Understanding Asperger's Symptoms in Adults

Medically Reviewed By William C. Lloyd III, MD, FACS
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Asperger’s syndrome used to be a unique diagnosis. Now, clinicians consider it part of autism spectrum disorder (ASD). Those who clinicians used to diagnose with Asperger’s syndrome may now receive a diagnosis of ASD. Symptoms of ASD can vary significantly, with clinical signs of autism in adults including differences in communication and socialization. In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM) removed Asperger’s syndrome as a distinct diagnosis. Instead, clinicians now regard what was formerly known as Asperger’s syndrome as ASD.

This article explains the signs and symptoms of ASD in adults. It also looks at how what used to be called Asperger’s syndrome clinically relates to ASD and the diagnosis of this condition.

What is Asperger’s syndrome?

An older male stands in front of a driveway wearing in-ear headphones.
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Clinicians first used the term “Asperger’s syndrome” to characterize certain behavioral characteristics, including difficulties with communication and social interaction.

ASD, which Asperger’s syndrome is now part of, is a neurodevelopmental disorder that has a variety of degrees and presentations. However, some people continue to identify as having Asperger’s syndrome.

Clinicians may also continue to refer to Asperger’s syndrome as a subtype of ASD due to extensive historical clinical information about the form of the disorder.

ASD can include differences in social communication, interactions, and behaviors, such as focused interests and repetitive behaviors.

What are the symptoms of ASD in adults?

Clinicians used to think that a clinical difference between Asperger’s syndrome and autism was that people with Asperger’s syndrome may have a lesser degree of language or intellectual impairment than those with autism.

In fact, some clinicians may refer to the type of ASD that was formerly known as Asperger’s syndrome as “ASD with lesser language and intellectual impairment.”

However, the symptoms of ASD are diverse, and each autistic individual may have different experiences and characteristics. Not everyone with ASD will experience the same behaviors and symptoms.

The symptoms of ASD can also be different according to many factors, such as the person’s age, their sex, and certain environmental and cultural factors.

Common symptoms in adults

Common symptoms of ASD in adults can include:

  • having difficulty understanding what others may be thinking or feeling
  • feeling very anxious about social situations
  • having difficulty making friends
  • preferring to be on your own
  • having difficulty expressing or saying how you are feeling
  • understanding things very literally or having difficulty understanding sarcasm or idioms
  • preferring to have the same routine every day and feeling anxious if the routine gets disrupted
  • having difficulty engaging with others

Additional symptoms of ASD

Other symptoms of ASD can include:

  • repetitive behaviors
  • focused or very specific interests
  • hyperactive, impulsive, or inattentive behaviors
  • epilepsy or another seizure disorder
  • particular eating or sleeping habits
  • gastrointestinal issues
  • anxiety, stress, or worry
  • a lack of fear or more fear than expected
  • unique mood or emotional reactions
  • being more or less sensitive than others to certain sensory stimuli, such as light, sound, textures, or temperature
  • sleep problems
  • irritability

Diagnosing ASD in adults

ASD is a developmental disorder, meaning that it can appear during the developmental period of life, including during childhood.

Autistic adults have always had ASD, but they may not have received a diagnosis previously in life. This may be due to experiencing certain factors that impeded diagnosis.

Challenges for diagnosis in adults

There are no diagnostic tests for ASD that focus exclusively on adults. Many diagnostic tools and criteria for ASD focus on development and symptoms in children.

Additional challenges in diagnosing ASD in adults may include:

  • a lack of recognition of symptoms by clinicians and others
  • experiencing symptoms that are not obviously from ASD
  • the person having devised ways to address their challenges alone, such as by masking their symptoms and trying to pass as neurotypical
  • financial, social, and emotional barriers to accessing assessment
  • receiving a different diagnosis that could plausibly explain some of the symptoms they experience

A 2021 review of the diagnosis and management of ASD in adults outlines that many autistic adults also experience social and economic factors that exclude them from accessible healthcare, education, and social support.

Diagnostic bias may also affect certain groups of autistic people.

These factors may contribute to an autistic person reaching adulthood without receiving a clinical diagnosis.

Some people do not seek a medical diagnosis

ASD is diverse. Autistic people can have widely varying experiences, and not all autistic people will view their condition in the same way.

Some people may not view their condition as a disorder that requires treatment. Instead, they may prefer to focus on addressing any environmental and social factors that affect their experience. Because of this, some people may not feel that a clinical diagnosis is necessary.

Many people also choose to conduct their own research and seek their own sources of support.

This can be especially important for certain groups, as there is less investigation into ASD and ASD diagnosis, symptoms, and support for those in underrepresented groups, including LGBTQIA+ people and People of Color.

Diagnosis developments

Factors including changes in awareness and the development of diagnostic criteria and professional practices mean that autism diagnoses in adults are becoming more and more common.

