Examining Daily Living Skills in Adults with Autism Spectrum Disorder

Background: Daily living skills (DLS) are the often taken-for-granted everyday activities needed for independent adult life. For adults with autism spectrum disorder (ASD), DLS are a predictor of employment success and post-secondary education (Gray et al., 2014; Klinger, et al., 2015). Across the life span, DLS for individuals with ASD lag behind non-disabled peers regardless of intellectual ability (Bal et al., 2015), with adults having the most significant deficits in community skills (Matthews et al., 2015). However, studies investigating DLS in adults are limited and lack detail regarding specific strengths and challenges.

Objectives: The objectives of this study were to examine the factor structure of DLS and to identify areas of strengths and needs at the factor and item level for adults with ASD based on conversational ability to inform the development of targeted interventions.

Methods: Caregivers of 274 adults diagnosed with ASD completed the Waisman Activities of Daily Living Scale (W-ADL), a 17-item scale developed for individuals with developmental disabilities. An exploratory factor analysis of the W-ADL using a varimax rotation was completed. The mean score for each subdomain and each item were calculated. In addition, the level of independence was calculated for each item. A one-way ANOVA was conducted to compare the effect of conversation ability on DLS. Within each conversation group, mean scores for each subdomain and level of independence on each item was calculated.

Results: Results of the factor analysis revealed a three-factor solution: Instrumental Activities of Daily Living (IADL), Self-Care and Simple Domestic Skills (SC), and Eating. Mean scores were: IADLs: 5.87 (Max score = 14), SC: 11.82 (Max score = 16), and Eating: 3.88 (Max score = 4). Only 8% percent (N= 22) of the sample received the maximum total score of 34, which reflects skills of a typical adult. Nearly all adults (95%) were independent in Eating. In the subdomain of SC, over 75% were independent with toileting and dressing but only 44% completed simple household tasks independently. In the IADL subdomain less than 20% were independent preparing a complete meal, doing basic home repairs, and managing finances. There was a statistically significant difference between conversation groups on SC and IADLs but not Eating, with those in the “good conversation” group showing the most independence, and those in the “no conversation” group being the most dependent across subdomains (see Table 1). However, those in the “good conversation” group still had significant deficits in IADLs (M= 9.3; Max score = 14) and less than 40% being independent in more complex activities.

Conclusions: As expected, conversation ability predicted DLS. Those with good conversation ability demonstrated strengths in Eating and SC but continued to have significant challenges with IADLs, skills considered essential for independent living. Results indicate a need for individually tailored interventions for individuals across the life span and across the spectrum. Programs designed to address IADLs of those with good conversation skills are crucial while interventions aimed at increasing independence in SC should be targeted for those with more significant conversation challenges.