Surviving to Thriving: A Grounded Theory of Post-Diagnostic Identity Reconstruction in Midlife and Older Autistic Adults

This study explored how midlife and older autistic adults make sense of receiving an autism diagnosis later in life and how this shapes post-diagnostic identity reconstruction. Although rising numbers of adults are diagnosed in later life, little is known about how they interpret this experience or the factors shaping post-diagnostic adjustment. Constructivist grounded theory was used to examine experiences among 14 autistic midlife and older adults aged 50 to 73. Seventeen semi-structured interviews were analysed using iterative coding and constant comparison. An autistic advisory group supported reflexivity and analytic credibility. Diagnosis was valued but had a liminal effect. Two broad patterns of post-diagnostic experience were identified: surviving , characterised by self-blame and deficit-based interpretations; and thriving, characterised by greater self-compassion, personal agency, and living in ways more aligned with their autistic identity. Thriving was delayed and followed years of identity reconstruction. It unfolded through the Thriving Cycle , comprising three interconnected processes experienced as a dynamic and iterative. The Thriving Cycle illustrates how some midlife and older autistic adults moved beyond diagnostic recognition towards a more integrated and affirming autistic identity. These findings suggest that identity-focused support may help individuals move from ‘survival’ towards greater self-understanding, agency, and well-being. Lay Abstract More adults are being diagnosed as autistic later in life, but little is known about how they make sense of this experience or how it affects their lives afterwards. This study explored how autistic adults diagnosed in midlife and older age understood their diagnosis and how it shaped the way they saw themselves. We interviewed 14 autistic adults aged 50 to 73. We explored their experiences of receiving an autism diagnosis later in life and what happened afterwards. An autistic advisory group helped ensure the findings reflected autistic perspectives. Participants valued receiving a diagnosis, but it also marked a period of uncertainty and adjustment. Two broad patterns of post-diagnostic experience were identified. Some participants remained in a pattern of surviving, marked by self-blame, and seeing themselves in negative ways. Others moved towards thriving, with greater self-compassion, a stronger sense of personal agency, and living in ways that were more consistent with their autistic identity. Thriving did not happen immediately after diagnosis but developed over time through years of making sense of their experiences. The study also identified the Thriving Cycle, a model describing three connected processes that supported thriving. These processes were experienced as ongoing, and people often moved back and forth between them over time. These findings suggest that receiving an autism diagnosis is only the beginning of the journey for many autistic adults. The Thriving Cycle shows how some midlife and older autistic adults moved beyond surviving towards thriving over time. The findings highlight the importance of providing post-diagnostic support to help autistic adults understand themselves and improve their well-being after diagnosis.