Fall 2025 Issue

Autism: Adult Autism Diagnosis
By Miriam Edelman, MPA, MSSW
Social Work Today
Vol. 25 No. 4 P. 30

Potential Benefits and Detrimental Effects of an Autism Diagnosis

An autism diagnosis for an adult can be life-changing, greatly benefiting your client. It may make the person understand themselves, their past, and their current life.1 They may finally be able to gain clarity about why their life is the way it is. An autism diagnosis may also allow them to connect with other autistic people. It may be crucial for your client to ask for and receive beneficial support and reasonable accommodations at work.2 A diagnosis may also reduce shame and/or empower the newly diagnosed person.3 It may provide access to support and/or improve mental health treatment, as treatment could be tailored to autism.4 Additionally, it may confirm to others who may have doubted the clients’ autism, leading to more understanding.1

You may believe that an autism diagnosis may also be beneficial to you as a therapist. Autism might explain many of your client’s mental health problems. Knowing about autism, you may think that an autism diagnosis could help the treatment of your client’s prevailing mental health conditions, the reason why your client came to you. You may need to change your treatment methods, as what works for the general population may not work for autistic people. However, just diagnosing a client without consent may have detrimental effects on your client and your therapeutic relationship.

A late autism diagnosis, by itself, may have harmful consequences. It may lead to immense anger and resentment. A person with such a diagnosis may think, “Why did I have to be born with autism, which prevented me from having the life that I always thought I would have?” Your client may feel that their lives might have been much better if they had received an autism diagnosis when they were young. As a result of a late diagnosis, they missed out on early interventions, which improve the lives of some autistic people by assisting with essential skills, social interactions, and communication-related and behavior-related problems.5 As many support structures are for children (not adults), it might be difficult for a late-diagnosed autistic person to get proper support. A late diagnosis might also create/increase suicidal thoughts and behavior.6

Reactions to Adult Autism Diagnosis
Adults newly diagnosed with autism may have a variety of reactions. Feelings include relief, anger, and more.

Sue Nelson, who was diagnosed with autism when she was 60 years old,3 saw the benefit of her late autism diagnosis. She wrote: “This is why I’ve gone public about having autism. This new understanding of life is a huge gift. I wish I’d gotten a diagnosis earlier. Admittedly, I’m still processing it all, but no longer view myself as broken. I am simply wired differently. And that’s OK.”3

In contrast, a redditor on r/AutismInWoman suffers from her autism diagnosis. She wrote online: “I was suicidal long before receiving my autism diagnosis, but it’s almost worse now that I know the real cause of the feeling—not a chemical imbalance, not a poor mindset, but being autistic in a world that wasn’t built for me. When I’ve been suicidal in the past, I had hope, thinking the right combination of meds and therapy could maybe pull me out of it. In that regard, autism feels like a death sentence—an affirmation that I was right, this is just how I am, and things aren’t going to get better.”7

She added, “The only real option other than [taking my own life] is to keep going, and I feel like I can no longer do that. Or at least not for very much longer.”

Over time, a client’s reaction to an autism diagnosis might change. Initially, they may find comfort in the diagnosis, finally understanding the reason for their struggles. Over time, they may become resentful and angry regarding being autistic. The inverse could also be true; they might be negative and then positive. Their views might also go back and forth between positive and negative.

Without really knowing your client, you may not be able to predict how your client is likely to react to an autism diagnosis. Your client may not even know exactly how they will respond. An unasked-for autism diagnosis is not worth the risk of suicidal ideation/a potential suicide.

Social Work Code of Ethics
When determining if you should give an autism diagnosis to your client, reviewing the “Social Workers’ Ethical Responsibilities to Clients” section of the Social Work Code of Ethics may be beneficial.8 The Code addresses two relevant topics: self-determination and informed consent.

Self-Determination
“Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients’ right to self-determination when, in the social workers’ professional judgment, clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others.”8

Informed Consent
“Social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent.”8

Your client very well may have signed consent forms as a requirement to begin meeting with you. Those consent forms generally are about typical diagnoses/treatments and do not seem to apply to something as major as an autism diagnosis. In order to receive an autism diagnosis, a person must have an evaluation, which typically involves informed consent.

Potential Harm of Diagnosing Autism Without Consent
Even if diagnosing your client with autism may not violate the Social Work Code of Ethics, you might be at risk of harming your client if you diagnose your client without consent:

You might misdiagnose your client.9 When giving a diagnosis of autism based on intake documents and the first few sessions, you may not have seen the full picture.

You might be perceived as yet another person who is doing something bad to them, as your diagnosing them without their consent severely limits their self-determination. Your client very well may have been bullied and/or fired due to autism-related behavior. They may be angry that you usurped their power to determine whether they receive an autism diagnosis. They may have felt that thinking they have autism (if they have that thought) is sufficient.1 They may have been actively trying not to get an autism evaluation/diagnosis. Any type of autism diagnosis might challenge their views about themselves.10

You may be contradicting the social work value of empowerment.11 Your client very well may have been bullied and excluded throughout their life. They might very well be unemployed, as shown by the approximately 85% of autistic people being unemployed.12 Thus, they may already feel disempowered. In what should be a safe space, they have been told they have a major diagnosis. This diagnosis may help you assist your client, but it could be a new, unnecessary problem for your client. Knowledge of autism may make your client feel weaker and less confident, as they may think that whatever they do, they will not succeed because the world is so unaccepting of autistic people.