Clinicians may make a diagnosis in an adult with a combination of in-person observation, questioning, and a medical history.

Research from a 2017 study suggests that certain screening tests, such as the ADOS-2 test, can also be accurate for ASD in adults. Many clinicians consider the ADOS-2 test the best test for autism diagnoses. Other rating scales, such as the Social Responsiveness Scale for Adults, may also provide additional diagnostic information surrounding social behaviors.

However, clinicians must first recognize and understand the symptoms to refer an individual for a test.

Additionally, the same 2017 study suggests that the autism diagnostic interview-revised — which is a test for ASD — may not be as reliable in adults who do not experience intellectual difficulties.

Living with ASD in adulthood

Treatment can involve varying approaches to ASD in adults.

Medical approaches may offer clinical options to treat some clinical aspects of ASD. For example, this can include therapy, such as cognitive behavioral therapy to address any mental health issues, or medication, to treat co-occurring conditions such as sleep or gastrointestinal problems.

Additionally, complementary or alternative therapies may help. These options can include animal therapy, relaxation therapy, chiropractic care, and dietary and supplemental approaches.

Social approaches may include charity or organizational programs that offer legal, financial, employment, educational, and social support to autistic people. They may also educate about and advocate for ASD to address systemic or social factors that may impact autistic people’s experiences.

For example, the Asperger/Autism Network offers both online and in-person support groups and community connections for adults in the United States. 

For further access to support groups and resources, contact your hospital, doctor, or local charity for information about what programs are available to you. 

Get more information about treatment and support options for ASD here.

Financial support

The Social Security Administration (SSA) runs two programs that offer benefits to provide assistance to adults with disabilities.

These programs are the Social Security Disability Insurance and Supplemental Security Income programs. They offer financial support to you and certain family members. To apply, you will need a clinical diagnosis. For more information, find an overview of SSA disability benefits here.

Work support

The SSA also runs a program that supports people with disabilities who are able and who want to work. The Ticket to Work program offers support such as access to individualized support services, maintenance of your disability benefits for at least 9 months after your return to employment, and Medicaid or Medicare while you work.

The U.S. Equal Employment Opportunity Commission (EEOC) also outlines that under the Americans with Disabilities Act (ADA), if you have a disability and are qualified to do a job, the ADA protects you from being discriminated against at work on the basis of disability. 

The ADA also means that employers must provide reasonable accommodations to qualified job applicants or current employees with a disability (unless the accommodation causes significant difficulty or expense). 

The EEOC suggests some examples of reasonable accommodations that may help you at work, including:

  • getting specific equipment or modifying your current equipment
  • restructuring your job
  • modifying your work schedules or working part-time
  • being reassigned to another available position
  • adjusting or modifying exams, training materials and programs, or policies
  • working with interpreters
  • making the work site more accessible

FAQs

Here are some commonly asked questions about Asperger’s syndrome and ASD in adults.

What are the three main symptoms of Asperger’s syndrome?

Symptoms of ASD vary widely according to the individual. Every autistic person will have different experiences, and many other symptoms are possible.

However, the DSM outlines two significant categories of specific diagnostic criteria for ASD. These are social communication impairments and restricted or repetitive behaviors.

What conditions might people confuse with Asperger’s syndrome?

The Autism Research Institute suggests that several disorders can present symptoms that are also common in ASD. These disorders include:

Although ASD may share some behavioral symptoms with other conditions, treatment approaches may be different. Getting a medical diagnosis may help differentiate conditions and help tailor treatment to the individual.

Why do people confuse Asperger’s syndrome with bipolar disorder?

The researchers behind a 2012 study into psychiatric conditions that co-occur with ASD suggest an association between bipolar disorder and ASD.

Additionally, the researchers question whether the diagnostic criteria for bipolar disorder are accurate in people with ASD. This is because the core symptoms of bipolar disorder can include manic or hypomanic moods, but with ASD, defining these symptoms can be more difficult.

Because of this, the researchers suggest that it is necessary to revise and better contextualize diagnostic criteria for co-occurring psychiatric conditions in autistic people.

Summary

The symptoms of ASD can be diverse. Clinicians used to diagnose Asperger’s syndrome when someone presented symptoms of autism with a lesser degree of language or intellectual impairment. Other characteristics may include repetitive behaviors, differences in social communication and interaction, and co-occurring conditions.

Diagnosis of ASD in adults can be challenging due to various clinical, social, and environmental factors. Many autistic adults may choose not to pursue a clinical diagnosis, while for others, a diagnosis may be helpful. Further developments in research and social factors are necessary to improve diagnosis and treatment access for all.

Support for autistic adults includes clinical therapies, social support, alternative therapies, and financial and employment entitlements. Contact your doctor, local hospital, or charity to find out what support is available to you.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jul 7
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