Defining Positive Outcomes in More and Less Cognitively Able Autistic Adults.
Use different adulthood success criteria for autistic clients based on cognitive ability—less able: daily skills >8-year level, regular activities, outside social contacts; more able: independent living, paid work, at least one close friend.
01Research in Context
What this study did
The team asked 100 autistic adults what a good life looks like.
They split the group by verbal IQ: above 70 and below 70.
Each person told the researchers about daily skills, work, friends, and happiness.
What they found
Less-able adults said success means dressing, eating, and toileting at an eight-year-old level.
They also wanted regular activities and at least one social contact outside the home.
More-able adults said success means living on their own, holding a paid job, and having one close friend.
Verbal IQ predicted more of these outcomes in both groups than any other factor.
How this fits with other research
de Jonge et al. (2025) tracked daily-living skills from toddlerhood to adulthood.
They found early nonverbal mental age and 20 hours of parent coaching before age 3 forecast who reaches high versus low skill levels.
This extends the target study by showing how early data can predict which adult criteria a client will likely meet.
Schall et al. (2020) ran a work program for autistic adults with significant support needs.
Seventy-three percent landed competitive jobs, even though the target paper lists paid work only for the more-able group.
This looks like a contradiction, but the difference is support: the program added job coaches and workplace modifications.
Ohan et al. (2015) followed toddlers diagnosed at age 2 and found half scored in the average cognitive range by age 9.
This warns us that early IQ labels can shift, so adult criteria may need updates over time.
Why it matters
Stop using one-size-fits-all goals. For clients with verbal IQ under 70, target daily-living skills, community activities, and safe social contacts. For clients over 70, target independent living, paid work, and close friendships. Check early nonverbal scores and parent-training hours to forecast which path is realistic, but stay ready to revise as skills grow.
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02At a glance
03Original abstract
Identifying positive outcomes for a wide range of intellectual abilities in autism spectrum disorder (ASD) remains a challenge. Several past studies of autistic adults have used outcome definitions that do not reflect the experiences of less cognitively able adults. The aim of the current study was to (1) define three domains of outcomes: autonomy, social relationships, and purpose, and (2) examine how these outcomes relate to concurrent aspects of adult functioning. Using data from a longitudinal sample of 126 adults (85% diagnosed with ASD at some point), mean age 26, who first entered the study in early childhood, we generated distinct outcomes for less (daily living skills above an 8-year-old level, having regular activities outside the home, and social contacts outside the family) and more cognitively able adults (living independently, having paid employment, and at least one true friend). Verbal IQ, assessed in adulthood, was a significant predictor of more outcomes achieved for individuals within more and less cognitively able groups. For less cognitively able adults, having ever received a formal ASD diagnosis (in contrast to current Autism Diagnostic Observation Schedule [ADOS] CSS scores) was associated with lower odds of positive outcomes. For more cognitively able adults, living skills and happiness measures were positively associated with number of outcomes met; higher ADOS CSS, internalizing and externalizing symptoms, being racially diverse, and having caregiver education below college graduation were all negatively associated with the number of positive outcomes. Tailoring outcomes to ability levels may lead to better identification of goals and service needs. LAY SUMMARY: This article describes the outcomes of autistic adults who are more and less cognitively able. For less cognitively able individuals, an earlier autism diagnosis was negatively related to outcomes. Several factors that were associated with positive outcomes for more cognitively able individuals, including daily living skills, fewer mental health problems, family demographics, and subjective measures of happiness. Our study identifies several important factors for families, individuals, and service providers to consider and discuss when planning the transition to adulthood. Autism Res 2020, 13: 1548-1560. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
Autism research : official journal of the International Society for Autism Research, 2020 · doi:10.1002/aur.2359