By Matt Harrington, BCBA · Behaviorist Book Club · April 2026 · 12 min read

Maximizing Adult Outcomes for Individuals with ASD: Building Meaningful Skill Acquisition Programs That Last a Lifetime

Overview & Clinical Significance

For too long, the behavior analytic field has concentrated its intervention energy on early childhood, treating the preschool and elementary years as the window during which real change is possible. The outcome of this orientation has been a generation of young adults with autism spectrum disorder who received intensive, high-quality ABA during childhood only to age out of services into a system that was largely unprepared for them — and a field that had relatively little to say about what adult life with ASD could look like when intervention was thoughtful, individualized, and genuinely focused on meaningful living.

The work of Dr. Peter Gerhardt and Dr. Shanna Bahry, introduced through the guide Make it Meaningful, directly challenges this trajectory. The central argument is that the selection of skill acquisition targets for individuals with ASD must be evaluated not primarily in terms of their developmental relevance or their proximity to neurotypical milestones, but in terms of their impact on the individual's ability to participate in the adult world they will actually inhabit. This requires practitioners to think further forward than most skill acquisition curricula are designed to support.

Adaptive behavior — the collection of practical, daily life skills that allow a person to function independently and participate meaningfully in their community — is the backbone of this framework. Domains including self-care, domestic skills, community navigation, vocational skills, and social-sexual knowledge are all areas where thoughtful, evidence-based ABA intervention can produce outcomes that matter. Yet these domains are frequently underprioritized in favor of academic or communication targets that, while valuable, may not represent the most functionally impactful investment of treatment time for a given individual.

This presentation by Dr. Gerhardt offers practitioners a framework for asking a different question: not just what can this learner do, but what does this learner need to be able to do to live a full and meaningful adult life — and what are we doing right now to close that gap?

Background & Context

The research literature on adult outcomes for individuals with ASD has been sobering. Employment rates, independent living rates, and measures of social participation for adults with ASD consistently fall below both the general population and the expectations that families and practitioners hold during the early intervention years. These outcomes are not inevitable — they reflect, at least in part, the cumulative effect of skill selection decisions made during childhood and adolescence that prioritized certain targets over others.

Dr. Gerhardt's work is grounded in this outcome data. His analysis suggests that many of the gaps in adult functioning can be traced to a failure to systematically teach the adaptive behavior skills that adult independence requires. Children may exit early intensive intervention programs with impressive communication and academic skills but without the domestic, community, and vocational competencies that adult life demands. The transition from structured intervention to adult services — which are typically far less intensive — often reveals these gaps in stark relief.

The Make it Meaningful framework draws on a long tradition in behavior analysis of functional skill selection — the principle that intervention targets should be chosen based on their impact on the learner's quality of life and functional independence rather than on developmental norms or administrative convenience. This tradition includes the work of Lou Brown and his colleagues in the severe disabilities literature, Gaylord-Ross and Haring on community-based instruction, and the broader applied behavior analysis literature on teaching adaptive and community living skills.

Behavior analysts working with adults with ASD and related disorders have an additional resource in the growing literature on self-determination — the capacity to set goals, make choices, and direct one's own life. Self-determination skills, including problem-solving, self-advocacy, and decision-making, are amenable to behavior analytic instruction and represent critical targets for maximizing adult outcomes.

Clinical Implications

Implementing the Make it Meaningful framework in practice requires behavior analysts to restructure how they approach skill acquisition programming for learners with ASD across the age range. The first clinical implication is a shift in assessment orientation. Traditional developmental assessments evaluate skills relative to normative milestones — at what age does a typical child acquire this skill? Meaningful adult outcomes programming requires an ecological assessment orientation that asks instead: what skills does the adult environment require, and which of those skills does this learner currently lack?

The VB-MAPP, ABLLS-R, and similar instruments remain useful for younger learners and for identifying foundational skill deficits that must be addressed before more complex adaptive behavior can be taught. However, practitioners working with older learners — and those doing forward planning for younger learners — should supplement these instruments with ecological inventories that examine the specific demands of the adult environments the learner will transition into: the group home, the supported employment site, the public transportation system, the community recreation center.

Goal writing must evolve alongside assessment. Goals that are connected to long-term adult outcomes should specify not just what the learner will do in therapy but what the skill looks like in the community setting where it matters. A goal targeting grocery shopping should be evaluated in a real grocery store, with real money, using real products — not approximations in a clinical kitchen. The specificity of context matters both for instruction and for generalization.

Community-based instruction (CBI) is a direct implication of this framework. Teaching skills in the natural settings where they will be used produces stronger generalization than clinic-based instruction with subsequent transfer to natural environments. BCBAs should build CBI into treatment plans for older learners, work with families and funding sources to support community-based instruction time, and train instructors in the specific prompting and reinforcement procedures that are appropriate for natural environment teaching.

