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J Autism Dev Disord. Author manuscript; available in PMC 2019 September 01.
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Published in final edited form as:

J Autism Dev Disord. 2018 September ; 48(9): 2925–2937. doi:10.1007/s10803-018-3545-6.

Parent Expectations and Preparatory Activities as Adolescents

with ASD Transition to Adulthood
Laura G. Holmes, Ph.D.1,2, Anne V. Kirby, Ph.D.3, Donald S. Strassberg, Ph.D., ABPP1, and
Michael B. Himle, Ph.D.1
1University of Utah Department of Psychology, 380 South 1530 East BEHS 502, Salt Lake City,
UT 84112
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2Children’sHospital of Philadelphia Center for Autism Research, 2716 South Street, 5th Floor,
Philadelphia, PA 19146
3Universityof Utah Department of Occupational and Recreational Therapies, 520 Wakara Way,
Salt Lake City, UT 84108

Abstract
Community stakeholders, researchers, and providers are increasingly focused on individual,
family, and systemic factors that contribute to positive outcomes for adults on the autism spectrum.
Parent expectations for their youth’s future are associated with adult outcomes (e.g., employment,
school success, independence), yet the mechanism for this effect remains unclear. This study
investigated how expectations were related to parent transition-related activities in a sample of 298
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parents of adolescents on the autism spectrum (48% female adolescents), stratified by parent-
reported IQ (average or above, borderline, or below 70). Parent expectations for the future
predicted engagement in some activities intended to enhance adult outcomes when controlling for
IQ, gender, age, and household income. The results have implications for how providers discuss
expectations and support families in preparing for adulthood.

Keywords
Transition; Adulthood; Vocation; Parents; Gender

Adult outcomes for individuals with autism spectrum disorder (ASD) are of great concern
for families, practitioners, policy makers, and individuals with ASD. Studies have shown
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that many individuals with ASD achieve limited independence in adulthood, are unemployed
or underemployed with low hours and wages (Carter et al. 2012; Cimera and Cowan 2009;
Roux et al. 2013), are less likely to participate in post-secondary education (Eaves and Ho
2008; Shattuck et al. 2012), are socially isolated (Howlin et al. 2013; Liptak et al. 2011), and
need ongoing support in daily activities (Farley et al. 2009; Taylor and Seltzer 2011).

Address all correspondence to: Laura G. Holmes, Address: 2716 South Street, 5th Floor, Office 5192, Philadelphia, PA 19146,
Phone number: 267-216-8680, [email protected].
Author contributions: LGH conceived of the study, participated in its design and coordination, recruited participants, performed the
statistical analyses, and drafted the manuscript. AVK conceived of the study, performed and interpreted statistical analyses, and drafted
the manuscript. MBH and DSS participated in study design and coordination, recruitment of participants, and helped to draft the
manuscript.
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Reflecting the need for high levels of support in adulthood, the average yearly costs of
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community services for an adult with ASD are estimated at $26,500 (Leigh et al. 2015).

Although less than optimal outcomes are common, there is a great deal of variability in adult
outcomes in ASD, with few factors serving as consistent predictors. Intellectual functioning
has been the most heavily studied predictor of adult outcomes, with studies finding that low
IQ is the strongest predictor of poor adult outcomes in ASD (Henninger and Taylor 2013;
Seltzer, Shattuck, Abbeduto, & Greenberg 2004). However, there remains considerable
variability in adult outcomes even among those with average or above-average IQ (Howlin et
al. 2013; Seltzer et al. 2004). Other factors have also been identified as predictors of more
positive adult outcomes, though less consistently, including better communication skills and
lesser diagnostic severity. Although not included in some discussions of adult outcome,
individuals with less socioeconomic advantage tend to have poorer postsecondary education
and employment outcomes than individuals with more advantage (Shattuck et al 2012).
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Women with autism are receiving increasing clinical, research, and media attention, yet there
remain few firm conclusions about gender differences in adult ASD symptom presentation
or experiences. For example, some research suggests that women with ASD have less
disruptive behavior than men, while other research has noted higher levels of self-injurious
behaviors, epilepsy, and social interaction impairment for women (Gray et al. 2012, Farley et
al. 2009; Perez & Sevilla 1993). The role of gender in predicting outcomes for adults with
ASD has only been minimally explored due to low proportions of females in adult outcome
studies (Magiati, Tay, & Howlin 2014), resulting in a high need for research focused on
females with ASD.

The Role of Parents in the Transition to Adulthood

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Although many individuals contribute to preparing youth for transition to adulthood,

including youth themselves and special education providers in high school, much of the
burden and stress of preparing youth with ASD to successfully transition to adulthood falls
to parents. For example, parents of youth with ASD are often responsible for making critical
decisions about what post-secondary activities are most realistic and appropriate for their
child (e.g., kinds of supports the youth needs to be successful, if youth will seek higher
education or employment opportunities; Lounds et al. 2007). Parents also play an active role
in identifying and engaging in activities that can facilitate or impede adolescents’
preparation for adult life. For example, evidence suggests that youth with severe disabilities
who are required to complete chores at home are significantly more likely to have post-
secondary employment after high school (Carter et al. 2012).
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Parent expectations for the future have been shown to predict the post-secondary outcomes
of individuals with disabilities, including ASD. Broadly, parent expectations are associated
with academic achievement (Yamamoto and Holloway 2010) and contribute to family
decision-making about the future (Hogan and Astone 1986; Lindstrom et al. 2007). Using
data from the National Longitudinal Transition Study-2 (NLTS2), Doren, Gau, and
Lindstrom (2012) found that parent expectation for future employment (i.e., paid job:
definitely will, probably will, probably will not, definitely will not) was a significant

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predictor of later employment for youth combined across multiple disability categories.
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Carter and colleagues (2012) reported similar findings for youth with severe disabilities. An
analysis focused on youth with ASD in the NLTS2 found that parent expectations function
as a significant mediator of longitudinal outcomes in the NLTS2 for youth with ASD.
Specifically, Kirby (2016) identified that socioeconomic status (i.e., race, household income,
and maternal education level) and youth functional status (i.e., academic performance, self-
care skills, social skills) significantly predicted parent expectations in adolescence, which
then predicted post-secondary outcomes in the areas of employment, independent living, and
social participation. Gender was also examined as a predictor of parent expectations, but was
not found to significantly predict expectations other than through an indirect relationship
between gender and functional performance (Kirby, 2016). Together, these studies suggest
that the role of parent expectations in predicting outcomes warrants further study.

