Scientists from Cardiff University, King’s College London have recently devised a new potential tool to help detect psychological strategies that disguise signs of autism.
Autism is usually diagnosed in childhood but a growing number of adults are being diagnosed with the condition, even in mid-to-late adulthood.
Many adults develop compensatory psychological strategies to hide their symptoms from clinicians, employers and even their own families.
These strategies make the developmental condition much harder to diagnose and “performing” to fit into society can place a huge mental strain on the autistic person.
Dr Loretta Burns, a US-based psychologist and behaviorist specialist, said that about one per cent of the world’s population is estimated to be on the autism spectrum.
Eloise Stark, 30, a postgraduate student at Oxford University diagnosed with autism three years ago, said the hardest part of being autistic was trying to “hide it,” and likened it to wearing a “mask.”
In a new study, published today in Molecular Autism, the researchers outline a checklist of 31 compensatory strategies that doctors, psychiatrists and psychologists could look for or ask their clients about.
They developed the checklist by asking autistic people about their experiences of using psychological strategies in everyday social situations.
Dr Lucy Livingston, who led the research, said: “This allowed us to come up with a checklist of the most frequently-reported ‘social scripts,” including things like copying gestures and facial expressions of others, learning when to laugh at a joke without understanding why it is funny and deliberately making eye contact, even when it might be really uncomfortable”.
Dr Livingston, a psychology lecturer from Cardiff University’s School of Psychology, who has worked with autistic people who received a first diagnosis in adulthood for many years, said the next step would be to test its clinical efficacy.
“At the moment, professionals know very little about these strategies and what to look for. The new tool, if found to be effective, could help clinicians assessing adults for autism who appear to be non-autistic or ‘neurotypical’ on the surface, particularly those who are highly intelligent,” she said.
“Being aware of these strategies should help clinicians to understand how hard the individual could potentially be working to keep up this appearance.
“Ultimately, this could mean that autistic people receive a more accurate and timely diagnosis”.
Eloise said: “This work has the potential to help spot autism in people like myself, who have gone ‘under the radar’ up to now.
“If I had received my diagnosis earlier, I may have avoided years of inappropriate medical and psychological interventions, and I would also have been able to build the positive autistic identity that I enjoy today much earlier”, he explained.
Dr Livingston said it might also help clinicians to identify and support those autistic people with additional mental health difficulties experienced as a consequence of “pretending to be normal.”
It could also be used by adults who think they might be autistic or are seeking a diagnosis to help them understand their own behaviour, she added.
About 700,000 people in the UK are living with autism and it is under-diagnosed in females; three times as many males as females are diagnosed.
Senior author Francesca Happé, who is Professor of Cognitive Neuroscience at King’s College London, said “Our work is one step towards helping to recognise compensating behaviours that autistic people use, often to avoid bullying and negative responses from neurotypical peers.
“We hope it will aid diagnosis and improve understanding of just how hard many autistic people work to fit in to an often hostile world”.