Early Adult Outcomes of High-Functioning Children with Autism Spectrum Disorder (ASD) in Hong Kong

Background:  

Autism spectrum disorder (ASD) is a neurodevelopmental disorder since childhood. Given the unavailability of a medical cure, it incurs considerable impairments to the psychosocial/educational/occupational development of the afflicted children. It is thus imperative to assess their adult outcomes for both academic and practical reasons.

Objectives:  

This cross-sectional study in Hong Kong examines outcomes of high-functioning ASD children at their early adulthood (aged 18-28) in terms of persistence of ASD diagnosis/symptoms, psychosocial adjustment, and educational/occupational attainment. IQs assessed during childhood were investigated as predictors of adult outcomes.

Methods:  

Sixty-four ASD adults were recruited from clinics and ASD groups in Hong Kong. They were Chinese with normal intelligence. All, except five, were males, aged between 18 to 28 years. A series of tests and interviews were administrated to them and/or their parents by clinicians in two half-day sessions.

Results:  

Sixty-seven percent of the participants at early adulthood still retained an ASD diagnosis (by 3Di, a standardized diagnostic interview revalidated locally in Hong Kong, Kelly et al., JADD, 2015). For the remaining 33%, only one-third of them (or only 11% of the whole group) was completely symptom-free. The psychosocial adjustment of 58% of the ASD adults was rated “fair/poor”, in contrast to 42% “near normal/good”, on the basis of five areas, namely, work, friendship, independence, stereotyped/repetitive behaviors, and use of language. When compared to population age-peers, the ASD adults were also found to be under-achieved both in terms of educational/occupational attainment. IQs assessed at childhood, particularly Verbal IQ, were found to be good predictors of the adult outcomes, including persistence of ASD diagnosis/symptoms, psychosocial adjustment, and educational/occupational attainment, besides current IQs. Performance IQ remained essentially unchanged from childhood to adulthood, while Verbal IQ had made some significant improvement. The outcome variables were themselves all interrelated. Those ASD children starting with lower IQs at childhood would continue at early adulthood having lower IQs, persistence of ASD diagnosis/symptoms, poorer adjustment, and lower educational/occupational attainment or vice versa.

Conclusions:  

Even amongst ASD individuals with normal intelligence, IQs remained potent predictors of their early adult outcomes. Our present outcome data indicated substantial developmental impairments/disadvantages with strong persistence of ASD diagnosis/symptoms. However, when compared to many previous studies, the early adult outcomes of our ASD individuals in Hong Kong were in fact at the favorable end. This could partly be explained by including only ASD adults with normal intelligence in our study. Or, this could also be partly due to facilitative environmental factors in Hong Kong such as an expanding economy with a labor market close to full employment, as well as to recent world-wide technological advances, including the mass availability of computers and web-based social networking platforms. Nonetheless, the overall chronicity and impairing nature of ASD identified here highlighted the needs for a wide range of services tailored to the adult problems of ASD in areas of education, vocational training, work, or independent living, besides those persistent autistic symptoms/traits.