A Late Diagnosis of Autism

Although pediatricians in the United States now routinely test for autism during early childhood, this practice did not exist during my childhood in the sixties. Autism wasn't recognized as a valid diagnosis until 1980 after I had already turned twenty. It was first included as a standalone category under "infantile autism" in the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III).

As a teacher, I hadn't even HEARD of autism until 2014. During my 2nd year of employment with the Clark County School District in Nevada, I received a new student some two months after the 2014-2015 school year had started. A special education teacher had delivered a copy of the student's IEP (Individualized Education Plan). Instead of reading about a student's learning disability or behavioral modifications, I learned that the student was autistic.

I had to google a definition for autism.

I subsequently found a website that listed common symptoms for teenagers and adults. As I read the symptoms, I found myself thinking that I could relate to a lot of these symptoms.

I subsequently found an online self-diagnostic test. If you decide to take this test, please note that the results for this particular test will cost $1.99. You should also be aware that while a self-diagnosis test may indicate the likelihood that one may have autism, any such diagnosis needs to be verified through clinical testing.

Although self-diagnostic tests may be completed within about 30 minutes, clinical testing is much more in-depth and can take 5-6 hours to complete.

It took me a long time to pursue clinical testing. There were several reasons for this.

1. I had a prolonged issue with denial. Although I related to nearly every symtom and my online test indicated a strong likelihood of autism, I struggled to believe that I was autistic because I had already lived 55 years without a diagnosis.

2. Since young children are easier to diagnose than adults, most clinicians only work with children.

3. An insurance company may decline to pay for clinical testing because they often regard a diagnosis of autism as a "pre-existing" condition. Since I had to pay out of pocket, my cost in December of 2020, was over $3,600.

What was included with my clinical testing? My evaluation required me to take six tests.

1. Wechsler Adult Intelligence Scale, 4th edition: This test allows the clinician to map out one's unique cognitive profile so as to provide a baseline context of how our brain processes different types of information.

   
   

2. Wide Range Achievement Test, 4th edition: The WRAT measures your actual learned skills. This tool is crucial for clinicians because it uncovers how autistic traits directly impact a person's practical, day-to-day execution of core skills

   
   

3. Tower of London, 2nd edition: This test s a neuropsychological tool that specifically measures how your brain's frontal lobe manages complex, multi-step problem solving in real time.

   
   

4. Autism Diagnostic Observation Schedule: While questionnaires and interviews rely on one's memory or self-report, the ADOS-2 is an interactive, face-to-face assessment that allows a clinician to observe one's natural social communication style and behavioral patterns in real time.

   
   

5. Minnesota Multiphasic Personality Inventory, 2nd edition: The MMPI-2 is a comprehensive, true-false personality and psychopathology questionnaire. It does not screen for autism itself, but it acts as a critical safeguards tool for the clinician. Because many mental health conditions mirror or overlap with adult autism, this test provides a macro-level map of one's psychiatric profile

   
   

6. Millon Clinical Multiaxial Inventory, 4th edition: This test is a 195-item true/false self-report tool developed by Dr. Theodore Millon. Unlike general personality tests, it is normed strictly on clinical populations (people actively seeking mental health services). It evaluates 15 personality traits or disorders and 10 clinical syndromes aligned with the DSM-5-TR. This tests allows the clinician to differentiate autism from complex personality disorders, uncover co-occurring mental health conditions, and protect against response bias.

What the Clinical Diagnostician Said:

After the testing was done, the clinical diagnostian told me that she would have my results in three months. I remember staring at her in disbelief. I had just spent five hours in testing. I had spent nearly five years wondering if I was autistic, finding a diagnostician, and saving money for an evaluation since my cheap teacher's health insurance wouldn't pay for what they referred to as a "pre-existing condition".

When I asked if the clinician could just tell me whether or not I was on the spectrum, she nodded. I nearly sagged with relief when she told me that I had "mild" (level 1) autism.

Everyone has a history! If you have been clinically diagnosed with autism, please feel free to share your journey in the comments. I would love to hear other perspectives and to learn whether your journey was similar to mine.

If you suspect you have autism but have not been clinically diagnosed, what barriers have kept you from moving forward?

Please share any thoughts in the comments.