AS w/wo Repetitive Behaviors

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Pretend that you are the neuropsychologist. How would you diagnose or assess an adult who clearly fit ASD criteria for social/communication traits, but didn't have repetitive behaviors until adulthood, and had very mild sensory issues (such as being fatigued by noise and seeing sunlight brighter than it should look) in childhood that became more severe in adulthood?

I can't pretend that I'm a neuropsychologist, because I don't have any of the training or expertise which comes with that.

That being said, I think some of my symptoms did become worse in adulthood. As a kid, I didn't really have to do much. A lot of the time, I was in my own world, doing what I wanted to do and what made me comfortable. As an adult, you don't really have that luxury. You have responsibilities, and you need to worry about your future and take care of yourself. Because I have to be more engaged with what's going on around me, and because of the emotional rollercoaster that life becomes when you're not a little kid spinning in circles on a playground, life in general becomes more difficult, my sensory issues are worse and more noticeable, and the sort of social/perceived gap between me and a neurotypical person has kind of widened a bit.

"Social (pragmatic) communication disorder – this diagnosis described difficulties in the social uses of verbal and nonverbal communication in naturalistic contexts, which affects the development of social relationships and discourse comprehension. The difference between this diagnosis and autism spectrum disorder is that in the latter there is also a restricted or repetitive pattern of behavior"

This sounds about right.

Would you try to diagnose the repetitive behaviors separately? Or ignore them?

I would really have to observe the person IN PERSON.

"Repetitive behaviors" could be a sign of Obsessive-Compulsive disorder, obviously.

If a person is fundamentally resistant to change, and has to perform actions in order to ease their transitions, I would find that to be a sign of autism.

I was one who was diagnosed very young, about 20 years after Kanner's work became known.

What are the repetitive behaviors developed in adulthood?

How can you be sure that repetitive behaviors were not present in childhood? They may have simply been different behaviors or been forgotten over the years.

I have a chronic stim, standing with hands in pockets, swaying side to side, like Stevie Wonder, which I can clearly trace back to about the age of 12, when I got my first real stereo and could stand between the speakers when I listened to music. Before that, all I'd had were a transistor radio and a box record player and unless I was at my desk drawing or model-building, I sat on the floor.

I can't recall the stim being present then, but at that age, I was always sitting on the floor with toys, or lying on the bed reading. I may have done it back then, but if I did, it wasn't often enough that I can clearly recall it. I should ask my mother about that. I do remember my parents constantly nagging me about jamming my hands in my pockets at church, so maybe I was doing it then.

So its possible some behaviors may have been present in childhood that were just never recognized as autistic in nature.

Maybe the person wasn't aware of their repetitive behavior in childhood.
The only way I know I had repetitive and autistic behaviors as a child is because I remember my mother's reaction to them.
behavior that was perfectly natural to me would upset my mother and without that I would not aware of it or remember it.

I would probably diagnose you with social communication disorder, a new category added to the DSM V which is exactly what you describe; autism without the restricted/repetitive behaviours. If those behaviours showed up in adulthood, I'd screen you for an anxiety disorder like GAD or OCD, because such symptoms can be indicative of obsessive rituals used by those with clinical anxiety as a means of keeping it at bay.

Sensory issues were never among Asperger's criteria. I'm particular about food, but smells, noise and lights have never caused me any more problems than they do anyone else (except when I suffer migraine, but that's not uncommon; just like I don't tend to suffer from nausea or dizziness, but I do during migraines).
Other than that, I can't relate to having sensory issues.
I've never been much of stimmer either. I do mostly wiggle my toes, tap my fingers, and fidget with things. I can pace when anxious and serial sneeze when stressed, and when I'm upset or anxious I can wring my hands (although somewhat seldom). I tend to be stiff around people.

So speaking for myself, I know what it's like to have AS without those issues being very prominent. I'm saying this because I know these things don't rule out AS.


Now, if I were a neuropsychologist I hope I would have had enough knowledge to know that AS symptoms can change and vary throughout one's life (as people have talked about here on WP before), and that anxiety (which would be more likely in adult age) is a common reason for it and looked into whether you suffered anxiety. I hope I would also be aware that people can have some symptoms more severe and others mild or practically non-existent.

I would think AS or PDD-NOS were possible, but I would also notice how the person seemed, talked, behaved, moved; what the bigger picture told me.

Well written, Skilpadde.
About OP´s question, I wouldn´t know, but not clearly meeting the criteria of repetitive movements as a toddler allways makes me unsure about my own dx, - but I also know, that I was a control freak ever since I was three and extensively concious about my physical behavior, - how to be well behaved and how not to make others point.
I was even taught that and I absolutely hated being the focus of amused, wondering adults.
I simply stiffened up.

I think, repetitive behaviors can take rather subtle forms and perhaps the official criteria are a bit stiff and mainly points at arch-typical traits and behaviors.
They are official guidelines, but do not take into account, what Skilpadde pointed out, that traits and behaviors can shift throughout life.

Thanks, Jensen!

Sensory sensitivities can change over time. As a kid I was undersensitive to some stuffs (cold temperature, bad smell) that I am oversensitive now.

That depends on whether or not the repetitive behaviors look like those of autism spectrum or not. If they could better be explained as a tic, OCD like behavior, or a retreat into a bizarre hobby/lifestyle due to social isolation- then I wouldn't diagnose autism. But if the repetitive behaviors were similar to those of autism spectrum (unique to autism or autism phenotype) then I'd diagnose autism spectrum.


DSM 5 is more strict than DSM 4 and requires more of the more symptoms (at least 2 of the repetitive behavior symptoms) to be present than DSM 4 did for Aspergers. It also requires the repetitive behaviors to be problematic.

Same here.

I may have had some repetitive behaviors as a child, but I can't remember, my mom can't remember, and my dad is dead, so I assume that I had none since I have no access to the truth.

Rocking, finger flicking, hand flapping, occasional echolalia. The first time I noticed myself do it was age 27 or 28.