What happens to autistic children when they get older?

The increased prevalence of autism, now estimated between 1 and 88 children and 1 and 50 males will present a sizeable challenge to the educational and health systems. But despite the increase in research in autism, little is known about the course of the condition in adults.

Some of what we know can offer clues to the overall pathophysiology of autism. For example, we know children with autism have a characteristic overgrowth in brain volume by the age of 2. Also, by the time individuals become adults, the parts of the brain that originally were larger become smaller over time, and those with autism have different patterns of aging compared with those without the disorder. The process suggests an underlying developmental process prompted by genetic and environmental factors that begins very early, but continues throughout life.

More clues about resilience and psychological functioning in autism can be gained from adults. About one-third of adults with autism will possess a savant skill, perhaps in mathematics or puzzle solving. Adults with autism may possess certain abilities that make them suited to high-level jobs that require precision and detail, eg, examining software code for mistakes. Also, the overall severity of autistic symptoms tends to diminish with age, and measures of verbal fluency don’t show the same decline as in normal adults.

Yet, problems exist. Adults with autism are likely to be medicated with multiple agents and be unhappy with the overall quality of their health care. They receive less preventive care and rely more on emergency rooms. Studies have shown that less than 20% of adults with autism will have a good or very good outcome. More than half will still live at home, and only 14% will be in a long-term relationship. About 33% of adults with autism will attend college, and about half will have some employment within 6 years of leaving high school. Many young adults with autism receive no services after leaving high school.

Meta-analyses have indicated that there is little evidence to prove what works best to maximize outcome. However, it seems supported employment programs may lead to better chances of remaining employed in a competitive environment. Certain businesses and programs do show that innovation can help these individuals find suitable employment. Families with autistic children need to educate themselves and begin transition planning by the age of 16 to increase the chance for a successful outcome.