According to the Centers for Disease Control and Prevention, about 1 in 68 children were identified as having ASD in 2012 (about 1.5 percent of 8-year olds). ASD is a complex developmental disorder with characteristics that can range from mild to more pronounced (see fig. 1). Each autism characteristic may vary in type and degree from person to person and can fluctuate over time. The combination of characteristics results in a highly individualized condition, as illustrated in figure 2. Certain medical or mental health conditions—called comorbid conditions—often occur with autism. For example, data from the 2011 Survey of Pathways to Diagnosis and Services showed that over half of autistic youth aged 15-17 had also been diagnosed with an attention deficit disorder (53 percent) or anxiety (51 percent), nearly one quarter had depression, and 60 percent had at least two comorbid conditions. Other common comorbid conditions include sleep disorders, intellectual disability, seizure disorders, and gastrointestinal ailments. To support the educational needs of children with disabilities, Congress originally passed IDEA in 1975. IDEA requires states and local educational agencies to identify and evaluate children with disabilities and provide special education and related services to those who are eligible. Such services and supports are formulated in an Individualized Education Program (IEP) and may include speech or occupational therapy and behavioral supports, among others. The 2004 reauthorization of IDEA required that, beginning no later than age 16, a student’s IEP must include measurable postsecondary goals, based on age-appropriate transition assessments, related to training, education, employment, and, where appropriate, independent living skills. The IEP must specify the transition services needed to assist the student in reaching those goals. Not all youth with autism received timely transition planning services, according to an analysis of data from the Department of Education’s (Education’s) National Longitudinal Transition Study-2 (NLTS2). That analysis showed that in 2009, 58 percent of young adults with ASD reported that they had been given a transition plan by the federally required age. This percentage was lower for youth from lower income households, African-American youth, and youth with the highest conversation skills. Upon exiting high school, youth with autism may obtain services by applying as adults and establishing eligibility for a number of programs. Specifically, we reported in 2012 that four federal agencies—Education, the Department of Health and Human Services (HHS), the Department of Labor, and the Social Security Administration—administer the key federal programs that provide services to youth with disabilities as they transition from high school. In addition, these and other federal agencies fund a number of other programs through grants to states, localities, and nongovernmental organizations, which often have flexibility on how to administer services. For example, Education’s Rehabilitation Services Administration funds state vocational rehabilitation agencies through formula grants, which have a state matching requirement, to help people with disabilities prepare for and engage in gainful employment, and some states use Medicaid funds to provide home and community-based services for individuals with certain types of disabilities who might otherwise be cared for in an institutional setting. In our 2012 report, we found that youth and their families faced challenges in identifying, navigating, and establishing eligibility for services for adults with disabilities, including autism. In addition, we found that the adult service system did not routinely provide a coordinated plan of services or objectives for youth making the transition to adulthood and—unlike the special education system for younger children—did less to ensure that needed services would be provided. Youth with autism who are entering the adult service system may have to apply to multiple agencies for services and establish their eligibility for each agency’s services. The difficulty obtaining adult services has been called “falling off a cliff” by the autism community. The panel told us that youth with ASD may need services addressing individual autism characteristics—or a combination of autism characteristics and other health conditions—that affect their ability to attain their goals for adulthood. The services needed to address any specific characteristic may differ depending on the goal. The panel told us that some characteristics of autism can be strengths that may help individuals with ASD achieve their goals—for example, intense focus on a specific interest can be very productive in the workplace. The panel discussed the importance of valuing the characteristics that may facilitate goals and warned against assuming that autism characteristics need to be “fixed.” The panel discussion, however, focused primarily on services and supports needed to address autism characteristics that can hinder progress toward goal attainment. The panel told us that, like their peers without autism, many youth with ASD pursue postsecondary education or training, although not all of them finish their academic programs. According to NLTS2, in 2009, 36 percent of young adults with ASD had attended some type of postsecondary education institution. Of those youth, 32 percent had attended a 4-year college, 70 percent had attended a 2-year college, and 33 percent had attended a vocational, business, or technical school. According to the