CCPR: What major challenges do autistic youth face as they transition out of school-based services?
Dr. Baker-Ericzen: The transition to adulthood is a dramatic shift in expectations and support. Prior to this, parents and school staff make most decisions, often without the autistic youth present. Now, the world views the autistic individual as an adult decision-maker—though the individual often has no experience with self-determination. Equally disruptive is the “service cliff.” During childhood, schools provide a one-stop shop of academic support, speech, occupational therapy, and often mental health counseling. Adult services are fragmented, with separate eligibility criteria and procedures. Many young adults lose access to therapies they relied on, and mental health coverage may vanish if autism alone isn’t billable in their state system. In our California public mental health system, you can’t bill and treat for autism.

CCPR: What are the typical outcomes for autistic young adults navigating this transition?
Dr. Baker-Ericzen: Outcomes vary widely, but only about 30% of autistic adults pursue postsecondary education (Shattuck PT et al, Pediatrics 2012;129(6):1042–1049). Around 85% are unemployed or underemployed, and about 5%–15% live outside their family home or residential group homes. Driving—a key marker of independence—is at about 30%, compared to 80%–90% for neurotypical adults (Curry AE et al, Autism 2018;22(4):479–488). Many young adults stay home, absorbed in special interests. They are often able to engage in the community or work, but they don’t have adequate support, ie, coordinated services and skill-building.

CCPR: How can clinicians support their higher education or vocational programs?
Dr. Baker-Ericzen: Refer people to college and career programs designed for neurodiverse students. Many universities offer coaching in socializing, executive functioning, and academic skills. In California, we have “college-to-career” programs where students with disabilities, including intellectual disabilities, can take college classes tied to career goals.

CCPR: What are some modifiable factors for a more successful transition?
Dr. Baker-Ericzen: Executive functioning is an important modifiable factor. Many autistic youth also have ADHD (often called AuDHD). Both conditions have executive functioning challenges. If you can’t organize your time, create goals, and break them into manageable tasks, then it’s hard to function independently. Teach these skills as early as middle school. Executive functioning predicts nearly every adult outcome—employment, education, and mental health—so it deserves focused attention.

CCPR: How can clinicians begin preparing autistic youth for decision-making?
Dr. Baker-Ericzen: Encourage families to give teens choices in shaping their own lives. Self-determination and supported decision-making don’t just click into place at 18—they are skills that need to be practiced. Too often, behavioral programs emphasize compliance rather than choice-making, which leaves teens unprepared for adulthood. Ask yourself, “Have I given enough information that this person can make a decision?” Use multimodal communication—spoken explanation, written materials, and visual aids. Avoid asking for on-the-spot decisions. Many autistic people need more time to process. Ask: “Can you give me your answer in [a day, or a few hours, or a week]?” (Editor’s note: For more information, see our article on supported decision-making in CCPR January/February/March 2024.)

CCPR: Are there other modifiable factors to work on for this population to get them ready for adulthood?
Dr. Baker-Ericzen: Anxiety impacts 80%–90% of autistic young adults and often underlies behavioral problems (Mutluer T et al, Frontiers in Psychiatry 2022;13:856208). When intervention programs interpret avoidance as defiance, focusing on compliance, they make an anxious child less able to think for themselves and act in their own interest. Address anxiety early on with intervention strategies and by enhancing executive functioning and decision-making. Adapt therapies such as cognitive behavioral therapy (CBT) and other evidence-based therapies to address sensory, communication, social, and cognitive differences. Some examples of adaptations to CBT include using visual aids; shifting language to concrete, literal forms (eg, saying “that feels better” instead of “that’s a weight off your shoulders”); incorporating parents; and addressing social deficits (Editor’s note: Psychiatrists can also consider pharmacologic options, particularly SSRIs for anxiety in autistic adults).

CCPR: How do social and cultural factors affect the transition to adulthood for autistic individuals?
Dr. Baker-Ericzen: Youth from minority or more diverse groups receive fewer services in childhood, which translates to more profound deficits in self-advocacy skills as adults. Many from diverse racial or cultural groups are underdiagnosed or misdiagnosed as children, especially females and verbal or hyperverbal individuals. Clinicians should apply culturally competent assessment practices and not rule out autism based on one feature (eg, superficial social fluency). 

“Teach these skills as early as middle school. Executive functioning predicts nearly every adult outcome—employment, education, and mental health—so it deserves focused attention.”

Mary Baker-Ericzen, MA, PhD 

CCPR: Let’s talk about interventions. What have you learned from the executive function programs you helped design?
Dr. Baker-Ericzen: Teaching executive function in real-world contexts leads to better generalization. For example, STEER (Strategies Transforming Executive Function Emotion Regulation), developed at San Diego State University, integrates virtual driving with the executive function curriculum for safe practice of newly developing skills. This type of program, which is ostensibly designed to assist individuals in learning to drive, can positively impact all other postsecondary life outcomes and is considered a gateway to independence. We model and break down concepts using a hands-on approach. We give guidance to improve our participants’ attention behind the wheel, increase situational awareness, manage emotions when somebody cuts them off, and talk with police. The simulator has AI-driven variability, so every scenario feels different. For clinicians who do not have programs like this, the principle still applies: Teach practical skills within an area of interest (eg, art, robotics, etc) and use that teaching to build problem-solving in other areas of function. 

CCPR: What outcomes have you seen from the program?
Dr. Baker-Ericzen: It’s remarkable. About 70% of participants thought they would never get a driver’s license. But after 6 months, 80% of STEER participants are pursuing their license outside of STEER, and 41% either have their permit or have obtained their driver’s license. They describe life-changing confidence: “I can get a job because I can drive.” “I can go to the ice cream shop.” Even if they’re not driving, it’s a confidence booster that carries into other areas. We see reduced anxiety and changes in cognition. We’ve replicated it across schools, clinics, and vocational centers nationwide. These skills build agency, and the benefits generalize beyond the original goal.

CCPR: You have a vocation program too.
Dr. Baker-Ericzen: SUCCESS (Supported Comprehensive Cognitive Enhancement and Social Skills) is a 26- to 28-week, evidence-based program designed with the autism community for the autism community. It breaks down organization, time management, and social cognition, building basic executive functions toward advanced workplace communication: “How do you interact differently with a supervisor versus a coworker?” The curriculum is in clinics, colleges, and ­job-training centers with both neurodiverse and neurotypical participants. Any clinician can use our principles: explicit instruction, repetition, and contextual practice. Nurture these lifelong skills, just like math or reading.

CCPR: Any final thoughts for clinicians about the transition to adulthood?
Dr. Baker-Ericzen: Every autistic person contributes to society. Each person has a form of communication, whether through speech, typing, or other means. What looks like indecision or poor motivation is often a systemic failure of adequate supports, accommodations, and opportunities. When clinicians adapt communication, allow processing time, provide access to evidence-based skill-building programs, and respect individuals’ autonomy, we see remarkable growth. Advocate for individuals and for systemic change that recognizes the potential in every autistic person. Help families, schools, and adult service systems understand that the goal isn’t managing behaviors, but genuinely supporting autistic people to build the lives they want to live.

CCPR: Thank you for your time, Dr. Baker-Ericzen.