Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders
Open accessAbstract
Background: The range of outcomes for young adults with Autism Spectrum Disorders ( ASD ) and the early childhood factors associated with this diversity have implications for clinicians and scientists. Methods: This prospective study provided a unique opportunity to predict outcome 17 years later for a relatively large sample of children diagnosed with ASD at 2 years old. Diagnostic and psychometric instruments were administered between 2 and 19 with data from 2, 3, and 19 included in this study. Clinicians administered tests without knowledge of previous assessments whenever possible. Caregivers provided additional information through questionnaires. Results: Significant intellectual disabilities at 19 were predicted by age 2 about 85% of the time from VIQ and NVIQ scores together, though prediction of young adult outcome for youths with average or higher intelligence was more complex. By 19, 9% of participants had largely overcome core difficulties associated with ASD and no longer retained a diagnosis. These youths with Very Positive Outcomes were more likely to have participated in treatment and had a greater reduction in repetitive behaviors between age 2 and 3 compared to other Cognitively Able youths ( VIQ ≥70) with ASD . Very Positive Outcome youths did not differ phenotypically from Cognitively Able ASD individuals at 2 but both groups differed from Cognitively Less Able individuals ( VIQ <70). Conclusion: Those most at risk for intellectual disabilities and ASD can be reliably identified at an early age to receive comprehensive treatment. Findings also suggest that some cognitively able children with ASD who participate in early intervention have very positive outcomes, although replication with randomized, larger samples is needed. In order to improve understanding of very positive outcomes in ASD , future research will need to identify how variations in child characteristics and environmental factors contribute to the nature and timing of growth across individuals and areas of development.
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Although it is possible to identify some children with ASD before parents or professionals have identified concerns, diagnosis is missed in many children, and most tested cohorts have not been systematically followed up to identify later-onset ASD in children who initially tested negatively.
“In addition, although it is possible to identify some children with ASD before parents or professionals have identified concerns, diagnosis is missed in many children 147 , and most tested cohorts have not been systematically followed up to identify later-onset ASD in children who initially tested negatively 148”
From Autism spectrum disorder (2020) · cites this paper as [147]
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Experimental — accuracy not yet measuredLanguage skills and IQ (nonverbal at early ages; verbal at later ages) are the strongest predictors of outcome both in naturalistic studies and in response to treatment.
“Nevertheless, language skills and IQ (nonverbal at early ages; verbal at later ages) are the strongest predictors of outcome both in naturalistic studies (Anderson et al. 2014) and in response to treatment (Beglinger & Smith 2005, Howlin et al. 2004, Sallows & Graupner 2005).”
From Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum Disorder (2015) · cites this paper as Anderson et al. 2014
The Results (Cognitively Able vs. Cognitively Less Able Youths; page unavailable) identify childhood IQ as the best predictor of the age-19 IQ group: verbal and nonverbal IQ together at age 2, and verbal IQ alone at age 3. The paper does not establish language skills as a separate strongest predictor, and its strongest-predictor finding concerns later IQ grouping rather than young-adult outcomes generally. The treatment-response portion of the sentence is attributed to other citations, not Anderson et al. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIQ 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 Anderson et al. 2014
Social communication deficits show significant abatement over time for some individuals with ASD.
“social communication deficits, which show significant abatement over time for some individuals with ASD (Anderson et al. 2014, Shattuck et al. 2007).”
From Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum Disorder (2015) · cites this paper as Anderson et al. 2014
Early evaluation, diagnosis, and evidence-based interventions could enhance short-term and long-term developmental outcomes for young children with ASD.
“Early routine screening for ASD and other developmental concerns is recommended by the American Academy of Pediatrics (1) because early evaluation, diagnosis, and evidence-based interventions could enhance short-term and long-term developmental outcomes for young children with ASD (2–6).”
Although a minority of autistic adults achieve very good or very positive outcomes, autistic adults are far less likely than nonautistic counterparts to have a job, live independently, or have extensive social networks.
“Although a minority achieve 'very good' (Howlin et al. 2004) or 'very positive' (Anderson et al. 2014; see also Fein et al. 2013) outcomes, autistic adults are far less likely than their nonautistic counterparts to have a job, live independently or to have extensive social networks”
From Childhood Executive Function Predicts Later Autistic Features and Adaptive Behavior in Young Autistic People: a 12-Year Prospective Study (2019) · cites this paper as Anderson et al. 2014
For cognitively able autistic individuals, adult outcomes are variable and not straightforward to predict on the basis of early language and intellectual functioning alone.
“This is not necessarily the case, however, for cognitively-able individuals, whose adult outcomes are notoriously variable and less than straightforward to predict on the basis of early language and intellectual functioning alone (e.g., Anderson et al. 2014;Howlin et al. 2004).”
From Childhood Executive Function Predicts Later Autistic Features and Adaptive Behavior in Young Autistic People: a 12-Year Prospective Study (2019) · cites this paper as Anderson et al. 2014
Early treatment may be more beneficial than treatment started at older ages.
“which research suggests may be more beneficial than treatment started at older ages.26,27,28”
From Evaluation of the Diagnostic Stability of the Early Autism Spectrum Disorder Phenotype in the General Population Starting at 12 Months (2019) · cites this paper as [26]
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- Authors
- Anderson, D. K., Liang, J. W., & Lord, C.
- Affiliations
- Cornell University (US)
- University of Denver (US)
- Corresponding author
- Anderson, Deborah K.
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2013-12-09
- Volume
- 55
- Issue
- 5
- Pages
- 485-494
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- PMC
- PMC5819743
- OpenAlex
- W2092522680
- Cited by
- 401
- References
- 36
- Citations by year
- 2026: 21 · 2025: 21 · 2024: 37 · 2023: 41 · 2022: 32 · 2021: 44 · 2020: 39 · 2019: 41 · 2018: 21 · 2017: 25 · 2016: 37 · 2015: 30 · 2014: 10 · 2013: 1
- FWCI
- 14.20
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH081873)
- National Institute of Child Health and Human Development (U 19 HD 035482)
- Autism Speaks
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
- Keywords
- autism spectrum disorder, intellectual disability, cognitive ability, early intervention, repetitive behavior, outcome trajectories, early childhood predictors, treatment participation
- MeSH terms
- Adolescent, Age Factors, Child, Child Development Disorders, Pervasive, Child, Preschool, Female, Humans, Intelligence Tests, Male, Intellectual Disability, Neuropsychological Tests, Prospective Studies, Psychiatric Status Rating Scales, Psychometrics, Young Adult
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