Guest Blog Post: Late-Diagnosed Autism with Dr. Karen Sheridan
Karen Sheridan, PhD, BCBA-D, is a licensed psychologist, doctorate-level behavior analyst, and owner of Access Autism Testing & Consultation. She specializes in autism assessments for all ages, parent consultation, and support groups. She works with individuals across the lifespan to understand neurodiversity, access services, and embrace their strengths.
Late-Diagnosed Autism: Recognition, Understanding, and Support Across the Lifespan
Autism is often perceived as a childhood diagnosis, yet many individuals receive their diagnosis much later in life, sometimes well into adolescence or adulthood. Late-diagnosed autism is increasingly recognized in clinical practice as a common experience, particularly among individuals who are highly verbal, mask their traits, or have co-occurring conditions. Understanding the unique needs of late-diagnosed individuals with autism is essential for therapists, educators, and families and can significantly impact quality of life and self-understanding.
Why Some Individuals Are Diagnosed Later
1. Subtle or Masked Traits
Many individuals develop strategies to camouflage their differences—often referred to as masking or social compensation. They may carefully observe peers and mimic social behaviors, suppress natural stimming behaviors, or rely heavily on learned social scripts. While these adaptations help them navigate social environments, they can delay identification, particularly when repetitive behaviors are not prominent.
2. Historical Gaps in Awareness
Several decades ago, autism was associated primarily with more overt presentations, including significant communication challenges or intellectual disability. Individuals who were highly verbal, academically capable, or socially motivated were often overlooked because they did not fit the traditional diagnostic profile.
3. Gender Differences
Girls and women are frequently underdiagnosed because their presentations often differ from stereotypical expectations. Many demonstrate strong social motivation, subtle masking strategies, or fewer externalizing behaviors which causes them to be less likely to be identified as having autism..
4. Co-Occurring Conditions
Conditions such as anxiety, depression, ADHD, or learning differences can overshadow traits of autism. A clinician may treat the presenting concern—for example, anxiety—without recognizing the underlying profile of autism. This frequently leads to delayed or missed autism identification.
Common Experiences of Late-Diagnosed Individuals with Autism
Adults and adolescents who receive a diagnosis later in life often describe a mixture of relief, validation, and grief. Many feel they finally have an explanation for lifelong challenges such as:
Chronic social exhaustion and feeling “different” from peers
Difficulty understanding social rules, sarcasm, or implicit expectations
Intense focus on specific interests or hobbies
Sensory sensitivities to noise, textures, lighting, or unpredictable schedules
Challenges in maintaining relationships due to differences in communication or social needs
While a diagnosis brings clarity, it often leads individuals to reflect on missed support opportunities and unrecognized struggles throughout childhood and adolescence.
The Benefits of a Late Diagnosis
1. Access to Tailored Supports and Accommodations
A diagnosis unlocks access to services such as social communication therapy, sensory regulation strategies, executive functioning support, and workplace or educational accommodations. Understanding one’s neurodivergence supports purposeful adjustments that reduce stress and improve functioning.
2. Enhanced Self-Understanding and Acceptance
A formal diagnosis can validate lifelong experiences and reduce self-blame. Many individuals report relief in realizing that their challenges stem from neurodivergence rather than personal deficits. This shift encourages self-acceptance and a strengths-based orientation.
3. Improved Relationships and Communication
Understanding one’s autism can improve interpersonal relationships. Family, partners, friends, and colleagues can adapt communication styles, establish clear expectations, and support sensory and social needs.
Supporting Late-Diagnosed Adults and Adolescents
Therapists play a central role in supporting later-identified autistic individuals. Empirical research underscores the need for autism-informed, individualized care. A study of 200 adults with autism (Camm-Crosbie et al., 2019) found that many participants “did not feel listened to” and believed their treatments were not tailored to their needs. When asked how clinicians could support them more effectively, adults recommended that clinicians:
Become more educated about autism
Ask direct questions rather than broad, open-ended ones
Listen rather than “talk at” clients
Understand sensory triggers and sensory overload
Account for literal thinking
Allow additional time for rapport-building
Support emotion recognition and emotional literacy
Maintain continuity of care
Provide a single, consistent point person within agencies
These findings align closely with best practices for supporting late-diagnosed individuals.
1. Validate Experiences & Provide Psychoeducation
Active listening and validation are foundational. Many late-diagnosed individuals have spent years navigating environments structured for neurotypical expectations. Provide clear information about traits of autism, masking, sensory processing, and communication differences. Direct questioning, attention to literal interpretation, and extended rapport-building—strategies suggested by adults with autism—can significantly improve treatment engagement.
2. Modify Traditional Therapy Approaches
Use concrete, precise language and minimize metaphors if they create confusion. Integrate visual supports, modeling, structured practice, or step-by-step frameworks. Predictability and consistency are essential. Exposure hierarchies can be used for anxiety or sensory-related concerns. Continuity of care—highlighted in the study—reduces fragmentation and reinforces trust.
3. Skills Training
Support may include:
Emotion identification and regulation
Reading nonverbal social cues
Perspective-taking and “Theory of Mind” tasks
Conversation and relationship-maintenance skills
Leveraging special interests is often effective in increasing socialization (ex. Special interest clubs or online communities). In addition, teaching organization and planning strategies for executive functioning challenges.
4. Understand Comorbid Medical Issues
Individuals with autism are at increased risk for gastrointestinal, sleep, metabolic, neurological, endocrine, and allergy-related conditions. These factors can influence mood, attention, and behavior. Refer to appropriate medical professionals when symptoms warrant further evaluation.
5. Address Co-Occurring Mental Health Needs
Anxiety, depression, and ADHD frequently co-occur with autism. Tailored, concrete approaches—such as behavioral activation for depression or structured coping strategies for anxiety—enhance treatment effectiveness.
6. Connect Clients to Community and Resources
Local and online peer communities can provide validation, shared experience, and social support. Adults in the Camm-Crosbie et al. study (2019) emphasized the value of having a consistent point person to coordinate services—an important consideration for agencies and group practices. Conclusion Late-diagnosed autism reflects expanding understanding of the diverse ways autism presents across the lifespan. While the diagnostic journey may be complex, it offers tremendous opportunities for:
Clarity and validation
Access to tailored supports and accommodations
Strength-based pathways that honor neurodivergent identity For therapists and caregivers, providing informed, empathetic, and structured support can profoundly influence an individual’s mental health, relationships, and overall well-being.
About Dr. Karen Sheridan
Dr. Karen Sheridan is licensed in Louisiana, Texas, and Florida. Here’s where you can find more information about her practice and working with her:
Website: https://www.accessautismtesting.com
Psychology Today: https://www.psychologytoday.com/profile/1601306
TikTok: https://www.tiktok.com/@accessautism
Instagram: https://www.instagram.com/accessautismtesting/
Pinterest: https://www.pinterest.com/accessautismtesting/
Facebook: https://www.facebook.com/profile.php?id=61575203788384
YouTube: https://www.youtube.com/@AccessAutism
Reference
Camm-Crosbie, L. et al. (2019). “People like me don’t get support”: Autistic adults’ experiences of support and treatment for mental health difficulties, self-injury, and suicidality. Autism, 23, 1431-1441.