Your client may not view your autism diagnosis as a real diagnosis, especially if your client already thinks they are autistic. Since some autistic people like to conduct research, they may have already learned online how to diagnose people with autism. They may also know that a formal/medical autism diagnosis sometimes comes after an evaluation, which involves assessments and diagnostic tests.13,14 Informed consent is given for an autism assessment.15

Your client may have also learned that brief interactions may not be sufficient for an autism diagnosis. As the Autism Society wrote:14 A brief observation in a single setting cannot present a true picture of someone’s abilities and behaviors. The person’s developmental history and input from parents, caregivers, and/or teachers are important components of an accurate diagnosis.

Thus, your client very well may feel that you might not know them well enough to diagnose them with autism.

Your client may be so taken aback by this unasked-for diagnosis that they may refuse to meet with you anymore. They might have difficulty finding a new therapist, as many medical professionals are not trained in disabilities. At an especially vulnerable time, they might have even less support and may not have many others to turn to, as autistic people often are lonely and socially isolated.16

Your Client’s Thoughts
Before giving your client an autism diagnosis, think about and assess whether your client actually wants an evaluation for autism and/or an autism diagnosis. Conduct an assessment to figure out your clients’ thoughts so you can “meet your client where they are” (an expression used frequently in social work school).17

How you approach your client about autism is influenced by your client’s comments (or lack of comments) about autism. If your client tells you they think they have autism, you can ask them if they would like an autism evaluation. They may say no, but later change their mind. Take their lead. If your client has not mentioned autism at all, be careful about how you bring up autism. Mentioning autism in relation to your client could backfire, potentially causing your client to be uncomfortable and defensive.

Your client’s thinking that they probably are autistic is not the same as consent. Your client may want to be treated as a probable autistic person without having a formal autism diagnosis. Your client may be fully expecting a mental health diagnosis (diagnoses), not looking for or expecting an autism diagnosis.

Your client very well may not want an official autism diagnosis because of one or more reasons, such as the following:

• They may not want to know that they actually are autistic. They may get upset when they realize that they have a condition, which may have caused them great harm.

• They may feel that a diagnosis could decrease job choices and/or result in stigma and/or discrimination.1

• They may understand that people with a late autism diagnosis have an increased chance of suicidal ideation.6

Talking With Your Client
If you suspect that your client is autistic but your client has not expressed an interest in getting evaluated, you might do the following:

• Discuss your speculation with your client. You might say that you think that they are autistic.

• Talk about the pros and cons of an autism evaluation/autism diagnosis.

• Provide resources on possible mental health providers who could conduct an evaluation and provide a diagnosis.

After that discussion/discussions, follow your client’s lead, as the client is the expert on themselves (a key social work principle). Meanwhile, try to adapt your treatment methods to autism-affirming tactics that could better help your client. They very well may tell you that they want an evaluation. If your client needs proof of autism for reasonable accommodations in the workplace, you may want to ask if your client wants a provisional diagnosis, as there might be lengthy delays for formal evaluations.10

Final Thoughts
If you end up diagnosing your client with autism, be there for your client. You can assist them in accepting that diagnosis.10 While autism is considered a developmental disability, telling your client that they have a disability may not go over well. As they are getting an autism diagnosis as an adult, they may have trouble accepting that they actually have a disability. In addition, saying that one has a disability can be perceived as being disabling.

Have empathy, a key social work value, for your client.18 Would you like to be diagnosed with a disability without your consent? Most likely, no. Thus, do not do it to your client.

— Native Washingtonian Miriam Edelman, MPA, MSSW, is a Washington, D.C.,-based policy professional. Her experience includes policy work for both the Senate and House of Representatives. Edelman’s undergraduate degree is from Barnard College, Columbia University, with majors in political science and urban studies and a concentration in history. She has a Master of Public Administration from Cornell University, where she was inducted into Pi Alpha, the national honorary society for public administration, and was awarded the Cornellwide Distinguished Leadership Award. She also has a Master of Science in Social Work (focusing on policy) from Columbia University. She is a commissioner of the DC Commission on Persons with Disabilities. Edelman aims to continue her career in public service. She is especially interested in democracy, civic education, District of Columbia autonomy, diversity, health policy, women’s issues, and disabilities.

