How do adults get an Autism diagnosis?

As you read, watch online content, or hear about others getting diagnosed with autism, you might start noticing autistic traits in yourself or a loved one. Or maybe you’re a parent, and while getting your child assessed, you’ve begun to recognise certain characteristics that make you wonder if you could be Autistic too.

This factsheet tells you about the various factors you should consider when going for an adult Autism diagnosis. It covers:

Common reasons adults seek an autism diagnosis
How gender can affect diagnosis
The impact of undiagnosed autism
What qualifications to look for in a private psychologist
How to tell if a psychologist is neurodiversity-affirmative
The standard diagnostic criteria that should be used during assessment
What should be included in a formal report after assessment

Should I get an Autism diagnosis?

A professional diagnosis is not accessible to everyone with Autistic traits because of cost. However, the main benefit of an Autism diagnosis is gaining access to supports. These supports can help manage a variety of everyday challenges. Challenges often come from trying to navigate environments or social structures designed for Neurotypical people. Neurotypical people are people whose brains respond differently to sensory input (e.g., sounds, light, textures) and social experiences.

Research shows that early diagnosis of Autism in children can improve their lives both as children and adults. These improvements come from accessing Autism-specific support and services from a young age.

When considering a diagnosis or supporting someone who is undergoing an autism assessment, it is important to recognise that:

• Many Autistic people welcome self-diagnosis because of the financial and cultural barriers to accessing an Autism assessment from a professional
• Diagnosis can have different meanings for different people. These meanings often depend on their own unique life experiences and viewpoints
• Many Autistic people believe that supports advertised as “treatments” for Autism are not neurodiversity-affirmative. A neurodiversity-affirmative approach sees neurodivergence as natural differences in ways of processing and understanding. Neurodiversity-affirmative approaches do not see Autistic traits as signs of an illness that needs to be “cured”
• Gender can impact diagnosis: Fewer women are diagnosed with autism as children, often due to differences in how autism traits present. Women and girls may have a higher tendency to mask or hide these traits in social settings. It is also possible that the assessment criteria used in diagnosing Autism may not fully capture how women and girls experience Autism

Do more men or women receive an Autism diagnosis?

Professionals formally identify Autism in men and boys four times more often than in women and girls. Girls and women can show signs of autism that are less easily recognised. This is especially true for those who do not show differences in learning and developing language and who mask differences in communication and social interaction. Unusual or limited interests (“special interests”) are a core feature of Autism. However, special interests in girls and women can sometimes be overlooked, since their interests are more likely to blend in with what is socially expected (e.g., animals, classical literature, make-up). As a result, misdiagnosis of Autism in females tends to be more common.

Possible effects of not receiving an Autism diagnosis

Undiagnosed Autistic adults can experience significant difficulties throughout life. These difficulties may be due to differences in social communication and restricted, repetitive behaviours. Without a diagnosis giving access to the right supports, Autistic people can struggle to do well at school, find a job that accommodates their needs, or maintain long-term relationships.

For some, the physical, emotional, and psychological strain of trying to hide (i.e., “mask” or “camouflage”) their Autistic traits can lead to Autistic burnout. Autistic burnout usually looks like extreme exhaustion and pulling away from social activities. Research shows that Autistic people experiencing Autistic burnout are often misdiagnosed with mental health conditions like depression, anxiety, bipolar disorder, and borderline personality disorder (BPD) or emotionally unstable personality disorder (EUPD). Autistic women are more likely than men to report being misdiagnosed with personality disorders, anxiety disorders, and mood disorders.

How do I get assessed for Autism as an adult?

Currently, there is no public route for adult Autism assessment and diagnosis in Ireland. If you are seeking a formal Autism diagnosis as an adult, you must go through a private professional or private clinic. Private assessments tend to cost €1,000 – €2,000. For this reason, they are not accessible for everyone.

Visit the As I Am website for a list of private clinics and professionals currently offering Autism assessments in Ireland. Before paying for a private assessment, there are important factors to consider.

What should I look for in a professional providing an Autism diagnosis?

Below are some questions you might want to ask before selecting a private professional.

What are their qualifications?

Psychologists and psychiatrists with the right knowledge and experience can conduct Autism assessments. However, in Ireland, the state does not currently regulate psychologists. CORU, Ireland’s health and social care regulator, is working on introducing regulations for the psychology profession. In the next few years, you may be able to check a psychologist’s professional standards by seeing if they are registered with CORU.

