Historically, ASD (Autism Spectrum Disorder) has been predominantly associated with childhood developmental challenges, leading to the oversight of adults who display atypical symptoms or present with unique coping skills, compensatory strategies, or masking mechanisms. However, autism is a lifelong neurodevelopmental issue with persistent challenges for those on the autism spectrum in social communication and reciprocal social interactions. The expanding understanding of autism, coupled with revisions to diagnostic criteria, has increased the prevalence of undiagnosed individuals within the adult population, leading to confusion amongst providers who are tasked with diagnosing and assessing autism in adults.
The Evolution of Diagnostic Criteria
The journey of understanding autism has been marked by changes in diagnostic criteria, leading to both increased recognition and confusion. Initially, autism wasn't recognized as a separate diagnosis until the DSM-III revision in 1980. Prior to that, descriptions of individuals who likely had autism date back to the 1700s. Hans Asperger's work in the 1940s marked a significant milestone in understanding the broader autism phenotype. However, differing diagnostic approaches in the DSM and the ICD caused confusion until the DSM-IV revision in 1994.
The subsequent inclusion of Asperger's Syndrome in the diagnostic criteria broadened perceptions of the autism spectrum. However, confusion persisted among clinicians in diagnosing and assessing adults with the updated criteria in the 2013 DSM. Stereotypes, stigma, biases, and a lack of training on adult autism further compounded the problem, resulting in the dismissal of autism based on various misconceptions.
Uncovering the "Lost Generation"
The decades of evolving research and diagnostic criteria, from the 1980 DSM-III to the 1994 DSM-IV, have led to a group of adults on the spectrum referred to as the "lost generation." Individuals within this group exhibit varying presentations and manifestations of autism, making diagnosis challenging. Clinicians often lack the necessary training to diagnose adults accurately, especially those with compensatory strategies and co-occurring conditions.
Research indicates that adults on the autism spectrum frequently receive multiple diagnoses prior to autism identification, which underscores the complexity of recognizing adult autism. The co-occurrence of other conditions further complicates diagnosis and contributes to professionals missing the underlying autism diagnosis. This lack of understanding and training hampers the identification of missed adults.
Impact on Neurodiverse Relationships
As the understanding of autism evolves, so does the realization that autism has a significant impact on marital relationships. Neurodiverse couples, where at least one one partner is neurotypical (NT) and the other is neurodivergent (ND), face unique challenges. Research indicates that individuals on the spectrum report challenges in initiating, developing, and maintaining long-term relationships, while ND partners often report higher marital satisfaction than their NT counterparts.
It's important for clinicians to assess not only adults with autism but also the dynamics of neurodiverse relationships. The prevalence of ASD is projected to increase, leading to a rise in neurodiverse couples seeking marital help. However, research often focuses on the impact of marriage on NT spouses, leaving a gap in understanding the experiences and challenges faced by ND partners.
Exploring Marital Satisfaction
An exploratory, phenomenological qualitative approach was undertaken to understand the dynamics of neurodiverse relationships from the perspective of adults on the autism spectrum. The study aimed to uncover themes of marital satisfaction and dissatisfaction as well as provide insights into the experiences of adults on the spectrum.
Results indicated that age of diagnosis, prior diagnoses, and the timing of autism identification played significant roles in marital satisfaction. Individuals diagnosed later in life often had mixed feelings about the diagnosis, with some feeling relief, while others experienced negative emotions due to missed opportunities for support. The study also highlighted the importance of specialized training for clinicians to accurately diagnose adults with autism.
Themes of Satisfaction and Dissatisfaction
Themes of satisfaction included shared activities, respect, recognition of contributions, teamwork, encouragement of pursuits, and physical intimacy. On the other hand, themes of dissatisfaction encompassed blame, criticism, lack of alone time, heightened conflict, lack of physical affection, and feelings of inadequacy.
The study also provided insights into the advice that adults on the spectrum would give to their NT partners. Slow communication, altered expectations, understanding emotional difficulties, and appreciating individual strengths were among the key pieces of advice offered.
This exploratory study sheds light on the complex interplay between adult autism and neurodiverse relationships. The evolving diagnostic criteria, missed opportunities for diagnosis, and lack of training contribute to the challenges of identifying autism in adults. Understanding the dynamics of neurodiverse relationships is crucial for clinicians and researchers alike, as this knowledge can lead to more effective support and interventions.
Moving forward, further research is needed to delve deeper into the intricacies of adult autism and its impact on various types of neurodiverse relationships. Bridging the gap between the evolving understanding of autism and the diagnostic challenges faced by adults can lead to better outcomes for individuals on the spectrum and their partners.
This blog is based on the research of Dr. Stephanie C. Holmes
Research article found at: