Psychosocial Outcomes of a Community Sample of High Functioning Individuals with Autism Spectrum Disorder

Background: Individuals with high functioning Autism Spectrum Disorder (HF-ASD) are reportedly not reaching their potential in terms of psychosocial outcomes (Howlin, Goode, Hutton & Rutter, 2004; Levy & Perry, 2011).  However, the use of select clinical samples limits our ability to generalize findings to the broader group of individuals with HF-ASD in the community.   One study suggests there is a large cohort of adults in the community, who are undiagnosed yet meet diagnostic criteria for ASD, who are as impaired in terms of psychosocial outcomes as those with a formal diagnosis (Stuart-Hamilton & Morgan, 2011); however, little is known about this undiagnosed group.  Moreover, there is a lack of information on age trends in adulthood, including a scarcity of information on older adults and on gender differences within this population. 

Objectives:   To examine the effects of age, gender and professional diagnosis on ASD symptoms and psychosocial outcomes of a large sample of adults with HF-ASD purposefully recruited from the community.  Four research questions were investigated:  1) do ASD symptoms and psychosocial outcomes improve across adulthood; 2) do men and women differ in their ASD symptoms and psychosocial outcomes; 3) do ASD symptoms and psychosocial outcomes differ between individuals who do and do not have a formal diagnosis; and 4) do these latter two factors interact with age?

Methods: Participants were 397 individuals (160 male, 237 female; age range 21 – 73 years) with HF-ASD who met cut-off criteria on the Autism Spectrum Quotient (AQ), a brief screening questionnaire designed to measure degree of ASD symptomatology in adults (Baron-Cohen et al., 2001).  Participants completed online questionnaires regarding ASD symptomatology and psychosocial functioning including education, adaptive skills, employment, living arrangements, relationships and parental status.

Results:   Participants in their 20s tended to report completing high school or less.  Older participants reported completing college or undergraduate education (F_(3,380) = 7.61).  Participants in their 20s reported being able to complete adaptive skills independently a little more than “sometimes”.  Participants in their 50’s reported completing skills independently “most of the time” (F_(3,381) = 3.57, p = .01).  Older people were more likely to have been in a relationship (Chi-square₍₃₎ = 38.69, p = .00) and to have children (Chi-square₍₃₎ = 71.10 , p = .00).  Men were more likely to be employed full-time (Chi-square₍₃₎ = 19.56 , p = .00) and women were more likely to have been in a long-term relationship (Chi-square₍₁₎ = 22.80 , p = .00).  Finally, people with a professional diagnosis had significantly higher AQ scores (F_(1,381) = 5.86, p = .02), however this difference was not clinically meaningful (m = 40 vs. m= 39). 

Conclusions:   People with HF-ASD continue to further their education and to acquire skills throughout their adult years.  In keeping with the general population, people with HF-ASD seem to be entering into relationships and having children in their 30’s.  Few gender differences were found.  Finally, the results also suggest that people without a formal diagnosis are functioning at a level similar to those with a formal diagnosis.