Understanding autism in older adults

Autism is usually identified in childhood, but many people are only diagnosed later in life. In recent years, increasing awareness has led to more adults – including people over 60 – receiving an autism diagnosis.

For some, a late diagnosis can bring relief and a better understanding of lifelong experiences. Others may realise that the challenges they’ve faced with communication, routine, or sensory sensitivities are linked to autism.

While research into autism in older adults is still developing, experts agree that autism is a lifelong neurodevelopmental condition that affects people in different ways throughout their lives.

Quick overview

• Autism is a lifelong neurodevelopmental condition that affects communication, behaviour, and how people interact with the world.
• Although it usually begins in childhood, many people are not diagnosed until adulthood or later life.
• Autism itself does not worsen with age, but life changes may affect how traits are experienced.
• Thousands of people over 65 may be living with undiagnosed autism.
• Receiving a diagnosis later in life can help people access support, understanding, and appropriate care.

What is autism?

Autism, also known as Autism Spectrum Disorder (ASD), is a neurological and developmental condition that affects how people communicate, behave, and experience the world around them.

Autism is referred to as a spectrum because it affects people in different ways and to varying degrees. Some autistic people need significant support in daily life, while others live independently with minimal support.

Autistic traits often relate to:

• Communication and social interaction
• Routines and repetitive behaviours
• Sensory sensitivities
• Strong or focused interests.

Autism has always existed, but awareness and understanding have changed significantly over time. It was first described in the 1940s, and wider recognition developed from the 1970s onwards.

Because of this, many older adults grew up during a time when autism was poorly understood, meaning they may never have received a diagnosis.

What are the signs of autism in older adults?

The signs of autism in older adults can vary widely. Some people may recognise autistic traits early in life, while others may not realise until adulthood.

Common signs of autism in older adults include:

• Finding it difficult to understand how others are feeling
• Struggling to communicate emotions or thoughts clearly
• Preferring to spend time alone rather than in large social groups
• Finding it difficult to make or maintain friendships
• Needing routines and becoming anxious when plans change
• Experiencing sensory sensitivities, such as sensitivity to noise, bright lights, or strong smells
• Developing very strong interests in specific topics
• Focusing closely on patterns, details, or systems
• Finding eye contact uncomfortable
• Feeling socially exhausted after interactions with others.

Some autistic adults may also experience anxiety, depression, or burnout, particularly if they have spent years masking their traits.

Signs of autism in older men

Historically, autism has been diagnosed more often in men. Some common traits observed in autistic men include:

• Strong interest in technical, structured, or specialist topics
• Preference for predictable routines
• Difficulty interpreting social cues
• Challenges with emotional communication.

Signs of autism in older women

Autism can sometimes be harder to recognise in women. Many autistic women develop strategies to mask or hide their traits, which can make diagnosis more difficult.

Signs of autism in women may include:

• Copying or mirroring other people's behaviour in social situations
• Maintaining a small number of very close friendships
• Strong emotional sensitivity
• Intense interests that appear socially typical, such as literature, animals, or hobbies
• Internalised anxiety or exhaustion from social interactions.

Because these traits may be less obvious, many women are diagnosed much later in life.

How autism can present differently in women

Autism symptoms can be more subdued in women, and may not fit what we think of as autistic behaviour. This can lead to some cases of autism being missed by healthcare professionals. In some cases, it may even mean misdiagnosing autism as a mental health issue.

According to the National Autistic Society, some autistic women develop ways of masking or hiding their traits during social interactions. This can involve copying the behaviour of others, rehearsing conversations, or suppressing behaviours that might appear unusual to others.

Researchers sometimes refer to this pattern as the “Female Autism Phenotype”, which describes traits that may be more common in autistic women. These can include:

• Being able to hide certain behaviours during social interactions
• Having a small number of very intense friendships
• Experiencing internal anxiety or emotional exhaustion after social situations
• Displaying repetitive behaviours linked to nervousness, such as fidgeting or humming
• Having strong interests that appear socially typical, such as literature, animals, or hobbies.

Because these traits may be less visible, autistic women are sometimes misdiagnosed with other mental health conditions, such as anxiety or personality disorders, before receiving an autism diagnosis.

Increasing awareness of how autism presents in women is helping healthcare professionals recognise autistic traits more accurately and support earlier diagnosis and understanding.

Does autism get worse with age?

Autism itself does not worsen with age. It is a lifelong condition that begins in early childhood.

However, the way autistic traits affect someone’s life may change over time. As people get older, life transitions such as retirement, health changes, or shifts in social routines can sometimes make certain traits more noticeable.

Because autism in later life has only recently begun receiving more research attention, there is still limited evidence about the experiences of older autistic adults. Much of this is because the first generations of people diagnosed with autism in the 1940s and 1950s are only now reaching older age.

Autism researchers at Goldsmith’s University have explored how autistic traits may change over time. Their research found that adults who received a later-life diagnosis often reported experiencing more autistic traits than those diagnosed in childhood. However, many were able to compensate for these difficulties using coping strategies they had developed throughout their lives.

How is autism diagnosed in older people?

Autism can be diagnosed at any age, including later in life. Adult assessments can be more complex than childhood evaluations, as many older adults have developed coping strategies that may mask autistic traits.

To understand if your loved one meets the criteria for autism, clinicians usually follow a structured assessment process that looks at lifelong patterns of behaviour, social interaction, and sensory experiences.

The assessment process

1. Initial consultation: Speak with a GP or healthcare professional, who may refer you for an autism assessment.
2. Personal history: Discussion of childhood behaviours, education, work, relationships, and routines.
3. Behavioural observations and questionnaires: Structured tools assess communication, social interaction, interests, and sensory sensitivities.
4. Input from family (if available): Information from relatives can help, though self-report is often primary.
5. Feedback: Clinicians explain whether the criteria for an autism diagnosis are met and discuss next steps.

For more information, read the ADHD & Autism clinic guide.

Undiagnosed autism in older adults

Many older people may be living with undiagnosed autism. In some cases, autistic traits may be mistaken for other conditions, particularly in later life. For example, symptoms may overlap with:

• Anxiety or depression
• Personality traits such as shyness
• Social withdrawal due to ageing
• Cognitive changes related to conditions such as dementia.

Changes in mobility, social circles, and lifestyle can also make autistic traits harder to recognise.

However, receiving a diagnosis later in life can still be valuable. It can help people understand their experiences and access appropriate support.

How Elder can help support older adults with autism

Supporting an older adult with autism can sometimes require patience, understanding, and consistent routines. Many autistic people feel more comfortable in familiar environments, which is why remaining at home can play an important role in maintaining wellbeing.

Elder connects families with experienced live-in carers who provide one-to-one support at home, helping older adults maintain independence while receiving assistance with daily life.

A live-in carer can help with:

• Maintaining routines and daily structure
• Providing companionship and reassurance
• Assisting with personal care and household tasks
• Supporting appointments and medication.

If you’re exploring care options for a loved one, speaking with a care advisor can help you understand what support may be available and whether live-in care could be the right fit for your family.

Speak with a care advisor