Many adults above 40 with autism spectrum disorder (ASD) have not been diagnosed or were diagnosed late into adulthood. Furthermore, those diagnosed may have limited community resources and assistance in adult life. The objective of this systematic review is to identify the current discourse on this topic and to identify voids in research and resources. An overview of ASD is presented, along with information on co-occurring conditions, services provided to adults with ASD, and considerations for employment, independent living, and social integration. A discussion of the challenges and solutions to the barriers faced by adults with ASD is provided. In addition, the paper provides a list of recommendations to assist vocational rehabilitation practitioners in better serving this population.
Get full access to this article
View all access options for this article.
References
1.
AdreonD.DurocherJ. S.Evaluating the college transition needs of individuals with highfunctioning autism spectrum disordersIntervention in School and Clinic425271–2792007
2.
American Psychiatric Association.Diagnostic and statistical manual of mental disordersDSM-5 ®). Author2013
3.
AttwoodT.Romantic relationships for young adults with Asperger's Syndrome and high-functioning autismhttps://iancommunity.org2009
BaldwinS.CostleyD.WarrenA.Employment activities and experiences of adults with highfunctioning autism and Asperger's Disorder 10.1007/s10803-014-2112-z Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-014-2112-z 44102440–24492014
6.
BillstedtE.GillbergI. C.GillbergC.Autism after adolescence: Population-based 13to 22-year follow-up study of 120 individuals with autism diagnosed in childhood 10.1007/s10803-005-3302-5 Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-005-3302-5 353351–3602005
7.
BolmanW. M.Brief report: 25-year followup of a high-functioning autistic child 10.1007/s10803-007-0362-8 Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-007-0362-8 381181–1832008
8.
BroadstockM.DoughtyC.EgglestonM.Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder 10.1177/1362361307078132 Autism : The International Journal of Research and Practice https://doi.org/10.1177/1362361307078132 114335–3482007
9.
BurgessS.CimeraR. E.Employment outcomes of transition-aged adults with autism spectrum disorders: A state of the States report 10.1352/1944-7558-119.1.64 American Journal on Intellectual and Developmental Disabilities https://doi.org/10.1352/1944-7558-119.1.64 119164–832014
10.
Centers for Disease Control and Prevention (CDCPrevalence of autism spectrum disorder among children aged 8 years -autism and developmental disabilities monitoring network, 11 sites, United StatesMorbidity and Mortality Weekly Reporthttps://www.cdc.gov/mmwr/preview/mmwrhtml/ss6302a1.htm6321–212010
11.
CervantesP. E.MatsonJ. L.Comorbid symptomology in adults with autism spectrum disorder and intellectual disability 10.1007/s10803-015-2553-z Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-015-2553-z 45123961–39702015
12.
CoeB. P.GirirajanS.EichlerE. E.The genetic variability and commonality of neurodevelopmental disease 10.1002/ajmg.c.31327 American Journal of Medical Genetics. Part C, Seminars in Medical Genetics https://doi.org/10.1002/ajmg.c.31327 160118–1292012
13.
CroenL. A.ZerboO.QianY.MassoloM. L.RichS.SidneyS.KripkeC.The health status of adults on the autism spectrum 10.1177/1362361315577517 Autism : The International Journal of Research and Practice https://doi.org/10.1177/1362361315577517 197814–8232015
14.
FreedmanR. I.BoyerN. C.The power to choose: Supports for families caring for individuals with developmental disabilities 10.1093/hsw/25.1.59 Health & Social Work https://doi.org/10.1093/hsw/25.1.59 25159–682000
15.
FungL. K.MahajanR.NozzolilloA.BernalP.KrasnerA.JoB.CouryD.WhitakerA.Veenstra-VanderweeleJ.HardanA. Y.Pharmacologic treatment of severe irritability and problem behaviors in autism: A systematic review and meta-analysis 10.1542/peds.2015-2851K Pediatrics https://doi.org/10.1542/peds.2015-2851K 137Supp 2124–S1352016
GhaziuddinM.GredenJ.Depression in children with autism/pervasive developmental disorders: A case-control family history study 10.1023/a:1026036514719 Journal of Autism and Developmental Disorders https://doi.org/10.1023/a:1026036514719 282111–1151998
HappéF. G.MansourH.BarrettP.BrownT.AbbottP.CharltonR. A.Demographic and cognitive profile of individuals seeking a diagnosis of autism spectrum disorder in adulthood 10.1007/s10803-016-2886-2 Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-016-2886-2 46113469–34802016
20.
