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Wondering if You Have Autism?: Understanding the Adult Autism Assessment Process

Navigating the adult autism assessment process can be a daunting journey, especially for those unfamiliar with the steps involved. This guide aims to demystify the process. By the end of this article, I hope you'll feel more confident about what to expect and how to proceed.

Navigating the adult autism assessment process can be a daunting journey, especially for those unfamiliar with the steps involved. This guide aims to demystify the process. By the end of this article, I hope you’ll feel more confident about what to expect and how to proceed. Let’s dive into the key aspects of adult ASD assessment, particularly in California.

Recognizing the Need for an Assessment

Recognizing the need for an autism assessment in adulthood can be a pivotal moment in your life. For many adults, this realization is the culmination of years of feeling different, misunderstood, or out of sync with societal expectations. Understanding why and when to seek an assessment is crucial for taking control of your mental health and well-being.

Understanding Your Experiences

Many adults come to suspect they might be on the autism spectrum after experiencing persistent challenges in areas such as social interactions, communication, sensory processing, and routines. Here are some common experiences that might prompt you to consider an assessment:

  1. Social Challenges: If you frequently find social situations overwhelming, confusing, or exhausting, this could be a sign. You might struggle to interpret social cues, maintain eye contact, or understand the nuances of social interactions. Often, adults with ASD feel a sense of disconnection or loneliness despite being in social environments.
  2. Communication Difficulties: Difficulties in communication can manifest in various ways, such as trouble starting or maintaining conversations, understanding sarcasm or jokes, or feeling misunderstood by others. You might also find it challenging to express your thoughts and feelings clearly.
  3. Sensory Sensitivities: Many adults with autism experience heightened sensitivity to sensory inputs like lights, sounds, textures, or smells. This can lead to discomfort or distress in everyday environments that others might find benign.
  4. Preference for Routines: A strong preference for routines and predictability is another hallmark of autism. You might feel distressed or anxious when your routines are disrupted or when faced with unexpected changes.
  5. Special Interests: Intense, focused interests in specific topics can be both a passion and a coping mechanism. While these interests can be a source of joy and expertise, they can sometimes interfere with daily responsibilities or social interactions.

The Impact of Unaddressed Autism

Living with unaddressed autism can lead to a range of difficulties, including:

  • Mental Health Issues: Adults with undiagnosed autism often experience anxiety, depression, and other mental health challenges due to the constant struggle to navigate a world that feels overwhelming or hostile.
  • Relationship Struggles: Difficulties in communication and social interactions can strain relationships with family, friends, and colleagues. Misunderstandings and frustrations can build up over time, leading to isolation or conflict.
  • Professional Challenges: In the workplace, the social and sensory demands can be particularly taxing. You might find it challenging to fit into the conventional work environment, leading to job dissatisfaction or frequent job changes.

Self-Reflection and Awareness

Self-reflection is a crucial first step in recognizing the need for an assessment. Take some time to consider your experiences and how they align with common characteristics of autism. Reflect on your childhood and developmental history, as many signs of autism are present from an early age but might have been overlooked or misinterpreted.

Seeking External Perspectives

Sometimes, an outside perspective can provide valuable insights. Talk to trusted friends, family members, or partners about your experiences and concerns. They might have noticed behaviors or patterns that you’re not fully aware of. Their observations can help you build a more comprehensive understanding of your challenges.

Initial Consultation and Pre-Assessment

Once you’ve decided to pursue an assessment, the next step is finding a qualified professional who specializes in adult ASD assessment. This could be a psychologist, psychiatrist, or a specialized clinician. The initial consultation typically involves a comprehensive interview to understand your developmental history, current symptoms, and any co-existing conditions.

During this pre-assessment phase, the clinician may ask about your childhood development, educational background, work history, and social relationships. This information helps in forming a complete picture of your experiences and challenges. It’s important to be as honest and detailed as possible during these discussions to ensure an accurate assessment.

Diagnostic Criteria for Adult Autism

Understanding adult autism assessment criteria is essential for anyone seeking an assessment. The criteria, outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), provide a framework for clinicians to identify Autism Spectrum Disorder (ASD) based on specific behaviors and characteristics. Here, we delve deeper into each criterion, explaining what they mean and how they might manifest in adults.

Persistent Deficits in Social Communication and Interaction

The first set of criteria involves persistent deficits in social communication and interaction across multiple contexts. This includes:

  1. Social-Emotional Reciprocity: This refers to the back-and-forth flow of social interaction. Adults with autism might struggle with initiating or responding to social exchanges. This can manifest as difficulty in making or maintaining conversations, a lack of spontaneous sharing of interests or emotions, or an inability to initiate or respond to social interactions in a typical manner. For instance, you might find it challenging to understand the give-and-take of conversation, often feeling like you don’t know how to keep a dialogue going or how to respond appropriately to others’ emotional cues.
  2. Nonverbal Communicative Behaviors: This criterion involves challenges in using and interpreting nonverbal communication such as eye contact, facial expressions, body language, and gestures. You might avoid eye contact or find it uncomfortable, have limited or unusual facial expressions, and struggle to interpret others’ nonverbal signals. This can lead to misunderstandings in social interactions, as nonverbal cues play a significant role in communication.
  3. Developing, Maintaining, and Understanding Relationships: Adults with autism often find it challenging to develop and maintain relationships appropriate to their developmental level. This might include difficulty adjusting behavior to suit different social contexts, sharing imaginative play or making friends, and a lack of interest in peers. You might have a small circle of friends and find it challenging to navigate the complexities of social hierarchies, or you might struggle with the nuances of romantic relationships.