Given broader societal differences between men and women in employment status, voting,
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and household management, parents of daughters and sons with ASD might have different
expectations for their youth’s future (Fisher, Egerton, Gershuny & Robinson 2007;
Schlozman, Burns, & Verba 1999), and these differing expectations could affect parent
transition-related activities. In addition to societal differences, practical concerns may play a
role in the choices parents make about adolescents’ participation in activities not supervised
by parents. While people of any gender presentation can be vulnerable to sexual abuse,
women and girls tend to report markedly higher rates of sexual victimization than males
(Finkelhor et al. 2014). Preliminary evidence suggests that parents of girls with ASD may be
more concerned about outcomes like unwanted pregnancy compared to parents of boys
(Holmes, Himle, & Strassberg 2016b). Parents must balance promoting autonomy with
monitoring youth to ensure safety during adolescence (DiClemente et al 2001; Dishion and
McMahon 1998), and parents may choose different activities for sons and daughters based
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on concerns.

Although several studies have shown an association between parent expectations and adult
outcomes in youth with ASD, the causal mechanisms are not well understood. One proposed
theory is that parent expectations influence the likelihood and/or degree to which parents
engage in preparatory activities (Yamamoto and Holloway 2010). Qualitative research
conducted by Kirby (2015) provides support for this theory among parents of youth with
ASD. Kirby interviewed parents of youth with ASD about their expectations for the future
and each participant described how their expectations were being enacted through their
various approaches to preparing for adulthood. To our knowledge, no quantitative study has
examined the association between expectations for adulthood (e.g., employment, education,
independence, or citizenship) and parent approaches to planning and preparing. However,
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Holmes and colleagues (2016a) reported that when parents had higher expectations that their
adolescent with ASD and intellectual disability would have sex or a romantic relationship,
they reported having discussed a greater number of sexuality-related topics with their child.
This provides preliminary support for the theory that parent expectations may contribute to
adult outcomes by shaping the discussions and activities that families of youth with ASD
engage in during childhood and adolescence.

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Study Purpose
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The goals of the current study were to identify family and youth factors that predict parent
expectations for the adult outcomes of youth with ASD, and to examine whether parent
expectations predict parents’ transition-preparation activities. Through this study, we sought
to test one theoretical mechanism through which parent expectations of youth with ASD are
associated with post-secondary outcomes, addressing the following aims. Aim 1 was to
identify family and youth factors that predict parent expectations for the adult outcomes of
youth with ASD. We hypothesized that parents of youth with lower intellectual functioning
and more severe ASD symptoms would have lower expectations for adult outcomes,
specifically within the domains of financial independence, school attainment, independent
living, and citizenship. Aim 2 was to determine whether parent expectations for the adult
outcomes of youth with ASD predict parent preparatory activities. We hypothesized that
higher parent expectations for adult outcomes would predict greater odds of parents
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endorsing that they engaged in relevant preparatory activities when controlling for their
youth’s intellectual functioning, age, gender, and household income. We chose to test
relationships between specific expectations domains (e.g., parent expectations that youth
will live independently) and relevant activities that would contribute to youth skill-building
in this domain (e.g., assigning household chores). It is possible that parent expectations in
other domains (e.g., financial independence) predict parent activities that are not directly
related to that domain (e.g., assigning household chores). However, we chose to test
theoretically plausible, direct relationships rather than exploring all associations between
expectations and parent activities in order to decrease the probability of Type 1 error.

Methods
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Recruitment and Participants

This research was approved by the authors’ university Institutional Review Board. Informed
consent was obtained from all individual participants included in the study. As reported in
[blinded for review], a subset of participants for the current study (n = 182) were recruited
through local and national autism support groups in the United States and were entered into
a raffle for ten $40 gift cards upon completing the survey. Our initial recruitment strategy
yielded a small sample of parents of female adolescents with ASD (n = 25). In order to
recruit a sample that would allow for examination of gender differences and to increase the
probability that results generalize to females with ASD, a secondary wave of targeted
recruitment of parents of adolescent females (n = 116) was conducted through the Interactive
Autism Network (IAN). Participants in this wave were paid $10 for completing the survey,
as is typical for IAN recruitment. Due to this targeted recruitment, the gender ratio in this
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study does not match the population gender ratio of individuals diagnosed with ASD. IAN is
a database of parents and individuals with ASD interested in participating in research
(Daniels et al., 2012). Parents from both groups were recruited through emails inviting them
to complete an anonymous online survey about ASD, parent expectations, and transition to
adulthood. Parents were eligible to participate if they reported that they had an adolescent
child (ages 12 – 18 years) with a formal ASD diagnosis conferred by a healthcare
professional (i.e., a physician, pediatrician, psychiatrist, or psychologist). Of the 308

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participants who completed the survey, 10 were removed from analyses because their child
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scored below the Social Responsiveness Scale-2 cutoff for ASD symptoms. The final sample
consisted of 298 parents.

Parent and youth demographic information is provided in Table 1.1 Parents were
predominantly Caucasian females with a median age of 46 years (M = 46.85, SD = 6.24)
and median income of 80,000–89,000 (range = <20,000 – >140,000). Most parents reported
that they were married or in a long-term relationship (79.2%). Most participants (69.5%)
characterized their location as suburban, with fewer reporting urban (16.3%) or rural
(13.9%) locations. Less than half of parents (44.3%) reported actively participating in an
autism support group. Of note, parents in the support group sample and the IAN sample did
not differ in terms of educational level (p = .90), income (p = .11), or religiosity (p = .23).

