Aging Well on the Autism Spectrum: An Examination of the Dominant Model of Successful Aging

  • Ye In HwangEmail author
  • Kitty-Rose Foley
  • Julian N. Trollor
Original Paper


There is a gap in our knowledge of aging with autism. The present study examined the applicability of the popular gerontology concept of “aging well” to autistic adults. Using survey data, a model of “aging well” was operationalised and applied to 92 autistic adults and 60 controls. A very small proportion (3.3%) of autistic adults were found to be aging well. Significantly less autistic adults were “maintaining physical and cognitive functioning” and “actively engaging with life” in comparison to controls. Whilst important differences in health and functioning status were found, the current dominant model of “aging well” is limited for examining autistic individuals. Suggested adjustments include development of a broader, more flexible and strengths -based model.


Adulthood Aging Aging well Successful aging Theory Medical comorbidities Physical functioning Cognitive functioning Activities of daily living Social participation Employment Education 



The authors also acknowledge the valuable contribution of the Research Advisory Network and members of the Autism CRC Research Academy whose insight and recommendations shaped this work. We also gratefully acknowledge the cooperation and participation of all participants on the autism spectrum and their carers involved in this study.

Author Contributions

YIH was involved in formulating the research question, designing the study, ethics preparation, recruitment, data collection, data analysis and writing the manuscript. K-RF was involved formulating the research question, designing the study, recruitment, data analysis and editing the manuscript. JT was involved in formulating the research question, designing the study and editing the manuscript.


This work was supported by the Cooperative Research Centre for Living with Autism (Autism CRC), established and supported under the Australian Government’s Cooperative Research Centres Program.


