Prosper Health's Autism Resource Center

Many autistic people experience relationship challenges—whether they’re romantic or platonic—in environments shaped around non-autistic social norms. Some unwritten rules and behaviors don’t necessarily come naturally to neurodivergent people. 
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Christal Castagnozzi, a clinical and school psychologist who received a late autism diagnosis, says that while she had friends growing up, there was an “underlying sense of being misunderstood.” She feels she “struggled to access deeper, more meaningful connections,” and ultimately believed she didn’t belong, even when her friends included her in their social activities. 
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Even in romantic relationships, Castagnozzi says she had difficulty “interpreting cues, flirting, [her partner’s] intentions, and emotional subtext.”
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If any of these experiences sound familiar, you are not alone. But more importantly, the challenges of autism and relationships are not a personal failing. They are often due to differences in communication style, sensory processing, social expectations, and mutual misunderstanding between autistic and non-autistic people. Castagnozzi says what made a difference for her was forming relationships with neurodivergent individuals who provided “less pressure to mask and more space for directness and authenticity.”
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In this article, we’ll examine how autism shapes all kinds of relationships, the roots of certain challenges, and practical strategies for effectively navigating relationships. 

As an adult diagnosed first with autism as a child and again as an adult, I have witnessed firsthand the change in the way the DSM, or The Diagnostic and Statistical Manual of Mental Disorders, has changed to affirm autistic people. In 2013, the DSM updated its resources with an eye to supportive care.

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Rather than labeling autistic people with misleading descriptors like high-functioning, low-functioning, or others, experts now categorize autistic individuals based on levels (one, two, or three). These levels indicate varying degrees of support needs, which are often fluid and can change over time.

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Mental health professionals and patients can now navigate autism support without labels, a notable step forward in recognizing the individuality of care. 

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This DSM change also did away with the term pervasive developmental disorder, which encompassed disorders such as Aspergers and child disintegrative disorder. Instead, they were replaced by autism spectrum levels.

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Kaila Hattis, MA, LMFT, founder and therapist of Pacific Coast Therapy, explains, “The change focuses less on what someone has to more on what someone needs, and changes the way families access services and disperse information on what their loved one needs."

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While these three levels of autism don’t capture the full picture of autism spectrum disorder, they’re a move in the right direction to fuller, more nuanced autism treatment.

When I was growing up in the 90s and early 2000s, autism spectrum disorder was heavily stigmatized and misunderstood. Since I did exceptionally well in school, no one in my family even considered I might be autistic. Throughout my life, I struggled a lot with focus, sensory sensitivities and interacting with other people. When I was diagnosed with Ehlers-Danlos Syndrome (EDS)  in 2019, I learned how common it is to have ASD or ADHD with EDS. I was diagnosed with ADHD in 2021, but it still felt like I was missing a piece of the picture.

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Until recently, most adults were not diagnosed with autism in their youth. There are likely several reasons for this, including a variety of issues within the diagnostic process. People of color, nonbinary people, transgender individuals and women have been historically underdiagnosed. This is due to discrimination, stigma or misconceptions. The diagnostic process started to improve in the early 2000s, with new diagnostic criteria that more accurately represents how autism shows up in the world.

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For those of us who weren’t diagnosed earlier in life, though, getting an accurate diagnosis can be hard. Some of us have learned how to mask or camouflage so efficiently that we blend into a neurotypical world really well, making it difficult to find a provider who will take our request for an autism assessment seriously.

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This is one of the many reasons why working with a neurodivergent-affirming clinician is critical when seeking a formal diagnosis. Regardless of the outcome, the diagnostic assessment process can play a helpful role in better understanding yourself. 

When autistic author Denea Marable experiences autistic burnout, she says it feels like she’s underwater. “I tend to move more slowly, I’m prone to sensory overwhelm, and I have challenges speaking. It’s tougher for me to focus when I’m in autism burnout; I feel as if the world is passing me by.”

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Autistic burnout is a state of intense exhaustion and loss of function caused by the stress of ongoing sensory overload, constant masking, and pressure to exist in a neurotypical world without adequate accommodation.