Parents reported on adolescents who were predominantly Caucasian males with a median
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age of 14 years (M = 14.36, SD = 1.83, range = 12 – 18 years). There was a slightly larger
proportion of younger adolescents (56%, 12–14 years) than older adolescents (44%, 15–18
years). Most youth in this sample were diagnosed with Asperger’s syndrome (41.1%) or
autism (35.7%), with 11.1% of parents reporting a diagnosis of pervasive developmental
disorder – not otherwise specified (PDD-NOS) and 11.4% of parents reporting that more
than one of these diagnoses had been provided. Parents reported that youth received these
diagnoses at a mean age of 6.1 years (SD = 3.65), with 51.6% diagnosed at or below 5 years
of age and 85.4% diagnosed at or below 10 years of age. Parents were asked to report their
youth’s measured IQ (if known, n = 257) or to provide an estimated IQ (n = 41). IQ was
presented in terms of standard scores and official descriptive guidelines (e.g., average,
slightly below average or borderline, severe, or profound mental retardation; American
Psychiatric Association 2000). Parents who did not know their child’s IQ were asked to
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estimate their youth’s overall level of cognitive functioning based on the same descriptive
guidelines. Per parent report, 66.1% of the adolescents fell in the average or above average
range (IQ = 86 – 116+), 12.8% had slightly below average or borderline IQ (71 – 85), 11.4%
had below average IQ or mild intellectual disability (ID; 56 – 70), 5.7% had far below
average IQ or moderate ID (41 – 55), and 4.1% had severe or profound ID (IQ ≤ 40). The
proportion of parents who estimated IQ was greater for parents of youth with ID than for
youth with average or above IQ (above average = 7% estimated, average = 8%, slightly
below average or borderline = 21%, below average or mild ID = 24%; far below average or
moderate ID = 19%, severe or profound ID = 50%). Most adolescents (64.3%) attended
public school and all but three (1.0%) adolescents lived at home with their parents.
According to parent report, the majority of adolescents (96%) had begun to show signs of
puberty.
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ASD symptoms were measured using the Social Responsiveness Scale – 2nd edition (SRS-2;
Constantino and Gruber 2012; see Measures section for details). SRS-2 Total Standard
Scores (T-scores) ranged from 60 – 90 (Median = 81, M = 79.89, SD = 8.52), which is

1Please note that a subset of participants (n = 198) have been described in previous research on parent-child sexuality communication
[Blinded for review].

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consistent with a diagnosis of ASD. Most youth (69.8%) fell within the “Severe” range, with
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others falling within the moderate range (22.1%), or mild range (8.1%).

Measures
Social Responsiveness Scale – 2nd edition (Parent Report) (SRS-2)—The SRS-2
(Constantino and Gruber 2012) is a 65-item rating scale designed to measure the severity of
ASD symptoms, with emphasis on specific aspects of social impairment and repetitive
behavior. The SRS-2 provides a total score and five subscale scores (i.e., Social Motivation,
Social Cognition, Social Awareness, Social Communication, and Repetitive Behavior). T-
Scores are standardized using male and female norms. T-Scores of 60 – 75 are typical for
people with ASD and lower support needs, and suggest deficiencies in reciprocal social
behavior with mild to moderate interference in everyday social interactions. The measure
has acceptable psychometric properties (Constantino and Gruber 2012).
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Online Transition to Adulthood Survey—Parents completed a 50-item online survey

containing questions about parent and youth demographics, youth ASD symptoms, parent
expectations about their youth’s future, and actions taken to prepare for adulthood.
Demographic questions included those about gender, race/ethnicity, parental education level,
and annual household income.

In the parent expectations section (based on Mutua and Dimitrov 2001, and Ivey 2004),
parents rated the likelihood of 25 outcomes (e.g., have children, be financially independent,
have a job or vocation; see Ivey, 2004 and [citation retracted for blind review] for measure)
on 5-point Likert-type scales (1 = “Very unlikely” to 5 = “Very likely”). For each parent,
likelihood ratings were summed to create a variable indicating total parent expectations
(TPE; range = 25 – 125, M = 84.13, SD = 19.40) with a higher score indicating higher
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expectations. Additionally, parents received summary likelihood scores for specific

expectations domains (i.e., financial independence, school attainment, citizenship; see Table
2 for items). Parents also rated several sexuality-related concerns on a 5-point Likert-type
scale (1 = “Not at all concerned” to 5 = “Extremely concerned”). Concerns about sexual
assault included two items indicating parent concern that the youth would be sexually
coerced or manipulated by peers, or would be the victim of rape or sexual assault. Parents
also rated their concern that their child would experience an accidental pregnancy.

Next, parents endorsed actions they had taken to facilitate their youth’s transition to
adulthood. Parents endorsed whether their youth had held a volunteer or paid employment
position (yes/no) and whether they had talked to their adolescent about their job-related
interests, about careers, or about the benefits of having a job. They also endorsed whether
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they had talked to youth about politics and voting or whether youth had been enrolled in
civics courses, whether youth were assigned chores and responsibilities, and whether they
had enrolled their youth in a class on adult roles to build independence.

Analytic Plan
Intellectual functioning was separated into three categories (average or above average IQ,
borderline IQ, IQ below 70). In some models we utilized only two intellectual functioning

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categories (average or above average IQ, below average IQ) to optimize model fit. To
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address Aim 1, we conducted a series of multiple linear regressions with youth

characteristics as the independent variables (IVs) and parent expectations as the dependent
variables (DVs). To address Aim 2, we first conducted Pearson Chi-Square tests to identify
differences in parent preparatory activities by gender and intellectual functioning, with post-
hoc examination of standardized residuals for variables with more than two groups (Sharpe,
2015). Then we conducted a series of logistic regression models with parent expectations for
adult outcomes and youth characteristics as the IVs and whether parents engaged in various
preparatory activities as the DVs. Due to the exploratory nature of the analyses, no
correction for multiple comparisons was applied.