panel, in addition to more traditional classroom settings, some youth with ASD also attend online programs and an increasing number of specialized colleges designed to meet the specific needs of students with disabilities. According to the panel, youth with autism may need some of the same supports as other postsecondary students to help them succeed in the higher education environment, but may require increased intensity or providers with training in autism. For example, many students need help with organizational skills, such as managing time or prioritizing tasks, to keep up with the pace of academic demands. The panel cited mental health conditions, especially anxiety, as some of the biggest impediments to success in postsecondary education and said these conditions can have a greater effect than youths’ autism characteristics. Youth may also need supports to help them navigate social demands of college life, such as relationships with roommates, dating, and issues with alcohol and drug use. The panel noted that self-care is especially important because poor personal hygiene can lead to isolation. The panel also discussed the need to have stronger supports at the beginning of college that taper down as students experience success and learn to navigate the environment. Table 1 shows some of the services and supports that may be needed in a postsecondary education environment. Young adults with ASD have lower rates of employment than some other people with disabilities. For example, in 2009, 58 percent of youth with autism in their early 20s had ever worked for pay outside the home, compared to 91 percent of youth with emotional disturbances and 74 percent of youth with intellectual disabilities. The diverse nature of autism means no single workplace setting or set of supports is appropriate for all autistic individuals. Examples of various workplace settings include the following: Full-time or part-time employment with market wages and responsibilities, with or without long-term supports—such as a job coach to help with communication and social navigation; Self-employment, which may offer the flexibility to tailor the job to the individual’s strengths and the work environment to their needs; and A workplace that primarily or exclusively employs individuals with disabilities—with wages that can fall below the federal minimum wage. Some workplaces provide services, supervision, or training in life skills or vocational skills. Customized employment may provide an opportunity for some individuals with autism who might otherwise not be able to find employment. Employers create a job specifically designed for an individual’s strengths, abilities and support needs. The panel told us that the type and level of supports that youth may need to succeed in the workplace may vary over time. For example, youth may need training in job-seeking, interviewing, or organizational skills at the beginning of their employment, while they may need job coaching throughout their employment. The panel noted that while some programs may teach youth with autism how to interview and some of the logistics of work, youth also need to learn about navigating the social aspect of employment and may require ongoing support in this area. The panel noted that social difficulties in the workplace could lead to isolation, marginalization, or job termination. Additionally, according to the panel, some vocational supports could help youth find jobs that build on some of their autism strengths, such as the ability to focus intensely on a problem or activity or skills in following routines and performing tasks consistently. Some of the services and supports the panel discussed in conjunction with successful employment are highlighted in table 2. One of the goals of IDEA is to prepare students for independent living. The level of independence that autistic youth may achieve varies widely— some are able to live in their own home (with or without supports), while others require 24-hour care. According to an analysis of NLTS2, young adults with autism are less likely to live independently than youth with other disabilities, including intellectual disabilities and emotional disturbances. Specifically, in 2009, 19 percent of autistic adults in their early 20s had lived independently at some point, either with or without supports. Fourteen percent had lived in a supervised setting, such as a group home or medical facility, which may have provided services such as life skills education or vocational supports. The panel discussed two key aspects of independence—performing daily living activities and making and carrying out decisions. Daily living activities may include tasks such as cleaning, shopping, paying bills, maintaining personal hygiene, and preparing meals. Again, while some youth with ASD do not need help with these activities, some may need to learn these skills step by step and then practice them in real life to gain proficiency. For example, some youth may need a list of each step of washing hair—shampoo in hand, lather into hair, rinse, etc. The panel said that some youth may be able to perform tasks in isolation, but may have trouble combining them with employment or social demands. Youths’ abilities to make their own decisions may also vary, depending on their skills in communication and self-advocacy—identifying and expressing their needs to others. Regardless of their level of disability, the panel said that it is critically important that all youth be given the opportunities to state their own preferences to the extent of their capabilities.