**6. Anders — A young adult diagnosed with autism spectrum disorder**

Anders, 26 years old, was referred to psychiatry for depression after having tried sixteen different training jobs without success. He was living alone in his own apartment, which his mother helped him to clean every week. He had a friend, but kept in touch by e-mail and had not met the friend for 4 years. He had never had a girlfriend, and, when asked, said "I don't want a girlfriend-it would be too time-consuming since I would have to be with her in my leisure time". He had no idea why the jobs he had tried had been failures, but he remembered one of them going well for several months, whereafter he was asked to leave. He described that in the job that went well, he had a written detailed description of his assignments which he had followed precisely. However, after three months his supervisor took away the instruc‐ tion, assuming that Anders now knew what he was supposed to do. But since there was no description any more, Anders did nothing. His supervisors in this and other jobs were contacted, and they described why Anders had been asked to leave. In the workplaces he had behaved oddly in many ways – not greeting his colleagues, taking the biggest pieces of cake first in the coffee room but without socializing, intruding on others' workspace and many other things. Consistently were described misunderstandings and misinterpretations – Anders had a tendency to interpret literally and to say things that were considered rude or offensive.

Anders and his parents described that he had been quite clumsy as a small child, but the parents did not worry since he started walking at 15 months of age. He was quite late to speak, but soon developed a large vocabulary that impressed the parents. He preferred to play by himself or with his 3 years younger sister, and had no special friends at school. He disliked surprises, and became upset when routines were changed, and the family had adapted to this by e. g. never going on trips overnight until Anders was 15. The teachers had expressed some worry since Anders was always by himself, but since he did not seem unhappy, and since the father thought of himself as a "happy loner", nothing was done. Anders got fairly good grades, especially in science subjects but had relatively more difficulties in subjects where more of a social or coherent understanding was required. He was never bullied, and he liked going to school. However, after finishing high school he did not know what to do. His most intense interest was in bird-watching, especially night-active birds and he had collected large amounts of facts and observations concerning these birds.

The jobs that Anders was assigned were mostly low-skilled work in offices, food shops or stockrooms. The assignments were below his intellectual skills, but he failed since he did not have any intuitive understanding of the aims, or the bigger picture of the workplace, in addition to irritating his coworkers by being socially clumsy.

The psychiatrist and a psychologist, after doing a cognitive assessment of Anders and interviewing his parents, diagnosed an autism spectrum disorder with IQ within the normal range. His depression was considered to depend on his lack of meaningful occupation, and he was referred to a job center for adults with developmental disorders and normal IQ. In the job center Anders was assigned a special job coach with experience in autism spectrum disorders, and at his last visit to the psychiatrist seemed hopeful regarding his future chances to get a part time job as an assistant in a research lab, and perhaps later study science at the university in a program for students with autism. Anders was also referred to the habilitation center, where he has regular visits with a social worker.

Looking backward, Anders may, or may not have been helped by an earlier recognition of his problems. After all, he managed to go through school with good grades and without emotional disturbances. His family and classmates considered him normal, even if a bit odd and seclusive, and he was never bullied. Thus, Anders did not need any special help until after school, and it can be speculated that his self-esteem and emotional well-being might have been disturbed by earlier interventions. However, it seems unnecessary and unhelpful that Anders had to wait for 8 years of repeated failures in jobs until his problems were recognized and accordingly managed.