Ethical Considerations

Programming for meaningful adult outcomes raises profound ethical questions that go beyond technique. At their heart, these questions are about self-determination, dignity, and who gets to decide what constitutes a meaningful life. Code 2.07 (Culturally Responsive and Individualized Services) explicitly requires BCBAs to involve clients in the treatment planning process to the greatest extent possible, and to design programs that respect the client's values and preferences. For adults with ASD, this means seeking the individual's active participation in identifying the outcomes they find most meaningful — not defaulting to practitioner or family priorities alone.

Code 2.01 (Providing Effective Treatment) supports the priority of adaptive behavior and functional skill instruction when these are the targets most likely to improve the individual's quality of life. When BCBAs choose targets based on what is easiest to measure or most familiar from training rather than what will most meaningfully improve the client's adult functioning, they are falling short of this standard. The Make it Meaningful framework is in part a challenge to BCBAs to hold themselves to a higher functional standard in skill selection.

Code 1.05 (Non-Discrimination) is relevant in the context of social-sexual knowledge and relationships — an area that is frequently avoided in programming for individuals with ASD due to practitioner discomfort or family resistance, but that is essential for adult dignity and safety. Adults with ASD have the same rights to relationships, intimacy, and self-expression as any other adult, and BCBAs have an ethical obligation to include social-sexual education in programming when it is relevant and desired rather than omitting it because the topic is uncomfortable.

Finally, Code 2.13 (Referrals) is relevant when the scope of meaningful adult outcomes programming extends beyond behavior analysis alone. Collaboration with vocational rehabilitation specialists, occupational therapists, speech-language pathologists, and social workers is often necessary to build the comprehensive supports that adult community participation requires. BCBAs should facilitate these referrals and collaborate effectively with allied professionals rather than attempting to address all programming needs within the ABA scope alone.

Assessment & Decision-Making

Selecting the right skill acquisition targets for meaningful adult outcomes requires a multi-step assessment process that begins well before the practitioner touches a single data sheet. The first step is an ecological inventory: examining the specific environments — domestic, community, vocational, recreational — that the learner will need to navigate as an adult, and identifying the skill demands of each environment. This inventory should be conducted collaboratively with the learner and their family or support system, with attention to the learner's own preferences and goals.

The second step is a skills inventory: assessing which of the identified skills the learner currently possesses at a functional level, which are present but not fluent or generalized, and which are absent. This inventory informs prioritization. Skills that are absent but critical for safety or participation in multiple high-priority environments should typically be addressed first. Skills that are present but not generalized may require less intensive instruction than absent skills but still require systematic programming.

Goal writing should follow directly from this assessment process. Goals should specify the target behavior in observable, measurable terms; the conditions under which the skill will be demonstrated (including the specific natural environment); and the criterion for mastery. Goals that are written at the level of the natural environment — rather than the level of the therapy session — are more likely to produce outcomes that are functionally meaningful.

Decision-making about instructional methods should be evidence-based. For skills that require complex behavior chains, task analysis with appropriate prompting and fading is typically indicated. For skills with significant motivational challenges, pairing community-based instruction with preferred activities or natural reinforcers embedded in the activity can support both acquisition and maintenance. When the skill requires safe navigation of complex social situations, video modeling and social narrative approaches have strong support in the literature.

What This Means for Your Practice

If you are working with learners who are approaching or have already reached adolescence or adulthood, the Make it Meaningful framework offers a clear call to action: look at your current treatment plans and evaluate each goal through the lens of adult outcome relevance. Ask yourself: will mastery of this goal meaningfully increase this individual's capacity to participate in adult life? If the answer is uncertain or negative, it may be time to reassess whether this goal is the best use of treatment time.

For practitioners working with younger children, the implication is about forward planning. Early intensive intervention should build the foundational skills that later adaptive behavior instruction will require — but it should be planned with an eye toward the adult life these skills are meant to support. This means consulting with colleagues who work in adult services, building relationships with vocational rehabilitation and transition planning programs, and helping families develop a long-term vision for their child's adult life that informs current goal selection.

Documentation practices should reflect the functional and community-based nature of meaningful adult outcomes programming. Goals should be written to the level of the natural environment. Data should be collected in natural settings whenever feasible. Progress notes should document not just skill acquisition in therapy but evidence of generalization to the target adult environments. This level of documentation both demonstrates clinical rigor and makes the functional significance of the work visible to families, funders, and other stakeholders.

Finally, Make it Meaningful is as much a values document as a technical one. It calls on the behavior analysis community to hold a higher standard for what intervention is actually for — not symptom reduction, not compliance training, not developmental milestone achievement as an end in itself, but a life in which the individual with autism has the skills, supports, and opportunities to participate fully in the community of their choice. That aspiration should be the organizing principle of every treatment plan you write.