Range of Adult Outcomes

This chapter reviews the results of research on adult outcomes for autistic people, from the early 1970s onward. While there has been an explosion of research on autism in adulthood in the past 10 years, the heterogeneity of symptoms across individuals, cohort effects, and variation in the life circumstances of autistic people contribute to difficulty drawing reliable conclusions from research. In broad strokes, premature death is 2–5 times more common in autistic people than in the general population, with females and people with severe co-occurring disabilities at greatest risk. Most autistic people, like their nonautistic peers, develop new skills and abilities that allow them to function more effectively in their environments over time; for autistic adults, this often means developing new social communication skills, which correspond to a reduction in reported and observed symptoms of autism. It is well established that an early childhood IQ in the near-normal range or higher and communicative phrase speech by age 6 are important prerequisites to achieving independence in adulthood; recent findings indicate that educational experiences, co-occurring mental health conditions, adaptive behavior, and selected early childhood social communication variables may be important to predicting adult outcome. Objective social outcomes for autistic adults tend to be limited compared to the general population. Subjective ratings of outcomes by autistic adults are generally better than what might be expected based on objective social outcomes but are usually not on par with the way their nonautistic peers rate their quality of life. Important social relationships, meaningful occupation, and managing co-occurring health conditions, including mental health disorders, are all important elements contributing to a good quality of life. These findings provide a foundation for further investigation of the adult autistic experience people and point to opportunities to modify practices and develop new interventions aimed at supporting autistic adults to reach their aims and live well.