Adult outcome for children with autism Howlin P, Goode
S, Hutton J, Rutter M Abstract: J Child Psychology and Psychiatry 45:2 (2004), pp 212–229 Findings Information on long-term prognosis in autism is limited. Outcome is known to be poor for those with an IQ below 5. However, regardless of the cause of their difficulties, only a minority of children with an IQ less than 50 achieve independence as adults. There have been few systematic studies of individuals with an IQ above 50. To study the outcomes of children into adulthood, Dr. Howlin and her colleagues followed 68 children meeting the criteria for autism and a performance IQ of 50 or above into adulthood. Their mean age when first seen was 7 years; at follow-up, their average age was 29 years, at which time they measured standard cognitive, language, and attainment tests as well as social, communication, and behavioral problems. Of the 68 individuals, outcomes were rated as “very good” (12%) , “good” (10%), and “fair” (19%); however, most adults were rated with an outcome of “poor” (46%) and “very poor” (12%). A majority of the adults remained dependent on their families and other support services, although a minority of adults had achieved some independence. Few individuals lived alone, had close friends, or permanent employment, and their communication was generally impaired and reading and spelling abilities were poor. Stereotyped behaviors persisted into adulthood. The adults with a childhood performance IQ of at least 70 had a significantly better outcome than those with an IQ below 70. However, within the normal IQ range, outcome was variable and, on an individual level, neither verbal nor performance IQ were reliable tests predicting outcome. Conclusions Many individuals with autism continue to make progress in adulthood. About 20% of the children obtained an academic qualification and 30% were in employment. However, a majority of adults with autism that had an IQ of over 50 as a child remained dependent on their parents or support groups in adulthood. IQ scores (especially non-verbal tests) remain stable into adulthood; thus, intellectual functioning is a reliable predictor of outcome—thus, individuals with IQ over 70 are likely to do well. However, even in this high IQ group a great variation in outcome was observed. Routines, rituals, and stereotypies,are not strongly influenced by IQ and the authors caution that these behaviors may ‘swamp’ or overcome the effects of a high IQ. It is clear that IQ is far from being a perfect predictor of outcome. An individual’s ability to function independently in adulthood life may depend as much on the degree of support offered (by families, employment and social services) as on basic intelligence. Dr. Howlin and colleagues suggest that “a focus on access to more extensive and appropriate supported living and employment schemes could help to ensure much greater progress in the future”. |