Academic Achievement during Early Childhood As a Predictor of Adult Outcomes in ASD: Longitudinal Follow-up from Age 2 to 26 Years

Background: Recent research highlights the wide variability in outcomes during adulthood in individuals with ASD (Howlin, 2004). Academic skills are associated with behavioral and mental health outcomes in typically developing children (Bond et. al, 2007); however, we know little about the link between early childhood academic skills and adult outcomes such as independent living, employment, and quality of life in individuals with ASD.

Objectives: Given our previous findings that children with ASD demonstrated relative delays in achievement compared to IQ (Kim et al., 2017), we examined if achievement levels relative to cognitive skills at age 9 would predict adult outcomes at age 26.

Methods: Participants included 111 children referred for possible ASD at age 2 (n=76 with a final diagnosis of ASD). Academic achievement was measured by the Wide Range Achievement Test (WRAT). Difference scores between achievement and full-scale IQ (FSIQ) were calculated for reading, spelling, and arithmetic domains. At age 26, the following outcomes were measured: Employment (full/part time paid job vs. no paid job); Independent Living (living independently vs. living with parents/in group homes); Driving (yes vs. no); Vineland Adaptive Behavioral Scale (VABS), and Psychological Well-Being Questionnaire (WBQ; Table 1). Regression analyses were used to examine if the achievement-FSIQ difference scores at age 9 would predict age 26 outcomes.

Results: Relative delays in achievement in reading, spelling, and arithmetic compared to FSIQ at age 9 predicted age 26 employment, independent living, and driving status, while controlling for age, gender, maternal education, and ASD diagnosis. Relative delays in achievement in reading, spelling, and arithmetic compared to FSIQ also predicted more impairments in the VABS Socialization, Communication, and Daily Living domains and lower scores for psychological well-being (WBQ). When FSIQ was controlled, relative delays in spelling compared to FSIQ at age 9 still remained as a significant predictor of lower scores for psychological well-being (WBQ). All p<0.05.

Conclusions: Results based on a longitudinal cohort of children with ASD followed from age 2 to 26 suggest that the patterns of academic achievement at age 9 have significant, longer-term impacts on adult outcomes. Results highlight the importance of developing effective interventions tailored to improving academic skills in individuals with ASD during early childhood, which would have cascading effects on their quality of life and well-being during adulthood.