On the Spectrum: High-Functioning Autism and Its Contemporary Relevance.

This review explains how autism diagnosis changed in 2013, leading to many more people being identified as autistic, especially adults with high-functioning autism. These individuals often have good language skills and intelligence but struggle with jobs and relationships. They may have learned to 'mask' their autism traits. While there's no cure, treating other health conditions and providing job training, therapy, and social skills support can help improve their quality of life.

This review discusses the impact of DSM-5's reconceptualization of autism spectrum disorder, which consolidated four previous diagnoses into one and nearly doubled autism prevalence to over 2% in the US. The increase is largely attributed to recognition of high-functioning autism (previously Asperger disorder), often undiagnosed until adulthood. These individuals typically have intact language and intellect but use compensatory strategies like social 'masking.' Adult presentations involve employment and relationship difficulties. The review emphasizes that many adult psychiatrists lack autism expertise, and while no specific treatments exist, addressing comorbidities and providing targeted support services can significantly improve outcomes and reduce isolation.

Clinicians should be aware of adult autism presentations, particularly in patients with employment or relationship difficulties. Many adults may be undiagnosed due to masking behaviors. Focus should be on identifying and treating comorbidities while providing comprehensive support including occupational therapy, psychotherapy, and vocational services.

As a narrative review, this study does not present original research findings or systematic analysis of evidence. The scope appears limited to discussing diagnostic changes and general clinical observations rather than empirical data on intervention effectiveness or prevalence statistics.

With publication of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) in 2013, autism's prevalence in the United States nearly doubled to more than 2% of the population. In reconceptualizing the condition, DSM-5 collapsed 4 diagnoses into 1 diagnosis: autism spectrum disorder. What the 4 had in common were deficits in 2 broad areas: restricted, repetitive behaviors or interests; and deficits in social communication. Three of the 4 were severe forms easily recognized in childhood.

The fourth, constituting most of the increase in prevalence, was Asperger disorder, or high-functioning autism, frequently going undiagnosed until adulthood. These patients typically have fluent language, intact intellect, and highly developed compensatory strategies including social "masking." The adult diagnosis is manifested in struggles to maintain employment or friendships both platonic and intimate. Nonpsychiatric providers are likely to encounter patients with autism spectrum disorder seeking care for myriad comorbid psychiatric and physical problems. Complicating matters is that many adult psychiatrists are unfamiliar with what was until recently the purview of child psychiatrists.

Autism has neither cure nor specific pharmacologic treatments, but addressing comorbidities, with psychiatric and medical referrals where indicated, mitigates suffering. Services targeting employment and educational support, occupational therapy focused on activities of daily living, and skill-based psychotherapies that aim to improve social interactions can reduce stress and anxiety while enhancing function, reducing isolation, and encouraging satisfying relationships.