Exploratory Analyses
Based on the results of Aims 1 and 2, exploratory analyses were conducted for parents of
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adolescent females with ASD to examine other parent characteristics that could account for
observed differences in parent activities for male and female youth.

Results
We first compared parents of males and females on youth IQ level, age, and SRS-2 Total T-
Score. Male and female adolescents did not differ on parent-reported IQ (χ2(2) = 3.216, p
= .200), or child age (t(296) = 0.737, p = .296). However, females had higher mean SRS-2
Total T-scores than males (t(296)= −2.230, p = .027, MMale = 78.85, SD = 8.50; MFemale =
81.04, SD = 8.41). Next we compared adolescents in the average and above, borderline, and
IQ below 70 categories on age and SRS-2 Total and subscale scores. Adolescents in the
average, borderline, and IQ below 70 categories did not differ in terms of child age (F(2,
295) = 0.683, p = .506, partial η2 = .005). Youth with parent-reported average or above IQ
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and those with borderline IQ had significantly lower SRS-2 Total T-Scores than youth with
IQ below 70 (F(2, 295) = 10.383, p < .001, partial η2 = .066). Similarly, youth with average
or above IQ or borderline IQ were rated as having less severe impairments in Social
Awareness (F(2, 295) = 10.417, p < .001, partial η2 = .066) and Social Cognition (F(2, 308)
= 4.582, p = .011, partial η2 = .030). However, parents rated youth with average or above IQ
as having less impaired Social Communication (F(2, 295) = 9.283, p < .001, partial η2 = .
059) compared to youth with borderline IQ, who were rated as less impaired than youth with
IQ below 70. A similar pattern emerged for Repetitive Behavior (F(2, 295) = 14.587, p < .
001, partial η2 = .090). For Social Motivation, parents rated youth with borderline IQ as
being less impaired than youth with average or above IQ or IQ below 70 (F(2, 295) = 5.279,
p = .006, partial η2 = .035).
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Youth Factors as Predictors of Parent Expectations

Table 3 shows results related to Aim 1 on youth factors as predictors of parent expectations
for adult outcomes. The first regression model examined youth factors (parent-reported IQ,
SRS-2 T-score, gender, age) and household income as predictors of total parent expectations.
First, parent-reported IQ, SRS-2 Total T-score, and youth gender predicted total parent
expectations (F(6) = 32.074, p < .001, R2 = .41, Cohen’s f = .69). Total parent expectations
were higher for youth with average IQ (B = .146, SE = 2.673, p = .031) and lower for youth

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with IQ below 70 (B = −.340, SE = 3.139, p < .001) compared to those with borderline IQ.
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Higher SRS-2 Total T-scores predicted lower parent expectations (B = −.365, SE = .108, p
< .001). Parents of male adolescents had higher expectations than parents of female
adolescents (B = .130, SE = 1.753, p = .005). Youth age (B = −.093, SE = .491, p = .051)
and household income (B = −.033, SE = .643, p = .491) did not predict parent expectations

Next, a series of multiple linear regressions were conducted to examine how youth and
family factors (i.e., SRS-2 Total T-score, youth gender, age, and household income)
predicted parent expectations for financial independence, school attainment, citizenship, and
independent living (see Table 3). Across models, lower expectations were predicted by lower
IQ (IQ below 70, compared with borderline IQ) and higher SRS-2 T-score. Higher
expectations were predicted by higher IQ (average or above, compared with borderline IQ)
for all models except for citizenship expectations. Youth age was only significant in one
model, with older age predicting lower expectations for school attainment. Youth gender and
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household income did not predict parent expectations.

Parent Activities Promoting Adult Vocational Skills and Independent Living

Table 4 presents chi-square results examining differences in endorsement of parent activities
by youth gender and intellectual functioning groups. Males were more likely than females to
hold a paid or volunteer work position, to have discussions with parents about future
employment, and to be educated about citizenship through classes about civics and
discussions with parents about politics and the importance of voting. Females were more
likely to participate in an adult roles and responsibilities class. Youth with average or above
IQ had a higher than expected probability and youth with IQ below 70 had a lower than
expected probability of having a paid or volunteer position. Similarly, youth with average or
above IQ had a higher than expected probability of talking about jobs and civic
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responsibilities with parents, while youth with IQ below 70 had a lower than expected
probability of having engaged in these discussions. Youth with borderline IQ were the most
likely to be provided with chores and responsibilities. Although over 80% of parents in all
three groups reported that their child engaged in these activities, youth with IQ below 70 had
a lower than expected probability of having engaged in chores and responsibilities.

A series of logistic regressions were conducted to determine whether parent expectations

predicted parent preparatory activities when controlling for youth and family characteristics
(see Table 5). Financial independence expectations were found to be a significant predictor
of the parent and youth having had discussions about future employment and careers, but not
of the youth being employed on a paid or voluntary basis. Expectations about school
attainment were examined, but not found significant, as a predictor of the parent and youth
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having had discussions about future employment and careers. Expectations about
independent living predicted whether parents assigned chores and responsibilities or enrolled
the youth in courses about adult roles and responsibilities. After controlling for child and
family variables, expectations about citizenship did not predict whether parents reported
discussing citizenship and the importance of voting with youth. The covariates included in
each model (youth intellectual functioning, age, gender, and household income) varied in
significance. Parents of older youth were more likely to endorse each activity. Parents of

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males were more likely to talk to their child about employment and careers and to have a
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child with work experience than were parents of females. Notably, parents of females were
approximately 10 times more likely to enroll their youth in adult roles courses than parents
of males. Parents with higher household income were more likely to report providing their
child with chores and responsibilities, but household income did not predict other parent
transition-related activities.

