To tell my friend I think she has autism

[Pianostrings]

I have a dilemma with a friend I have known for 12 years. It seems very likely she has autism (I think maybe ADHD too). I appreciate it's complex to diagnose, particularly by a friend (!), but I would be astonished if I wasn't correct. Over the last 2 years, 4 other mutual friends have raised it with me and feel strongly she could be, one of them being a teacher who has taught autistic children.

She seems to have no inkling at all it's a possibility. None. She falls out with people endlessly and doesn't understand the subtleties of relationships. I've seen her be very blunt to people and offend other friends repeatedly over the years. She has sensory issues in terms of what she eats and wears. She is noise sensitive. She talks about not understanding why people would want to wear make up or wear nice clothes. It baffles her. She was relentlessly bullied at school for being different. She gets extremely upset at the idea of upsetting others. In recent group zooms several of us have spotted her rocking through the whole conversation. She can be pretty manic and hyper and then crashes with exhaustion. And I know it's a stereotype but she is a science and maths whizz - she's hugely bright.

She is convinced she falls out with people so much just because the world is full of mean people. I honestly think she would be very shocked and angry at me saying anything. But she has various other physical disabilities and her parents are getting to a point of being too old to care for her (she is 40 but still lives with them). She's already been bullied by doctors and carers over the years and I feel if she is autistic and was diagnosed, she would possibly stand a chance of receiving better care and understanding when it comes to a point that she's more reliant on others. As things stand I genuinely fear for her in terms of her future and it seems wrong not to try to talk to her.

Would I be unreasonable to talk to her? And how on earth do I broach the subject. I'd be very grateful if people with autism have any idea in particular. I know for many, the diagnosis comes as a relief but I can't see my friend reacting like that.

I have no idea how you would broach this with her but good luck.
Tell her to do this quiz and score it.

www.wired.com/2001/12/aqtest/

I think you're coming from a place of kindness. I'm pretty certain I'm on the spectrum myself but I probably would have been horrified if someone had suggested it when I was younger. Any diagnosis would obviously have to be sought by her, so she'd have to be completely on board with the idea.
One way you could do it would be to discuss it in the context that we're all somewhere on the spectrum, and that you've been reading up about it and ask if she's ever read about it.
You'd probably sense straight away if she were open to looking into it and you could see where that discussion leads you. If she's not interested, you'll probably just have to leave it really.

Hello OP. This is a hard one. She certainly sounds from your description like she could be on the spectrum.

I would say leave it, if it wasn't for how you describe her being bullied and how she feels about other people and their interactions with her.

Being diagnosed with both adhd and autism has answered a lot of questions for me and helped me to understand why I was picked on, what behaviours singled me out, all sorts of things. But it has also helped me to begin to learn to be myself and stuff anyone who isn't prepared to accept me as I am.

She may respond well to it being broached with her, she may not. But the aq test would be a starting point.

Almost accidentally I discovered I’m autistic this year. It’s blown my mind a little but a lot of things that have happened in my life now make sense. I’m so glad I found out before lockdown too - being essentially confined to a house with two young kids all day while also trying to work has driven me mad, but at least I now know what I specifically find difficult (noise, interruption, lack of personal space) and I’ve been able to help myself when it all gets a bit much by putting on headphones and finding some space to myself.

I’ve done loads of reading this year and have found that really helpful as I can totally relate to experiences. Women in particular are often not diagnosed with high functioning autism as apparently they are much better than men at copying others when it comes to social interaction.

I’m sure knowing would help your friend out, even if it is self diagnosed and could give her some coping strategies. I’m not sure entirely how you could raise this with her but perhaps buying her a book and sitting down with her and saying that you have noticed some indications that she might be on the spectrum and then suggesting she read the book might be a good idea. Sarah Hendrickx - Women and girls with autism spectrum disorder was the first book I read and I found it really quite revealing.

@MakeItRain

I think you're coming from a place of kindness. I'm pretty certain I'm on the spectrum myself but I probably would have been horrified if someone had suggested it when I was younger. Any diagnosis would obviously have to be sought by her, so she'd have to be completely on board with the idea. One way you could do it would be to discuss it in the context that we're all somewhere on the spectrum, and that you've been reading up about it and ask if she's ever read about it. You'd probably sense straight away if she were open to looking into it and you could see where that discussion leads you. If she's not interested, you'll probably just have to leave it really.

I hope you don't mind me picking up on a point in your post. It's a misconception that we're all on the autistic spectrum.

Who knows how she’ll react. I tried telling my half-sister that perhaps she has ADHD after I got diagnosed but she wasn’t interested.

Her life is a mess even though she’s a good person and tries so hard but everything always goes wrong for her.

@PotatoScones.. I was just thinking of a way into the discussion that might make it less likely she would get defensive. But on reflection, maybe it wouldn't be the best way in, because you're right, lots of people don't show traits.
I just did that quiz and scored 39 so I obviously do though!

I'm autistic and was diagnosed at 40. Also possible that I have ADHD but never assessed for that.

I am very self aware so I self diagnosed but I also know people who it took completely by surprise.

Having a questionnaire to do is much more objective than you as an unqualified friend diagnosing her. It would be different if you were a professional working with autistic people and could be more certain based on your professional judgement. The assessment process is in depth involving interviews and assessment questionnaires. Leading and guiding her towards finding out for herself might be a better approach than telling her what you think which she could quite justifiably reject as well meaning but nonsense!

Most autistic people prefer to say autistic rather than person with or having autism. And no, we are not all on the spectrum. Only those who are autistic and meet the threshold are autistic. It's not a linear spectrum.