  1. American Psychiatric Association. (2013). Neurodevelopmental disorders. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association. Scholar
  2. Australian Bureau of Statistics. (2017). Autism in Australia. Canberra: Australian Bureau of StatisticsGoogle Scholar
  3. Baron-Cohen, S., Wheelwirght, S., Skinner, R., Martin, J., & Clubley, E. (2001). The autism-spectrum quotient (AQ): evidence from asperger/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31(1), 5–17.CrossRefPubMedGoogle Scholar
  4. Bennett, M. (2015). “What is it like for adults with ASDs in old age?” A letter about the scant amount of literature on the elderly with autism spectrum disorders. Age and Ageing. Scholar
  5. Bennett, M. (2016). “What is Life Like in the Twilight Years?” A letter about the scant amount of literature on the elderly with autism spectrum disorders. Journal of Autism and Developmental Disorders, 46(5), 1883–1884. Scholar
  6. Birch, R. C., Foley, K.-R., Pollack, A., Britt, H., Lennox, N., & Trollor, J. N. (2017). Problems managed and medications prescribed during encounters with people with autism spectrum disorder in Australian general practice. Autism. Scholar
  7. Bosnes, I., Almkvist, O., Bosnes, O., Stordal, E., Romild, U., & Nordahl, H. M. (2016). Prevalence and correlates of successful aging in a population-based sample of older adults: The HUNT study. International Psychogeriatrics, 29(3), 1–10. Scholar
  8. Bowling, A., & Iliffe, S. (2006). Which model of successful ageing should be used? Baseline findings from a British longitudinal survey of ageing. Age and Ageing, 35(6), 607–614. Scholar
  9. Bowling, A., & Iliffe, S. (2011). Psychological approach to successful ageing predicts future quality of life in older adults. Health and Quality of Life Outcomes, 9(1), 13. Scholar
  10. Braden, B. B., Smith, C. J., Thompson, A., Glaspy, T. K., Wood, E., Vatsa, D., … Baxter, L. C. (2017). Executive function and functional and structural brain differences in middle-age adults with autism spectrum disorder. Autism Research, 10(12), 1945–1959. Scholar
  11. Brown, L. J., & Bond, M. J. (2016). Comparisons of the utility of researcher-defined and participant-defined successful ageing. Australasian Journal on Ageing, 35(1), E7–E12. Scholar
  12. Brugha, T. S., Spiers, N., Bankart, J., Cooper, S.-A., McManus, S., Scott, F. J., … Tyrer, F. (2016). Epidemiology of autism in adults across age groups and ability levels. The British Journal of Psychiatry: The Journal of Mental Science. Scholar
  13. Cashin, A., Buckley, T., Trollor, J. N., & Lennox, N. (2016). A scoping review of what is known of the physical health of adults with autism spectrum disorder. Journal of Intellectual Disabilities. Scholar
  14. Chowdhury, M., Benson, B. A., & Hillier, A. (2010). Changes in restricted repetitive behaviors with age: A study of high-functioning adults with autism spectrum disorders. Research in Autism Spectrum Disorders, 4(2), 210–216. Scholar
  15. Croen, L. a., Zerbo, O., Qian, Y., Massolo, M. L., Rich, S., Sidney, S., & Kripke, C. (2015). The health status of adults on the autism spectrum. Autism. Scholar
  16. Cusack, J., Shaw, S., Spiers, J., & Sterry, R. (2016). Personal tragedies, public crisis: The urgent need for a national response to early death in autism. London: Autistica.Google Scholar
  17. Elichaoff, F. (2015). What’s it like being you? Growing old(er) with autism spectrum conditions—A Scoping Study. The European Journal of Social and Behavioural Sciences, 13(2), 1851–1864. Scholar
  18. Feng, Q., Son, J., & Zeng, Y. (2014). Prevalence and correlates of successful ageing: a comparative study between China and South Korea. European Journal of Ageing, 12(2), 83–94. Scholar
  19. Fortuna, R. J., Robinson, L., Smith, T. H., Meccarello, J., Bullen, B., Nobis, K., & Davidson, P. W. (2015). Health conditions and functional status in adults with autism: A cross-sectional evaluation. Journal of General Internal Medicine. Scholar
  20. Freedman, V. A. (2014). Research gaps in the demography of aging with disability. Disability and Health Journal, 7, S60–S63. Scholar
  21. Hategan, A., Bourgeois, J. A., & Goldberg, J. (2017). Aging with autism spectrum disorder: an emerging public health problem. International Psychogeriatrics, 29(04), 695–697. Scholar
  22. Hirvikoski, T., Mittendorfer-Rutz, E., Boman, M., Larsson, H., Lichtenstein, P., & Bö, S. (2015). Premature mortality in autism spectrum disorder. The British Journal of Psychiatry. Scholar