Exploratory analyses
Given that male adolescents were more likely to have had volunteer or paid work in the
community when controlling for cognitive level and age, we hypothesized that parents with
greater concerns about negative sexual health outcomes (e.g., accidental pregnancy, sexual
coercion or assault) may be less likely to have daughters who had worked or volunteered.
We also hypothesized that parents who were more concerned about negative sexual health
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outcomes might be less likely to have talked to daughters about careers. We tested these
hypotheses in parents of female adolescents in our sample (n = 147). To retain adequate
power, we conducted logistic regression analyses with cognitive functioning dichotomized
by whether youth had parent-reported average or above IQ vs. borderline or below average
IQ (see Table 6). Contrary to our hypotheses, parent concerns about sexual assault and
accidental pregnancy did not predict whether daughters had held a paid or volunteer position
or whether parents talked to daughters about employment and careers.

Discussion
There is a critical need for research on family factors that contribute to optimal outcomes for
youth with ASD as they transition into adulthood. Previous research has identified parents’
expectations as a significant predictor of vocational and independence-related outcomes. The
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current study explored potential mechanisms underlying this association. Specifically, we

identified youth and family factors that predicted parent expectations for adult outcomes,
and tested whether higher parent expectations across different domains predicted greater
likelihood of engaging in specific preparatory activities when controlling for child
characteristics.

Consistent with a priori hypotheses, more severe ASD symptoms and parent-reported IQ
below 70 were significant predictors of lower parent expectations for the future in the areas
of financial independence, school attainment, citizenship, and independent living, while
average or above IQ predicted higher expectations. This aligns with existing literature
suggesting that youth characteristics predict parent expectations in ASD samples (Kirby
2016; Thomas et al. 2017). In addition to intellectual functioning, the equal distribution of
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parents of males and females in this sample provided a unique opportunity to examine
gender differences in parent expectations for the future. Parents of daughters with ASD in
this sample reported lower total expectations for the future compared to parents of sons. This
is consistent with Kirby’s (2016) work using structural equation modeling to examine the
association between child characteristics and parent expectations for the future showing that
female gender predicted lower parent expectations. However, in that study, the association
between female gender and lower parent expectations was mediated by functional

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performance (i.e., females with ASD in the sample had lower functional skills). In the
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current study, males and females did not differ on parent-reported IQ level, but on average
parents rated females as slightly more impaired on the SRS-2. However, gender differences
remained predictive of parent expectations when controlling for IQ, autism symptom
severity, and age, suggesting that gender differences in parent expectations were not an
artifact of other youth characteristics. Other factors, such as access to early diagnosis
(Giarelli et al. 2010) or services, or culturally-mediated differences in what is considered
adult success for men and women may influence parent expectations for their daughters with
ASD and should be investigated.

In the current study, parent expectations predicted whether parents and youth participated in
some, but not all, of the included transition-preparation activities. For talking about jobs,
providing chore and responsibilities, and enrolling youth in courses on independent living,
expectations predicted actions over and above child characteristics including IQ, gender,
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age, and household income. Thus, parent expectations for the future appear to be a small but
meaningful contributing factor to the activities parents engage in to prepare youth to
transition to adulthood. It makes sense that a parent’s expectations about their adolescent’s
future employability and independence are related to how they talk to their child about
careers or encourage their child to work. Parents who believe it is less likely that their child
to be employed as an adult may invest more time and energy in different activities (e.g.,
those that develop adaptive skills) compared to actions focused on employability or financial
independence. However, it should be noted that higher parent expectations of students’
academic achievement result in higher achievement, including when controlling for a child’s
prior academic achievement (Davis-Kean 2005; Englund et al. 2004), suggesting that high
parent expectations are beneficial for youth. There may be a “goodness of fit” aspect to
parent expectations and activities such that parents with expectations that are too low may
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not engage in activities that could contribute to success in employment or financial

independence, while other parents may better serve their children by focusing on supporting
them in doing what youth enjoy and what challenges them (e.g., serving in volunteer rather
than paid positions) while ensuring access to appropriate adult services.

Additionally, the results of this study indicate that gender affects how parents make
decisions about how to prepare their child for adulthood. Specifically, parents reported that
males in this study were over two times more likely than females to participate in volunteer
or work experiences in the community and parents were 2.5 times more likely to talk about
careers and employment with sons, while females were 10 times more likely than males to
be enrolled in a class about adult roles and responsibilities. There are at least two potential
reasons for this. First, this pattern of results suggests that parents of females may feel more
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comfortable seeking support and preparatory experiences for their youth in more controlled,
safer settings (e.g., classes), whereas parents of males may be more willing to provide their
youth with real-world experiences. We hypothesized that gender differences in transition-
related activities might be related to gender-specific concerns such as risk for sexual assault
or accidental pregnancy, but these hypotheses were not supported. Second, societal norms
for male and female roles in adulthood could account for this pattern of findings, particularly
if classes on adult roles and responsibilities are perceived to be in the model of home
economics courses targeted largely at female adolescents in decades past. According to the

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 Holmes et al. Page 11

United States Bureau of Labor Statistics American Time Use Survey, males continue to be
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employed at higher rates and earn more money doing the same jobs compared to women,
while women (even those who are employed full time) spend more time than men engaged
in child care and household activities (United States, 2017). Societal expectations for male
and females with ASD and disability more broadly remain unexamined. Regardless of why
these differences in opportunities exist, they could be causing unintended negative
consequences for the independence of adult females with ASD. Consistent with this, there is
evidence that females with ASD may have more difficulty maintaining employment as
adults compared to males with ASD (Taylor and Mailick 2014). Additionally, males with
ASD may be losing the opportunity to learn skills of independence that benefit all adults.
The results of the current study contribute to a small but growing body of literature about
gender differences and ASD (Magiati et al. 2014) and highlight the importance of
prioritizing research with females with ASD related to transition and adult outcomes.
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Consistent with our hypotheses, parents expected youth with ASD and average/above IQ to
be more financially secure, succeed more in school, and to live more independently than
parents of youth with borderline IQ or below 70 IQ. One exception to this was in the area of
citizenship, as parents had similar expectations that youth with average and borderline IQ
would vote and participate in other citizenship activities. Generally, these differences in
expectations do not seem to have translated into differences in preparatory activities for
parents raising children with average or borderline IQ. Compared to parents of youth with
borderline IQ, parents of youth with average IQ were no more likely to report that their child
had a job or that they talked about jobs and careers or civics with their child.

