Maybe conversation has always felt like hard work that everyone else finds easy. Maybe a child’s diagnosis made you recognise yourself. Many autistic adults were never diagnosed as children. This guide covers the signs, and how to get assessed in Nigeria.
Autism in adults is a lifelong difference in social communication, routines, interests and senses that started in childhood but was never recognised. Many autistic adults have learned to hide it. Only a trained clinician can diagnose autism; online tests can’t. In Nigeria, start with an adult psychiatrist or clinical psychologist.
What autism is
Autism is a lifelong difference in how a person develops. It has two core parts:
- lasting differences in social communication and interaction
- repetitive patterns of behaviour, routines or interests, including sensory differences
It starts in childhood, but it may not become obvious until life’s demands outgrow what someone can manage. Many people also learn ways to cover it. The WHO’s classification, ICD-11, says the diagnosis still applies when someone copes only through exceptional effort.
The World Health Organization estimates that about 1 in 127 people were autistic in 2021, and says autism is often diagnosed much later than it could be. One English study estimated that most autistic people in England, between 59% and 72%, were undiagnosed in 2018. Autism in adults isn’t new or rising: in England’s adult surveys, about 1 in 100 adults were autistic, and the figure didn’t differ by age.
Signs in adults
You may:
- find conversation tiring, or struggle with the back and forth, facial expressions, gestures or tone of voice
- take things literally, or be told you seem rude or blunt without meaning to
- find it hard to make or keep friends or romantic relationships, or prefer time alone
- rely on routines and get very upset when plans change
- have intense, long-lasting interests
- be very sensitive, or not sensitive at all, to noise, light, smells, textures, heat, cold or pain
- feel exhausted after socialising, or have learned “rules” and scripts for conversation
- be good at detail, memory or focus on what interests you
Many adults first seek help for anxiety or depression. Often it’s another condition that brings someone to a clinic, and autism is noticed later.
One sign on its own doesn’t mean autism. Shyness and social anxiety can look similar, but they don’t involve lifelong differences in communication plus repetitive patterns. Culture matters too: in many Nigerian settings, not holding eye contact with elders is respect, not a sign of autism.
Why it gets missed
- Masking. Many autistic adults copy others, hide their traits and rehearse conversations. It works for a while, but it’s exhausting, and it’s linked with “autistic burnout”: months of exhaustion, lost skills and less tolerance for noise and crowds.
- Other diagnoses come first. In one Italian study of adults diagnosed late, two-thirds had earlier psychiatric diagnoses, and there was typically a gap of 11 years between first contact with mental health services and the autism diagnosis.
- Services focus on children. A review of autism research across sub-Saharan Africa found no studies on adults at all.
Online tests can’t diagnose autism
Questionnaires measure traits; they don’t diagnose. The UK’s NICE guideline suggests a 10-question screen, the AQ-10, only to decide who to refer for a full assessment, and a clinician can refer you whatever your score.
Even that has limits. In one UK referral clinic, questionnaire scores didn’t predict who was diagnosed, and 64% of people who scored below the cut-off turned out to be autistic. Anxiety can push scores up. These tools were developed mainly in Western countries, and we found no study testing them in Nigerian adults.
Suggested read: Shift Work and Your Mind
So if an online test suggests autism, treat it as a reason to talk to a professional. If it says no but you still recognise yourself, the same applies.
What an assessment involves
Adult assessment is done by trained clinicians, ideally a team that includes a psychiatrist or clinical psychologist. It usually covers:
- Your history since childhood, ideally from a parent or someone who knew you as a child, or from old school reports.
- Your life now, at home, at work and with other people.
- Direct observation, often with a structured session lasting about an hour.
- Sometimes a structured interview with a parent, which can take up to two and a half hours.
- Checks for other conditions, such as anxiety, depression and ADHD, which often come with autism.
No blood test or brain scan can diagnose autism. If your parents aren’t alive or available, assessment is harder but still possible: a sibling, an aunt, old reports or your own detailed account can help. It may take more than one appointment, followed by feedback and a written report. You can ask for a second opinion if you disagree.