  23. Hoekstra, R. A., Vinkhuyzen, A. A. E., Wheelwirght, S., Bartels, M., Boomsma, D. I., Baron-Cohen, S., … van der Sluis, S. (2011). The construction and validation of an abridged version of the Autism-Spectrum Quotient. Journal of Autism and Developmental Disorders, 41, 589–596.CrossRefPubMedGoogle Scholar
  24. Howlin, P., Goode, S., Hutton, J., & Rutter, M. (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry and Allied Disciplines, 45(2), 212–229. Scholar
  25. Hsu, H., & Jones, B. L. (2012). Multiple trajectories of successful aging of older and younger cohorts. The Gerontologist 52(6), 843–856. Scholar
  26. Hwang, Y. I., Foley, K.-R., & Trollor, J. N. (2017). Aging well on the autism spectrum: the perspectives of autistic adults and carers. International Psychogeriatrics, 29(12), 1–14. Scholar
  27. Jones, K. B., Cottle, K., Bakian, A., Farley, M., Bilder, D., Coon, H., & McMahon, W. M. (2015). A description of medical conditions in adults with autism spectrum disorder: A follow-up of the 1980s Utah/UCLA Autism Epidemiologic Study. Autism. Scholar
  28. Kapp, S. K., Gillespie-Lynch, K., Sherman, L. E., & Hutman, T. (2012). Deficit, difference, or both? Autism and neurodiversity. Developmental Psychology, 49(1), 59–71. Scholar
  29. Khanna, R., Jariwala, K., & West-Strum, D. (2015). Validity and reliability of the Medical Outcomes Study Short-Form Health Survey version 2 (SF-12v2) among adults with autism. Research in Developmental Disabilities, 43–44, 51–60. Scholar
  30. Knight, T., & Ricciardelli, L. A. (2003). Successful aging: Perceptions of adults aged between 70 and 101 years. International Journal of Aging & Human Development, 56(3), 223–245. Scholar
  31. Kozar-Westman, M., Troutman-Jordan, M., & Nies, M. A. (2013). Successful aging among assisted living community older adults. Journal of Nursing Scholarship, 45(3), 238–246. Scholar
  32. Lever, A. G., Werkle-bergner, M., Brandmaier, A. M., Ridderinkhof, K. R., & Geurts, H. M. (2015). Atypical working memory decline across the adult lifespan in autism spectrum disorder? Journal of Abnormal Psychology, 124(4), 1014–1026. Scholar
  33. Levy, A., & Perry, A. (2011). Outcomes in adolescents and adults with autism: a review of the literature. Research in Autism Spectrum Disorders, 5, 1271–1282.CrossRefGoogle Scholar
  34. Maenner, M. J., Smith, L. E., Hong, J., Makuch, R., Greenberg, J. S., & Mailick, M. R. (2013). Evaluation of an activities of daily living scale for adolescents and adults with developmental disabilities. Disability and Health Journal, 6(1), 8–17. Scholar
  35. Martinson, M., & Berridge, C. (2014). Successful aging and its discontents: A systematic review of the social gerontology literature. The Gerontologist, 55(1), 58–69. Scholar
  36. McLaughlin, S. J., Connell, C. M., Heeringa, S. G., Li, L. W., & Roberts, J. S. (2010). Successful aging in the United States: Prevalence estimates from a national sample of older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 65(2), 216–226. Scholar
  37. Minkler, M., & Fadem, P. (2002). Successful aging: a disability perspective. Journal of Disability Policy Studies, 12(4), 229–235.CrossRefGoogle Scholar
  38. Myers, E., Davis, B. E., Stobbe, G., & Bjornson, K. (2015). Community and social participation among individuals with autism spectrum disorder transitioning to adulthood. Journal of Autism and Developmental Disorders, 45, 2373–2381.CrossRefPubMedGoogle Scholar
  39. Nicolaidis, C., Raymaker, D., McDonald, K., Dern, S., Boisclair, W. C., Ashkenazy, E., & Baggs, A. (2013). Comparison of healthcare experiences in autistic and non-autistic adults: A cross-sectional online survey facilitated by an academic-community partnership. Journal of General Internal Medicine, 28(6), 761–769. Scholar
  40. Perkins, E. A., & Berkman, K. A. (2012). Into the unknown: Aging with autism spectrum disorders. American Journal on Intellectual and Developmental Disabilities, 117(6), 478–496. Scholar
  41. Pinto, J. M., & Neri, A. L. (2017). Trajectories of social participation in old age: a systematic literature review. Brazilian Journal of Geriatrics and Gerontology, 20(2), 259–272. Scholar
  42. Robertson, A. E., & Simmons, D. R. (2015a). The sensory experiences of adults with autism spectrum disorder: A qualitative analysis. Perception, 44, 569–586. Scholar
  43. Robertson, A. E., & Simmons, D. R. (2015b). The sensory experiences of adults with autism spectrum disorder: A qualitative analysis. Perception, 44(5), 569–586. Scholar