Perhaps you could 'wonder' about things with her.
' I wonder if there's a reason you're so very sensitive to noise'
'I wonder whether there's something particular that means you like very specific foods',
'it's unusual to get so upset someone else gets upset. I wonder why that happens'.

After a few 'wonders' she may be more interested in looking for an underlying cause.

Also the opposite way round.
'I just read people with autism find noise really irritating'.
'I did this test to see if I have autistic traits- I was surprised that I don't score at all, I thought I would. I wonder how accurate the tests are?'
Do you meet many people with autism, in your field (if she works somewhere)?

How do you get diagnosed??

Someone has to refer you to whatever the adult assessment pathway is in your area. This would usually be a GP or a psychiatrist. And the assessor would be either a part of the mental health system or a specialist autism service.

To get on their waiting list you'd have to complete various screening questionnaires and meet their assessment threshold.

The assessment can be in two parts of up to three hours each but might only need one of those. They use a mixture of observations and asking structured questions to come to a conclusion. If possible they will also ask family members.

"One way you could do it would be to discuss it in the context that we're all somewhere on the spectrum, and that you've been reading up about it and ask if she's ever read about it."

I really hate this utter crap. It's not true at all and I've heard it so many times. If you are autistic, you are thought of as ND so somewhere on the autistic spectrum. If you are NT then you are nowhere on the ^autistic' spectrum.

It's a tricky one OP. I was diagnosed in my 30s and found it a huge relief and I finally had an explanation for my difficulties. I had friends describe me as weird which was very unhelpful and I hated this label. It was being thought of as 'weird' that made me first question it then go looking for possible answers. Personally I would have welcomed a good friend gently suggesting that I show a lot of the traits and have I considered it as a possibility, then pointing me in the direction of the AQ test.

You risk upsetting your friend but if she genuinely needs support then I would just bite the bullet and suggest it and let her know it comes from a place of concern for her difficulties.

OP this is so hard.

My dad, I am 99% sure, has ASD. He is almost like a textbook example: he is highly intelligent, very qualified in a specific technical field, has special interests that he will talk about for half an hour or more at a time, very sensitive but limited ability to understand how others might feel differently, sensory issues, noise averse, special routines, zero interesf in his environment outside his computer (and on and on).

He has been told by his family dr and a psychiatrist that they think he is autistic, family members have raised it, and multiple family members have diagnoses.

But he refuses to countenance it. It has basically ruled his life, but he can't "see" it, as everyone else is always the issue, not him.

It is really sad because his life might have been different with a dx and support. But although you can suggest, you can't push, and you need to be prepared for an angry reaction.

I realised I was autistic when I was 19 (many years before I was diagnosed). I think if someone had suggested it to me before that, I would have avidly read about it and come to the conclusion they were right.

So maybe just send her an article about autistic women and say you thought it would interest her, so there's no pressure in the sense of feeling defensive and her rejecting the idea.

Tell her. But do it directly so you can be there with her not over the phone.

Personally if I was going to bring this up with a friend, I would say that I wondered whether she might have ADHD (which you have mentioned) and that it might be a good idea to ask her GP for a referral to a Psychiatrist for an assessment of this. That way if she does have autism then this will be picked up at the assessment.

Autism can be such a negative label that I'm not sure if I would bring that up!

Thank you so much for all the insight. I had a really busy day and got sidetracked.

The questionnaire is a good idea except I am pretty sure she'd refuse to do one on the basis she thinks online quizes are meaningless. And I looked at one a few months ago and felt she would likely not get a high score which flagged anything up for her as it was so subjective. She honestly thinks she's very good at reading people despite a lot of evidence to the contrary, as an example. I just don't think it's ever occurred to her she's different in any way (and to be clear I think the world needs a variety of people in it. Different doesn't mean bad)

I do genuinely worry about what will happen when her parents aren't around anymore because she will struggle so severely. But there is only so much I can do. I am going to spend some more time thinking this all through. I don't want to upset her but I wonder even if she was furious with me and never spoke to me again if it wouldn't be best if it did sink in that she isn't NT and needs some more support. This is someone who takes stuffed toys to bed and at least ten away with her to hotels if she ever spends a night away and she can't even visit her gp without her mum being in the room because she's too scared . She has never properly managed to live independently.

Interesting. We discovered / recognised through marriage counselling that my husband is HFA. And it wouldn't surprise either of us if I was too. Things are easier now that we each recognise our differences and areas where we struggle. Life is so much calmer as a result. It did take a long time for us to accept though, as neither of us understood that you didn't need the full compliment of quirks to qualify! If anyone is to broach it with her then I think your friend who works with autistic children would be best placed - perhaps just to talk about the children and leave your other friend to work out the similarities and ask questions if she wants to. I imagine she'd have more respect for someone with a qualification / experience in this area (no disrespect to you of course). Autistic people can be highly sensitive to perceived criticism too. It's worth remembering that her behaviour is normal to her though and probably also reinforced by her family members. Difficult one, good luck!

This is brilliant to listen to (for anyone), 1800 seconds on autism. www.bbc.co.uk/programmes/p06sdq0x

One other thought is that my natural instinct is to read as much as I can about a subject when I find it interesting or it’s relevant to me. When someone first mentioned I might be autistic I spent ages reading up on high functioning autism online which was rather enlightening. Even floating the subject to her gently might result in her reading up on the subject and recognising some tell tale signs.

It’s going to be difficult to broach the subject, but from my experience working with children on the autism spectrum, she definitely sounds like a possibility.
Do you have her on social media? Perhaps you could share a few videos from women with autism to your page - not tagging her in them specifically, but their presence may plant a seed.