Autism Answers

Is it possible to go 18 years of life unknowingly having being on the Autism spectrum?

Hi Averagejoshmoe, Thank you for asking this question about autism and possible undiagnosed Autistism Spectrum Disorders. The short answer to your question is, yes it is possible for a person to have Autistism Spectrum Disorder and make it to the age of 18 or even further into adulthood and never receive an official diagnosis. As with every mental disorder or illness diagnosed using the criteria contained in the Diagnostic and Statistical Manual of Mental Disrders Fifth Edition (DSM-5), Autism Spectrum Disorder will only be diagnosed or rather should only be diagnosed when the minimum criteria are met, the person seeks assistance from a menta health professional or assistance is requested on behalf of an individual and this professional is able to complete a full diagnostic interview that includes the individual in question and the involved parents or other care givers. If this diagnostic interview takes place later in the individual's life, such as in K-6 grades, then at least one teacher and a person involved in professionally supporting the individual, such as a social services worker or a developemental aid who might asist in supportive educational activities and possibly a behavioral analyst who has cloosely and extensively observed the individual interacting with peers should also be included as sources of information so that a clear clinical picture can be put together. Using evidence from this number of reliable and specialized sources will allow the clinician to put together a very detailed diagnostic assessment and it would be extremely unlikely that a diagnosis would be missed. The deficits that come together for a diagnosis of Autism Spectrum Disorder include persistent impairments in social communication and social interaction along with repetitive behaviors and restricted intersts in activities and topics of interest or discussion. There are additional criteria, although the ones just mentioned are not just present in an individual. A person could display evidence to meet every diagnotic criteria, yet may also have above average intelectual developement such that an individual could create or develop methods of coping with the deficits so that they are not imaired to a significant degree.  I think it would be highly unlikely for an individual to meet all of the diagnostic criteria for Autism except for the criteria that the deficits cause significant impairment in functioning in either social, occupational or self care activities. However, I do not think it is impossibe that perhaps an individual could have mild to moderate  impairments in most of the diagnostic criteria and if the individual does not have an intellectual impairment,  maybe even above average or superior level of intellectual development (in other words, an IQ in the range of 110-130), this could allow a person to overcom the deficits by compensating for them using creative strategies. However, because Autism is generally evident between 12-24 months of age, and intelectual development is in early stages at this age, an individual meeting diagnostic criteria for Autism Spectrum Disorder at this young age is not going to have compensatory mechanisms in place. The social and social communication deficits at this age are going to be fairly obvious, such as a child at this age might not be pointing or follow a poined finger or does not pick items up to show his mother , they often have little interest in other children their age just as a couple of examples. Care givers are usually very sensitive to differences and particularly things their child is not doing that most other kids of the same age are doing at this age and the deficits of autism are unikely to escape the notice of a mother.   This brings up a question that is beyond the scope I think of what you were asking, if a person meets the criteria for autism as a child and as an adult they have learned to compensate for some of their deficits, is the person still consider to fit the diagnosis of Autism Spectrum Disorder. Technically yes, and probabally functionally yes also, although it might not be as aparent. I hope this has helped you come to your own answer to your question. answers your question. Austism Spectrum Disorder is included in the DSM because the number of deficits a person has all but ensures an individual will have significant impairments in functioning. 
(LCSW)
Answered on 01/20/2022

I think I'm autistic. My sister thinks I'm a narcissist and a sociopath.