HedleyD.CaiR.UljarevicM.WilmotM.SpoorJ. R.RichdaleA.DissanayakeC.Transition to work: Perspectives from the autism spectrum 10.1177/1362361316687697 Autism : The International Journal of Research and Practice https://doi.org/10.1177/1362361316687697 225528–5412018
21.
HendricksD.Employment and adults with autism spectrum disorders: Challenges and strategies for success 10.3233/JVR-2010-0502 Journal of Vocational Rehabilitation322125–1342010
22.
HendricksD. R.WehmanP.Transition from school to adulthood for youth with autism spectrum disorders: Review and recommendations 10.1177/1088357608329827 Focus on Autism and Other Developmental Disabilities https://doi.org/10.1177/1088357608329827 24277–882009
23.
HillierA.CampbellH.MastrianiK.IzzoM. V.Kool-TuckerA. K.CherryL.BeversdorfD. Q.Two-year evaluation of a vocational support program for adults on the autism spectrum 10.1177/08857288070300010501 Career Development for Exceptional Individuals https://doi.org/10.1177/08857288070300010501 30135–472007
24.
HowlinP.Outcome in adult life for more able individuals with autism or Asperger syndrome 10.1177/1362361300004001005 Autism https://doi.org/10.1177/1362361300004001005 4163–832000
25.
HowlinP.GoodeS.HuttonJ.RutterM.Adult outcome for children with autismJournal of Child Psychology and Psychiatry, and Allied Disciplines https://doi.org/452212–2292004
26.
HurtigT.KuusikkoS.MattilaM. L.HaapsamoH.EbelingH.JussilaK.JoskittL.PaulsD.MoilanenI.Multi-informant reports of psychiatric symptoms among high-functioning adolescents with Asperger syndrome or autismAutism : The International Journal of Research and Vocational Rehabilitation, Independent Living, and Social Integration2009
27.
Practice 10.1177/1362361309335719 https://doi.org/10.1177/1362361309335719 13583–598
28.
KalinoskiZ. T.Steele-JohnsonD.PeytonE. J.LeasK. A.SteinkeJ.BowlingN. A.A meta-analytic evaluation of diversity training outcomes 10.1002/job.1839 Journal of Organizational Behavior https://doi.org/10.1002/job.1839 3481076–11042013
29.
KeelJ. H.MesibovG. B.WoodsA. V. 10.1023/a:1025813020229 Journal of Autism and Developmental Disorders https://doi.org/10.1023/a:1025813020229 273–91997TEACCH-supported employment program
30.
KittayE.AdamsR.ReissB.SerlinD.DependenceKeywords in disability studiesNew York University Press54–582015
31.
KoegelL. K.AshbaughK.KoegelR. L.DetarW. J.RegesterA. 10.1002/pits.21715 Increasing socialization in adults with Asperger's syndrome. Psychology in the Schools https://doi.org/10.1002/pits.21715 50899–9092013
32.
LawerL.BrusilovskiyE.SalzerM. S.MandellD. S.Use of vocational rehabilitative services among adults with autism 10.1007/s10803-008-0649-4 Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-008-0649-4 393487–4942009
33.
LorenzT.FrischlingC.CuadrosR.HeinitzK.Autism and overcoming job barriers: Comparing job-related barriers and possible solutions in and outside of autism-specific employment 10.1371/journal.pone.0147040 PloS One https://doi.org/10.1371/journal.pone.0147040 1112016
34.
LugnegårdT.HallerbäckM. U.GillbergC.Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome 10.1016/j.ridd.2011.03.025 Research in Developmental Disabilities https://doi.org/10.1016/j.ridd.2011.03.025 3251910–19172011
MattilaM. L.HurtigT.HaapsamoH.JussilaK.Kuusikko-GauffinS.KielinenM.LinnaS. L.EbelingH.BloiguR.JoskittL.PaulsD. L.MoilanenI.Comorbid psychiatric disorders associated with Asperger syndrome/highfunctioning autism: A community-and clinicbased study 10.1007/s10803-010-0958-2 Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-010-0958-2 4091080–10932010
37.
MordreM.GroholtB.KnudsenA. K.SponheimE.MykletunA.MyhreA. M.Is long-term prognosis for pervasive developmental disorder not otherwise specified different from prognosis for autistic disorder? Findings from a 30-year follow-up study 10.1007/s10803-011-1319-5 Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-011-1319-5 426920–9282012
38.
MüllerE.SchulerA.BurtonB. A.YatesG. B.Meeting the vocational support needs of individuals with Asperger syndrome and other autism spectrum disabilitiesJournal of Vocational Rehabilitation183163–1752003
39.