Notably, youth age was not related to parent expectations with the exception of expectations
for school attainment. Parents of older youth reported lower expectations for school
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attainment than parents of younger youth. Some research suggests that parents’ academic
expectations for students with disabilities decrease with age (Masino & Hodapp, 1996),
which is not the case for students without disabilities. It is possible that parent expectations
for school attainment decrease with age due to students with ASD being enrolled in different
academic tracks or classes than students without ASD (e.g., life skills classes) or the
communication of teacher perspectives of attainable outcomes during Individualized
Education Plan meetings for transition-aged youth. Alternatively, researchers conceptualize
parent expectations as dynamic and responsive to students’ academic abilities and needs
(Goldenberg et al., 2001; Mistry et al., 2009). It is possible that parent expectations for
youths’ academic achievement change based on how well youth are able to navigate the
challenges of high school, which include increased organizational demands, frequent
transitions, future-oriented thinking and actions, and heightened social expectations (e.g.,
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group assignments). Longitudinal research would help determine how youth, parent, school,
and community variables affect parent expectations and activities related to academic
achievement for students with ASD.

Previous literature has demonstrated that socioeconomic status and access to resources play
a role in terms of what parents expect their children to accomplish in the future (Davis-Kean
2005). We anticipated that household income, as a proxy for socioeconomic status, would
predict parent expectations and transition preparation activities. Many such activities may

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 Holmes et al. Page 12

depend on the resources of schools and funding for services like vocational training in
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families’ geographic area. Surprisingly, household income did not predict parent
expectations or actions in this study. Although there were a range of income levels
represented, the median household income in this study ($80–89,000) was markedly higher
than median U.S. household income ($56,000). Nationally representative samples with more
representation from less advantaged households and other markers of socioeconomic status
(i.e., eligibility for free or reduced school lunch, type of employment) might reach different
conclusions.

The associations between parent expectations for the future, preparatory activities during
adolescence, and adult outcomes raise important issues for healthcare providers, school
personnel, and researchers. The meaning of optimal adult outcomes for individuals with
ASD is evolving (Henninger and Taylor 2013). It has been suggested that researchers
interested in appropriately conceptualizing nuance in optimal adult outcomes (and
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appropriate preparatory activities associated with outcomes) should consider the fit between
an individual and their environment (Halpern 1993). Indeed, a variety of different post-
school activities likely contribute to health and happiness for adults (e.g., having friends,
contributing to community, earning money, getting married, voting and advocating for public
policy, recreation, religious service). To the extent possible given access to services and
resources, families likely align their preparatory activities to facilitate adult outcomes that fit
with their goals, values, and perception of what is possible. Although youth characteristics
play a role in what parents expect their adolescent to achieve as an adult, parent expectations
for the future and conceptualization of optimal outcomes for their youth are likely also
shaped by school personnel and healthcare providers, who approach this task with their own
understanding of the possibility and desirability of various adult outcomes.
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Finally, this study included questions about parent expectations and transition-related
preparatory activities about citizenship (e.g., voting, being socially responsible and law
abiding). Parents of males and of youth with average or above IQ were more likely to
educate youth about being a good citizen (e.g., via discussions about voting and politics,
civics classes) than parents of females or those with borderline or below 70 IQ. There is little
research on inclusion of individuals with autism or developmental disabilities in voting and
politics (e.g., Agran et al. 2015). Importantly, neurotypical adolescents’ political
engagement and participation are influenced by parents’ participation, and this effect is
stronger for girls than boys (Cicognani et al. 2012), suggesting that parent modeling and
discussion of politics and voting is important for developing youth citizenship and advocacy.
The political activism of people with disabilities has been critical in the design and
implementation of policy and services currently benefitting millions of Americans with
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disabilities and their families (Campbell and Oliver 1996; Shakespeare 2006). Additionally,
citizenship and political participation could be conceptualized as part of a broader movement
to support people on the autism spectrum in becoming self-advocates (Test et al. 2005).
More research on the experiences of political participation, voting, and citizenship for
individuals on the autism spectrum is needed.

This study is limited in terms of cross-sectional methods, recruitment, and questionnaire

design. First, data on parent expectations and transition-related preparatory activities were

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 Holmes et al. Page 13

collected at one time-point, and thus do not allow for inference of causality. It is possible
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that parent expectations and actions interact in a reciprocal manner over time as parents
incorporate information from their child’s response to various actions into their expectations
for the future, which in turn help them choose activities they believe will be effective for
achieving their child’s goals. Longitudinal research on parent expectations, actions, and
adult outcomes for individuals with ASD is needed to determine whether parent expectations
play a causal role in transition activities. Second, parents in this sample were recruited from
parent support groups and a database of individuals interested in participating in research.
Parents in this sample were predominantly Caucasian, well-educated, and well-resourced
individuals with access to the Internet and connections to support groups and research
networks. The characteristics of the present sample are important context for the
interpretation of these results. Finally, the list of adult preparatory activities was short, and
parents likely engaged in many other activities of benefit to their children, particularly youth
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with co-occurring intellectual disability (e.g., special needs recreation groups where youth
can gain valuable adult skills). Additionally, activity engagement was conceptualized as a
dichotomy with parents endorsing whether they ever engaged in activities like discussing
jobs and careers with their child. Conceptualizing activities in terms of frequency, depth,
content, and attitudes conveyed to youth where appropriate would clarify parent preparation
for transition to adulthood and would provide a more precise understanding of how activities
are linked to adult outcomes. Future research on this topic should include interviews or
focus groups with parents and individuals on the autism spectrum to include a broader range
of potential activities and outcomes for adults.

