What Skills Should Adaptive Functioning Interventions for Intellectually Able, Transition-Aged Youth Target? an Examination of Caregiver Responses on the Vineland-II

Background:  Research indicates the need for effective adaptive functioning (AF) interventions for intellectually able adolescents and adults with autism spectrum disorder (ASD). Specifically, adult outcomes are suboptimal (Eaves & Ho, 2008; Gary et al., 2014), and development of AF skills in intellectually able individuals appears to stagnate relative to cognitive development (Kanne et al., 2011). In order to develop effective interventions, targets must first be identified.

Objectives:

(1) To examine profiles of intellectual and adaptive functioning in intellectually able adolescents and adults and with ASD.

(2) To identify daily living skills (DLS) that the majority of intellectually able individuals and adults are unable to complete independently.

Methods:  Participants were 29 adolescents (M age = 15.20, SD = 1.10), 37 young adults (M age = 21.22, SD= 2.95), and one caregiver of each participant. Participants had a DSM-IV or DSM-5 ASD diagnosis, met criteria for autism or autism spectrum on the ADOS or ADOS-2 administered by a research reliable rater, and had a composite IQ of 70 or above on the KBIT-2 (Kauffman & Kauffman, 2004). Each caregiver was administered the Vineland Adaptive Behavior Scales Survey Interview, Second Edition (Sparrow et al., 2005).

Results:

A 2 (age group) x 4 (IQ, Communication, DLS, Socialization) ANOVA was used to examine profiles of intellectual and adaptive functioning. The adolescent group had significantly higher scores than the adult group on all assessments (F(1, 64) = 22.40, p < .001; pairwise ps < .01). Across groups, intellectual functioning was significantly higher than all AF domains (F(3, 192) = 140.01, p < .001; pairwise ps < .001). The group by assessment interaction was not significant. Because the adolescent group had significantly higher IQs than the adult group, a 2 (age group) x 3 (AF domains) ANCOVA controlling for IQ was conducted. The adolescent group had higher (ps < .02) or marginally higher (socialization: p = .09) scores in all three domains (F(1, 63) = 6.79, p = .01). The main effect of AF domain and the interaction were not significant. Across groups, socialization scores were significantly lower than communication and DLS scores (pairwise ps < .001). DLS items were examined separately using percentages. DLS items were selected for analyses given their relevance to independent living and employment. Items for which more than one third of the sample were not functioning independently were identified as potential intervention targets (Table 1).

Conclusions:  Findings replicate previous reports of a gap between intellectual and adaptive functioning in intellectually able individuals. Additionally, response percentages identified a number of skills that the majority of adolescents and adults in the current sample do not complete independently. These skills should be considered in the development of AF interventions for transition-aged youth. Reinforcing the need for this type of intervention, very few adult participants had held a part-time (n = 7) or full-time (n = 1) job for at least one year.