The Hidden Work of Being an Autistic Adult and What Nobody Taught You
April Ratchford, Occupational Therapist, Registered/Licensed, is an autistic occupational therapist and the voice behind Adulting with Autism. She supports neurodivergent adults across the world with relatable storytelling, lived wisdom, and empowering strategies for real-life challenges.
You wanted independence. Great. But nobody warned you that adulthood is hundreds of tiny jobs stacked on top of each other: appointments, insurance, groceries, transportation, bills, laundry, subscriptions, car maintenance, work schedules, and remembering where you put your insurance card. For autistic young adults, the hidden work of adulthood can be especially overwhelming when everyone assumes you somehow learned it by watching. Here is the practical cheat sheet I wish more young adults were given.
Independence means doing your own stuff
Whether you are living independently or still living with your parents, independence is important. But here is the first thing nobody likes hearing: nobody is required to do everything for you anymore.
Clean your room. Wash your clothes. Wash your own dishes. Learn how to clean a bathroom. If you are living independently and want to stay up until 3 a.m. gaming when you have to work at 8, do you, boo. You will discover the consequences at approximately 7:15 the next morning.
If you are still living with your parents, there is a caveat. You are an adult, but you are also living in somebody else's house. Sit down together and establish house rules. Your parents have spent years being responsible for you, and everybody now has to figure out what the adult version of that relationship looks like.
When I was 16, I loved talking on the phone. Young people, gather around because I am about to tell you about the ancient times. Long-distance phone calls cost money. Since I stayed on the phone constantly, my mother eventually handed me the phone bill and basically said, "Since you are going to be on it all the time, here is your bill." When my younger sister started working, she got the cable bill.
I am not saying every 16-year-old needs a utility bill. That is simply how my parents operated. But adulthood means learning that housing, electricity, internet, food, and all the other things you use cost actual money.
Know your own medical history
Know your medical history. Know what medications you take, why you take them, when you take them, your allergies, your doctors, and your family medical history.
My son is 24, and we are still working on medication management. His medical history is not simple. Autism is only one part of it. He has a ventriculoperitoneal (VP) shunt, neurogenic bladder, and a history of spinal and other medical procedures. At one point, we were juggling neurosurgery, orthopedics, spine, urology, primary care, and psychiatry.
Eventually, he has to be able to tell a healthcare provider his own history without looking at me like, "Mom? You wanna take this one?"
If your history is complicated, put it in your phone or keep a document with diagnoses, surgeries, medications, allergies, doctors, and important dates. You do not get extra adulthood points for memorizing everything.
Make your own appointments
Parents, rejoice. One day, we do not have to make all these appointments anymore. If you do not know how to make an appointment, that is okay. Learn. Have your parent sit beside you, use a three-way call, or write yourself a simple script. You do not magically know how to do something you have never done before.
If somebody else is your transportation, tell them about the appointment before the day of the appointment. My son has announced appointments to me like he is informing me of an upcoming lunar eclipse: "Oh yeah, I have an appointment Tuesday." Sir. I work.
Welcome to the hellscape known as health insurance
Medical insurance will throw you for a loop. I am a healthcare professional, and our healthcare system still makes me want to throw things.
Once you are an adult, you also have privacy rights. Your parents generally cannot simply call your healthcare providers or insurer and demand information because they are your parents. Depending on the situation, you may need to authorize them to help.
Learn what insurance you have, what a copay is, what a deductible is, what in-network means, and where your insurance card is. Medical, dental, and vision coverage are not necessarily the same thing.
Keep up with routine primary care, dental care, and eye exams based on your individual needs and your healthcare providers' recommendations. Put appointments in your phone and set as many reminders as you need. Your brain does not get a trophy for remembering everything without assistance.
Grocery shopping: You actually have to feed yourself
First rule: make a list. Otherwise, you will walk into the store for seven things, come out with $93 worth of nonsense, and somehow still forget the one thing you needed.
You will hear people say to shop around the outside of the grocery store because that is where you often find produce and other fresh foods. That can be a useful shortcut, but the middle aisles also contain useful staples such as rice, beans, canned vegetables, and other foods.
The bigger lesson is to have a plan before you walk in. Also remember that buying food and preparing food are two different executive function tasks. Do not buy a refrigerator full of aspirational vegetables if you know you will be too exhausted to cook them. Buy food for the life you actually live.
Subscriptions will nickel and dime you
Netflix. Hulu. Disney+. Spotify. Gaming. Cloud storage. Apps. Whatever else you signed up for because it was "only $7.99."
Seven dollars here, fifteen there, twenty over there, and suddenly you are spending a ridiculous amount every month and cannot figure out where the money went. Audit your subscriptions. If you are not using it, cancel it.
Your cell phone is not free either
Let us talk about that phone that is probably attached to your hand right now. A lot of young adults are still on a parent's family plan, and sometimes that is actually the cheaper option. But being on your parents' plan does not mean you are entitled to a brand new phone every time one comes out.
My niece and older nephew started paying their own cell phone bills once they had jobs. With my son, I knew he was not ready for that responsibility yet, so he is still on mine. Independence does not mean everybody has to take over every responsibility at exactly the same age.
Understand what your phone actually costs. Unlimited service, device payments, insurance, extra storage, hotspot access, and other features can make the bill climb quickly.
If you are an Apple person, you know the ritual: a new iPhone appears, and suddenly the perfectly functional phone in your hand looks like it was manufactured during the Civil War. Stop and ask whether you actually need the upgrade.
My son and I kept our iPhone 6s until those poor things practically could not participate in modern society anymore. Now we have iPhone 16s. I handle a huge amount of podcast communication and business through mine, while my son uses his for school and sometimes relies on his hotspot when campus internet goes down.