Another important note is that some parents in this study needed to estimate their child’s
cognitive functioning level, and a higher proportion of parents in the borderline and IQ
below 70 groups provided an estimated IQ. It is possible that some parents inaccurately
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reported or estimated their child’s IQ or intellectual functioning. Given the inconsistencies

between nonverbal and verbal functioning for individuals with ASD and the preliminary
differences reported between parents based on their child’s cognitive functioning, samples
characterized by both cognitive and adaptive functioning would allow for better
understanding of differences in parent expectations, activities, and developmental
trajectories.

To conclude, the ultimate goal of this research is to support communities in providing

evidence-based and patient-centered guidance for families about how to choose among the
variety of activities available to best support youth in achieving a high quality of life as
adults. Researchers can contribute to this goal by investigating stakeholder perspectives on a
range of optimal outcomes, how activities during adolescence (e.g., volunteering,
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conversations with parents, peer relationships) are associated with these outcomes, and how
family environments (e.g., advice from healthcare providers, schools, parent support groups)
shape parents’ expectations and actions in support of individuals on the spectrum achieving
fulfillment as adults. This study replicated previous work on the importance of parent
expectations for the future and their actions during adolescence to support positive adult
outcomes for individuals on the autism spectrum. This study explored differences in parent
expectations for the future for sons versus daughters, and for individuals with borderline
intellectual functioning compared to those with average or above IQ and to those with IQ

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 Holmes et al. Page 14

below 70. There is evidence that parent expectations and transition preparatory activities
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differ by child gender, and the present study did not explain why this difference may exist.
Further research with parents of daughters with ASD is needed, and guidelines for improved
recruitment of females with ASD and their families would be helpful (Halladay et al. 2015).
Additionally, researchers interested in parent expectations for the future and on adult
outcomes may want to carefully consider how to conceptualize heterogeneity in intellectual
functioning. There are many different ways to compare individuals with ASD based on
intellectual functioning or disability status, and this study provides some evidence that youth
with borderline intellectual functioning may not fit well with either youth with average or
above IQ (formerly “high functioning”) or youth with below 70 IQ (formerly “low
functioning”). Finally, this study suggests the need for research on how communities (e.g.,
public policies, healthcare providers, schools, parent support groups) influence parent
expectations. Healthcare providers and school personnel may appreciate evidence-based
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practice guidance on how to talk to parents and individuals themselves about their
expectations for the future, and about the preparatory activities families can engage in to
promote a variety of positive adult outcomes for youth with ASD.

Acknowledgements
Anne V. Kirby’s research efforts were supported by the University of Utah Program in Personalized Health and the
National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number
KL2TR001065. The content is solely the responsibility of the authors and does not necessarily represent the official
views of the National Institutes of Health.

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Table 1.
a
Parent and Child Demographics (N=298 )
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N (%)

Parent Child

Gender
Male 23 (7.8) 157 (52.7)
Female 272 (92.2) 141 (47.3)
Ethnicity
American Indian/Alaskan Native 5 (1.7) 9 (3.1)
Asian 6 (2.0) 4 (1.4)
Black/African American 3 (1.0) 2 (0.7)
Hispanic 9 (3.1) 6 (2.0)
Multiracial 9 (3.1) 25 (8.5)
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Native Hawaiian/Pacific Islander 1 (0.3) 0 (0.0)

White 261 (88.8) 248 (84.4)
b
Income
0 – 49,000 56 (19.4)
50 – 69,000 58 (20.1)
70 – 99,000 65 (22.5)
100 – 139,000 55 (19.0)
140,000+ 55 (19.0)
Education
Junior High/High School/GED 16 (5.4)
Some college 43 (14.5)
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Associate degree/Vocational school 30 (10.1)

Bachelor’s degree 116 (39.1)
Master’s degree 70 (23.6)
Professional or Doctoral degree 22 (7.4)
Type of School Attended
Public school 191 (64.3)
Private school 15 (5.1)
Homeschooled/Cyber charter/Online 32 (10.8)
Therapeutic school 40 (13.5)
Charter school 12 (4.0)
College 2 (0.7)

Note.
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a
Not all participants answered all questions (range = 294–298). ASD = autism spectrum disorder.
b
Income levels collapsed from 12 to 5 categories.

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Table 2.

Parent Expectations and Concerns

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What do you expect your child to accomplish? My child will…

Financial Independence α = .80
…have a secure financial future
…live independently
…hold a job/vocation
School Success α = .83
…be successful in school
…attain highest education possible
Citizenship
…participate in citizenship activities
Independent Living
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…live independently
Concerns: I am concerned about…
Pregnancy
…accidental pregnancy
Sexual Assault α = .88
…my child being sexually coerced or manipulated by peers
…my child being a victim of rape or sexual assault
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Table 3.

Parent Expectations and Concerns Means and Standard Deviations by IQ Level (N=298)
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Average+ IQ Borderline IQ IQ<70

M (SD) M (SD) M (SD)
Expectations
…have a secure financial future 3.37 (1.0) 2.74 (1.2) 2.53 (1.2)
…live independently 3.68 (0.9) 2.87 (1.1) 1.71 (1.0)
…hold a job/vocation 4.12 (0.8) 3.82 (1.0) 2.98 (1.2)
…be successful in school 3.90 (1.0) 3.29 (1.3) 2.63 (1.4)
…attain highest education possible 3.82 (1.1) 3.37 (1.3) 2.74 (1.5)
…participate in citizenship activities 3.44 (1.2) 3.16 (1.3) 2.27 (1.3)
Concerns
…accidental pregnancy 2.46 (1.2) 3.29 (1.3) 2.29 (1.4)
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…my child being sexually coerced or manipulated by peers 2.96 (1.3) 3.79 (1.4) 3.41 (1.4)
…my child being a victim of rape or sexual assault 2.69 (1.3) 3.35 (1.5) 3.57 (1.3)
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Table 4.

