What Happens to Autistic Adults as We Age? The Review That Finally Asked
The Annual Review of Developmental Psychology has published a rare thing: a full narrative review on autism and aging. Authored by Gavin Stewart and Francesca Happé (King’s College London), the paper pulls together what little research exists on autistic people past midlife.
MedicalXpress covered it with a plain headline — “What we do (and don’t know) about autism and aging.” For once, the media didn’t distort. The summary was careful: the field is thin, the results are mixed and the gaps are glaring.
That’s the story — and it matters, because absence itself becomes harm when the record stays silent.
What the Paper Found
Autism doesn’t disappear. Core traits remain visible into older age, though some aspects may shift. Some people notice shifts, especially in sensory sensitivity, but the core does not vanish. At the same time, health problems can pile up. Midlife and older autistic adults are more likely to face epilepsy alongside heart disease, osteoporosis, Parkinson’s, anxiety, depression and sleep disruption, with suicide still a real risk. Life expectancy is often reported as shorter — estimates suggest around six years shorter for autistic adults without intellectual disability, and up to fifteen years shorter for those with it — but these numbers are uncertain, blurred by underdiagnosis and sample bias. The drivers are co-occurring conditions, systemic neglect, healthcare barriers and suicide risk, with the numbers further blurred by how many older autistic adults remain undiagnosed.
The Neglect of Silence
Cognitive research shows a mixed picture. Some strengths hold, while other domains show gaps. Dementia risk is a major unknown: some studies suggest parallel age-related decline, others hint at a double jeopardy effect, while some find no extra risk at all. Quality of life is often low, dragged down by depression, isolation and weak support networks. Where people do better, it is usually tied to social support, autonomy and the self-acceptance that can come with a later diagnosis. And perhaps the sharpest finding is absence itself: just 174 out of more than 34,000 autism studies since 1980 — only 0.4 percent — have looked at older adults. Most stop at age 40. That silence is neglect.
The Frame That Matters
Notice what the review did not do: it didn’t call older autistic adults a burden. It didn’t chase prevention panic or early detection fetish. It pointed at barriers — underdiagnosis, healthcare access, isolation — and named them as problems in the system, not problems in us.
But notice what’s missing: autistic authorship. Priorities are pulled from stakeholder consultations, not autistic-led framing. We are still data points more than narrators. That keeps the paper in ally territory, not fully protective.
The Shape of Harm
One strength of this review is how it names the lack of research on older autistic adults. When 90 percent of us over 50 remain undiagnosed, and almost no literature looks beyond midlife, that absence shapes care, planning and policy. It leaves doctors untrained, services unready and families confused.
The mechanism is neglect. The beneficiary is the status quo — autism framed as a childhood condition, nothing more. This review avoids cure language, but the wider research culture still leans on it.
Why Methods Matter
This is a review, not new data. But it matters because it shows a pattern across registries, insurance records, surveys and interviews. The pattern is consistent: autistic people age, but research ignores us. Naming absence as finding is itself a method of critique.
Better Questions to Ask
What if dementia research always checked for autistic traits? What if menopause studies asked how care should adapt, not how burden should be measured? What if late diagnosis was treated as normal, not anomaly? What if quality of life was measured by autistic standards — autonomy, access intimacy, self-acceptance — not just jobs and independence?
The Uncomfortable Truth
This review should not be rare. But when only 0.4 percent of autism research looks at older adults, simply asking the question — what happens to us as we age — becomes radical.
The answers aren’t pretty: more illness, shorter lives and deeper isolation. But the bigger indictment is silence. When studies go quiet after 40, that is not a gap. It is erasure.
Aging autistic people exist. The record should show it.