Addressing the Needs of Adolescents and Adults with Autism: A Crisis on the Horizon

This article describes a longitudinal analysis of the behavior of a birth cohort of 435 boys. 4 groups were defined at age 13 on the basis of both self-reported delinquent behavior and professional diagnosis of Attention Deficit Disorder: ADD + delinquent, ADD only, delinquent only, and nondisordered. Biennial correlates of delinquency (antisocial behavior problems, verbal intelligence, reading difficulty, and family adversity) were traced across childhood. The ADD + delinquent boys consistently fared the worst on the assessments of family adversity, verbal intelligence, and reading. Their antisocial behavior began before school age, escalated at school entry, and persisted into adolescence. The ADD-only boys had normal family, intelligence, and reading scores, and showed only mild antisocial behavior in middle childhood. The delinquent-only boys showed no early risk from family, low intelligence, or reading deficit, and remained relatively free of conduct problems until they initiated delinquency at age 13. Persistence of criminal offending beyond adolescence is predicted for the ADD + delinquent boys.

To describe the age-specific and lifetime incremental societal costs of autism in the United States. Estimates of use and costs of direct medical and nonmedical care were obtained from a literature review and database analysis. A human capital approach was used to estimate lost productivity. These costs were projected across the life span, and discounted incremental age-specific costs were computed. United States. Hypothetical incident autism cohort born in 2000 and diagnosed in 2003. Discounted per capita incremental societal costs. The lifetime per capita incremental societal cost of autism is $3.2 million. Lost productivity and adult care are the largest components of costs. The distribution of costs over the life span varies by cost category. Although autism is typically thought of as a disorder of childhood, its costs can be felt well into adulthood. The substantial costs resulting from adult care and lost productivity of both individuals with autism and their parents have important implications for those aging members of the baby boom generation approaching retirement, including large financial burdens affecting not only those families but also potentially society in general. These results may imply that physicians and other care professionals should consider recommending that parents of children with autism seek financial counseling to help plan for the transition into adulthood.

To determine the demographic and psychosocial correlates of physical and sexual abuse among children with autism. Data collected from 1997 to 2000 through the national evaluation of the Comprehensive Community Mental Health Services for Children and their Families Program on 156 children with autism were used. Data included a baseline assessment of child and family psychosocial experiences and presenting problems associated with referral into system-of-care service, demographic information, and a clinical record review to obtain psychiatric diagnosis. Binary and multinomial logistic regression was used to determine the association of different characteristics of children who were abused compared with those who were not abused. Caregivers reported that 18.5% of children with autism had been physically abused and 16.6% had been sexually abused. Physically abused children more likely had engaged in sexual acting out or abusive behavior, had made a suicide attempt, or had conduct-related or academic problems. Sexually abused children more likely had engaged in sexual acting out or abusive behavior, suicidal or other self-injurious behavior, had run away from home, or had a psychiatric hospitalization. In adjusted multivariate models, the relationship between sexual abuse and sexual acting out, running away from home and suicidal attempts persisted. Based on the prevalence of abuse and its association with various behaviors, clinicians should be as attuned to the psychosocial histories of children with autism as they are for other children, and consider the potential of abuse when these behaviors are observed.