diagnostic criteria of autism and unpacks the many ways it can present. Great for people who are actively looking for answers and clarity.
Neurotribes: This is more of an academic/theoretical read. However, super helpful in understanding the history of autism and how we got where we did (the bias in research and society).
*Some of these are affiliate links.
Consider an Assessment
Typically after a person has spent a significant amount of time listening to Autistic voices, researching and reading about autism, they begin to wonder about a formal diagnosis. It can be hard to find autism assessments in adulthood but not impossible. You can find several directories of neurodivergent-affirming therapists and a directory of assessors on my resource page (scroll to the middle of the page).
Summary
In true Autistic fashion, this article has turned into quite the info dump. We have done quite a comprehensive exploration of autism, and I applaud you for making it to the end. We have unpacked autism by delving into its nature as a form of neurodivergence and the unique brain style differences associated with it. We have unpacked what Autistic masking is and taken a deep dive into two distinct presentations of autism and discussed important considerations if you suspect you might be Autistic. If you would like to learn more, I’d recommend you stay in touch by joining my neurodivergent newsletter, where you’ll get weekly emails about topics related to autism and ADHD.
