Autism Spectrum

What is autism

Autism Spectrum Disorder (ASD) is a different way of sensing, thinking, learning, and relating to the world. It is not a disease to be cured, but a neurodevelopmental difference that shapes how a person experiences everyday life, often in ways that are invisible to others until stress, change, or co-occurring conditions make them impossible to ignore. The core features of autism are impairments of social cognition and restricted or repetitive behaviors.

Social communication and interaction. Autistic individuals may communicate differently due to alterations in social cognition. This can include finding it exhausting to maintain eye contact, struggling to interpret neurotypical body language or tone of voice, or taking language very literally. Some autistic people are non-speaking, while others are highly articulate. Many learn strategies to “mask” these differences, which frequently delays diagnosis into adulthood.

Restricted and repetitive behaviors or interests. This can manifest as a strong preference for routine and predictability, deep and intense passions for specific subjects, or repetitive movements (“stimming”) used to regulate emotion and sensory input.

Autism is increasingly viewed through the lens of neurodiversity, which recognizes neurological differences as natural variations of the human brain. Associated strengths commonly include exceptional attention to detail and pattern recognition, deep focus within areas of interest, honesty and a strong sense of justice, and out-of-the-box problem solving.

Co-occurring conditions

It is more common for an autistic person to have at least one co-occurring condition than to have autism alone. Diagnosis and treatment planning are complicated by the number of autistic features that overlap with, or are mistaken for, other psychiatric diagnoses.

• ADHD, one of the most common overlaps; studies suggest 50–70% of autistic individuals also meet criteria, with difficulty in executive functioning, impulse control, and focus.
• Anxiety disorders, up to half of autistic people experience severe anxiety, often driven by sensory overload or the strain of navigating a neurotypical world.
• Depression, higher rates in adolescents and adults, frequently linked to social isolation, burnout from masking, or lack of support.
• OCD, repetitive autistic routines can be difficult to distinguish from genuine intrusive thoughts and compulsions.
• Psychosis, a meaningful minority of autistic youth go on to develop a primary psychotic disorder such as schizoaffective disorder or schizophrenia.
• Pathological Demand Avoidance, an emerging profile characterized by an extreme, anxiety-driven need to resist everyday demands.
• Physical health, chronic gastrointestinal problems and sleep disorders are common and can amplify anxiety and emotional dysregulation.
• Learning and motor differences: dyspraxia, dyslexia, dyscalculia, dysgraphia, and tic disorders occur more frequently in autistic populations.

How autism often presents in later-diagnosed adults

• Exhaustion or burnout after social situations that look “fine” from the outside
• A strong need for routine, predictability, or sameness
• Deep expertise and passion for specific interests
• Difficulty reading unspoken social cues or shifting plans on the fly
• Sensory overload in bright, loud, or crowded environments
• Identity questions following a late or recent diagnosis

When thought disorder emerges in an autistic person

Research increasingly recognizes meaningful overlap between autism and the psychosis spectrum. Autistic people are more likely than the general population to experience psychotic symptoms, and they are also more likely to be misdiagnosed in both directions, autistic communication mistaken for thought disorder, or genuine psychotic symptoms attributed to autism and left untreated. When real thought disorder is present, autism-specific interventions alone are not sufficient: antipsychotic decisions must account for sensory and metabolic sensitivities, CBT for psychosis must be adapted for autistic cognition, and care must be coordinated rather than split between teams that do not talk to each other.