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Lifelong Implications of Autism Spectrum Disorder

by Nicholas W. Gelbar

Media reports consistently emphasize the increasing prevalence of Autism Spectrum Disorder (ASD), captivating the public focus on this once obscure syndrome. The focus of this attention is on controversies regarding potential causes of the increased prevalence, rather than the consequences of the disorder for individuals and their families. ASD involves not only developmental difficulties during early childhood, as the consequences of this disorder persist across the lifespan.

Most research efforts have focused on improving diagnosis and providing early intervention services to this population. Until recently, the research community has failed to focus on the lifelong consequences of this disorder. Research from a variety of disciplines, utilizing a variety of methods, has shown that young adults with ASD do not have good long-term outcomes. For example, they struggle while attending college or in other postsecondary training environments, and have difficulty finding employment. Those who do become employed have difficulty maintaining employment and have few prospects for advancement in their careers. Most young adults with ASD have few friends and are unlikely to live independently.

While individuals with ASD vary in terms of cognitive, academic, and other abilities, the core features of the disorder involve difficulties with social communication and challenges with restricted interests and/or repetitive behaviors. Individuals with ASD who have more developed language skills and higher academic abilities are just as likely to have poor adult outcomes than those who experience greater difficulties in these areas. Many factors in addition to intellectual ability contribute to the poor outcomes faced by this group. Any of the difficulties discussed will likely only apply to some individuals with ASD so it is important not to overgeneralize these difficulties, as they do not occur in all individuals with ASD.

Social skills (defined as observable behaviors related to social communication) are crucial to attaining and maintaining employment. Job interviews largely focus on likability versus competence, which places individuals with Autism Spectrum Disorder at a major disadvantage. Advancement in employment settings is often based on one’s ability to work well with colleagues, a skill that can be especially difficult for individuals with ASD. The very narrow interests of many individuals on the Autism Spectrum can also make the social aspects of employment challenging, as individuals with ASD often have difficulties interacting with others.

Another barrier that individuals with ASD face in the employment market is that most jobs require flexibility, and individuals with ASD are often rigid and need to follow routines. They sometimes have difficulty coping with unexpected changes, and struggle to know what to do when presented with a novel situation.

Many individuals with ASD also have difficulty with executive functions such as self-regulation and the ability to initiate tasks. These abilities are crucial in postsecondary education settings as well as in employment. The major difference between secondary and postsecondary settings is one is expected to manage one’s own time and spend significant amounts of time studying alone. Employment settings often require the ability to manage one’s own time and to move between projects seamlessly. These requirements of both employment and educational settings after high school are often particularly challenging for individuals with ASD because of difficulties with self-management and executive functions.

Numerous factors influence the educational and economic success of individuals with ASD, including their family socioeconomic status, the timing of their diagnosis, and the severity of their symptoms. The difficulties discussed in this article demonstrate that there are potential solutions to many of the challenges that contribute to the outcomes of this group. These solutions could include more robust on the job training and mentoring opportunities as well as social skill interventions. While the current adult outcomes for individuals with ASD are poor, interventions can be designed to address these difficulties and research to demonstrate how these can be effectively implemented has already begun.