Importance: Understanding early predictors of independent performance of daily living skills (DLS) in adolescents with autism can guide targeted interventions to promote independence and improve outcomes. Objective: To compare DLS performance among adolescents with autism, other developmental disabilities (DD), and the general population (POP), and identify early childhood predictors of independently performed DLS acquired by adolescence. Design, Setting, and Participants: This longitudinal study collected data from caregivers of adolescents 12 to 16 years old (2018-2021) with a mean follow-up of 9.7 (range, 7-12) years. The study took place at 4 US sites that surveyed caregivers of adolescents from the Study to Explore Early Development (SEED). Participants included caregivers of adolescents who participated in SEED at ages 2 to 5 years. Analyses were conducted June to August 2025. Exposure: Adolescents who met diagnostic criteria for autism at ages 2 to 5 years. Main Outcomes and Measures: The primary outcome was independent DLS in adolescence measured with the Waisman Activities of Daily Living scale. Other measures included early learning abilities, social symptoms, emotional functioning, and intellectual disability (ID) in adolescence. Model-based recursive partitioning identified early childhood predictors of independent DLS acquired by adolescence. Results: The analytic sample included 852 caregivers of adolescents (median age, 14.7 years; 533 male 63% and 319 female 37%): 204 with autism, 341 with other DD, and 307 in the POP group. Adolescents with autism had lower Waisman Activities of Daily Living Scale scores (median IQR, 24.5 17-29) compared with the DD (30 IQR, 26-33) and POP groups (32 IQR, 30-33) (P < .001). Compared with the DD and POP groups, adolescents with autism performed fewer DLS independently with frequency decreasing as skill complexity increased. Among adolescents with autism or other DD, those with lower expressive language and fine motor skills in early childhood acquired the fewest number of independent DLS, while those with stronger expressive language, without ID, and with fewer attention problems in early childhood acquired the greatest number of independent DLS. Conclusion and Relevance: In this study, DLS were lower in adolescents with autism compared with adolescents without autism. Early expressive language, fine motor skills, and attention problems predicted wide variation in the independent DLS acquired by adolescents with autism and other DD. These findings highlight potential early prognostic indicators that may help prioritize early support to improve DLS acquisition and promote greater independence.
Powell et al. (Mon,) studied this question.