Predictors of Success for Adults on the Autism Spectrum
There is a growing
literature documenting the social, employment, and mental health difficulties
faced by adults with ASD. With the increasing rates of ASD diagnoses, the
number of individuals with ASD entering adulthood each year is expected to double
over the next 6 years. Although research indicates that outcomes are almost
universally lower for adults on the autism spectrum compared to their peers, few
longitudinal studies from childhood to adulthood have been conducted. Most studies
have focused on the transition years from adolescence to young adulthood or on
describing adult outcomes. While there is little research on the predictors of
positive outcome, surveys completed for adults with ASD in middle adulthood who
were diagnosed during childhood offers some important insights into the predictors of success (Klinger et al.,
2015).
Interviews were
conducted with caregivers to gather information on employment status, quality
of life, social isolation, mental health issues (such as anxiety, depression
and mood), symptom severity, and language skills. Predictors included symptom
severity, adaptive behavior (self-help skills), and language ability. Childhood
predictors included symptom severity, adaptive behavior, and IQ. Analyses were
conducted to examine predictors of adult outcome. Results indicated that current
adaptive behavior was the single best
predictor of adult outcome. Symptom severity and language ability had no impact
on outcome. Adaptive behavior in childhood was an equally strong predictor of
outcome (employment, social isolation, depression, and quality of life),
regardless of symptom severity and childhood IQ.
Adaptive behavior
is the collection of conceptual, social, and practical activities and skills necessary
for people to live independently and to function safely and appropriately in
daily life. They include real life skills such as grooming, dressing, safety, meal-related
activities, school rules, shopping, ability to work, money management,
cleaning, making friends, social skills, navigational skills, and personal
responsibility and other household tasks. It appears that these skills are more
important than language, intellectual ability or the severity of autism
symptoms when it comes to maintaining successful employment and achieving positive
life outcomes. Both childhood and adult adaptive living skills were found to be
strong, independent predictors of a wide variety of adult outcomes.
Implications
Research indicates
that children and youth with ASD consistently demonstrate adaptive behavior
levels significantly lower than their measured intellectual ability. Many individuals
on the autism spectrum are functionally impaired because they are unable to
translate their cognitive abilities into efficient adaptive behavior. Adaptive
behavior should be included as a core component in a comprehensive
developmental assessment for students who have or are suspected of having
autism spectrum disorder (Wilkinson, 2017). The use of a formal adaptive
behavior measure allows the assessment team to determine the student’s level of
functioning in daily tasks required to be successful in the home, community,
and work place. This type of assessment will assist in transition planning and
ensure the student has the necessary skills to be productive when he or she leaves
the school environment. While teaching social interaction and communication
skills has traditionally received the most attention, there is a critical need
to emphasize the importance of improving adaptive behavior across the lifespan,
regardless of symptom severity, IQ, and communication skills. This includes a
focus on the practical life skills necessary for the growing number of adults
on the spectrum to achieve success in employment and life satisfaction.
References and Further
Reading
Anderson, K. A., Shattuck, P. T.,
Cooper, B. P., Roux, A. M., & Wagner, M. (2014). Prevalence and correlates
of postsecondary residential status among young adults with an autism spectrum
disorder. Autism, 18, 562-570. doi: 10.1177/1362361313481860
Campbell, J. M., Ruble, L. A.,
& Hammond, R. K. (2014). Comprehensive Developmental Approach Assessment
Model. In L. A. Wilkinson (Ed.), Autism spectrum disorders in children
and adolescents: Evidence-based assessment and intervention (pp.
51-73). Washington, DC: American Psychological Association.
Floyd, R. G., et al. (2015). A
systematic review and psychometric evaluation of adaptive behavior scales and
recommendations for practice, Journal of
Applied School Psychology, 31, 83-113. doi:10.1080/15377903.2014.979384
Klinger,
L. G., Klinger, M. R., Mussey, J. L., Thomas, S. P., Powell, P. S.
(2015, 05). Correlates of middle adult outcome: A follow-up study of
children diagnosed with ASD from 1970-1999. Paper presented at the 2015
International Meeting for Autism Research, Salt Lake City, UT.
Lake, J.
K., Perry, A., & Lunsky, Y. (2014). Mental health services for
individuals with high functioning autism spectrum disorder. Autism
Research and Treatment, Volume 2014, Article ID 502420.
doi:10.1155/2014/502420
Ohio Center for Autism and Low Incidence (OCALI). Transition
to Adulthood Guidelines.
http://www.ocali.org/project/transition_to_adulthood_guidelines
Roux, A. M., Shattuck, P. T.,
Rast, J. E., Rava, J. A., & Anderson, K. A. (2015). National Autism
Indicators Report: Transition into Young Adulthood. Philadelphia, PA: Life
Course Outcomes Research Program, A.J. Drexel Autism Institute, Drexel
University. Available from http://drexe.lu/autismindicators
Wagner, S. (2014). Continuum of
services and individualized education plan process. In L. A. Wilkinson
(Ed.). Autism spectrum disorder in children and adolescents:
Evidence-based assessment and intervention in schools (pp. 173-193).
Washington, DC: American Psychological Association.
Wilkinson, L.A. (Ed.).
(2014). Autism Spectrum Disorder in Children and Adolescents:
Evidence-Based Assessment and Intervention in Schools. Washington, DC:
American Psychological Association.
Wilkinson, L. A. (2017). A best
practice guide to assessment and intervention for autism spectrum disorder in
schools. Philadelphia & London: Jessica Kingsley Publishers.
Lee
A. Wilkinson,
PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist.
He is author of the award-winning books, A
Best Practice Guide to Assessment and Intervention for Autism and Asperger
Syndrome in Schools and Overcoming
Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He
is also editor of a text in the APA School Psychology Book
Series, Autism
Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and
Intervention in Schools. His latest book is A
Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder
in Schools (2nd Edition)
© Lee A. Wilkinson, PhD
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