The simple answer to this question is, no. Autism Spectrum Disorder is not like heart disease or diabetes or similar physical conditions that can deteriorate over time. People are born with Autism Spectrum Disorder, and while the condition itself can change with time and often does, the underlying causes of Autism Spectrum Disorder do not worsen.
Tony Attwood, the internationally recognized expert on Autism Spectrum Disorder, notes that the symptoms of ASD are usually obvious when the child starts school and is exposed to greater social interaction. Later, as the adolescent and adult develops more coping skills and is better able to manage the demands of being around people, the same symptoms become less noticeable. In later years, those symptoms often are more prominent, not because the underlying condition has declined but because the person cares less about how his or her behavior affects others.
In short, the simple answer to “Can Autism Spectrum Disorder get worse?” is that the symptoms of ASD can get worse but the condition itself doesn’t.
Here are various considerations that help explain how and why changes, both positive and negative, in one’s symptoms occur as aging continues.
- Often, adults with Autism develop one or more comorbid conditions, a term for mental and emotional disorders that tend to occur along with Autism. Depression and anxiety are the most common, and both intensify the negative symptoms of ASD. An adult with Autism Spectrum Disorder who is significantly depressed is likely to become more irritable and prone to meltdowns, for example. Anxiety interferes with concentration and thus one’s ability to engage socially or converse in a meaningful way.
- Life circumstances have a significant impact on the symptoms of an adult with ASD. A work promotion, geographic relocation, marriage, even less noticeable changes in one’s environment and situation might exceed the person’s ability to cope. What are seen as “normal” ASD symptoms become intensified and more visible. Referred to as “Autism Spectrum Disorder regression” the loss of typical skills and abilities appears as a worsening of one’s Autism.
- A little-known fact of Autism Spectrum Disorder are the natural changes in this condition that happen over time. Studies show that restrictive, repetitive behavior, a hallmark of Autism prevalent during childhood, is less noticeable in adulthood. The same is true of repetitive body movements, such as the hand flapping in classical autism. Clearly, the symptoms of ASD can change, and while in these cases the changes are in a positive direction other symptoms can get worse.
- Studies have also found a direct association between the prevalence of certain symptoms in childhood and changes in different symptoms during adulthood. Children with Autism Spectrum Disorder who have strong executive functioning skills (the ability to plan and carry out complex tasks) tend to also have a more developed theory of mind (the ability to understand others’ thoughts and beliefs). These children typically develop better coping skills later in life. The converse is also true. The coping skills of children with poor executive functioning and theory of mind tend to diminish through their adult years.
- Finally, there are the natural effects of aging. Cognitive flexibility diminishes. Attention and memory decline. Emotional well-being is tested by the physical demands of growing old. Social connections are often harder to sustain as one’s mobility decreases and care for one’s physical health and safety takes priority. All this tends to amplify the existing challenges of Autism. It does not mean, however, the Autism Spectrum Disorder itself is worsening.
You might wonder what the argument about worsening of symptoms is really about. After all, if one’s behavior deteriorates and it’s harder to be around the person, what does it matter whether the actual condition has changed. My answer is that attributing changes in behavior to a worsening of the condition deflects attention away from the real causes of this change and makes it harder to successfully address these negative behaviors. Understanding the real reason why someone’s Autism Spectrum Disorder is more difficult and harder to deal with makes reversing those changes much easier.
You can read about the goals of therapy for adults with Autism Spectrum Disorder here.
