MHM Magazine

22 | MENTAL HEALTH MATTERS | 2022 | Issue 5 MHM Importantly, while some people with autism may prefer person-first language, others feel that identity-first language better reflects their own experience. Here, we use these interchangeably, with the understanding that the “right” language is that which respects each individual’s experience. Increasing global prevalence Globally, autism diagnoses have increased by almost 800% over the last 20 years. However, this is not reflective of an increase in prevalence , but an increase in incidence recognition as our diagnostic guidelines have evolved. Historically, autism was largely diagnosed in young children, and mostly in males. There is a growing recognition that the gender bias in autism does not reflect a true disparity in incidence , but that diagnostic tools are better at “catching” presentations in males. Moreover, the DSM-5 explains that while autistic traits must be present during early development, they may fully manifest only when social demands exceed capacity . Many individuals remain undiagnosed into adulthood due to masking or social camouflaging strategies used to suppress autistic traits. People often have an unconscious misconception that they would “just be able to tell” if they spoke to someone with autism. The truth is that sometimes you can see autism from the outside and sometimes you can’t. Some people with autism are preverbal and others are hyperverbal. Some may develop slower than their peers and some develop “spikily” – that is, faster in some areas and slower in others. Some are diagnosed before 2 or 3 years old, and others are still undiagnosed at 56. Regardless of age, gender or apparent “levels of functioning”, a diagnosis can be life-changing - and the evidence shows that earlier diagnoses are linked to significantly better clinical outcomes across the spectrum. Missed diagnosis: the mental and physical cost So much misinformation and stigma still surrounds autism that a diagnosis is sometimes met with apprehension. Often, autism isn’t even considered if an individual is “functioning” appropriately in an academic or social context. What people on the outside can’t see is the immense physical and mental effort required to achieve neurotypical standards of functioning without a neurotypical brain. Imagine having to consciously control your lungs every time you need to breathe. This is what autistic masking feels like, and it has profound psychological and physiological consequences. Autism is associated with significantly higher rates of psychopathology, which are even higher in late-diagnosed individuals. Common neuropsychiatric comorbidities include depression, anxiety, eating disorders, executive dysfunction, OCD, panic attacks and social anxiety. Critically, suicidal ideation, suicide rates and mortality by suicide are more than two times higher in autism, with the highest prevalence reported in late-diagnosed adults. Autistic camouflaging is a significant contributor to both psychopathology and suicidality. Chronic masking also leads to something called autistic burnout, which is marked by long- term exhaustion, an increased presentation of autistic traits and an inability to cope with sensory, social or cognitive demands. Autism is also associated with a range of co-occurring health concerns that may be exacerbated when it has remained undiagnosed. These include auto-immune conditions, gastric complications such as IBS and Crohn’s disease, food and skin allergies, headaches, fibromyalgia, inflammation, sensory issues, chronic fatigue and other central sensitivity syndromes. Interestingly, many of these conditions are also associated with exposure to chronic stress. Thus, not only are autistic individuals more likely to be exposed to psychosocial stress, but they may also be predisposed to detrimental stress responses that contribute to pathology.