Assessment of adaptive behavior in autism spectrum disorder

Adaptive behavior skills are often delayed in autism spectrum disorder (ASD), and these behaviors are significantly associated with poor outcomes in adulthood, especially for autistic individuals that have no cognitive and/or language delays. Therefore, despite having the capacity to be self‐sufficient, the vast majority of autistic adults fail to obtain successful levels of employment, independent living, and interpersonal relationships. Given that more than 60% of autistic individuals have intact cognition and language, adaptive behavior skills need to be appropriately assessed as part of the diagnostic process of ASD, and profiles of delays and deficits need to be accommodated throughout development. This paper provides guidelines for conducting adaptive behavior assessments as part of a comprehensive diagnostic evaluation for ASD, which is now considered standard practice. The history and definition of the construct of adaptive behavior are discussed, and considerations for the administration of various measures, interpretation of results, and translation of findings into intervention strategies are provided. Key Points Adaptive behavior skills are those skills that every individual needs for personal social and self‐sufficiency throughout life. Deficits or delays in adaptive functioning are common across many neurodevelopmental disorders, particularly autism spectrum disorder (ASD). Individuals on the autism spectrum tend to have the greatest delays in adaptive or functional social interaction skills. In ASD, gaps between chronological age and intellectual ability tend to be the greatest for individuals who do NOT have cognitive and/or language impairments, and these gaps tend to widen with age. Delays in adaptive functioning are strongly correlated with poorer adult outcomes in ASD, even for individuals who have no cognitive or language impairment. Adaptive behavior skills are extremely modifiable, meaning that they can change quickly over time, particularly if direct intervention/instruction targets specific adaptive skills. Fostering adaptive skills from the time of ASD diagnosis is critical for optimizing adult outcomes and maximizing any individual's potential for self‐sufficiency. School systems need to embed strategies and supports to teach and hone adaptive skills within educational programs. Waiting until “transition” years is far too late.