Suspected feigning of autism in adults: a clinician survey, indications and proposed guidelines

Abstract

Purpose This paper aims to provide a discussion and summary of a clinician survey exploring the experiences of suspected feigned autism. Design/methodology/approach This study is an online survey targeting a range of autism professionals, with varying levels of experience, working in different clinical settings. Findings Approximately half of the professionals who completed the survey reported experiencing situations of suspected feigning of adult autism across a range of clinical contexts and with various motivations. In terms of best indications of potential feigning, most clinicians reported “textbook” self-descriptions of problem behaviours with vague examples, as well as inconsistent presenting problems and mismatch with any known developmental history. Approximately half of clinicians expressed the view that autism was more difficult to feign than a psychiatric disorder and had experienced situations involving differences in professional opinion as to an individual autism diagnosis. Research limitations/implications The survey is limited by a potential sample bias and no information regarding the clinical characteristics of those suspected to have feigned autism. However, these initial findings offer further questions for future research to pursue. Originality/value As an initial examination of practicing clinicians’ experiences of suspected feigned autism, the survey highlights the complexities of an autism diagnosis and suggests feigning is a potential clinical scenario. Some guidance as to when to suspect possible feigned autism is also offered, as well as a provisional assessment protocol.

Trauma or autism? – understanding how the effects of trauma and disrupted attachment can be mistaken for autism

“…, 2016). Further adding to this dilemma is the fact that autism can be subtle and masked (Pearson and Rose, 2021) and significant diversity exists among individuals with autism in terms of their presenting features (Murphy and Broyd, 2023) thus, further creating a challenge for its diagnostic exclusion. Other traumagenic developmental features may be equally broad and subtle and can be difficult to distinguish with certainty.…”

“…Whilst in many cases, this can make for an easier diagnostic interview and offer a longer and more longitudinal history with a wider range of tests of autistic functioning to draw diagnostic inferences from, in other cases, the assessment may be impacted by far more diagnostic "red herrings" (Havdahl et al, 2016). Further adding to this dilemma is the fact that autism can be subtle and masked (Pearson and Rose, 2021) and significant diversity exists among individuals with autism in terms of their presenting features (Murphy and Broyd, 2023) thus, further creating a challenge for its diagnostic exclusion. Other traumagenic developmental features may be equally broad and subtle and can be difficult to distinguish with certainty.…”

“…As a result, many patients may think that their experience may match autism descriptions and use autism language to describe their history to clinicians, filtering their past non-autistic experiences through an autism lens as a means of adaptative coping and in an attempt to process their adversarial circumstances (Murphy and Broyd, 2023) and derive positive meaning from them. In turn, clinicians may also find it harder to distinguish such descriptions from traumatic sequelae.…”