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Cited by 255Autism Spectrum Disorder ResearchDown syndrome and intellectual disability researchFamily and Disability Support Research

Cognitive and language skills in adults with autism: a 40‐year follow‐up

Howlin, Patricia, Savage, Sarah, Moss, Philippa, Tempier, Althea, Rutter, Michael·2014·Journal of Child Psychology and Psychiatry
DOI 10.1111/jcpp.12115
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Abstract

Background: It is well established that very few individuals with autism spectrum disorders ( ASD ) and an IQ below 70 are able to live independently as adults. However, even amongst children with an IQ in the normal range, outcome is very variable. Childhood factors that predict later stability, improvement or decline in cognitive functioning remain uncertain and, in particular, very little is known about trajectories in later adulthood. Method: Changes in cognitive and language ability from childhood to adulthood were assessed in 60 individuals with autism, all of whom had an IQ in the average range as children. Mean age in childhood = 6 years (range 2–13 years); mean age in adulthood = 44 years (range 29–64 years). Trajectories of change and factors related to current cognitive abilities were explored. Results: For the majority of participants ( N = 45, 75%), who were testable both as children and adults, IQ remained very stable and language also improved over time. However, 15 individuals could not be assessed on standard tests as adults and their developmental level could be estimated only on the Vineland Adaptive Behavior Scales. Almost all these adults (apart from one who had suffered a major stroke) showed severe aggressive or self‐injurious behaviours; none had ever developed language above a 3‐year level, and seven had developed epilepsy. Conclusions: For most individuals with autism who had an IQ in the average range (i.e. ≥70) as children, childhood IQ proved a reliable predictor of cognitive functioning well into mid‐ to‐ later adulthood. However, a significant minority was no longer testable on standard tests as adults. Their current very low levels of functional ability were generally associated with severe behavioural disturbance and persisting and severe language impairment; 50% of these individuals had also developed epilepsy, pointing to the role of organic brain dysfunction. Implications for early intervention are discussed.

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Crossref · 10.1111/jcpp.12115

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  • IQ and language level are closely tied to overall functioning and outcome in ASD.

    “IQ and language level are closely tied to overall functioning and outcome in ASD (Anderson et al. 2014, Howlin et al. 2013), so for practical purposes, knowing an individual's IQ and functional language ability usually serves as a reasonable proxy for how severely affected the individual is.”

    From Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum Disorder (2015) · cites this paper as Howlin et al. 2013

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Authors
Howlin, P., Savage, S., Moss, P., Tempier, A., & Rutter, M.
Affiliations
  • The University of Sydney (AU)
  • Department of Psychology Institute of Psychiatry London UK
  • MRC Social, Genetic and Developmental Psychiatry Centre Institute of Psychiatry London UK
Corresponding author
Howlin, Patricia
ORCID
Venue
Journal of Child Psychology and Psychiatry
Publisher
Wiley
Published
2013-07-15
Volume
55
Issue
1
Pages
49-58
ISSN
  • 0021-9630 (ISSN-L)
  • 1469-7610
DOI
10.1111/jcpp.12115
OpenAlex
W2048166438
Cited by
255
References
13
Citations by year
2026: 12 · 2025: 11 · 2024: 22 · 2023: 22 · 2022: 21 · 2021: 33 · 2020: 15 · 2019: 27 · 2018: 16 · 2017: 17 · 2016: 20 · 2015: 22 · 2014: 14 · 2013: 2
FWCI
10.60
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of Child Psychology and Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
Nuffield Foundation
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
  • Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
Keywords
autism spectrum disorder, autistic adults, language development, IQ stability, language impairment, adaptive behavior, epilepsy, organic brain dysfunction, early intervention, long-term outcomes
MeSH terms
Adult, Child Development Disorders, Pervasive, Cognition Disorders, Female, Follow-Up Studies, Humans, Intelligence, Language Development Disorders, Male, Middle Aged, Predictive Value of Tests, Time Factors

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