6 ASD and Aging in Adulthood  

ASD symptoms often decline in quantity and intensity over time due to acquisition and use of new and added adaptive skills; however, such decline may plateau in the late 20s or at the time when many educational or support programs decrease (McGovern & Sigman, 2005; Piven, Harper, Palmer, & Arndt, 1996; Seltzer et al., 2003; Smith et al., 2012; Taylor & Seltzer, 2010, 2011; Shattuck et al., 2007). Continued engagement in educational programs, sustained access to supports and services, and participation in sustained, meaningful employment or service contribute to continued gains in daily living skills, reductions in behavior, improved physical and mental health, and optimal gains in overall quality of life (Taylor et al., 2012). However, as individuals with ASD move into adulthood, the network of support that surrounded them in early childhood and continued through to school and transition planning tends to narrow thus limiting their ability to manage their health care, to live independently, to access and retain jobs, and to sustain relationships without adequate planning (Farley et al., 2018).

Retrospective reviews of health records among adults with ASD also reflect increased rates of select mental (e.g., depression, obsessive-compulsive disorder (OCD)) and physical (i.e., sleep, immune and gastrointestinal (GI) disorders, obesity, hypertension) health problems while other health conditions were less than (e.g., sexually transmitted diseases, smoking, alcohol misuse) or comparable (e.g., hypothyroidism, constipation) to the general population (Fortuna et al, 2016). While education and awareness of these considerations is essential to individual’s primary care and treating providers, it is noted that many adults with ASD who have treatable conditions report difficulty in accessing and advocating for appropriate health care (Nicolaidis et al., 2013). Both self-advocacy and health care management skills on behalf of the individual with ASD as well as awareness and consideration of everyday health needs of adults with ASD among providers can influence his/her presenting and long-term healthcare outcomes.

With a need for a sustainable network and effective health care transition planning and management, gainful employment is a key social determinant of health and overall outcomes. Employment or engagement in meaningful vocational or volunteer experiences enhances individuals’ overall quality of life, encourages improved psychological well-being, and promotes healthier aging (Health People, 2020). While a range of services are necessary to support adults with ASD, many adults with ASD express frustration in pursuing added social opportunities or finding work commensurate with their skills or in areas of interest (Seltzer et al., 2011; Van Bourgondien, Dawkins, & Marcus, 2014).

While much research and effort has been accomplished and is relatively well-established in the work of health and education services for individuals with ASD, services, research, and legislation for adults with ASD is burgeoning and in its early stages. Increased work is need with a focus on evidence-based and cost-effective models of care to enable adults with ASD to access coordinated, high quality health and social care across the lifespan.