Change in Autism Symptoms and Maladaptive Behavior after Exiting High School

I’m not quite in the mood for studying. However, I thought that, since I’ve been nominated for best autism spectrum blogger in the Mental Nurse TWIM blog awards, I’d better do an autism post for a change. This time, I’m going to review a study on a subject that is dear to my heart: the effects of exiting high school on autism symptomatology and maladaptive behaviors in adolescents and young adults with ASD.

The study authors measured autistic symptoms using mothers’ responses on the Autism Diagnostic Interview-Revised (ADI-R) and maladaptive behaviors using the behavior problems subscale of the Scales of Independent Behavior-Revised (SIB-R), a scale I’ve never heard of so can’t judge. The ADI-R has four subscales – non-verbal communication, verbal communication, repetitive and stereotyped behaviors, and reciprocal social interaction. A symptom was rated as either present or absent, which allowed for a conservative estimate of improvement. On the SIB-R, there are three subscales – internalized behavior, externalized behavior, and asocial behavior -, and in this case, the mothers filling out the scale did rate severity and frequency. Autism symptoms and maladaptive behaviors were assessed at five different times over a ten-year period. For this study, only those who would exit high school during the study period or who were still in high school at the end of the study period (N = 242) were eligible. They were a subgroup of a larger study of 406 autistic adolescents and adults.

The study authors hypothetized that there would be a continuing improvement in symptomatology, but that improvement would slow down after high school exiting. This hypothesis was indeed confirmed. On all autism symptom subscales except for verbal communication, progress slowed or was reversed into a decline after high school exiting. The same goes for the internazed behavior score, but not externalized or asocial behavior.

The authors hypothetize that the reason for the slowed improvement after high school, is the less stimulating adult services as compared to school services. However, they cannot prove this by comparing services, because they did not examine them. I think there are numerous other explanations: ones the authors already mentioned, such as hormonal changes and slowing cognitive development, but also post-high school burn-out from a too stimulating environment.

Unlike what the authors expecting, the slowing in improvement after high school was the greatest among those who did not have an intellectual disability (ID). The authors assume that this is because the services to adults without intellectual disabilities are poorer than those for autistics who do have ID. This is quite possible, since a lot less non-ID autistics have employment or day activities than do autistics with ID.

Family socio-economic status had some influence on trajectories, where autistics living in the lower classes had more change in improvement after exiting high school than did those in the higher classes. This was, however, difficult to prove, because the sample included an overrepresentation of Caucasians and those in the higher socio-economic classes.

The authors recommend that adult day activities and employment programs should be improved to adequately serve autistics, especially those without intellectual disabilities. This is rather an early conclusion, given that services were not examined. However, any improvement to autism services is always welcome, of course.

Reference

Taylor J, Seltzer M (2010), Changes in the Autism Behavioral Phenotype During the Transition to Adulthood. Journal of Autism and Developmental Disorders, 40(12):1431-1446. DOI: 10.1007/s10803-010-1005-z.