This is a time of transition which is challenging. It can bring a lot of ups and downs emotionally. As you learn how to handle things for yourself it’s natural to make some mistakes and to need help.

Handling increasing daily demands, such as sensory and social communication issues, brings stress that impacts mental health as well as physical health. Finding ways to manage that stress and feelings like anxiety and depression are vital for you to feel your best physically and mentally.

Your brain is still developing until you're 25 years old, which impacts your behavior, emotions and executive functioning. Many autistic young adults have challenges with what are called executive function skills. Executive functioning refers to a set of brain functions for managing your daily living including working memory, organizational skills, flexible thinking and self control.

This is why young adults are more likely to get in traffic accidents, act impulsively, engage in risky behavior, and have frequent mood shifts. Learning to understand and handle your emotions will help you enjoy life and deal with the natural stresses of life that can feel more intense during this stage.

To learn more about executive functioning, visit the Education section of the Milestones Autism Planning (MAP) Tool. To learn more about brain development in teens and young adults, check out The Evolutionary Advantage of the Teenage Brain from the University of California.

Expressing Your Feelings

It’s important to learn how to express how you feel. Sometimes you may not be sure what is causing you to feel frustrated, upset or angry because it can be complicated or confusing. A therapist or a trusted family member may be able to help you sort out your feelings.

It can be confusing thinking through the different kinds of love and relationships you may have. The level of caring in relationships can vary so much, such as friendships, when you admire someone, or if you are in love with someone. Do you love and care about someone as a friend, or feel lust or attraction to them?

Journaling or artwork to express your emotions can help you cope with stress. Think about ways like these that you enjoy and can serve as an outlet.

Asking for Help

It is important for you to learn how to ask for help when something is difficult. It is OK to say no to something that you do not want to do or that is uncomfortable for you. You do not always need to say yes. It is OK to say “No” politely but firmly and can be important to keep people from taking advantage of you.

Asking for What You Need

You also have a right to ask for what you need.

You have a right to privacy. You can say, “I need my privacy” for example in your bedroom and in the bathroom.

If you are trying to do something and someone steps in to try to “fix it” for you or show you what to do when you don’t want them to, it’s ok to say something tactfully. For example, “Thank you, but I am figuring out how to do it myself and feel good about my idea. I will ask you if I need help.” If you decide you do want help after trying to do it yourself and struggling too much, it’s okay to change your mind and ask for help.

Working with Your Therapist or Counselor

Discuss with your therapist or counselor your needs including privacy and ask how they usually handle these issues. If your parent or guardian is involved in your therapy, define the boundaries and expectations of you, your parent and the therapist for sessions. Your therapist sets those boundaries and you as the client who is 18 or older decides. Understand the limits of confidentiality for what is discussed in therapy in your state.

It’s important for you to gradually develop independence and practice the skills you need. For example, make your own counseling appointments and take your own medications. Though you may still need help selecting your own providers, start learning what kind of provider you like and express whether you like your provider.

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Advice for Parents

By this time it should not just be you talking to your loved one about issues. Your loved one should be discussing these feelings with other trusted people. Your mental health team may include a counselor, therapist, other close relatives or your clergy.

You need to understand that if you are not your loved one’s guardian (unless you have established legal guardianship), they are in charge of their own decisions. You can be by their side and help them if they sign a consent form with providers. It can also be helpful for your loved one to have a power of attorney and healthcare power of attorney. The Law and Finance article in the Milestones Autism Planning (MAP) Tool provides more information. It’s important to know that conversations between your loved one and their providers are confidential.

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Dealing with Loss or Change

Big changes or loss can have a huge impact and be hard for you to express and deal with. Grief and change are difficult and can be traumatic for everyone. Having family, friends or a therapist you trust can help.

Handling Mistakes

Everyone makes mistakes. It can be frustrating but we all learn best from the mistakes we make. Think about what happened and what you could do differently next time.

Discuss it with someone you trust who you are close to. Sometimes you may just want them to listen and be supportive. Other times you may want to ask their advice to help you deal with your current situation or to think about what you might do if you have a similar situation in the future.

You might find it helpful to discuss it with a trusted therapist, guidance counselor or clergy. The Milestones free autism Helpdesk is here to support you and the Resource Center lists Northeast Ohio support groups and professionals you may find useful.

Friendships and Social Challenges

Friendships bring companionship and fun but also hurt feelings. A special social skill challenge is understanding the nuances and steps in friendship or romantic relationships. This includes levels of friendship from an acquaintance like a student or co-worker who says hi to you to a real friend who wants to hang out with you or text with you. Or being romantically interested in someone, or someone being interested in you.

It’s hard dealing with a friendship ending or someone being mad. It can be challenging understanding the other person’s perspective and how they are feeling.

You may find a social skills group helpful or seeing a therapist who works with autistic people. For example they might be able to coach you on picking up on cues such as facial expressions, language (jokes or puns or comments that are subtle) or body language.

It is common for autistic people to “mask” their autistic traits to fit into the neurotypical world at either work or school. While it is important to get along with people and be part of your work or school environment, masking can cause some stress. It’s important after work or school to find ways to release stress in safe ways that are comfortable for you.

A Word about LGBTQ+

Some young adults may question their sexuality or gender preference including which bathroom you want to use. You may be exploring what pronouns you want to use.

