What it is:
According to the Diagnostic and Statistical Manual, 5th ed. (APA, 2013), Autism Spectrum Disorder (ASD) is a neurological condition that affects approximately 2% of the U.S. population (Maenner, 2020) and is characterized by (1) difficulties in social communication, and (2) stereotypic, restrictive, or repetitive patterns of behavior. However, many people (including all of us at TAP) view this as a narrow, pejorative description that contributes to many common misconceptions about autism. It also means many autistic adults may go misdiagnosed or undiagnosed, such as those who are assigned female at birth, identify as genderqueer or non-binary, or have more subtle presentations paired with histories of trauma, atypical upbringings, or other mood concerns.
The term autism has come to describe an incredibly diverse and wide-ranging group of people. At TAP, we have worked with many autistic adults who have been misdiagnosed or whose autism was missed entirely (e.g., they were correctly diagnosed as depressed or anxious, but their neurotype was not accounted for). These folks may also experience difficulties navigating a world that is not built for their neurotype (e.g., social difficulties, preferences for routine or predictability) and may have struggled to access empirically supported treatments that were not properly modified for their neurotype.
Does This Sound Familiar?
- I study others’ body language and expressions, or learn them from TV, movies, or social media to blend in better
- I create scripts that I repeat in my head to use in social situations
- I often feel like I’m “pretending to be normal”, which requires a lot of my energy. I often feel burned out at the end of the day.
- I have been diagnosed with several disorders in the past, but never seem to make great progress in treatment. It feels like something is missing.
- I’ve gotten feedback that sometimes I can seem blunt or rude without intending to be.
- I have sensory experiences that differ from others - I can be very sensitive to some things (e.g., sounds, smells) but not sensitive at all to others (e.g., noticing internal sensations like hunger).
- I get really nervous in social situations, and I spend a long time planning for and recovering from social interactions.
- I tend to notice small details and patterns more than other people do. Sometimes these small details bother me more than they bother others.
- I grew up thinking or being told that I was “weird” or “different”.
- I have strong interests and passions.
- I prefer routines and am most comfortable in a predictable environment.
Specialty Services at TAP:
If this sounds like you, you may benefit from an assessment to further explore your neurotype. We offer comprehensive autism assessments at the TAP clinic, including for adults who think they may have been misdiagnosed previously. Autism assessments for adults include self-report measures and semi-structured interviews, and they may include reports from parents or others to obtain a developmental history. We use evidence-based measures, including the ADOS-2, as well as novel measures (like the CAT-Q) that may better account for high camouflaging individuals, such as adults assigned female at birth. More information is available on our Assessment page.
Unfortunately, very few of the existing empirically-supported treatments (e.g., DBT, exposure-based treatments) have been adapted for autistic individuals, even though psychological difficulties are present at higher rates in autistic individuals compared to allistic (non-autistic) people. Effectively adapted treatments would need to take into account that autistic people often learn better with more visual cues and behavioral practice, rather than by reading lots of words on a page. In addition, they may be overstimulated by – or just not connect with – skills that are often taught to alleviate emotional distress (e.g., the TIP skill in DBT). Instead, they would benefit more from treatments that incorporate their area of focused interest (e.g., Magic cards, machines, clocks, super heroes) and that account for their sensory sensitivities (e.g., being over or under sensitive to sounds, tastes, smells, having difficulty identifying bodily sensations).
At TAP, our therapists do not specialize in treating autism, but are specialists in many mental health areas that affect autistic people and are trained to modify treatments to be more autism affirming- or adapted for an autistic neurotype. This means that our specialists work to incorporate neurotype considerations into any empirically supported treatment we offer (e.g., DBT, UP, CBT). We take a neurodiversity-affirming approach, meaning that we do not approach autism as a disorder to be “fixed” but rather a learning style to be understood and incorporated into treatment. Thus, we encourage neurodivergent individuals interested in services at TAP to feel very free to share what they'd like with us about their neurodivergence in addition to describing any other psychological or emotional difficulties they would like to focus on.
Associated Concerns:
Many autistic adults have co-occurring concerns that may be targets for treatment. Autistic adults are more likely to also struggle with anxiety, depression, ADHD, trauma, sensory differences, sleep difficulties, chronic pain, and metabolic or GI difficulties. More information about each co-occurring problem is available below, including links to our treatment modalities.
Anxiety (& OCD)
- Up to 84% of individuals with autism also experience impairing anxiety, including OCD, which can exacerbate insistence on sameness, repetitive behaviors, emotional distress, and self-harm behaviors.
Trauma
- Up to 45% of autistic adults meet criteria for PTSD, compared to 4% in the general population.
- Autistic individuals are both more likely to experience potentially traumatic events, but are also more likely to have greater distress in the face of traumatic events.
- Autistic individuals are chronically invalidated by living in a neurotypical world, which can result in symptoms similar to people with PTSD.
Strong Sensory Preferences
- Many autistic adults report difficulty tolerating specific sounds or associated stimuli (e.g., specific clothing textures, or sounds (sensitivity to sounds is sometimes called misophonia)).
- Autistic people often have intense physiological (e.g., increased heart rate, muscle tension) and emotional (most often anger and anxiety) responses to sensory overwhelm, which can result in autistic shutdown or meltdown.
ADHD
- ADHD is estimated to co-occur with autism in as much as 75% of autistic adults.
- ADHD can exacerbate work-related stressors, difficulties with time management, hyper-focus, school-related concerns such as testing and study habits, and generally managing day-to-day functions.
We offer neurodivergent-friendly therapies focused on issues all adults may experience, including anger, shame, identity-related stress, parenting difficulties, and burnout.
Empirically Supported Treatments at TAP:
Any of our specialty therapy services can be adapted to be neurodiversity-affirming. Below you can find a list of our empirically supported assessment services or those treatments that can be adapted (if needed) to incorporate neurotype. Click to learn more!
Lots of people have misperceptions about Autism, to learn more read this blog post on Myths About Autism.