Hello Skunkette. I want to begin by saying how proud of you I am for reaching out and asking for some clarification on what you have been experiencing.    Before I begin I do want to put the disclaimer I am basing my answer on only the information you provided in your question.  Let’s begin with what I feel is the simpler of the questions you have asked me.  “Does the person writing this even sound like a sociopath, in your honest opinion?”.  I do not feel what you disclosed describes a sociopath.  A sociopath is not an actual diagnosis but a person who demonstrates more severe traits of a person who has Antisocial Personality Disorder.  A person who is truly a Socio Path is the opposite of how you described yourself.  Meaning they are not the “weird kid”, they are the popular ones, the ones that everyone loves.  They will go above and beyond to make people love them, but when they are not performing in front of others and have alone time with one or two people this is when they can show their true colors.  A genuine sociopathic person is highly aggressive, arrogant, impulsive, unempathetic, narcissistic, immoral, enjoys causing severe harm to others (such as cutting, burning, and even murder), and will not stop until they feel they have caused enough suffering to their pleasing. So, leaving a poor review on Google or sending them mail is nowhere near a Sociopath.   To further support you not sounding like a Sociopath,  per the Diagnostical Statistical Manual Five (DS-5) to receive a diagnosis of Antisocial Personality one must fit the below criteria.   A pervasive pattern of disregard for and violation of the rights of others, since age 15 years, as indicated by three (or more) of the following: 1.    Failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest. 2.   Deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit. 3.   Impulsivity or failure to plan. 4.   Irritability and aggressiveness, often with physical fights or assaults. 5.   Reckless disregard for the safety of self or others. 6.   Consistent irresponsibility, failure to sustain consistent work behavior or honor monetary obligations. 7.   Lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person. 2.   The individual is at least age 18 years. 3.   Evidence of conduct disorder typically with onset before age 15 years. 4.   The occurrence of antisocial behavior is not exclusively during schizophrenia or bipolar disorder."   Moving on to your concern with possibly having ODD is more complex to answer.  Typically ODD is diagnosed in childhood, others in the family have been diagnosed, and more times than less you outgrow it by adulthood.  If a person has not outgrown it this adult will struggle immensely with having healthy long-term relationships, they will be angry the majority of the time, will go out of their way to make others angry, and will purposefully do things just to get on other people's nerves. These people get a euphoric feeling out of making others mad.  You reported the examples of “not like being told what to do, especially if a person has no authority over me, and often flaunt I'm doing the opposite of what they said.”  A person with ODD will focus on authority, meaning those are who they want to fight/argue with most.  To properly diagnose you with ODD I would need to know more about your history and meet with you regularly to observe behaviors.  To further clarify what is needed to be diagnosed with ODD here is the criteria per the DSM-5 A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling. Angry/Irritable Mood 1. Often loses temper. 2. Is often touchy or easily annoyed. 3. Is often angry and resentful. Argumentative/Defiant Behavior 4. Often argues with authority figures or, for children and adolescents, with adults. 5. Often actively defies or refuses to comply with requests from authority figures or with rules. 6. Often deliberately annoys others. 7. Often blames others for his or her mistakes or misbehavior. Vindictiveness 8. Has been spiteful or vindictive at least twice within the past 6 months. Note: The persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from a behavior that is symptomatic. For children younger than 5 years, the behavior should occur on most days for a period of at least 6 months unless otherwise noted (Criterion A8). For individuals 5 years or older, the behavior should occur at least once per week for at least 6 months, unless otherwise noted (Criterion A8). While these frequency criteria provide guidance on a minimal level of frequency to define symptoms, other factors should also be considered, such as whether the frequency and intensity of the behaviors are outside a range that is normative for the individual’s developmental level, gender, and culture. B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning. C. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder. Specify current severity: Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers). Moderate: Some symptoms are present in at least two settings. Severe: Some symptoms are present in three or more settings. Now, for the most complex question, are you on the spectrum?  I can clinically say don’t know.  Please try not to be too frustrated and keep reading.  I say this because I do not feel any clinician will be able to diagnose you from what you shared with us with your entry.  You shared some symptoms that could be related to the spectrum but also other diagnoses.  The first two diagnoses I addressed are more specific with their criteria that need to be met, whereas being on the spectrum has more of a broader base.  For example, you shared you wet the bed until the age of 11.  This could be related to the spectrum, this could be trauma, this could be anxiety, or a medical issue.  With you biting your nails could also be trauma, anxiety, or you are being on the spectrum.  I know you may be thinking at this point “but my son is on the spectrum”, that does not necessarily mean you or his father must be.  That also does not rule out you are not.  If you desire full psychological insight into yourself I recommend for you meet with a licensed therapist and even a psychologist.  This will be the only genuine way for you to get answers.
(LCSW, CSAYC)
Answered on 01/20/2022