Pathways to Psychopathology Among Autistic Adults

Perceived misdiagnosis of psychiatric conditions in autistic adults

“…An alternative explanation is that individuals later diagnosed as autistic may have initially been diagnosed with psychiatric conditions that were more readily observable at the surface level, but the underlying difficulty, autism, was missed. Patterns of co-occurrence between autism and mental health conditions likely originate from various sources, including shared underlying neural, affective, and cognitive mechanisms pervading autism and mental health conditions, 61 or accumulated adverse life experiences associated with being autistic. 15 , 61 , 62 One the one hand, prior diagnoses could reflect distinct co-occurring conditions, with symptom presentation identical to what would be observed in non-autistic individuals.…”

“…Patterns of co-occurrence between autism and mental health conditions likely originate from various sources, including shared underlying neural, affective, and cognitive mechanisms pervading autism and mental health conditions, 61 or accumulated adverse life experiences associated with being autistic. 15 , 61 , 62 One the one hand, prior diagnoses could reflect distinct co-occurring conditions, with symptom presentation identical to what would be observed in non-autistic individuals. 63 , 64 On the other hand, prior diagnoses could reflect mental health difficulties that resulted from living without an established autism diagnosis and with limited access to appropriate care and support.…”

“… 5 , 59 Autistic youths and adults may experience discrimination, loneliness, bullying, social exclusion, difficulty accessing employment or healthcare, as well as other adverse interpersonal events that can result in long-term trauma, symptoms of post-traumatic stress, difficulties navigating social situations, and unmet needs for social engagement. 61 , 62 , 63 These adverse interpersonal events can also prompt a negative feedback loop, wherein autistic adults face negative interpersonal experiences, grow less motivated to seek social contact, and become increasingly isolated, lonely, or anxious. 61 Moreover, previous quantitative and qualitative studies focusing on late-diagnosed autistic adults have documented poor past experiences with mental health professionals, prolonged mental health treatment before obtaining access to an autism assessment, lack of clinician awareness regarding the presentation of autism in adulthood, as well as multiple or inappropriate referrals.…”

“… 61 , 62 , 63 These adverse interpersonal events can also prompt a negative feedback loop, wherein autistic adults face negative interpersonal experiences, grow less motivated to seek social contact, and become increasingly isolated, lonely, or anxious. 61 Moreover, previous quantitative and qualitative studies focusing on late-diagnosed autistic adults have documented poor past experiences with mental health professionals, prolonged mental health treatment before obtaining access to an autism assessment, lack of clinician awareness regarding the presentation of autism in adulthood, as well as multiple or inappropriate referrals. 8 , 10 , 32 , 65 , 66 , 67 , 68 Such experiences were often accompanied by long gaps between first concern, professional assessment, and diagnosis.…”