If you look normal, then act normal
The reality is this concept is society's expectation. Adults having, or suspected of having, high functioning Autism Spectrum Disorder (hfASD) have unique characteristics that are often overlooked by well-intentioned therapists. In many instances they were misdiagnosed years earlier, thinking they had Schizotypal Disorder, Schizoaffective Disorder, Depression, Dysthymia, Anxiety, Paranoia, Bipolar Mood Disorder, ADHD, or Narcissism. Why? Because that’s how they looked at that time to the diagnostician. As a result, treatment may have been ineffective and lead to further frustration – especially if the individual is in a committed relationship.
The following eight topics may help you understand more about how HFA/AS is manifested in adults:
Misunderstood
• Diagnostic criteria reflect childhood symptoms which may be significantly different in adults
• Adults have had many years to fine tune their compensatory strategies
• Brilliance in the classroom may not be a predictor for functional effectiveness in an adult setting
• hfASD in adults is often described as a "Hidden Disability"
• Symptoms are often not as obvious as that seen in children
• It is an underserved population
• Because the adult individual does not look impaired, he/she is presumed to be proficient
Common Characteristics
Not every individual will present with all the symptoms described below. Many will have only a few of these, while others may seem to possess them all. Severity levels of each may widely differ between individuals and what is often seen in one individual may not be seen in others. It is imperative to keep this concept in mind when discussing the subject of characteristics.
• IQ is typically normal to gifted
• Typically male
• Motor skills may be impacted
• May be clumsy
• May have an unusual gait
• May have an unusual posture
• Communication skills may be misunderstood, rude, or abrasive
• May have a restricted range of interest
Employment
A wide disparity is often seen in the employment setting. Some individuals may be perceived as societal trendsetters and many CEOs of well-known technology industries are known to be diagnosed with hfASD. Their propensity for detail and hyper-vigilance on qualities of utmost interest to them are seen as positive traits that often led the company to success. Unfortunately, other adults are at the other end of the continuum and are still living with their parents or found wandering the streets living in homeless shelters.
• May have sophisticated career as CEO or university professor
• Often found in very specific fields such as math, statistics, actuarial science, or engineering
• May prefer to be socially isolated and will seek employment settings that satisfy this quality
• Social deficits may interfere to the extent that the individual is incapable of obtaining or keeping employment – remember, there is no such thing as mildly unemployed
• No matter how brilliant one is, an interview is still required
• Sadly, many adults' talents are underutilized and as such may be found working as baggers in grocery stores, convenience store clerks, or shelf stockers
Comorbidity
Many individuals with social-pragmatic communication deficits, especially those in which the deficit is secondary to hfASD, often present with traits characteristic of other diagnoses. When these traits have been formally labeled, they are said to be comorbid. Often these comorbid traits present with such severity that they mask the actual diagnosis. Frequent comorbid diagnoses may be:
• Attention Deficit Hyperactivity Disorder
• Depression
• Dysthymia
• Anxiety
• Post-Traumatic Stress Disorder (PTSD)
• Eating disorders
• Bipolar Disorder
• Gender identity disorder
• Obsessive Compulsive Disorder
Relationships
Many adults are able to establish and maintain lasting relationships but unfortunately, some are incapable of achieving what they so dearly seek. Relationships are often impacted by subtle factors that create significant difficulty.
• Limited, if any, sustained relationships
• May have difficulty discriminating between friend or acquaintance
• Social blunders may lead to accusations of date-rape
• Often accused of lacking common sense
• Strengths are often overshadowed by deficits
• Eager to please
• Strong sense of social justice which may, in its extreme, be considered as the "Rule Nazi"
• Often desires emotional connection but frequently doesn't know how to obtain it
• Often lack the "Language of Emotions"
• May use incorrect terminology to describe current emotional states
• Terminology may be inappropriate for social settings
• Often mistakenly accused of faulty emotional reciprocity – especially when nonverbal deficits are present
• Often shocked when told their comments were hurtful or inappropriate
• Often don't know how to fix the damage which may lead to rage, increased anxiety or repetitive behavior
Forensics
It should be noted that the vast majority of adults with this diagnosis are law-abiding citizens. But, when issues arise that land an individual in the court system, a unique set of concerns specific to social-pragmatic communication may be found which causes both the District Attorney's office and the defense team to simply be bewildered and wonder "How can someone with such a high IQ possible not have realized what he was doing was improper?"
• Difficulties are frequently related to an inability to process social cues
• Naiveté often predisposes the individual to exploitation
• Inability to perceive social cues, especially nonverbal communication, may lead to accusations of date rape
• Inability to succinctly express himself may be perceived as "lacking in remorse"
• Issues related to obsessive compulsive disorder may predispose an individual to negative consequences which when admonished may lead to increased anxiety increasing the likelihood of a repeat occurrence
• May refuse to change patterns – especially when he perceives himself to be "in the right"
Restricted Interests
Adults often demonstrate a highly refined area of interest that far exceeds what is considered by others as "typical interest."
• May be extremely knowledgeable about a specific topic
• May be seen as a positive trait in a CEO
• May be seen as a negative trait when perceived as obsessive
• Collection of information and facts often has minimal relationship to functional living needs
• May be consumed by movie trivia, train schedules, sports statistics or similar data
• Often accidentally bores others by not reading nonverbal signals used to express "enough already" by those he is lecturing
• This quality may have been perceived as "cute" when he was a child but is often considered "obnoxious" as an adult
Communication Skills
Typically these adults have unique communication skills which are often misinterpreted by others.
• Strong vocabulary
• Strong knowledge in a specific topic
• Exceptional memory
• Conversation may often be uni-focused and self-centered
• Often hyper-literal and fail to consider alternative definitions
• Idioms and metaphors may be difficult
Family and Spousal Concerns
Social-pragmatics, especially when secondary to hfASD impacts not just the spouse but the entire family. Understanding the unique strengths and weaknesses and how they impact the ability to establish and maintain relationships with others is a key to harmony. In general the following issues may impact relationships:
• Difficulties dealing with intimacy. Complacency seems to be a common theme as does blaming the spouse for his/her difficulties.
• Social ineptness leading to isolation. New social outings are often not enjoyable. History has shown they are unpredictable and lead to awkward moments. A coping strategy is to avoid these situations at all costs. No engagement assures no failure.
• Parenting problems. “I was just like that as a kid,” doesn’t help the situation. Aloofness, hypercriticism, and indifference are just some of the issues. It doesn’t mean the individual doesn’t love his/her child. They have a difficulty expressing emotions.
Professional Communication Services, Inc.
Timothy P. Kowalski, M.A.,CCC-SLP, ASDCS