In the meantime, you can check whether they are a chartered member of the PSI. The PSI is a professional body that upholds professional standards and high training quality by offering chartered membership to psychologists who meet specific requirements. If you’re unsure, ask to see their PSI Chartered Membership Certificate.

Bear in mind, however, that the law does not require fully qualified psychologists to be Chartered members of the PSI. There are many psychologists who are not Chartered members who are qualified to carry out Autism assessments. 

Are they neurodiversity-affirmative?

Not all private psychologists and psychiatrists offering Autism assessments view Autism in the same way. You may feel most comfortable getting an assessment from a professional whose views on the Autistic experience align with your own view of what it means to be Autistic. Many people who suspect they are Autistic prefer to go to a neurodiversity-affirmative professional.

If you’re unsure about a professional’s views on neurodivergence or their approach to working with Autistic individuals, pay attention to the language they use. Neurodiversity-affirmative practitioners typically avoid terms that frame Autism as a “disorder” or illness. Instead, they highlight an Autistic person’s unique strengths and talk about “differences” rather than “impairments” or “deficits” that need treatment. They may acknowledge that Autistic people have different levels of support needs. However, they still view Autism and its traits as natural variations in how we think, learn, and experience the world.

If you choose to work with a neurodiversity-affirmative professional for your assessment, expect someone who wants to hear about how you experience the world. They may ask questions like:

• Do you need a consistent routine to structure your day?
• Do you use stimming or body movements to manage situations or feel calmer (often referred to as “emotionally regulated”)
• Do you have interests that you feel especially passionate about?

In the end, they may or may not determine that you are Autistic. However, they should be willing to collaborate with you to find an explanation that fits with your unique life experiences and differences.

What diagnostic criteria are they using?

Diagnostic criteria are a set of rules or guidelines that mental health professionals need to use in their work to identify specific forms of neurodivergence, such as Autism or ADHD (although they are referred to as “disorders” in the written criteria). These criteria help ensure that diagnoses are consistent and based on the same standards.

The two stands diagnostic criteria used in Ireland

In Ireland, qualified professionals use one of two standard sets of diagnostic criteria to assess and diagnose Autism:

• The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V): a widely accepted set of guidelines, developed by the American Psychiatric Association (APA), used by mental health professionals worldwide for diagnosing and treating mental health conditions and types of neurodivergence
• The International Classification of Diseases 11th Revision (ICD-11): a global standard for diagnosing and classifying health conditions, developed by the World Health Organisation

The DSM-5 and ICD-11 list the core characteristics of the Autistic experience, although these are framed in ways that are not neurodiversity-affirmative (e.g. behavioural, social, emotional, and learning “deficits”). To identify someone as Autistic, a psychologist or psychiatrist compares the DSM-5 or ICD-11 characteristics with the person’s lifelong thinking, processing, and communication patterns.

Core characteristics leading to Autism diagnosis

A person doesn’t need to show every single trait listed in the DSM-5 or ICD-11 to be formally identified as Autistic. However, in general, they must show differences in these three core areas:

• Social-emotional reciprocity: This describes back-and-forth conversation between people, where they respond to each other’s words, actions, and emotions in a way that shows mutual understanding
• Language and non-verbal communication: This includes possible differences in use of language, eye contact, facial expressions, and body movements
• Repetitive behaviours and restricted interests: Autistic people may engage in self-stimulatory behaviours (often referred to as “stimming”) such as flapping arms, hands or objects, finger-flicking, hair twirling, rocking, or spinning. They often do this when they are feeling excited, anxious or over-stimulated. They may also have highly focused interests (often referred to as “special interests”) which they spend a lot of their time absorbed in. Special interests can provide the opportunity to connect with others who share the same passions. For more information on special interests and an A-Z glossary of similar terms, check out the As I Am Teenage Years Guide.

