Cómo se diagnostica el autismo de alto funcionamiento en adultos

el síndrome de Asperger (AS)? En realidad, desde la publicación de los últimos criterios de diagnóstico, ya no existe un diagnóstico llamado Síndrome de Asperger. Pero es perfectamente posible que usted sea un adultodiagnosticable con una forma relativamente leve (de alto funcionamiento) del trastorno del espectro autista (o un trastorno similar o relacionado).

Los síntomas

Si eres un adulto que ha logrado llegar a la escuela secundaria o incluso a la universidad y obtener o mantener un trabajo (incluso con síntomas que podrían estar asociados con el autismo), es probable que tu autismo sea relativamente leve. Sin embargo, el autismo “leve” o de alto funcionamiento puede ser extremadamente desafiante. Esto se debe a que la mayoría de los síntomas se relacionan con la comunicación social y las respuestas sensoriales, y si se encuentra fuera de su hogar en el mundo del siglo XXI, debe comprometerse socialmente y hacer frente a una gran variedad de ataques sensoriales en casi todos los entornos. .

Síntomas de la comunicación social

Estos son algunos de los síntomas que puede encontrar a diario. También pueden ser síntomas que experimentó cuando era niño pero que aprendió a controlar con el tiempo. Pueden incluir:

  • Dificultad para interpretar la “agenda oculta” en una situación social. Por ejemplo, todo el mundo, excepto usted, parece saber de alguna manera cuándo hablar, cuándo callarse, qué ponerse, qué tono de voz utilizar.
  • Dificultad para usar el nivel o tono de voz correcto, o elegir las palabras “correctas” para una situación. Por ejemplo, puede usar lenguaje formal en una situación informal, hablar demasiado alto en una situación “tranquila”, o usar un tono muy plano cuando en realidad está sintiendo emociones fuertes.
  • Tiene problemas para interpretar correctamente el lenguaje corporal y el tono vocal. Por ejemplo, alguien que encuentra sonrisas atractivas a medida que pasan, o lo invita a unirse a ellas en una salida grupal. ¿Significa eso que están expresando interés romántico o amistad simple? ¿El tono de tu jefe indica enojo o sarcasmo real?
  • Desafíos para mantener una conversación, especialmente si no es sobre un tema que le interese. A las personas neurotípicas generalmente les resulta fácil mantener una “pequeña charla” en cualquier situación, desde programas de televisión hasta chismes. Pueden hacer esto incluso si el espectáculo o la gente solo son ligeramente interesantes para ellos. Las personas con autismo, sin embargo, generalmente prefieren hablar largo y tendido sobre temas que les interesan personalmente; También pueden tener problemas para darse cuenta de que su compañero de conversación está aburrido.
  • Extreme focus on a topic of interest. Some adults with autism are so fascinated by a particular topic of interest that they find it almost impossible to change the subject. This can be an invisible problem if your friends and workmates all share the same interest but can become an issue when you’re interacting with family or neighbors who have different interests.
  • Difficulty with knowing when and how to ask questions or make statements you know to be true. For example, when is it ok to tell your boss that their ideas won’t work? Is it ever ok to ask someone “what caused your divorce?” People with autism find it tough to know when to speak up; as a result, they may choose to say nothing at all.
  • Difficulty with change. Most people with autism prefer to know exactly what’s going to happen next. Many prefer to do the same things in the same order each day, eat the same foods, take the same routes, etc. Life, however, throws a lot of curve balls; it can be tough for autistic people to make quick changes without great effort or emotional upset.

Sensory and Behavioral Symptoms

The most recent criteria for autism include sensory challenges that are common to all people on the spectrum. Sensory challenges (along with the social challenges described above) can lead to unexpected behaviors.

  • Sensitivity to light, sound, smell, touch, and taste. Like many people with other disorders (such as migraine), people with autism are unusually sensitive. While most neurotypical people, for example, can spend all day under fluorescent lights in a loud environment, most people with autism can’t. Autistic people may also react strongly to smell or taste, or have a hard time with physical intimacy.
  • Need for physical pressure for calming. Temple Grandin, a major figure in autistic self-advocacy, actually built herself a “squeeze machine” as a way to help herself to stay calm in college.
  • Need to move or vocalize in usual ways. This need, called “stimming,” is a form of self-calming and may involve pacing, rocking, hair-twirling, humming, etc. It’s difficult to control and can result in uncomfortable stares from the people around you.
  • Autistic melt-downs. Some adults with autism, even those with very high IQs, can become very frustrated and upset and find it impossible to control their words and actions. This response is sometimes called an “autistic melt-down.” While it’s rare for an adult with autism to act out in a violent way, even non-violent melt-downs can be frightening to the people who witness them.

Self-Tests and Professional Evaluations

You can start the process of diagnosis with a self-test such as the “AQ” designed in 2001 by Dr. Simon Baron-Cohen or the RBQ2, available online, which “measures restricted and repetitive behaviors such as routines and rituals, repetitive motor behaviors, sensory interests and repetitive actions with objects.”

While these self-tests can help you determine whether you might be autistic, however, they’re not a substitute for a medical diagnosis performed by a professional. Most psychiatrists with autism experience should be able to administer appropriate tests and provide a useful diagnosis, though the majority of people with autism experience do work with children.

Dr. Shana Nichols of the Fay J. Lindner Center for Autism on Long Island in New York specializes in diagnosing and treating teens and adults with the symptoms associated with high functioning autism (Asperger Syndrome).

When adults come to the Lindner Center for a diagnosis, Dr. Nichols begins her exam with an IQ test. She also administers an assessment of adaptive skills which tests the patient’s ability to manage complex social situations.

While she uses several specific diagnostic tools to identify specific symptoms, she says that even those tools are somewhat out of date.

“If a parent is available,” says Nichols, “we administer a parent interview called the ADI (Autism Diagnostic Interview-Revised). We’re looking at current functioning and early history to get a sense of the patient’s skills in social, communication and behavior domains.” After all, as she says, “autism doesn’t suddenly show up when you’re 25, so most people with true autism showed symptoms throughout their childhood.” If parents aren’t available, Nichols and her colleagues ask the patient to recall their childhood, asking such questions as “Did you have a lot of friends?” and “What did you enjoy doing?”

Nichols also administers the ADOS Module IV. ADOS (Autism Diagnosis Observation Schedule) is the autism diagnostic observation schedule, and module four is for high-functioning verbal young adults and adults. Along with the ADI, it allows doctors to look carefully at social and communication skills and behavior. For example, says Nichols, the tests look at such questions as “Can you have a reciprocal social conversation? Are you interested in the examiner’s thoughts and feelings? Do you demonstrate insight into relationships? Do you use appropriate non-verbal gestures and facial expressions? Do you have odd or over-focused interests?” The tests allow doctors to attach a grade in each domain to determine whether the patient meets the criteria for autism.

A newer test, the Developmental, Dimensional and Diagnostic Interview-Adult Version (3Di-Adult), is now available and (according to researchers) is simpler and shorter than ADOS, and just as accurate. It measures social communication and interaction, as well as restricted interests and behaviors. 3Di-Adult is slowly becoming a standard tool for evaluating adults.

When the Diagnosis Is Not Autism

It’s not unusual, says Nichols, for a patient to come in expecting an autism diagnosis and to leave with a different diagnosis. “Distinguishing between social phobias or shyness and actual impairment with autism can be very tough for a layperson,” she says. Other disorders, such as obsessive-compulsive disorder (compulsions, hoarding, needing to do things over and over), social communication disorder, or social anxiety can sometimes look like autism. If doctors do pick up on these other disorders, they can recommend appropriate therapy and/or medication.