There is a higher percentage of people in the autism community who identify as LGBTQ+. You can get support and learn more about it from your therapist, social worker or local LGBTQ+ center. You also may find a support group helpful. Organizations like Milestones can help you find someone in your community to support you.

More information is available in the social skills/communication and friendship articles in the MAP Tool. We will be adding articles about sexuality, dating and relationships to the MAP Tool later in 2022.

Bullying

We know bullying is an incredibly difficult challenge to go through. While we think of bullying as happening to kids, sadly it happens with adults, too. Bullying takes many different forms.

• Not being invited to a party that your fellow students or co-workers were.
• Someone making you feel uncomfortable focusing on a behavior they may not understand is part of your being autistic.
• Someone making fun of you on social media or as minor as a negative emoji on your Instagram post.

You are not alone. Get professional help from a counselor, therapist or clergy who you feel comfortable with.

Just as we don’t want to be bullied we need to watch that we not be the one bullying others.

Additional Resources on Bullying

An Autism Perspective on Bullying: Creating a Culture of Acceptance

Know When to Be Assessed for Co-existing Conditions

Autistic people can have mental health illnesses as well, such as depression and anxiety, and at a higher rate than the general population. How depression or anxiety is expressed in autistic people may be different than neurotypical adults. For example, depression or anxiety in neurotypical individuals is often expressed by social isolation and a decrease in communication with other people. Since these are already struggles for autistic people those typical symptoms may not be as noticeable. It’s important to get help from a counselor or therapist with experience treating autistic people.

The Difference Between Life Stress and the Need for Outside Help or Diagnosis

It’s important to weigh the difference between common challenges and ones that need outside medical or therapeutic help. Manageable behaviors as opposed to signs that you may have a mental health condition like anxiety, depression or self-injuring behavior that should be assessed by a professional.

There are various conditions like these that can be common in autistic people or their families and it’s vital to get professional help and support. They are often treated with therapy and/or medication.

While some people may hesitate to go to a therapist, sometimes you need a neutral, objective person to talk to who understands your situation. When you have a medical challenge like diabetes, you see a doctor and may take medications like insulin. Your brain is a vital organ that needs support, too. Seeing a therapist is a way to get that support to help you through.

Bear in mind that many mental health conditions have biological causes like chemical imbalances in the body that can be helped with medications and therapy. An outline of different co-existing mental health conditions is in the Physical and Mental Co-existing Conditions page.

The Milestones Helpdesk can connect you with resources. The service options and recommendations may also change at different ages and stages of your life.

The Milestones Mental Health Tool Kit provides an overview of mental health services available for autistifc individuals as well as professional roles and forms of therapy. The Mental Health page also offers information and tips.

Getting Help If You Experience Self Harming or Suicidal Thoughts

We know these are very difficult topics, but it is vital to get help if you are hurting yourself through self-harming behaviors such as cutting (repeatedly, purposely making cuts or marks on yourself) or are having suicidal thoughts. Find a professional such as a therapist with experience treating autistic people.

Self harming is a sign you are feeling emotional stress and pain that you’re having a hard time expressing or handling in other ways. You may be feeling anger, frustration and sadness.

You may be dealing with sensory issues, meaning you may experience touch, sound, light/seeing, smell or taste in a more intense or much lower degree.

Call the National Suicide Hotline at 800-273-8255 or visit them online at Lifeline (suicidepreventionlifeline.org). We know it can be stressful to make a phone call, so know you can text with them.

If you have a mental health provider you can ask for a crisis appointment, but if they do not have one immediately available, find out if your community has a mobile crisis center. You can also go to the Emergency Room at your hospital.

If you feel you have depression or anxiety it is important to seek help from a trained counselor or therapist. While not all suicide attempts are intent to die, you can end up in a life threatening situation without meaning to.

Trauma-Informed Care

Trauma-informed care is an approach that is very helpful for autistic people. The idea of trauma-informed therapy is that painful things happen to people and when that trauma happens it impacts the brain and sensory system. Many people have experienced some type of trauma. This type of therapy is based on how the brain processes trauma, especially important for autistic people who usually have sensory challenges.

Ask for a Trauma-Informed Counselor and ask any potential therapist if they have this type of training and that they specialize in autistic patients. They know how to help you share your story and pain and handle it using what is meaningful to you.

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Advice for Family Members

If your loved one expresses wanting to hurt themself or attempt suicide, don’t be dismissive or assume it’s not serious. Don’t be afraid to ask questions. You’re not going to give them ideas. If they express having a plan or specific ideas for how they might hurt themselves that is an urgent call for help. Call the National Suicide Hotline at 800-273-8255 or visit them online at Lifeline (suicidepreventionlifeline.org).

Make a safety plan right away, especially if there are guns or knives in the house, making sure they are properly locked and stored away, locking up medications, household cleaners, etc.

While not all suicide attempts are intent to die, they can end up in a life threatening situation without meaning to.

Additional Resources

Department of Developmental Disabilities (DODD) Trauma Informed Care Guide

FrontLine 24/7 Crisis Hotline - 216.623.6888

National Suicide Prevention Line - 1-800-273-8255

Crisis Text Line - Text HOME to 741741 to connect with a Crisis Counselor

Ohio Addiction Hotline - 888-796-5986