The hidden faces of autism and misdiagnosis in the lifespan: Clinical observations in adults with Autism Spectrum Disorders

Autism Spectrum Disorder (ASD) includes early-onset developmental disorders characterized by symptoms ranging from impaired social communication skills, stereotyped behaviors, impairment in social interactions, to poor language development. Although the autistic condition is stable across the life span, a substantial number of adult ASD patients may be undiagnosed or misdiagnosed as having other mental disorders. Twenty-three ASD adult patients underwent clinical examination and were assessed by the following psychodiagnostic instruments: the RAADS-R, the Y-BOCS, and the Rorschach inkblot test. The mean RAADS total score was higher than cut-off threshold (126 +/- 43; cutoff = 65). Y-BOCS total scores were moderately high (21 +/- 9; cutoff = 7). Rorschach protocols were characterized by a mean productivity (number of responses: 23 +/- 12), a concrete intelligence with traits of meticulousness (D = 39%, Dd = 8%), inaccurate formal perception with falls of representation (F- > F+), poor attention to human contents, and perseveration and devitalization as particular phenomena. Adult ASD patients are characterized by peculiar psychopathological features that can be effectively investigated with the use of both psychometric and projective methods. An accurate investigation of behavioral and clinical features and personality traits, should integrate the diagnostic pathway of those adult subjects often presenting with comorbid psychiatric disorders and symptoms heterogeneity.