The Big Move: Predictors of Residential Status and Age at Leaving the Family Home in Adults With Neurodevelopmental Disabilities

Living arrangements play essential roles in the lives of adults with autism and neurodevelopmental disabilities (NDDs). Many individuals with NDDs face challenges transitioning from the family home to long-term independent or supported living arrangements, but few studies have examined the ages at which residential transitions may occur within NDD adulthood, nor how residential transition ages differ by co-occurring intellectual disability (ID) status. This study examined predictors of residential status and residential transition ages among 134 American adults (52% with ID) diagnosed with NDDs, primarily autism, in childhood. Kaplan-Meier survival analyses revealed 37% of participants with ID moved from the family home by their mid-30s (predominantly to supported living), compared to 69% without ID (predominantly to independent living). Cox models indicated higher family income and irritability (behavioral difficulties) predicted earlier-aged transitions among participants with ID; these effects were stronger at younger ages. For participants without ID, greater autistic behaviors predicted later-aged transitions; these effects strengthened with age. Findings point to potential "windows of opportunity" to transition to independent or supported living between ages 18 and 22, though these windows may differ by adult symptom and family income profiles. Needs for early-aged, equitable access to residential planning services are discussed.Lay AbstractHousing is a major part of daily life. This study investigated the ages at which adults with autism or neurodevelopmental disabilities (NDDs) leave the family home to move into longer-term supported or independent living settings, and how those pathways differ for those with and without co-occurring intellectual disability (ID). Among 134 American adults diagnosed with NDDs (mostly autism) in childhood, 37% of participants with co-occurring ID had moved by roughly their mid-30s (predominantly to supported living, for example, group homes), compared to 69% of those without ID (predominantly to independent living). Different factors were linked to moving at different ages. Among people with ID, those with higher family income and those with more irritability (behavioral challenges) were more likely to move out earlier, especially around ages 18 to 22. Among people without ID, those with greater autistic behaviors tended to move later in adulthood; this pattern became stronger with age. These findings suggest neurodivergent adults with different support needs follow unique pathways to moving out of the family home, and that both individual traits, such as irritability and autistic behaviors, and family financial assets may shape these pathways in complex ways. However, for both adults with and without ID, there may be key "windows of opportunity" for moving out in early adulthood (around ages 18-22). These results highlight the need for more numerous and flexible supported housing models, and for equitable and earlier-aged access to supports (such as functional skills supports) that help adults with NDDs both with and without ID to make transitions to supported and independent living if and when they desire them.