How to evaluate ASD in adults

Autism spectrum disorder (ASD) is a neurodevelopmental problem whose difficulties are reflected in social interaction, communication, the presence of stereotyped behaviors (rigid and repetitive), resistance to change and restricted interests. The way it is expressed varies from one person to another and the stage they are in..

Most people with ASD are diagnosed in childhood. However, they can also be diagnosed in adulthood, although it is more difficult to identify. ASD is increasingly common, its prevalence is estimated to be 1 in 68.. This increase in cases may be attributed to increased awareness, overdiagnosis, or overly inclusive diagnostic criteria.

Symptoms of autism spectrum disorder

People with ASD have difficulty communicating and interacting socially; Furthermore, as a rule, they have limited interests and repetitive behaviors. Also, they have difficulties with cognitive and behavioral flexibility, altered sensory sensitivity, sensory processing difficulties, and emotional regulation difficulties.

Next, we will review the criteria that the APA has established to diagnose it.

A. Persistent deficits in social communication and social interaction in various contextsmanifested by the following, currently or by history (examples are illustrative, but not exhaustive):

The deficiencies in socio-emotional reciprocity, They vary, for example, from abnormal social approach and failure of normal two-way conversation, through decline in shared interests, emotions, or affects to failure to initiate or respond to social interactions. deficiencies in non-verbal communication behaviors used in social interaction, vary, for example, from poorly integrated verbal and non-verbal communication, through anomalies of eye contact and body language or deficiencies in the understanding and use of gestures, to a complete lack of facial expression and of non-verbal communication.Problems in developing, maintaining, and understanding relationships vary. They range from difficulties adjusting behavior in various social contexts, to difficulties sharing imaginative games or making friends, to the lack of interest in other people.

B. Restrictive and repetitive patterns of behaviorinterests or activities, which are manifested in two or more of the following points:

Stereotyped or repetitive movements, use of objects, or speech (e.g., simple motor stereotypies, alignment of toys or changing the location of objects, echolalia, idiosyncratic phrases).Insistence on monotony, excessive inflexibility of routines, or ritualized patterns of verbal or nonverbal behavior (e.g., great distress over small changes, difficulties with transitions, rigid thought patterns, greeting rituals, need to take the same path or eat the same foods every day).Very restricted and fixed interests that are abnormal in their intensity or focus of interest (e.g., strong attachment or preoccupation with unusual objects, excessively circumscribed or perseverative interests). Hyper or hyporeactivity to sensory stimuli or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive sniffing or palpation of objects, visual fascination with lights or movement).

C. Symptoms must be present in the early phases of the development period (but they may not fully manifest until social demand exceeds limited capabilities, or they may be masked by strategies learned in later phases of life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of normal functioning.

E. These alterations are not better explained by intellectual disability (disorder of intellectual development) or global developmental delay. Intellectual disability and autism spectrum disorder often overlap; To make diagnoses of comorbidities of an autism spectrum disorder and intellectual disability, social communication must be below that expected for the general level of development.

Assessment of ASD in adults

There are questionnaires that people can take to decide whether they should see a professional for an evaluation. Be careful because these self-assessment tools are not suitable for generating a diagnosis.; They should not be relied upon to confirm this disorder.

Among the most common self-assessment tools for ASD are the following:

Autism Spectrum Quotient (AQ-10): This is a 10-question assessment tool adapted from a much longer questionnaire called the Autism Spectrum Quotient (AQ).Adult Repetitive Behaviors Questionnaire-2 (RBQ-2A): This 20-item questionnaire focuses on “restricted and repetitive behaviors.”Adult Social Behavior Questionnaire (ASBQ): The 44 questions in this tool focus on a wide range of aspects of adult autism. It can be used to evaluate another person, as well as a self-assessment.

Professional Evaluations

Consulting a health professional is the only means to receive a diagnosis of ASD. He will be responsible for observing the patient’s behavior, including the way he speaks and interacts. He will also ask you to complete one or more assessments that are more detailed than the previous ones. Among the tests he can use are the following:

Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) Module 4: It is considered the gold standard for diagnosing autism in people of all ages. Module 4 is used specifically for adults and is not a quiz. Instead, the professional administering the test will observe how you respond to certain prompts. They evaluate both what the person says and their behavior.Developmental, Dimensional, and Diagnostic Interview-Adult Version (3Di-Adult): focuses on how the patient communicates and interacts in social situations. Likewise, look for restricted interests, such as obsession with a particular object and certain behaviors.Social Responsiveness Scale (SRS): This test is not used to diagnose autism, but to measure how impaired social skills are.Autism Diagnostic Interview-Revised (ADI-R): This test focuses on the three main areas affected by autism: language and communication, social interaction, and repetitive behaviors or interests.

He National Institute for Health and Care Excellence (2021) recommends screening for possible autism when a person has one or more of the following problems:

Persistent difficulties in social interaction.Persistent difficulties in social communication.Stereotypical behaviors (rigid and repetitive), resistance to change, or restricted interests.Problems obtaining or maintaining employment or education.Difficulties initiating or maintaining social relationships.Previous contact or current with mental health or learning disability services History of a neurodevelopmental condition (including learning disabilities and attention deficit hyperactivity disorder) or mental disorder.

The evaluation of ASD in adults should always be carried out under the direction of a professional, since the condition may have similarities with other disorders that may confuse the non-expert.

These disorders are ruled out through differential diagnosis. Autism can be more easily confused with social communication disorder. People with this problem have difficulty using words and language appropriately.

Treatment of ASD in adults

Some interventions that can be used to treat ASD in adults include the following:

Cognitive behavioral therapy: During the sessions people learn about the connections between feelings, thoughts and behaviors. This can help you identify thoughts and feelings that trigger negative behaviors.Social skills training: Through these skills, the adult with autism can learn to interact with others. The person will be able to learn to maintain a conversation, understand humor and read emotional signals.Speech therapy: teaches the adult verbal skills that can help them communicate better.Occupational therapy: It focuses on teaching the person the fundamental skills they need to function in their daily lives.

Finally, ASD in adults is a disorder that also affects the family environment. Therefore, it is pertinent that the evaluation of this spectrum includes a dialogue with the patient’s family or loved ones: father, mother, partner, children, friends… Evaluating their support group is an excellent way to better understand how they relate to others and what their life is like in society.

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