We describe the results of a long-term follow-up examination of two adult females diagnosed exhibiting an autism spectrum disorder in childhood. Over four decades after the initial diagnosis made by Gerhard Bosch, besides Leo Kanner and Hans Asperger, one of the first clinicians to describe cases of autistic behavior, the individuals had largely different psychiatric outcomes. Despite the fact that both females continuously showed definite autistic traits, one woman exhibited a generalized anxiety disorder, while the other was predominantly characterized by schizoaffective symptoms. The trajectories of the two cases are discussed in the light of research on possible associations and overlaps between autism spectrum disorders, psychosis and anxiety disorders. It is suggested that adult outcome studies in autism should consider a broader range of comorbidity.