If you provide an autism diagnosis to your adult client, you can provide resources. Relevant resources include the following:

Organizations:
• Association for Autism and Neurodiversity (https://aane.org)

• Local autism support groups, meetup groups, and community organizations,
such as Autistics Association of Greater Washington, Inc (https://aagw.net)

• Organization for Autism Research’s (https://researchautism.org) Hire Autism
program (www.hireautism.org), if your client is unemployed or soon to be
unemployed

• Autism-related magazines, such as Autism Digest (www.autismdigest.com)

Documents:
• “Therapy for Newly Diagnosed Autistic Adults”: www.research.chop.edu/car-autism-roadmap/
therapy-for-newly-diagnosed-autistic-adults

• Autistic Women & Nonbinary Network’s “Information & Resources for Newly Diagnosed or Recognized Autistic Women & Nonbinary Individuals”: https://awnnetwork.org/wp-content/uploads/2019/05/AWNNetworkWelcomeautisticadultspacket.pdf

• NeuroLaunch’s “Autistic Adults: A Comprehensive Guide for the Newly Diagnosed”: https://neurolaunch.com/im-autistic-now-what/

• NeuroLaunch’s “Late Autism Diagnosis: Embracing Your Neurodiversity in Adulthood”: https://neurolaunch.com/late-autism-diagnosis/

• Reframing Autism’s “Welcome to the Autistic Community: A Welcome Pack”: https://reframingautism.org.au/service/welcome-pack/

• State- and city-specific documents, including the Kentucky Advisory Council on Autism’s “New Autism Diagnosis Resource Sheet”: https://www.kyaca.org/wp-content/uploads/2023/08/Resource-Sheet-Full-KYACA.8.7.23.pdf

References
1. Deciding whether to seek an autism assessment. National Autistic Society website. https://www.autism.org.uk/advice-and-guidance/topics/diagnosis/before-diagnosis/deciding-whether-to-seek-an-autism-assessment#:~:text=some%20people%20feel%20that%20a,don't%20want%20to)

2. Benefits of an adult autism diagnosis. Help and Healing Center website. https://helpandhealingcenter.com/benefits-of-an-adult-autism-diagnosis/

3. Nelson S. Autism: I was diagnosed at 60. BBC website. https://www.bbc.com/future/article/
20220405-the-life-changing-diagnosis-of-autism-in-later-life. Published April 6, 2022.

4. Understanding undiagnosed autism in adult females. UCLA Health website. https://www.uclahealth.org/news/article/understanding-undiagnosed-autism-adult-females. Published October 12, 2023.

5. Uncovering the negative impact of late autism diagnosis. Gold Star Rehabilitation. https://www.goldstarrehab.com/parent-resources/negative-effects-of-an-autism-diagnosis-later-in-life#theimpactoflateautismdiagnosis. Published February 26, 2025.

6. 6 reasons autistic people are at greater risk of suicide. Psychology Today website. https://www.psychologytoday.com/us/blog/women-with-autism-spectrum-disorder/202302/6-reasons-autistic-people-are-at-greater-risk-of. Published February 17, 2023.

7. Suicidal ideation as a late diagnosed autistic. Reddit website. https://www.reddit.com/r/AutismInWomen/comments/1k4m0ki/
suicidal_ideation_as_a_late_diagnosed_autistic/

8. Social workers' ethical responsibilities to clients. NASW website. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English/Social-Workers-Ethical-Responsibilities-to-Clients

9. Pros and cons of getting an autism diagnosis as an adult. Altogether Autism website. https://www.altogetherautism.org.nz/pros-and-cons-of-getting-an-autism-diagnosis-as-an-adult/. Published April 18, 2024.

10. Levine H. Autism: the challenges and opportunities of an adult diagnosis. Harvard Health Publishing website. https://www.health.harvard.edu/mind-and-mood/autism-the-challenges-and-opportunities-of-an-adult-diagnosis. Published December 3, 2024.

11. Empowerment. The Social Work Graduate website. https://www.thesocialworkgraduate.com/post/empowerment. Published October 18, 2024.

12. Addressing the autism unemployment rate. Mastermind Behavior website. https://www.mastermindbehavior.com/post/autism-unemployment-rate. Published March 3, 2025.

13. Getting an autism diagnosis as an adult. Adult Autism Health Resources website. https://www.adult-autism.health.harvard.edu/resources/getting-an-autism-diagnosis-as-an-adult/

14. Screening & diagnosis: identifying autism. Autism Society website. https://autismsociety.org/
screening-diagnosis/

15. How to get an autism diagnosis: step-by-step instructions. Neurospark website. https://www.neurosparkhealth.com/blog/how-to-get-an-autism-diagnosis-step-by-step-instructions

16. For some autistic people, the feeling of loneliness can be really strong, and it can feel incredibly isolating. I want you to know that you’re not alone if you are feeling this way. National Autistic Society website. https://www.autism.org.uk/advice-and-guidance/the-autistic-perspective/emily-katy-social-isolation-blog#:~:text=As%20an%20autistic%20person%2C%20it,may%20not%20know%20how%20to.

17. Meeting clients where they are. The Generalist Social Worker. https://thegeneralistsocialworker.blogspot.com/2020/08/meeting-clients-where-they-are.html. Published August 31, 2020.

18. Vasquez E. The critical role of empathy in social work practice: a comprehensive guide. Social Work Degrees website. https://www.socialworkdegrees.org/the-importance-of-empathy-in-social-work#:~:text=Empathy%20allows%20social%20workers%20to,social%20worker's
%20emotional%20well%2Dbeing. Published August 29, 2025.