Autism Treatment: Adults
Autism spectrum disorder (ASD) is a neurodevelopmental condition that creates difficulties in social interaction and communication. For example, individuals have a hard time interpreting body language and facial expressions.
Autism also is characterized by rigid, repetitive patterns of behavior, such as arranging and rearranging objects. The smallest changes can be incredibly stressful for someone with ASD.
Autistic individuals might have intense interests in one or two subjects (such as science), and when harnessed, these interests can be a great strength.
Autism is a widely heterogeneous and complex condition that ranges from very mild to severe. Individuals also have varying degrees of intellectual disability, ranging from above average intelligence to significantly below.
Autism commonly co-occurs with other conditions. The most common is attention deficit hyperactivity disorder. Also prevalent are anxiety disorders and depression.
No two autistic individuals are alike. This means that different people will need different kinds of support for their different abilities, challenges, needs, and strengths.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)(American Psychiatric Association, 2013) separates autism into three levels depending on the type of support a person needs, their social communication challenges, and the severity of inflexible behavior. For example, level 1 includes high-functioning individuals who require “support.” Level 2 includes individuals who require “substantial support,” and individuals under level 3 require “very substantial support.”
Consequently, treatment will depend on the severity of autism. For many autistic adults, therapy can be tremendously helpful. Some individuals who have significant challenges will require 24-hour care. Medication may be helpful, but there’s a paucity of data on its effects in autistic adults.
There hasn’t been much research on psychosocial interventions for adults with autism spectrum disorder (ASD), so there isn’t a clear-cut best treatment.
Also, psychotherapy can be particularly tough for autistic adults because it’s inherently a social process and communication difficulties are at the core of the condition. Other challenges to therapy include rigid thinking, difficulty completing homework, and not identifying or understanding emotions.
These challenges highlight the need for therapy to be adapted to autistic individuals. For instance, an article published in Research in Autism Disorders suggested incorporating both written and visual information; emphasizing behavior change (instead of cognitive approaches); thoroughly explaining therapy rules; taking breaks; using concrete language; and involving a loved one.
The authors also noted that therapy must be adapted for intellectual disabilities, when present. This might include using simpler language with visual materials and repeating key points.
Therapy should take a concrete, skills-based approach. For instance, cognitive behavioral therapy (CBT) can help with decision making and problem-solving skills. It’s also important for therapy to address emotions. According to the same article, “If a psychological therapy does not include training in identifying, labelling and scaling the intensity of emotions, this could result in poor treatment outcomes.”
Another promising intervention is social cognition training, which helps individuals with ASD interpret and respond to social cues. This training includes computer programs and even virtual reality. The latter provides participants with real-life social interactions in a safe, controlled setting. For instance, Charisma is a social cognition virtual reality training at the Center of Brain Health at University of Texas. You can learn about it here and here.
A 2015 review found that group social skills interventions “may be effective for enhancing social knowledge and understanding, improving social functioning, reducing loneliness and potentially alleviating co-morbid psychiatric symptoms.”
UCLA offers an evidence-based social skills intervention called the program for the education and enrichment of relational skills (PEERS) for young adults, ages 18 to 35. It teaches individuals with ASD the skills to make and keep friends and develop romantic relationships. (Here’s a list of mental health professionals and educators that are trained in implementing the intervention.)
Research suggests that CBT and mindfulness based stress reduction (MBSR) are effective in diminishing anxiety and depression symptoms, decreasing rumination, and improving overall mood. MBSR trains individuals to be mindful by incorporating exercises such as walking meditation and yoga.
In general, when looking for a therapist, the key is to find someone who specializes in helping autistic individuals—or at the very least is sincerely interested in doing so.
The research on medication for adult autism spectrum disorder (ASD) has been scarce. Serotonergic drugs might be helpful for reducing repetitive behaviors in adults. Fluoxetine (Prozac), a selective serotonin re-uptake inhibitor (SSRI), appears to be the best tolerated, but there aren’t any head-to-head studies comparing it with other medication.
Also, some data suggest that the atypical antipsychotic medications aripiprazole (Abilify) and risperidone (Risperdal) might help with reducing irritability and repetitive behaviors. (Both drugs have been approved by the U.S. Food and Drug Administration to treat irritability in kids and adolescents.) Common side effects include drowsiness, dizziness, weight gain, movement disorders, and tremors.
Doctors might prescribe medication to someone with autism for a co-occurring disorder, such as an SSRI to reduce symptoms of depression or anxiety. However, the research on medication for anxiety disorders and depression in adults with ASD is very limited.
Overall, guidelines from the British Association for Psychopharmacology concluded that “current evidence does not support the routine use of any pharmacological treatment for the core symptoms of ASD.” They recommend that treatment decisions be made on a case-by-case basis, including for the medications above.
Sadly, services for adults with autism are limited. It really depends on where someone lives and the severity of their condition. Some autistic individuals have part-time or full-time jobs. Some attend day programs. Some require round-the-clock care.
Some clinics, located within research hospitals around the country, provide case managers and coordinate medical care, which includes a yearly physical check-up and weekly psychiatric appointments. This is vital because in addition to anxiety and depression, adults with autism also have co-occurring medical conditions (e.g., asthma, diabetes, heart disease). Two examples of these clinics are Mount Sinai’s Adult Autism Clinic and University of Utah’s Neurobehavior Healthy Outcomes Medical Excellence (HOME) program.
