A Mixed-Methods Approach to Understanding the Abilities and Transition Experiences of Young Adults with ASD and Their Parents

Background: The current understanding of adult outcome in autism spectrum disorder (ASD) stems primarily from quantitative analysis of large datasets or clinically ascertained samples. There is a relative dearth of qualitative data that describe experiences during the transition to adulthood, which could contribute to improved understanding of the needs of this population. This study examined the abilities and transition-related experiences of young adults with ASD without intellectual disability using a mixed-methods approach.

Objectives: (1) To compare intellectual and adaptive functioning among young adults with ASD to determine whether previous findings of an adaptive functioning (AF) disadvantage would replicate in the current sample, and (2) to qualitatively explore transition experiences of young adults and their parents.

Methods: Participants were 18 young adults with an ASD diagnosis (14 males; ages 18-33 years; M=24.55, SD=4.16) and at least one parent (15 mothers, 3 mother/father dyads). All young adults had a composite IQ ≥ 70 (M=95.67, SD = 13.88), and all but one met criteria for autism/autism spectrum on the ADOS-2. We oversampled for employed adults (n = 8); the remaining 10 participants included 2 full-time college students, 2 part-time college students, 1 high school student (age 21), 2 participants about to begin jobs, and 3 unemployed participants not enrolled in school.

Parents completed the ABAS-3 (Harrison & Oakland, 2015), a questionnaire about their young adult’s AF. Participants and their parent(s) completed separate 90-minute semi-structured interviews developed by the authors about independent living skills, employment, and post-secondary education. Interviews were coded line-by-line using grounded theory methodology (Strauss & Corbin, 1990). Qualitative findings include axial codes derived from the interviews of 10 participants and their parents. Coding of remaining interviews is in progress and final analyses will include focused coding of all interviews from the full sample.

Results: Depicted in Figure 1, within-subjects ANOVA followed by Bonferroni post hoc tests indicated that composite IQ was significantly higher than ABAS-3 conceptual, social, and practical AF standard scores (ps ≤ .001). Table 1 reports preliminary axial codes from qualitative analysis.

Conclusions: Quantitative analyses replicated previous findings (Matthews et al., 2017) such that participants had significantly lower AF scores relative to intelligence scores. Visual examination of Figure 1 suggests that employed adults had a smaller intellectual-adaptive functioning gap relative to unemployed adults, which may indicate that employment allows young adults to develop increased independence in social and practical AF. Future research using a prospective design should examine this possibility.

Supporting AF impairments documented by quantitative analysis, preliminary qualitative analysis indicated that most participants needed reminders to initiate daily living tasks or to complete tasks adequately, despite knowing how to complete these tasks. Participants with relatively high levels of independence attributed their success to parents setting clear expectations for independence during adolescence. Most employed adults and their parents described methods for overcoming barriers to employment. A minority of participants experienced events that caused substantial interruptions to independence. Qualitative findings provide insight into the well-documented intelligence-AF gap. Findings will inform future interventions aimed at improving the transition to adulthood.