Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition that is often under-recognized and misdiagnosed in primary care, particularly in low- and middle-income countries. Adult presentations of ASD remain uncommon in family medicine literature, despite their significant clinical, psychosocial, and caregiver implications. The challenges are magnified in resource-limited rural settings where access to specialist services is constrained. This case highlights the role of family physicians in identifying ASD in adulthood and addressing the complex needs of both patient and caregiver through a holistic, community-oriented approach.This paper presents a descriptive family case of adult twins diagnosed with ASD managed in a rural primary care setting. Clinical evaluation included comprehensive history-taking, physical examination, and functional assessment using the Mini Mental Status Examination (MMSE) and Adaptive Behavior Assessment System (ABAS). Family dynamics, resources, and caregiver burden were assessed using Family APGAR, SCREEM-RES, family lifeline, ecomap, and Modified Caregiver Strain Index (MCSI). Management followed the Patient-Centered, Family-Focused and Community-Oriented Care, emphasizing interdisciplinary collaboration and linkage with local government and community resources.Case is distinctive in presenting late-diagnosed adult ASD complicated by chronic medical comorbidities and severe caregiver strain within a single-parent household. It demonstrates the pivotal role of family physicians in correcting misdiagnosis, coordinating long-term care, and addressing caregiver well-being in the absence of readily accessible specialist services.Routine developmental surveillance and functional assessment should be integrated into primary care across the life course. Family physicians must proactively assess caregiver strain and mobilize community-based resources. Strengthening primary care capacity for ASD recognition and caregiver support can reduce health inequities in underserved communities.Delayed diagnosis of ASD in adulthood contributes to fragmented care, inappropriate labeling, and psychosocial distress for families. This case illustrates that structured family assessment, continuity of care, and community engagement can improve disease understanding, treatment adherence, and caregiver coping despite persistent functional limitations.Family medicine is uniquely positioned to provide comprehensive, continuous, and compassionate care for individuals with ASD and their families. Integrating clinical, family, and community perspectives enables primary care to address complex neurodevelopmental conditions and caregiver burden, reinforcing the central role of family physicians in holistic health care delivery.