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For healthcare professional Jodes* (they/them), who has autism and ADHD, autistic burnout has a multilayered, almost snowball-like effect on their day-to-day life. “It looks like being in a consistent fog, and the pressure of the fog pushes you down, feeling so tired it's hard to move,” they explain.

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Jodes also says their autistic burnout impacts their ability to complete daily living skills and tasks. Their burnout additionally causes a need for more sleep, increased procrastination, meltdowns, and migraines––as well as verbal shutdowns. 

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But Jodes’ and Marable’s stories just go to show that autistic burnout in adults is quite common, even more so in late-diagnosed adults. 

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If you’re someone who experiences autistic burnout, you deserve to understand why it occurs and its root causes. In this article, we’ll cover what autistic burnout is, why it happens, the early signs to look for, and the supportive steps you can take to recover and protect your well-being.

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Autism spectrum disorder (ASD) is a neurodevelopmental disorder. This means it’s a developmental disability involving an individual's neurological system. It is not a mental disorder or mental illness. ASD affects how people communicate, behave and process sensory information.

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Some people believe that the term "spectrum" means everyone falls somewhere on the spectrum of autism. This is because autistic traits are human traits. Many people do have some features of autism, but this does not mean they have enough features of autism, at a high enough level, to be clinically diagnosed as autistic. In actuality, the term “spectrum” helps to highlight that there are many ways that autism can affect people differently. There’s a wide range of how autism presents in someone’s life. For example, there are some autistic people who need significant support, while others can live more independently. This is why clinicians now categorize autistic individuals based on levels (one, two, or three). These levels indicate varying degrees of support needs, which are often fluid and can change over time.

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The diagnosis “autistic disorder” was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R)––a reference manual for mental health providers—in the late 1980s.

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However, the DSM-5, released in 2013, resulted in a major change in language surrounding autism. Autism spectrum disorder (ASD) is now an overarching diagnosis, encompassing the older diagnoses of Asperger’s syndrome, pervasive developmental disorder-not otherwise specified (PDD-NOS), and autistic disorder.

Increasing awareness and understanding autism

People used to think autism spectrum disorder was rare, but many people are realizing it’s more common than they thought.

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The Cleveland Clinic estimates that 1 in 36 children in the U.S. is autistic, and the CDC estimates that 2.21% of U.S. adults are autistic.

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However, these percentages may actually be higher due to factors like misdiagnosis, underdiagnosis or late diagnoses. These occurrences are particularly common among certain groups, such as girls and women, people of color and those from marginalized communities.

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This doesn’t mean autism is more common now than it used to be. Rather, autism awareness among healthcare providers is higher, especially now that there’s better access to tools and resources for continued learning. The general public knows more about autism, too. These advances help foster better understanding for autistic people as well as their families, friends and communities.

In 2017, the CDC released findings where they estimated that 2.21% of adults in the US were autistic. This data is imperfect. First, it’s from 2017. And, secondly, it’s mostly based on childhood diagnoses of autism. But, it gives us a number to start from, showing that adult autism is not absent from most workplaces.

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Research also shows that people with autism spectrum disorder are more likely to be underemployed or unemployed than their neurotypical peers. That number may be as high as 85%. This can be due to burnout, inaccessibility, or not having appropriate support and accommodations at work.

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Being autistic can make working difficult. Many jobs are incompatible with autism, like working at the customer service desk of a department store. There can be a lot of unpredictability, challenging social interactions, and stress. 

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Plus, stimming and fidgeting may not be easy to do at work. These coping mechanisms might draw negative attention and are sometimes seen as unprofessional. It is vital for us to be able to engage in these activities, because they can quickly and drastically improve our health and well-being.

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But, often, workplaces don’t see the benefits of hiring and working to retain autistic individuals. They don’t know that we’re often more productive than our neurotypical counterparts—or that, many times, a combination of a severe lack of resources and some intolerance lead to us leaving for another position.

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Thankfully, employees can take steps to get our needs met by seeking out reasonable accommodations.