A retrospective chart study: the pathway to a diagnosis for adults referred for ASD assessment.
Adults often carry anxiety or mood labels for decades before someone spots autism.
01Research in Context
What this study did
Griffith et al. (2012) pulled 125 adult charts from an ASD clinic. They traced how each person finally got an autism diagnosis.
The team counted years, prior labels, and doctor visits. No tests or interventions were given; they just read the records.
What they found
Most adults had spent decades called something else: anxiety, depression, bipolar. The wrong labels piled up before anyone mentioned autism.
Each pathway looked different. There was no standard route to the correct diagnosis.
How this fits with other research
Rodas et al. (2017) saw the same mix-up in little kids. Pragmatic language gaps at age four forecast later anxiety diagnoses. The child study and the adult study match: missed autism looks like anxiety across the lifespan.
Humphrey et al. (2008) add the teen view. Their high-schoolers with ASD felt 'broken' and just wanted to be normal. M et al. show why: years of being told they had mood disorders, not autism, shaped that self-view.
Smith et al. (2008) found adults with Asperger's landing in the justice system after similar service gaps. Together the papers map one long story: late or wrong diagnosis leads to mental-health labels, poor self-image, and even legal trouble.
Why it matters
When an adult client lists anxiety or depression but therapy stalls, ask about autism traits. Probe pragmatic language, sensory issues, and lifelong social gaps. A quick screen can flip years of failed treatment and give the client the right label—and the right help.
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02At a glance
03Original abstract
Charts of 125 adults (18 to 82 years), referred to an autism expert team for Autism Spectrum Disorder (ASD) assessment, were reviewed to explore the pathway to an adulthood ASD diagnosis. The participants first contacted the mental health care clinic at a median age of 19 years (range 2 to 78 years). Men contacted the clinic slightly earlier than women. The main referral reasons were social problems, feelings of anxiety and mood disturbances. The most common earlier diagnoses were anxiety and mood disorders or psychosis-related disorders. These diagnoses were more common in women than in men. Surprisingly few differences emerged between those who finally received an ASD diagnosis and those who did not. However, those with an ASD diagnosis contacted the clinic a mean of 15 years earlier and less frequently received different former diagnoses, although the type of diagnoses did not differ. The diagnostic criteria that were prevalent during early childhood of these adults did not influence their diagnostic history. A quarter of these clients were known with social problems within the mental health care system, but ASD was not assessed. Hence, the current study shows that the pathways to an adulthood ASD diagnosis are very heterogeneous.
Autism : the international journal of research and practice, 2012 · doi:10.1177/1362361311421775