Restricted, Repetitive Patterns of Behavior, Interests, or Activities

The second set of criteria involves restricted, repetitive patterns of behavior, interests, or activities. These behaviors must be present currently or in your history. They include:

  1. Stereotyped or Repetitive Motor Movements, Use of Objects, or Speech: This can include repetitive body movements such as hand-flapping or rocking, repeating phrases or words (echolalia), or an insistence on using objects in the same way each time. These behaviors often serve as a way to self-soothe or manage sensory input.
  2. Insistence on Sameness, Inflexible Adherence to Routines, or Ritualized Patterns of Behavior: You might feel extremely distressed by small changes in your routine or environment and have rigid thinking patterns. For example, you might need to follow a specific routine every day and become very upset if something disrupts it. This insistence on sameness can provide a sense of security and predictability.
  3. Highly Restricted, Fixated Interests: Adults with autism often have intense and focused interests that are abnormal in intensity or focus. These interests can dominate conversations and activities, sometimes to the exclusion of other topics. You might have an encyclopedic knowledge of a specific subject and spend a significant amount of time engaged in related activities.
  4. Hyper- or Hyporeactivity to Sensory Input or Unusual Interest in Sensory Aspects of the Environment: This involves either heightened or reduced sensitivity to sensory stimuli such as sounds, lights, textures, or smells. You might be easily overwhelmed by loud noises or bright lights, or you might seek out sensory experiences like touching certain textures or smelling objects.

Symptoms Must Be Present in Early Developmental Period

While these symptoms must be present from an early age, they might not become fully apparent until social demands exceed capacities or might be masked by learned strategies in later life. This means that even if you’ve developed coping mechanisms over time, the core challenges associated with autism have been part of your developmental history.

Clinically Significant Impairment

For an autism diagnosis, these symptoms must cause clinically significant impairment in social, occupational, or other important areas of current functioning. This impairment can manifest in various ways, from difficulties maintaining employment or educational pursuits to challenges in everyday social interactions and relationships. The impact on your life must be significant enough to warrant a clinical diagnosis.

Not Better Explained by Intellectual Disability or Global Developmental Delay

Finally, the symptoms of autism must not be better explained by an intellectual disability or global developmental delay. While these conditions can co-occur with autism, the social communication challenges and restrictive behaviors must be distinct from what would be expected in someone with an intellectual disability alone.

The Formal Assessment Process

Recognizing the need for an autism assessment in adulthood can be a pivotal moment in your life. For many adults, this realization is the culmination of years of feeling different, misunderstood, or out of sync with societal expectations. Understanding why and when to seek an assessment is crucial for taking control of your mental health and well-being.

The formal assessment process typically involves several steps, including standardized tests, questionnaires, and direct observations. Here’s a breakdown of what you can expect:

  1. Standardized Tests: These may include tools like the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). These tests are designed to evaluate your social communication skills and repetitive behaviors.
  2. Questionnaires and Self-Reports: You might be asked to complete questionnaires about your experiences and symptoms. These can provide valuable insights into your daily functioning and how you perceive your challenges.
  3. Interviews with Family Members or Close Friends: With your permission, the clinician may speak with family members or close friends who can provide additional perspectives on your behavior and history.
  4. Direct Observations: The clinician may observe your interactions and behaviors in a structured setting to identify specific traits associated with ASD.

Understanding the Results

Once the assessment is complete, the clinician will compile the results and provide a comprehensive report. This report will outline whether you meet the criteria for ASD and may also include recommendations for support and interventions. It’s important to take the time to review this report thoroughly and ask any questions you may have. Understanding your diagnosis can be a powerful tool for self-advocacy and accessing appropriate resources.

Post-Diagnosis: Next Steps

Receiving a diagnosis of ASD as an adult can be both relieving and overwhelming. It’s a validation of your experiences and challenges, but it also raises questions about the future. Here are some steps you can take post-diagnosis:

  1. Education and Resources: Learn as much as you can about ASD. There are numerous resources available, including books, websites, and support groups that can provide valuable information and support.
  2. Therapeutic Interventions: Depending on your specific needs, you might benefit from psychotherapy, occupational therapy, or social skills training. These interventions can help you develop strategies to manage your symptoms and improve your quality of life.
  3. Support Networks: Connecting with others who have similar experiences can be incredibly supportive. Consider joining support groups for adults with ASD, either in person or online.
  4. Workplace Accommodations: If you’re employed, it might be helpful to discuss your diagnosis with your employer and explore potential accommodations that can help you perform your job more effectively.

Finding Support in California

If you’re seeking an adult ASD assessment in California, there are numerous clinics and professionals who specialize in this area. It’s important to find a provider who is experienced in working with adults and understands the unique challenges faced by this population. Online directories, professional organizations, and recommendations from your healthcare provider can be valuable resources in finding the right clinician.

Empowering Yourself Through Knowledge

Understanding the adult autism assessment process is a significant step toward self-empowerment. By knowing what to expect and how to navigate each phase, you can approach the assessment with confidence and clarity. Remember, the goal of the assessment is not just to label but to provide a framework for understanding your experiences and accessing the support you need.


The journey to an adult autism assessment can be challenging, but it’s a crucial step in understanding yourself and improving your quality of life. Whether you’re just starting to explore the possibility of an assessment or you’re ready to take the next step, having the right information and support is essential. If you have any questions or need further guidance, don’t hesitate to reach out.

Contact me for a virtual consultation to discuss your specific needs and how we can navigate this journey together.

By taking this step, you’re empowering yourself to live a more informed and fulfilling life.


Dr. Kenneth Roberson

Dr. Kenneth Roberson is an Adult Autism Psychologist in San Francisco with over 30 years of experience. Click below to ask a question or schedule an appointment.

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