Autism Outcomes
Autism is a developmental disorder that is usually diagnosed during early childhood. However, the impairments of
autism are considered to last a lifetime, and continue to create challenges for the affected individual and his or her
family. Adolescence is a time of stress and confusion; and it is no less so for teenagers with autism. Like all
children, they need help in dealing with their prepubescent development.

While some behaviors improve during the teenage years, some get worse. Increased autistic or aggressive behavior
may be one way some teens express their worries and embarrassment. The teenage years are also a time when
children become more socially sensitive. At the age that most teenagers are concerned with acne, popularity,
grades, and dates, teens with autism may become exceedingly aware that they are different from their peers. They
may notice that they lack friends. And unlike their schoolmates, they aren't dating or planning for a career.

For some, the despair that comes with such realization motivates them to learn new behaviors and gain better social
skills. Despite its early emergence, autism is believed to be a lifelong condition; however, little is known about the
symptoms at the root of autism in adolescence and adulthood.

Studies on Autistic Symptoms

There have been only a handful of studies that have addressed questions about the developmental path of autism
from childhood through adolescence and into adulthood. In general, studies have focused on age related differences
and changes in the severity of the symptoms of autism, asking (1) whether symptoms decrease, remain stable, or
become more severe over the life course and (2) whether individuals continue to meet the diagnostic criteria for
having an autism diagnosis after the early childhood years.

Studies regarding changes in autistic symptoms have extended four decades, and therefore they differ in the
diagnostic observation through time. Despite inconsistencies in diagnostic practices, as well as differences in plan,
sample, and evaluation, the gathered evidence signifies that the major symptoms of autism decrease to some degree
during adolescence and young adulthood. Recent studies provide a fine distinction in description of symptom
change, suggesting that development may be divided, with improvement in only some behaviors that characterize
autism and with different timing of improvement in behaviors.

Additionally, although the overall course for many with autism is progress during adolescence and adulthood, there
can be a period of little or no growth or decline. Even periods of aggravation along the way, and for some
individuals, symptoms may not subside or even may worsen. For example, in a study of 23 people between the
ages of 16 and 23 years diagnosed with autism as part of a population epidemiological survey (the field of medicine
that deals with the study of the causes, distribution, and control of disease in populations) it was found that 35% of
the individuals experienced temporary (1-2 years) periods of frustration in behavioral symptoms (aggression,
hyperactivity, insistence on sameness), and 22% displayed continuing deterioration throughout puberty in these
same areas of behavior plus loss of language skills and cognitive abilities. A small percentage of individuals
experienced the onset of seizures in puberty. Improvement is typically seen in terms of the acquisition of new skills
and a decline in difficult behaviors.

Changes in Communication

Substantial studies have also documented improvements in communication, though not seen for all individuals and
even in those who do improve, changes are rarely significant enough to move the individual into the normal range
of functioning. Other researchers have also documented the improving, but lasting, symptoms of autism.  There are
also considerable differences in the course of change in communicative behaviors. For example, speech symptoms
that are the “classic” signs of autism (e.g., pronoun reversal, phrases) improve the most, whereas failure in pointing
to express interest and use of gestures to communicate are less likely to improve from childhood.

Early language achievements have been found to be a predictor of outcomes in adolescence and adulthood. Adults
with autism who had better early language skills were more successful than those who had little communication
skills during childhood. A study found that the presence of social language at age 5 or 6 years contributed to better
outcomes in adolescence and adulthood.

Duration of Autistic Behavior

Studies have shown that few if any individuals who receive a diagnosis of autism in childhood recover fully and
achieve levels of functioning typical of their age peers. For example, one study used ratings of the Childhood
Autism Rating Scale (CARS) to decide on the appropriateness of the autism diagnosis in a clinical study of 59
adolescents, who as children had received an autism diagnosis also using the CARS. More than 80% of the children
who met criteria for autism before age 10 continued to do so after age 13, although the group as a whole showed
improvement on most features of behavior.

Retrospective studies provide a similar picture. In an analysis of 76 adolescents and adults with autism, found that
82% of the individuals who qualified for a diagnosis of autistic disorder based on the retrospective reports of
caregivers still qualified based on responses about current functioning. Individuals who outgrow the ASD diagnosis
are mainly those who are initially diagnosed as having Asperger’s Syndrome or PDD-NOS. Even among those with
high functioning autism, however, most continue to meet criteria for the diagnosis in adolescence and adulthood.
Change in diagnostic status among more severely affected individuals may be less likely.

In summary, only a small percentage of individuals show improvement during the adolescent and adult years that is
of sufficient extent to prove the diagnosis of autism invalid. Those most likely to “outgrow” the diagnosis are those
who as children displayed the least severe symptoms. In fact, it is amazing that as many as between 10% and 20%
outgrow the diagnosis, as autism is perhaps among the most severe and persistent of the developmental disorders.
However, given this severity and frequency, its stability throughout the life course is not a surprising finding.

Independence in Adulthood

Based on parental reports, 72% of the adults with autism have little independence in basic daily living skills. Few
adults with autism live independently, marry, go to college, work in competitive jobs, or develop large network of
friends. The majority remain dependent on their families or professional service providers for assistance with tasks
of daily living. Even among those who work, jobs are often insufficiently paid and do not provide enough for their
cost of living expense. Furthermore, adults with autism tend to have poorer outcomes than others with disabilities.
However, higher functioning individuals are able to live independently, work in competitive jobs, and may have a
network of social relationships.

Clinical research experiences emphasize the importance of the family and formal service supports for adults with
autism. There is a growing research suggesting that casual support from family and friends is associated to better
outcomes for adults with psychiatric disabilities. It is quite possible that adequate functioning in adulthood for
individuals with autism may depend as much on the amount of support offered by families, friends, and service
providers as on basic intelligence and language skills. More research on the contributions of familial, formal
supports and other methods used for individuals with autism are important to develop new and effective
interventions and services created for their unique needs in adolescence and adulthood.
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