Abstract
Over the past four decades there have been significant advances in our understanding of autism, yet services for autistic adults continue to lag far behind those for children, and prospects for employment and independent living remain poor. Adult outcomes also vary widely and while cognitive and language abilities are important prognostic indicators, the influence of social, emotional, familial and many other factors remains uncertain. For this special issue marking the 40th anniversary of DSM-III, the present paper describes the changing perspectives of autism in adulthood that have occurred over this period, explores individual and wider environmental factors related to outcome, and suggests ways in which services need to be changed to improve the future for adults living with autism.
Highlights
In the four decades since the publication of DSM-III (American Psychiatric Association [APA] 1980) there have been many changes in our understanding of autism
To mark the 40th anniversary of DSM-III, the following article focuses principally on research conducted over the intervening period that has changed our understanding of autism in adulthood
While many follow-up studies have focused on the difficulties associated with adulthood, the outstanding achievements of some autistic adults have led to increased interest in those individuals who are described as having “optimal outcomes”, “very positive outcomes”, or even as showing “recovery” from autism
Summary
When DSM-III appeared 40 years ago, Infantile Autism remained the formal diagnostic classification and autism was still considered as a predominantly childhood disorder. At the time of publication of DSM-III, autism was generally viewed as being almost always associated with moderate to severe intellectual impairment and diagnostic criteria required “gross deficits in language development”. The wide range of intellectual and language skills associated with autism was highlighted in Lorna Wing’s article (1981), “Asperger’s syndrome: a clinical account”. This described a group of individuals, many of whom were adults, who, despite showing the core symptoms of autism were of at least average intellectual ability, often had good language, and tended to possess well developed skills or interests in areas such as memory, mathematics, astronomy, history, geography, geology, etc. The diagnostic category of “Asperger’s Disorder” did not survive into DSM-5, its introduction at the time was important in describing the heterogeneity of cognitive and linguistic abilities in autism and highlighting the significant potential of many autistic adults
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