Autism in Adults

By the clinical team at Next Step Psychiatry • Lilburn, GA

You Are Not “Too Old” for an Autism Diagnosis

More adults than ever are realizing they may be autistic—and the experience can be equal parts relieving and overwhelming. If you’ve spent your whole life feeling like you’re performing a role rather than being yourself, struggling with social situations that seem effortless for everyone else, or having sensory experiences that others don’t understand, you’re not alone.

Autism Spectrum Disorder (ASD) affects an estimated 1 in 36 people, but diagnostic criteria were historically biased toward children, particularly boys. This means millions of adults—especially women and people of color—grew up without a diagnosis, often misdiagnosed with anxiety, depression, or personality disorders.

Common Signs of Autism in Adults

Autism presents differently in adults than in children, partly because adults have had years to develop coping strategies (known as masking). Common signs include difficulty reading social cues and unwritten social rules, preferring deep conversations over small talk, intense special interests that others find unusual, sensory sensitivities (certain textures, sounds, lights, or smells), need for routine and difficulty with unexpected changes, and social exhaustion after gatherings.

• Difficulty with eye contact that feels forced or unnatural
• Taking things literally or missing sarcasm and implied meanings
• Struggling with executive function tasks like planning and organizing
• Emotional responses that feel disproportionate to the situation
• A history of being called “too sensitive,” “too intense,” or “quirky”
• Feeling fundamentally different from peers since childhood

The Masking Problem

Many autistic adults, particularly women, have become experts at “masking”—consciously or unconsciously copying neurotypical social behaviors to fit in. While masking can help navigate social situations, it’s exhausting and unsustainable. Over time, masking leads to autistic burnout, anxiety, depression, and a profound sense of disconnection from your authentic self.

This is why so many autistic adults first seek psychiatric help for anxiety or depression—not realizing that these conditions are often downstream effects of unrecognized autism.

Getting Diagnosed as an Adult

An adult autism evaluation typically involves a comprehensive clinical interview covering your developmental history, current functioning, social experiences, and sensory profile. Some evaluations include standardized assessments like the ADOS-2 or self-report measures like the AQ-50.

Importantly, a formal diagnosis is not required to benefit from understanding yourself through an autism lens. Many adults find that even without a formal evaluation, learning about autism and connecting with the autistic community provides enormous relief and practical strategies for daily life.

Co-Occurring Conditions

Autistic adults frequently have co-occurring mental health conditions that benefit from psychiatric treatment.

• Anxiety disorders: Affecting up to 50% of autistic adults
• Depression: Particularly related to masking, isolation, and burnout
• ADHD: Co-occurs with autism in approximately 30–50% of cases
• OCD: Repetitive behaviors can overlap with autistic traits
• PTSD: Higher rates due to bullying, social trauma, and sensory overwhelm

How We Support Autistic Adults

At Next Step Psychiatry, we take an affirming, strengths-based approach to autism. We don’t view autism as something to be “fixed”—rather, we help manage co-occurring conditions like anxiety and depression while supporting your overall wellbeing. Our team provides comprehensive evaluations, medication management for co-occurring conditions, and referrals to autism-affirming therapists in the Atlanta area.

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider. If you or someone you know is in crisis, call 911 or the 988 Suicide & Crisis Lifeline.