What Are the Common Misdiagnoses of Autism Spectrum Disorder?

Autism spectrum disorder (ASD) is a complex and dynamic disorder. While some behaviors define the core of ASD, in real life, these behaviors and symptoms are displayed differently based on factors such as gender, ethnicity, and culture. Additionally, the degree to which these behaviors interfere with a person’s functioning also shifts from person to person and from context to context. This means that ASD can be difficult to diagnose.

Comorbidity and Autism

Diagnosing ASD can be complicated because individuals who have ASD frequently also have one or more other mental or physical health disorders. When an individual has multiple disorders, this is known as comorbidity. Comorbidity can make diagnosis more challenging because there is now a broader range of symptoms a mental health professional must consider.

The Diagnostics Statistics Manual 5th Edition, the most commonly used tool in the United States to diagnose mental illness, estimates that 70% of individuals with ASD will have another mental disorder, and 40% will have two or more. One study focusing on children between the ages of four and eight found that 95% of the children in their study had at least one co-occurring condition or symptom.

Similar Disorders

Accurately diagnosing ASD can be complicated because many other disorders share similar criteria. For example, all mental health disorders have a set of criteria that define them. These criteria include symptoms, behaviors, and experiences. Therefore, the individual should display all or most of the criteria to receive a diagnosis of any disorder.

Sometimes, though, it isn’t easy to see the whole picture. This may be because the clinician is only allowed to see the individual in a specific setting or because the individual’s struggle with one behavior overshadows the existence of another behavior. When the entire picture is not visible, an individual can end up with a misdiagnosis.

These disorders all have one or more symptoms that are similar to ASD:

• Antisocial personality disorder: Individuals with ASD often have difficulty connecting with or relating to others, a core feature of antisocial personality disorder.
• Borderline personality disorder:  Individuals with borderline personality disorder (BPD) have difficulty regulating emotions and may have emotional outbursts, which can also be found in ASD.
• Avoidant personality disorder: Individuals with this disorder avoid social interaction and social situations, a common symptom of ASD.
• Language-based learning disabilities: A core feature of ASD is difficulties with communication, which can easily be mistaken for a learning disorder.
• Selective mutism: Some individuals with ASD may be non-verbal, leading to a diagnosis of selective mutism.
• Sensory processing disorders: Individuals with ASD often experience sensory abnormalities, being over-sensitive or under-sensitive to certain sensations.
• Eating disorders: Individuals with ASD can be very picky eaters and may refuse to eat certain foods.
• Social anxiety disorder: A core feature of ASD and social anxiety disorder is difficulty participating in social situations.
• Generalized anxiety disorder: Individuals with ASD often experience anxiety in various situations.
• Obsessive-compulsive disorder: The compulsive behaviors seen in obsessive-compulsive disorder can look very similar to the repetitive motions and rigid behaviors that are a core component of ASD.
• Schizophrenia and other psychotic disorders: ASD and schizophrenia share symptoms such as struggles with social communication skills, unique ways of thinking, and odd behaviors.
• Depression: Individuals with ASD can appear withdrawn or display less emotion, both symptoms of depression.
• Attention-deficit/hyperactivity disorder: ASD and attention-deficit/hyperactivity disorder (ADHD) are defined by difficulties with social functioning and executive functioning, making it difficult to differentiate between the two at times.

The Difficulty of Diagnosis

Given the likelihood that individuals with ASD will have multiple disorders and the overlapping nature of symptoms and criteria, individuals with ASD will often be diagnosed with other disorders long before they are diagnosed with ASD.

A recent study examined the history of diagnoses of adults who had ASD. Researchers found that of their 161 participants, 59 people had received one diagnosis other than ASD, and 40 had received two or three diagnoses other than ASD. It was also noted that one woman in the study had received six different diagnoses, and one man had received eight different diagnoses.

Comorbidity vs. Misdiagnosis

In some of the cases, the multiple diagnoses were accurate. For example, the individuals had ASD and had one or more other disorders.

In other cases, diagnosing a disorder other than ASD was simply inaccurate. For example, 35 individuals in the study were diagnosed with an intellectual disability. However, researchers found nine individuals had IQs within the normal range and should likely not have been given this diagnosis.

Getting a Correct Diagnosis

The reality of comorbidity and misdiagnosis can be daunting for individuals with ASD. An accurate diagnosis helps individuals better understand themselves and allows for appropriate treatment options and plans. Conversely, a misdiagnosis or a missed diagnosis can cause frustration, misunderstanding, and increased struggles for individuals with ASD.

Autism spectrum disorder (ASD) is a complex and dynamic disorder that can be difficult to diagnose. Many other mental health disorders share similar symptoms. Also, many individuals with ASD will have another disorder besides ASD. This reality means that if you have ASD, it is quite possible that at some point, you may be misdiagnosed or may even go undiagnosed well into adulthood. While greater understanding and changes in the nature of the ASD diagnosis have helped, it is still vital that you seek an expert on ASD to receive an accurate diagnosis. If you think you may have ASD or are simply searching for an accurate diagnosis, Alter Wellness Care can help. We specialize in ASD diagnosis and treatment. Call us today at (866) 311-3510 to help you find the information and treatment you need to succeed on your mental health journey.