Adult Autism Assessment

In recent years, there has been increasing awareness of Adult Autism Assessment. In the past, the definition of Autism was different, and professionals primarily looked for children with very prominent difficulties, while intelligent children with high verbal abilities (what was formerly known as "Asperger's Syndrome") were simply missed. These adults, now defined as being on the Autistic Spectrum with High-Functioning Autism, often suffered from an unexplained feeling of being different and were mistakenly labeled as "shy," "weird," or as suffering from various emotional problems.

Common Signs of Autism in Adulthood

In adults, Autism does not disappear; rather, it takes on a more mature and sophisticated form, often camouflaged by coping mechanisms the person has developed over the years. Prominent signs include:

• Social "Hangover": A feeling of immense exhaustion after social interactions, requiring recovery time in isolation.

• Difficulty deciphering social cues: Difficulty understanding non-verbal language (body language, facial expressions, tone of voice), difficulty understanding sarcasm, or a tendency to state the "truth" in a way that may unintentionally offend others.

• Hyper Sensitivity: Extreme sensitivity to clothing textures, certain types of food, bright lights, or noises.

• Deep need for routine: Significant difficulty, stress, or disproportionate anger when unexpected changes occur in the schedule.

• Intense Special Interests: Obsessive and in-depth engagement in narrow and specific fields of knowledge that serve as a refuge.

• Camouflaging/Masking: An enormous effort to hide difficulties and behave "normatively" in society, which takes a heavy emotional toll.

Why get an Adult Autism Assessment?

Although many autistic people are High-Functioning Autism, an adult assessment has significant advantages:

1. Self-understanding and release from guilt: Receiving a diagnosis provides the person with a new "dictionary" for understanding themselves, releases them from harsh self-criticism, and allows for significant improvement in quality of life and in relationships.

2. Institutional recognition and financial assistance: A formal diagnosis allows for recognition by the National Insurance Institute (Bituach Leumi) and the Ministry of Welfare (Disabilities Administration). This recognition opens doors to a disability allowance (depending on the level of functional impairment) and a rehabilitation basket that includes employment assistance, vocational rehabilitation (funding for studies), supported housing, and community support.

3. Accommodations at work and in frameworks: Receiving Reasonable Accommodations in the workplace, and even the option to volunteer for IDF service for young adults who wish to do so.

4. Personalized treatment: Avoiding misdiagnoses and receiving psychological, psychiatric, or group therapy specifically tailored to the needs of an autistic person.

The Assessment Process in Israel - Ministry of Health Requirements

For the diagnosis to be valid and recognized by state institutions (such as the National Insurance Institute), it must meet the requirements of the Ministry of Health Director-General's circular for Adult Autism Assessment. The main requirement is that the assessment must be performed by two different professionals who will write separate opinions, and both must agree on the diagnosis:

1. An adult psychiatrist or neurologist.

2. A clinical or rehabilitation psychologist (up to age 21, an educational psychologist with Autism training is also acceptable).

The process itself is very comprehensive and includes several mandatory components:

Clinical interview and history taking: Gathering information about early development, medical, mental, and therapeutic history. Efforts should be made to obtain information from an additional source (such as parents or a spouse), even for adults.

Assessment of Autism symptoms: Use of up-to-date screening questionnaires (such as AQ, SRS, SCQ). It is also recommended (but not mandatory) to use observation and interview tools considered the global "gold standard," such as the ADOS-2 test for adults and the ADI-R interview. The diagnosis itself must be based on the current criteria of the DSM or ICD.

Cognitive and Executive Functioning assessment: In cases where cognitive impairment is suspected, an intelligence test (such as WAIS) will be performed. Impairment in Executive Functioning (working memory, planning, cognitive flexibility) will also be assessed using validated questionnaires such as BRIEF-A.

Functional-adaptive assessment: Examination of the person's daily functioning at home, at work, and in society, using structured tools (such as ABAS-II, Vineland-II, or WHO-DAS 2.0).

Differential diagnosis and risk assessment: Ruling out other conditions that could explain the symptoms (such as schizophrenia, depression, social anxiety, Complex PTSD, learning disabilities, or ADHD). Furthermore, attention is required for risk factors such as suicidality, self-harm, or risk of exploitation by others.

Feedback session: At the end of the process, a meeting will be held where the assessment results, their implications, and recommendations for further steps will be explained to the person.

Costs and Challenges on the Path to Assessment

It is important to know that Adult Autism Assessment (for those over 18) is not funded by the state or health funds. The assessment is done privately at a cost that can reach thousands of NIS. Due to the heavy expense, some recommend starting with one of the two assessments (psychologist or psychiatrist), and only if it is positive, proceeding to the second professional.

After the Assessment: Dealing with State Institutions

When applying to the National Insurance Institute, it is very important to understand that the institution does not grant allowances based solely on the "title" of an Autism diagnosis, but rather examines the extent of functional impairment and the difficulty in earning a living. Therefore, during the committees, it is important to be honest and detail all functional difficulties, even if you have developed mechanisms to "compensate" for them or avoid them (for example, using earplugs to survive a bus ride). Sometimes, because there is no specific section for Autism in adults in the National Insurance Institute's disability book, recognition may be granted under other psychiatric or intellectual sections, but the derived rights are maintained.

Frequently Asked Questions