  44. Rosenthal, M., Wallace, G. L., Lawson, R., Wills, M. C., Yerys, B. E., & Kenworthy, L. (2013). Impairments in real world executive function increase from childhood to adolescence in autism spectrum disorders. Neuropsychology, 27(1), 13–18. Scholar
  45. Rowe, J. W., & Kahn, R. L. (1987). Human aging: Usual and successful. Science, 237(4811), 143–149.CrossRefPubMedGoogle Scholar
  46. Rowe, J. W., & Kahn, R. L. (1997). Successful aging. The Gerontologist, 37(4), 433–440. Scholar
  47. Schmidt, L., Kirchner, J., Strunz, S., Broźus, J., Ritter, K., Roepke, S., & Dziobek, I. (2015). Psychosocial functioning and life satisfaction in adults with autism spectrum disorder without intellectual impairment. Journal of Clinical Psychology, 71(12), 1259–1268. Scholar
  48. Smith, L. E., Maenner, M. J., & Seltzer, M. M. (2012). Developmental trajectories in adolescents and adults with autism: The case of daily living skills. Journal of the American Academy of Child & Adolescent Psychiatry, 51(6), 622–631.CrossRefGoogle Scholar
  49. StataCorp. (2015). Stata statistical software. College Station: StataCorp LP.Google Scholar
  50. Stowe, J. D., & Cooney, T. M. (2014). Examining Rowe and Kahn’s concept of successful aging: Importance of taking a life course perspective. The Gerontologist, 55(1), 1–8. Scholar
  51. Strawbridge, W. J., Wallhagen, M. I., & Cohen, R. D. (2002). Successful aging and well-being: Self-rated compared with Rowe and Kahn. The Gerontologist, 42(6), 727–733. Scholar
  52. Stuart Hamilton, I., & Morgan, H. (2011). What happens to people with autism spectrum disorders in middle age and beyond? Report of a preliminary on-line study. Advances in Mental Health and Intellectual Disabilities, 5(2), 22–28. Scholar
  53. Szatmari, P., Bryson, S., Duku, E., Vaccarella, L., Zwaigenbaum, L., Bennett, T., & Boyle, M. H. (2009). Similar developmental trajectories in autism and Asperger syndrome: From early childhood to adolescence. The Journal of Child Psychology and Psychiatry, 12, 1459–1467. Scholar
  54. Tate, R. B., Swift, A. U., & Bayomi, D. J. (2013). Older men’s lay definitions of successful aging over time: The Manitoba follow-up study. International Journal of Aging and Human Development, 76(4), 297–322.CrossRefPubMedGoogle Scholar
  55. Tobin, M. C., Drager, K. D. R., & Richardson, L. F. (2014). A systematic review of social participation for adults with autism spectrum disorders: Support, social functioning, and quality of life. Research in Autism Spectrum Disorders, 8(3), 214–229. Scholar
  56. Tyler, C. V., Schramm, S. C., Karafa, M., Tang, A. S., & Jain, A. K. (2011). Chronic disease risks in young adults with autism spectrum disorder: Forewarned is forearmed. American Association on Intellectual and Developmental Disabilities, 116(5), 371–380.CrossRefGoogle Scholar
  57. Üstün, T. B., Chatterji, S., Kostanjsek, N., Rehm, J., Kennedy, C., Epping-Jordan, J., … Pull, C. (2010). Developing the world health organization disability assessment schedule 2.0. Bulletin of the World Health Organization, 88(11), 815–823. Scholar
  58. Wahl, H.-W., Deeg, D., & Litwin, H. (2016). Successful ageing as a persistent priority in ageing research. European Journal of Ageing, 13(1), 1–3. Scholar
  59. Wehman, P., Brooke, V., Brooke, A. M., Ham, W., Schall, C., McDonough, J., … Avellone, L. (2016). Employment for adults with autism spectrum disorders: A retrospective review of a customized employment approach. Research in Developmental Disabilities, 53–54, 61–72. Scholar
  60. Wright, S. D., & Wadsworth, A. M. (2015). Autism and aging: Research, community services and programs, and policy issues. The Gerontologist, 55(Suppl_2), 480.Google Scholar
  61. Wright, S. D., Wright, C. A., D’Astous, V., & Wadsworth, A. M. (2016). Autism aging. Gerontology & Geriatrics Education, 00(00), 1–17. Scholar
  62. Zerbo, O., Massolo, M. L., Qian, Y., & Croen, L. A. (2015). A study of physician knowledge and experience with autism in adults in a large integrated healthcare system. Journal of Autism and Developmental Disorders, 45(12), 4002–4014. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ye In Hwang
    • 1
    • 2
    Email author
  • Kitty-Rose Foley
    • 1
    • 2
  • Julian N. Trollor
    • 1
    • 2
  1. 1.Department of Developmental Disability Neuropsychiatry, School of PsychiatryUNSWSydneyAustralia
  2. 2.Cooperative Research Centre for Living with Autism (Autism CRC)BrisbaneAustralia

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