MunesueT.OnoY.MutohK.ShimodaK.NakataniH.KikuchiM.High prevalence of bipolar disorder comorbidity in adolescents and young adults with high-functioning autism spectrum disorder: A preliminary study of 44 outpatients 10.1016/j.jad 02.015Journal of Affective Disorders https://doi.org/10.1016/j.jad 1112-3170–1752008
40.
MurphyC. M.WilsonC. E.RobertsonD. M.EckerC.DalyE. M.HammondN.GalanopoulosA.DudI.MurphyD. G.McalonanG. M.Autism spectrum disorder in adults: Diagnosis, management, and health services development 10.2147/NDT.S65455 Medical comorbidities in autism spectrum disorders: A primer for health care professionals and policy makerspdf National Autistic Societywww.autism.org.uk/about/adult-life/ageing/aspx121669–16862016 2013. March. 2013. 2017Getting older
41.
NesbittS.Why and why not? Factors influencing employment for individuals with Asperger syndrome 10.1177/1362361300004004002 Autism https://doi.org/10.1177/1362361300004004002 44357–3692000
42.
NicholasD. B.RobertsW.MacintoshC.Advancing vocational opportunities for adults with Autism Spectrum Disorder: Proceedings from the 1st annual Canadian ASD Vocational ConferenceCurrents: Scholarship in Human Services1311–192014
43.
O'reganD.TobianskyR.Diagnosing autism spectrum disorders in older adultsCME Journal of Geriatric Medicine33146–512014
44.
OrsmondG. I.KraussM. W.SeltzerM. M.Peer relationships and social and recreational activities among adolescents and adults with autism 10.1023/b:jadd.0000029547.96610.df Pennsylvania Bureau of Autism Serviceshttps://www.dhs.pa.gov/Services/Disabilities-Aging/Documents34245–2562004Housing options for adults with autism spectrum disorder. Autism%20Services/Housing%20 Options%20for%20Adults%20with%20Autism %20Spectrum%20Disorder.pdf
45.
PhillipsB. N.DeichesJ.MorrisonB.ChanF.BezyakJ. L.Disability diversity training in the workplace: Systematic review and future directions 10.1007/s10926-015-9612-3 Journal of Occupational Rehabilitation https://doi.org/10.1007/s10926-015-9612-3 263264–2752016
46.
PivenJ.RabinsP.AutismOlder Adults Working GroupAutism spectrum disorders in older adults: Toward defining a research agenda 10.1111/j.1532-5415.2011.03632.x Journal of the American Geriatrics Society https://doi.org/10.1111/j.1532-5415.2011.03632.x 59112151–21552011
47.
RentyJ. O.RoeyersH.Quality of life in high-functioning adults with autism spectrum disorder: The predictive value of disability and support characteristics 10.1177/1362361306066604 Autism: The International Journal of Research and Practice https://doi.org/10.1177/1362361306066604 105511–5242006
48.
RouxA. M.RastJ. E.AndersonK. A.ShattuckP. T.A. J. Drexel Autism Institute, Drexel UniversityNational autism indicators report: Vocational rehabilitationLife Course Outcomes Research Program2016
49.
SarrettJ.Interviews, disclosures, and misperceptions: Autistic adults’ perspectives on employment related challenges 10.18061/dsq.v37i2.5524 Disability Studies Quarterly https://doi.org/10.18061/dsq.v37i2.5524 3722017
50.
SchallC.Positive behavior support: Supporting adults with autism spectrum disorders in the workplaceJournal of Vocational Rehabilitationhttps://vcurrtc.org/resources/viewContent.cfm/875322109–1152010
51.
ShattuckP. T.NarendorfS. C.CooperB.SterzingP. R.WagnerM.TaylorJ. L.Postsecondary education and employment among youth with an autism spectrum disorder 10.1542/peds.2011-2864 Pediatrics https://doi.org/10.1542/peds.2011-2864 12961042–10492012
52.
TrammellB.WilczynskiS. M.DaleB.McintoshD. E.Assessment and differential diagnosis of comorbid conditions in adolescents and adults with autism spectrum disorders 10.1002/pits.21720 Psychology in the Schools https://doi.org/10.1002/pits.21720 509936–9462013
53.
VohraR.MadhavanS.SambamoorthiU.Comorbidity prevalence, healthcare utilization, and expenditures of Medicaid enrolled adults with autism spectrum disorders 10.1177/1362361316665222 Autism : The International Journal of Research and Practice https://doi.org/10.1177/1362361316665222 218995–10092017