The Emory Autism Center at Emory University in Atlanta offers myLIFE social engagement groups, which helps adults with autism participate in fun, age-appropriate activities, interact with peer mentors, and build and practice social and daily living skills.
The nonprofit organization Autism Speaks includes a tool kit that outlines the different types of housing and residential services for autistic adults, along with providing links to housing resources. You can download the kit at this page.
Easterseals also offers services for adults with autism, including workforce development services, day programs, and in-home services.
Read books that resonate with you. You might check out the below resources, some of which are written by autism experts or autistic individuals. Some are self-help titles, while others are essays.
- Living Well on the Spectrum: How to Use Your Strengths to Meet the Challenges of Asperger Syndrome/High-Functioning Autism
- An Adult with an Autism Diagnosis: A Guide for the Newly Diagnosed
- The ABCs of Autism Acceptance
- Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT
- Marriage and Lasting Relationships with Asperger’s Syndrome (Autism Spectrum Disorder)
- Knowing Why: Adult-Diagnosed Autistic People on Life and Autism
- Neurotribes: The Legacy of Autism and the Future of Neurodiversity
This page also features a comprehensive list of all kinds of resources on autism.
Check out online forums. Wrong Planet is the largest forum for autistic individuals to communicate. Another resource is #AutChat, a “Twitter hashtag by and for autistic and similarly neurodivergent people. It is used both for unscheduled conversations and weekly scheduled chats…”
Help doctor visits go smoother. Researchers have created the Autism Healthcare Accommodations Tool (AHAT), which generates a customized report to give to your healthcare provider. It includes information to foster effective communication between you and your doctor, and help you better tolerate an exam. That website also includes helpful checklists, worksheets, and tips for your appointments.
Reconnect to your inner artist. Art can be a powerful way to communicate and express yourself on your own terms. Consider participating in online or in-person programs. For example, The Art of Autism is a non-profit organization that features art, poetry, photography, video, and blog posts created by autistic individuals. The Miracle Project, which is based in Los Angeles, is an inclusive theater, film, and expressive arts program for kids, teens, and adults with autism and all abilities.
For inspiration, check out The Art of Autism: Shifting Perceptions, which features the artwork and poetry of 77 artists on the autism spectrum.
Check out autism organizations. Autism Speaks, for example, has an Autism Response Team (ART), which you can call or email to learn about different resources. This link includes 10 ways that the team can help. Also, this link features resources for adults.
The Simons Foundation Autism Research Initiative created an editorially independent and super informative publication called Spectrum, which features news, articles, and webinars.
The Autistic Self Advocacy Network (ASAN) is a nonprofit organization “created to serve as a national grassroots disability rights organization for the autistic community, advocating for systems change and ensuring that the voices of autistic people are heard in policy debates and the halls of power.” In collaboration with the Autism NOW Center, ASAN provides this excellent guide with information and resources.
The Autistic Women & Nonbinary Network (AWN) focuses on providing “community, support, and resources for Autistic women, girls, nonbinary people, and all others of marginalized genders.”
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Beversdorf, D., Farley, M., Kirschner, E., Magro, K., Nussbaum, P., Paradiz, V., …Smigel, M. (2015, March). Is it autism and if so, what next? A guide for adults. Autism Speaks. Retrieved from https://www.autismspeaks.org/tool-kit/it-autism-and-if-so-what-next-guide-adults.
Bishop-Fitzpatrick, L., Minshew, N. J., & Eack, S. M. (2013). A systematic review of psychosocial interventions for adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 3, 687–694. DOI:10.1007/s10803-012-1615-8.
Cachia, R. L., Anderson, A., & Moore, D. W. (2016). Mindfulness in individuals with autism spectrum disorder: A systematic review and narrative analysis. Review Journal of Autism and Developmental Disorders, 3, 165–178. DOI:10.1007/s40489-016-0074-0.
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Kandalaft, M. R., Didehbani, N., Krawczyk, D. C., Allen, T. T., & Chapman, S. B. (2013). Virtual reality social cognition training for young adults with high-functioning autism. Journal of Autism and Developmental Disorders, 43, 1, 34–44. DOI:10.1007/s10803-012-1544-6.
Kiep, M., Spek, A. A., Hoeben, L. (2015). Mindfulness-based therapy in adults with an autism spectrum disorder: Do treatment effects last? Mindfulness, 6, 3, 637-644. DOI: 10.1007/s12671-014-0299-x.
Sizoo, B.B., Kuiper, E. (2017). Cognitive behavioural therapy and mindfulness based stress reduction may be equally effective in reducing anxiety and depression in adults with autism spectrum disorders. Research in Developmental Disabilities, 64, 47-55. DOI: 10.1016/j.ridd.2017.03.004.
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Wright, J. (2017, May 16). Specialty clinics offer complete care for adults with autism. Spectrum. Retrieved from https://www.spectrumnews.org/news/specialty-clinics-offer-complete-care-adults-autism/.
Tartakovsky, M. (2020). Autism Treatment: Adults. Psych Central. Retrieved on October 1, 2020, from https://psychcentral.com/autism/autism-treatment-adults/