Parent Expectations by Child and Family Variables (N=298)

Parent Expectations
Holmes et al.

Total Financial Independence School Attainment Citizenship Independent Living

Predictors B (SE) B (SE) B (SE) B (SE) B (SE)
IQ < 70 −0.340 (3.1)*** −0.24 (0.5)** −0.18 (0.4)* −0.21 (0.2)** −.32 (0.2)***
Borderline IQ Reference Reference Reference Reference Reference
Average/Above IQ 0.146 (2.7)* 0.29 (0.4)*** 0.21 (0.4)** 0.11 (0.2) .31 (0.2)***
SRS-2 T-Score −0.365 (.11)*** −0.30 (0.02)*** −0.27 (0.02)*** −0.28 (0.01)*** −.23 (0.01)***
Male 0.130 (1.8)** 0.08 (0.3) 0.07 (0.2) 0.06 (0.1) .09 (0.1)

Female Reference Reference Reference Reference Reference

Age −0.093 (0.5) −0.05 (0.08) −0.13 (0.1)* 0.02 (0.04) −.07 (0.03)

Household Income −.033 (0.6) 0.01 (0.1) −0.06 (0.1) −0.02 (0.1) −.03 (0.04)

Model F (df = 6) 32.074*** 29.822*** 14.839*** 11.94*** 37.27***

R2 0.41 0.39 0.24 0.20 0.44

Cohen’s f2 0.69 0.64 0.32 0.25 0.80

Note.
*,
p<0.05
**,
p<0.01
***
p<.001.

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Table 5.

Preparation Activities Differences by Gender and Intellectual Function (N=298)

Paid/Volunteer Position (%) Talk About Jobs (%) Talk about Civics and Voting (%) Chores & Responsibilities (%) Enrolled in Courses (%)
Holmes et al.

IQ Group χ2 (df) 9.41(2)** 95.54(2)*** 55.69(2)*** 8.94(2)* 4.51(2)

IQ <70 21.3 36.1 6.6 80.3 8.2

Borderline IQ 42.1 81.6 47.4 100.0 21.1
Average/Above IQ 42.8 93.3 61.2 88.8 19.4

Gender χ2 (df) 9.73(1)** 8.16(1)** 4.28(1)* 0.41(1) 44.43(1)***

Male 46.8 86.4 53.9 89.6 3.2
Female 29.1 73.0 41.8 87.2 32.6

Note.
*
p<.05
**
p<.01
***
p<.001.

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Table 6.

Logistic Regression Results: Parent Expectations as Predictors of Parent Preparatory Activities (N=298)

Parental Preparatory Activities

Holmes et al.

Paid/Volunteer Position Talk About Jobs Talk about Civics and Voting Chores & Responsibilities Enrolled in Courses
Predictors OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
PE: Financial Independence 1.1 (1.0, 1.2) 1.3 (1.1, 1.6)** - - -

PE: School Success - 1.0 (0.8, 1.2) - - -

PE: Citizenship - - 1.2 (1.0, 1.5) - -
PE: Live Independently - - - 2.0 (1.3, 3.0)** 1.6 (1.1, 2.3)*
IQ<70 0.6 (0.2, 1.5) 0.2 (0.05, 0.5)** 0.1 (0.03, 0.3)*** Reference Reference

Borderline IQ Reference Reference Reference Reference Reference

Average/Above IQ 0.9 (0.4, 2.1) 2.0 (0.6, 6.5) 1.7 (0.8, 3.6) 3.1 (1.0, 9.2)* 1.2 (0.4, 3.1)

Male 2.1 (1.2, 3.5)** 2.4 (1.1, 5.4)* 1.4 (0.8, 2.4) 1.5 (0.7, 3.4) 0.1 (0.02, 0.2)***
Female Reference Reference Reference Reference Reference
Age 1.4 (1.2, 1.6)*** 1.6 (1.2, 2.1)*** 1.2 (1.0, 1.4)* 1.3 (1.0, 1.7)* 1.4 (1.1, 1.7)**
Household Income 1.2 (1.0, 1.4) 1.0 (0.7, 1.4) 1.1 (0.9, 1.3) 1.5 (1.1, 2.0)* 1.0 (0.8, 1.3)

χ2 (df) 41.57(6)*** 117.14(7)*** 71.15(6)*** 23.74(5)*** 64.03(5)***

Cox & Snell R2 0.14 0.34 0.22 0.08 0.20

Note.
*,
p<0.05
**,
p<0.01

J Autism Dev Disord. Author manuscript; available in PMC 2019 September 01.
***
p<.001.

OR, odds ratio. CI, confidence interval. PE, parent expectation. Dashes (-) indicate variables that were not included in the specified model.
Page 22
 Holmes et al. Page 23

Table 7.

Parent Preparatory Activities and Concerns for Daughters (n=141)

Author Manuscript

Parental Preparatory Activities

Paid/Volunteer Position Talk About Jobs

Predictors OR (95% CI) OR (95% CI)
Concern – Sexual Assault 1.0 (0.8, 1.2) 0.9 (0.7, 1.2)
Concern – Pregnancy 1.0 (0.7, 1.4) 1.5 (0.9, 2.5)
Average/Above IQ 1.3 (0.6, 3.0) 29.7 (9.2, 95.5)***
Borderline/IQ Below 70 Reference Reference
Age 1.4 (1.1, 1.8)** 1.8 (1.3, 2.6)**

χ2 (df) 12.87(4)* 70.41(4)***

Cox & Snell R2 0.09 0.39
Author Manuscript

Note.
*,
p<0.05
**,
p<0.01
***
p<.001.
Author Manuscript
Author Manuscript

J Autism Dev Disord. Author manuscript; available in PMC 2019 September 01.