Eliminating other possible diagnoses

Showing some Autistic traits over your lifetime does not necessary indicate that you are Autistic. Working together, a mental health professional and the person who suspects they may be Autistic must also confirm that:

1. The person’s characteristics (referred to as “symptoms”) are not caused by another form of neurodivergence, such as intellectual disability, that might produce traits similar to those seen in Autistic people. The thorough assessment process that helps distinguish one form of neurodivergence from another is known as differential diagnosis
2. These differences, even if well-masked or camouflaged, lead to a person having support needs in everyday life. Autism is a spectrum condition, meaning different Autistic people have different levels of support needs. However, all Autistic people will experience at least some social and/or communication differences. They will also have behaviours they like to repeat, or a preference for sameness

Deficit-based language

While acknowledging that being Autistic brings with it its own challenges as well as strengths (the same with many different neurotypes), the language used in the DSM-5 and ICD-11 is rejected by neurodiversity-affirmative clinicians and many in the Autistic community. Both standard classification systems describe Autism-related challenges as “deficits” and “impairments” rather than natural variations in thinking, feeling, moving, and processing. You may recognise the list of traits (referred to as “behaviours”) in the DSM-5 or the ICD-11 as valid. But you do not have to agree with the deficit-based view some people have of these differences.

What diagnostic tools are they using?

Diagnostic tools are specific methods or tests used to gather information during the assessment process. These tools help professionals evaluate whether a person meets the diagnostic criteria for Autism. While diagnostic criteria like the DSM-V and ICD-11 provide the framework, professionals use diagnostic tools to collect the detailed information needed for making a diagnosis.

However, it’s important to be aware that there is no requirement to use any of the current diagnostic tools available for assessing Autism. Many of these tools look at being Autistic through a very narrow and deficit-focused lens. Some professionals use these tools (e.g., a play-based assessment called the ADOS-2 for children or the ADI-R for adults). However, best practice guidelines do not require professionals to use them. Best practice guidelines are recommendations on the best way to do something based on current knowledge, research, and experience. 

When looking for a suitable professional to carry out your child’s assessment, ensuring that the professional is fully qualified and experienced in working with Autistic children is the most important consideration. The process should be thorough and include:

• Detailed interviews with the person who suspects they’re Autistic and family members or guardians, if appropriate
• Information gathered about different environments 

Do they offer a report formally identifying Autism and including support recommendations?

When a professional, such as a psychologist or psychiatrist, formally identifies someone as Autistic, they should always provide a formal report. This report includes information such as how the professional carried out the assessment, a summary of the person’s unique strengths and challenges, and recommendations to help the Autistic individual navigate some of their differences and barriers to inclusion, access and participation.

The Disability Act 2005 entitles Autistic people to additional support at work, school, or home, depending on their level of need. The recommendations in the formal report should address the individual’s specific needs. These can include:

• Educational supports at school or university
• Entitlements to social welfare payments, like Disability Allowance
• Reasonable accommodations at work

Teachers, employers, or others can make changes to help you benefit equally from opportunities to learn, interact, and work, despite any challenges you face. These changes are called “reasonable accommodations.”

Types of support for Autistic people

Autistic students finishing secondary school and thinking about college might benefit from the Disability Access Route to Education (DARE) scheme. Visit the DARE website to find out if you could be eligible to apply for reduced-points places to the third-level courses of your choice. If you are Autistic and at university, you can reach out to a trusted member of university staff, such as a course tutor, disability advisor, or counsellor. They may be able to offer guidance on available supports and how to access them.

Autism-specific support can include:

• Speech and language therapy: For children and adults with language processing differences or who need alternative ways to communicate. Make sure the Irish Association for Speech and Language Therapists has accredited any professional you see
• Occupational therapy: For children and adults with sensory processing differences and/or differences with coordination and movement
• Psychological support: For those experiencing anxiety or depression due to multiple pressures. These pressures may include masking, autistic burnout, or differences with communication, social interaction, and sensory processing. Ensure that the Psychological Society of Ireland has accredited any psychologist you visit. Similarly, psychotherapists and counsellors should be accredited by the Irish Association for Counselling and Psychotherapy or an equivalent Irish accreditation body

What if I’m not Autistic?

You and a suitable professional may find that you are not Autistic. You might discover other neurodevelopmental differences or mental health conditions that better explain the emotional and sensory processing differences you have faced. Regardless of the outcome, you will gain a deeper understanding of yourself and your experiences. For some, this newfound understanding can bring feelings of grief for past losses and challenges. For others, it may be a source of relief and self-acceptance. You may also find that discovering you are Autistic can bring confusing or mixed emotions.

Whatever your feelings after your diagnosis, remember that support is available. Visit the As I Am website for a comprehensive list of resources and services.

For more general information, visit our factsheets on common Autism traits, accessing supports as an Autistic adult, and having your child assessed for Autism.

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