Getting assessed in Nigeria
Here’s the honest picture. When we checked public hospital websites, the autism assessments they described were for under-18s, such as the child and adolescent services at the Federal Neuro-Psychiatric Hospitals in Yaba and Kaduna. None of the sites we could read said it assesses adults. The federal government has announced six regional autism centres from 2027, but they’re planned around children.
That doesn’t mean adults can’t be assessed. To start:
- Contact an adult psychiatry clinic at a federal neuropsychiatric or teaching hospital, or a clinical psychologist. Our guides to psychiatric hospitals in Lagos and in Abuja list public options.
- Ask directly whether they assess adults for autism, who does it, how many sessions it takes and what it costs.
- Prepare: write down examples from childhood to now, collect any school reports, note sensory issues and past mental health diagnoses, and ask a parent or older sibling to come or to write down what they remember.
Some adults go to private clinicians or get assessed abroad.
After a diagnosis, or while you wait
Adults diagnosed late often describe relief and finally understanding themselves. Some also grieve the years without an explanation, and many find little support afterwards. Others identify as autistic without a formal diagnosis, which many people find meaningful, though it won’t open doors that require one.
What helps, according to NICE:
- Social skills groups or coaching, in a group or one to one.
- Support with work: help with applications and interviews, careful job matching, and advice to employers.
- Therapy for anxiety or depression, adapted for autistic people: more structured, with written material and plain language.
- Practical adjustments, like the ones below.
No medicine treats autism itself, though a doctor may prescribe for a co-occurring condition such as depression. Special diets, supplements, chelation and hyperbaric oxygen aren’t treatments for autism, and some are harmful.
At work
Changes that often help, from UK guidance: a quieter workspace or headphones, instructions broken into written steps, interview questions in advance, regular check-ins, and early warning of changes. Nigeria’s 2018 disability law bans discrimination on the ground of disability and gives an equal right to work. It doesn’t name autism and hasn’t been tested on it, but the national disability commission’s portal lists autism as a type of disability.
Suggested read: Corporate Mental Health Programmes in Nigeria: Why They Matter
Looking after your mental health
Anxiety and depression are common among autistic adults: in a review of studies, about 1 in 4 currently had an anxiety disorder, and about 1 in 4 had depression. Suicide risk is also higher, roughly three times the general rate. Both are treatable, and help works best early.
If you’re thinking about ending your life, call 112, or 767 in Lagos. To talk to someone at any hour, Safe Place Nigeria is on 0800 800 2000. It’s toll-free and answered 24 hours a day.
Getting help
Online sessions can’t replace a full assessment, but a therapist can help with anxiety, burnout, relationships and making sense of your experiences before or after one. You can find a therapist who works with neurodevelopmental conditions by video, voice or chat.
Read more about autism in Nigeria, a first-hand account of working life with autism and ADHD in adults, or see our pages on neurodevelopmental conditions and autism spectrum disorder.
Frequently asked questions
Can you be diagnosed with autism as an adult?
Yes. Autism starts in childhood, but many people are diagnosed as adults, often after years of masking or of treatment for anxiety or depression. Assessment looks at your whole life.
What are the signs of autism in adults?
Lasting differences in social communication, such as finding conversation tiring or hard to read; reliance on routine; intense interests; and sensory sensitivities, all going back to childhood. One sign alone isn’t enough.
Can an online test tell me if I’m autistic?
No. Questionnaires like the AQ-10 can suggest whether to seek an assessment, but they miss many autistic adults and anxiety can push scores up. Only a trained clinician can diagnose autism.
Where can adults get an autism assessment in Nigeria?
Options are limited. Start with an adult psychiatry clinic or a clinical psychologist and ask whether they assess adults for autism. The public services that describe autism assessment online are mostly for children.
Is there medication for autism?
No medicine treats autism itself. A doctor may prescribe for a co-occurring condition, such as depression or anxiety.
This article is awaiting clinical review. It’s based on published research and health guidelines, and we’ll update it once a clinician has reviewed it.
Suggested read: How to Deal With a Stressful Work Environment.
