The Reality of Adults With Autism

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Autism is defined as persistent deficits in social communication and social interactions across multiple contexts and restricted repetitive patterns of behavior interests or activities (DSM-V-TR, 2023). We all have an internal vision of what deficits in social communication and social interactions look like in children. We visualize the awkward child that is either quiet or talks incessantly and other kids avoid and bully. Yet, what does a deficit in social interactions look like in adults? Most people have no idea. The awkwardness may still be there, but it isn’t the primary problematic issue.

The first thing we must conceptualize to understand how this plays out in functional adults with autism is that almost all of them have been trained since early childhood to mask their autistic traits and look to neurotypicals for our understanding of normal.

The messages that are given to autistic children are brutal. Autistic children are told to, “Use social narratives and social cartooning as tools in describing and defining social rules and expectations.” (Autism Speaks, School Community Tool Kit). The worst part of the messages that were given to us as children is that we weren’t even allowed to receive these messages directly because we were considered too weird, broken, and incompetent to receive them, so our schools and caretakers were taught how to train us properly. Our caregivers were told to, “teach imitation, motor as well as verbal.” (Autism Speaks, School Community Tool Kit).

These messages are given to those who aren’t diagnosed with autism in childhood in different ways. Parents and teachers label us as difficult and try to train us to be normal so we can make friends and fit in. As one psychiatrist told me, “Social skills training is important because everyone needs friends.” We are told to hide our behaviors and try to watch those others around us because our behaviors are “weird,” “difficult,” or “wrong.” My mother used to ask me, “What is wrong with you?” all the time. Friends and peers reinforce these messages. Many of us have faced lifetimes of rejection that remind us that we aren't acceptable as who we are.

Through this process, people with autism learn to suppress their natural drives, instincts, needs, and comfort zones and assume others are correct and they are wrong. This is often combined with an intrinsic inability to learn safety cues, danger cues, and a lack of understanding of what normal should be, all of which can create a perfect storm in which unhealthy, abusive, and toxic relationships can thrive in the adult lives of people with autism.

What I see these “deficits in social communication and social interaction” (APA, 2023) playing out as in adults with autism is a chain of very unhealthy relationships and unhealthy social interactions. Most of my adult clients with autism have been in at least one extremely unhappy, pair-bonded relationship. They often feel lucky anyone will have them at all and are in relationships where they are relentlessly criticized and told they need to change. They are told they use autism as an “excuse” for bad behavior.

People with autism often have similarly unhealthy friendships. They are used, manipulated, and frequently end up with narcissists and unhealthy people. Research shows that 66 percent of adults with autism have PTSD and 91 percent of women with autism have PTSD. Although correlative data can’t be used to attribute causation, it is an easy intuitive leap to assume that people with autism’s inability to recognize the difference between healthy and unhealthy relationships and their inability to read danger and safety cues in social interactions plays a role in this.

When I treat adults with autism, a massive part of what I do is help them unwind all the negative messages they have learned in unhealthy relationships and as children. It helps them learn to seek out healthy relationships and understand that a healthy relationship should be driven by mutual respect and support.

Pair-bonded relationships are often the most problematic in these scenarios. People with autism often end up dating and married to people who are emotionally and physically abusive. They end up with people who expect them to change and berate them or make them feel flawed for who they are. The worst part of this is that most people with autism can’t even tell the difference between a healthy relationship and an abusive one.

This scenario plays out in all interactions. I have been duped or ended up taken advantage of numerous times due to this. I can’t read when people are trying to trick me. I once bought a business from a man who told me in advance he had constant panic attacks, needed Valium, and couldn’t handle his finances. Yet I believed him when he said the business was solid and had no debt. I didn’t see these huge red flags that others would know immediately were cues to flee.

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This is the problem with the way we relate to the relationship impairments of autism. We expect them just to be awkwardness and an inability to talk well, but really it is deeper. We may be able to speak clearly, but we don’t understand the subtle aspects of social communication and interaction that help normal people see when people are being hurtful, unstable, or chaotic. We are unable to understand what is healthy and what isn’t. We struggle with social interactions, but we crave them, so we tend to embrace anyone who likes us and we don’t recognize red flags.

As we move forward in our understanding of treatments for autism, this level of social impairment needs to be addressed. Instead of just leaning into social skills training, we need to lean into social interaction training that teaches people with autism to recognize red flags, value their needs and boundaries, recognize abuse and deception, and set healthy boundaries that will keep them safe and happy.