Upgrade because the device no longer meets your needs, not simply because something newer exists. Adult independence includes paying for the things you independently decide you need.
Clothes also cost money
Some parents will continue helping their young adults buy clothes, especially while they are still in school. I am one of those parents.
My son is at college and needed an updated wardrobe. I am proud to report that we have progressed from sweatpants and a hoodie every single day to jeans and cologne. I consider this growth.
If you are earning your own money, start understanding what clothes actually cost. If you love name-brand things, save for them, shop sales, thrift, or use resale apps. Socks and underwear are unfortunately also part of the adult economy. Welcome.
Transportation is more than getting a car
If you drive, you may be responsible for some or all of your car expenses. Cars are expensive: insurance, gas, registration, tires, brakes, oil changes, repairs, and possibly a car payment.
Please maintain your vehicle. Oil changes are cheaper than engines. Tires are cheaper than accidents. That little light on the dashboard is not decorative.
If you do not drive, transportation still needs a plan. Learn the bus system, bike if it is safe and practical, use rideshare when necessary, and budget for it.
When my son was working, sometimes he needed to be at work at 1 p.m. while I was not getting off until 3. Guess what? Lyft. I was not leaving work two hours early because his shift existed. If your parents can drive you, appreciate it. They have jobs, appointments, and responsibilities too.
Keep up with your own work schedule
Once you have a job, nobody else should have to memorize your work schedule. I have my own work schedule, and that thing is banana pants.
When my son was working, I told him, "You better know when you work because I am not keeping up with your schedule and mine." Use your calendar, take a picture of the posted schedule, set alarms, know when you are supposed to be there, and figure out transportation before your shift starts.
DoorDash will have you broke and hungry
Food delivery is convenient. It is also very good at turning a relatively inexpensive meal into "what did I just pay for?" Food, delivery fee, service fee, tip, and whatever other fee crawled out from under a rock.
My son has a $500 credit card that I pay while he is in school. That card is for emergencies. One year, this mofo ran that thing up with DoorDash. I read him the riot act. "I do not feel like going to the cafeteria" is not an emergency. Convenience is useful. Convenience also has a price.
Amazon will sneak up on you too
Be careful with online shopping. You can place several orders and look at your available money, thinking you are fine, while some purchases have not actually been charged yet because they have not shipped.
Keep track of what you ordered and what is still pending. Do not spend the same money twice just because the first transaction has not appeared yet.
Credit cards are not free money
A credit card is borrowed money, not free money. Credit cards can help establish credit when used responsibly, but carrying a balance can get expensive quickly because of interest.
If a card has a 24% annual percentage rate (APR), that does not mean 24% of the balance is added every month. APR is an annual percentage rate, and card interest is generally calculated using a daily periodic rate. But high-interest debt can still kick your ass.
When you are able, a good habit is to use the card for planned expenses you already know you can afford and pay the statement balance in full by the due date.
Do not look at a $2,000 credit limit and think, "I have $2,000!" No. You have permission to borrow $2,000. Very different sentence.
If your parents are paying your credit card while you are in school, remember that is real money coming out of their paycheck. Treat it accordingly.
Ask for help before everything is on fire
Independence does not mean never needing help. If you are struggling financially, ask for help. Depending on your income and where you live, programs may help with utilities, food, healthcare, or housing expenses. In the United States, the Low Income Home Energy Assistance Program (LIHEAP) is one program that may help eligible households with home energy costs, and other assistance varies by state and community.
There is nothing shameful about using assistance when you qualify. There is also nothing shameful about living with your parents longer because rent is ridiculous or having roommates.
But choose roommates carefully. Real life is not The Big Bang Theory. Sometimes your best friend is a terrible roommate. You need someone who pays their portion of the bills, respects shared spaces, and understands that dishes cannot remain in the sink until they develop their own government.
Asking somebody to teach you something does not make you less independent. Independence is not the same thing as doing everything alone.
Build systems instead of trusting your brain
This is especially important for autistic young adults and those with attention deficit hyperactivity disorder (ADHD). You do not have to keep adulthood entirely inside your head.
Use calendars, autopay where appropriate, medication organizers, alarms, lists, recurring reminders, a budget, a folder for important documents, a note containing your medical information, a designated place for your keys, and scripts for phone calls. Use whatever works for your brain.
That is not cheating. That is adulting. The hidden work of adulthood is not necessarily one gigantic, difficult task. It is remembering hundreds of tiny things repeatedly for the rest of your life.
Nobody really explains that part. We parents thought you were watching. You were not. You were gaming.
Is this everything you need to know about adulthood? Hell no. I am 50 and still learning things. But it is a damn good start.
The hidden work is learnable
You do not have to master every part of adulthood at once. Take over responsibilities gradually, build systems around the things that are hard for you, and ask for help before a small problem becomes a crisis.
If you have questions, want more practical autistic adulting advice, or want to share what nobody taught you about adulthood, visit me at Adulting With Autism. You can also find me on social media. I generally answer.
Until next time, I hope this helps. Change your oil. Cancel the subscription you are not using. Make your appointments. Pay attention to your bank account, and wash your own dishes. Your parents will thank you.
Read more from April Michelle Ratchford
April Michelle Ratchford, Occupational Therapist & Podcast Host
April Ratchford, Occupational Therapist, Registered/Licensed, is an autistic occupational therapist, writer, and global advocate for neurodivergent adults. As the creator and host of Adulting with Autism, an internationally ranked podcast with over two million downloads, she blends clinical expertise with real-life lived experience. April specializes in supporting autistic young adults as they transition into independence, higher education, and adult identity. She is known for her clear, empowering approach that makes complex neurodivergent challenges accessible and manageable. April is currently advancing her studies in neuroscience through King’s College London to further elevate her work in autistic well-being and adult development.
