Is it possible for children to 'grow out' of autism?

Behind the Headlines

Thursday January 17 2013

Autism can normally be diagnosed in children from the age of two

"Children can 'grow out of' autism, psychologists say, challenging the established view that autism is a permanent, incurable condition," The Independent has reported.

The story is based on a study that documented a group of individuals with an early history of diagnosed autism. These individuals no longer met the criteria for this diagnosis in later life and seemed to function normally.

The study compared the functioning of this group with a group consisting of people with high functioning autism (often referred to as Asperger syndrome) and a second group of people who were developing or had developed "normally".

The study found that people in the first group, who had lost the autism diagnosis, showed language, face recognition, communication and social interaction skills no different from the "normal" group and had no remaining autistic symptoms.

While this study suggests that some children with a diagnosis of autism can go on to function normally, although whether they genuinely "grow out" of autism is uncertain. It is possible that some of these children were misdiagnosed initially, or that intensive therapy helped this group ‘mask’ their underlying condition.

And while this study suggests that there may be individual cases where symptoms of autism can be overcome, it does not provide any evidence about the most effective way this can be done.

As the authors say, more research is needed to explain their findings and to explore how children with autism can be best helped to develop their potential. 

 

Where did the story come from?

The study was carried out by researchers from the University of Connecticut, Queen’s University Canada, The Children’s Hospital of Philadelphia, Hartford Hospital and the Child Mind Institute. It was funded by the US National Institutes for Health and was published in the peer-reviewed Journal of Child Psychology and Psychiatry.

It was covered fairly in the papers, with BBC News and The Daily Telegraph including comments from an expert in the UK. However, the repeated claim in the headlines that children may "grow out" of autism is misleading. The direct effects of ageing on autism symptoms were not studied.

It is uncertain whether children who did not receive treatment for autism would still have experienced an improvement in symptoms as they grew older.

 

What kind of research was this?

This was an observational study that documented the cognitive, language and social functioning of a group of individuals who had been diagnosed with autism at a young age but who no longer had an autism diagnosis. It is part of a larger ongoing study looking in detail at these individuals.

In this study, the researchers compared the functioning of these children to two other groups:

  • one group of individuals with high functioning autism
  • one group of individuals with "typical development"

They wanted to find out if the first group still had some residual symptoms of autism or if they genuinely fell within the normal range of functioning.

The authors say that although autistic spectrum disorders (ASDs), which also include Asperger syndrome and pervasive developmental disorder, are generally regarded as lifelong, some research suggests that a small number of children with an early history of autism do not meet the criteria for this diagnosis in later years.

Although this could be due to an initial misdiagnosis, some studies suggest that with the right intervention, some individuals can achieve an "optimal outcome" (OO), no longer meeting the criteria for diagnosis of ASD, and losing all symptoms.

Studying individuals who have "lost the diagnosis", the researchers say, has important implications for understanding:

  • the neurobiology of autism – how autism affects the brain and how the brain affects autism
  • the impact of therapy on functioning
  • the mechanisms underlying improvement

 

What did the research involve?

The researchers recruited:

  • 34 individuals with a history of ASD and OO, which is defined as no longer having a diagnosis of autism and losing all symptoms
  • 44 high functioning individuals with a current ASD diagnosis
  • 34 people who had typical development

Their ages ranged from 8 to nearly 22 years. The groups were matched on age, gender and non-verbal IQ.

All potential participants were carefully screened by telephone interviews with parents, to ensure they met the criteria for inclusion. After screening by telephone, participants were evaluated by specialist clinicians over the course of two or three testing sessions carried out at university or at home. Further parent interviews were also conducted.

The OO individuals that were included:

  • had a documented diagnosis of ASD that had been carefully reviewed by an expert
  • had a current evaluation by a clinician that ASD was not present
  • had high scores on one of the scales used to measure and evaluate symptoms and signs of autism in the areas of communication and socialisation, as reported by parents
  • were in normal education, with no special assistance to address autism deficits

The high functioning autism individuals needed:

  • to meet diagnostic guidelines for high functioning autism

The "typical development" individuals:

  • did not meet criteria for ASD at any point in their development, according to parental reports
  • did not have a first degree relative with an ASD diagnosis
  • did not meet current diagnostic guidelines for ASD

Participants performed a series of well-established tests to measure their language function, facial recognition, social interactions, communication skills and autism symptoms.

 

What were the basic results?

Researchers found that:

  • The average scores for socialisation, communication, face recognition and most language tests did not differ between the OO group and the typical development group, although three OO individuals showed below-average scores on face recognition.
  • Early in their development, the OO group displayed milder symptoms than the HFA group in the area of social interaction but had equally severe difficulties with communication and repetitive behaviours.

 

How did the researchers interpret the results?

The researchers say the results clearly demonstrate the existence of a group of individuals with an early history of ASD who no longer meet the criteria for this condition. Their communication and social skills are on a par with individuals of typical development, matched for IQ, sex and age.

They say a small number of this group had some weakness on a face recognition test, but not beyond what might be expected by chance.

As this is the first part of a wider study, the researchers say that further tests will examine possible deficits in more subtle aspects of social interaction or cognition, in the OO group. 

These first results, they say, confirm the possibility that some individuals initially diagnosed with autism can have “optimal outcomes” [ie, their symptoms improve] and function within normal limits.

 

Conclusion

This interesting study is part of a larger ongoing study looking in detail at individuals with an early history of autism who no longer meet criteria for a diagnosis. It raises several, as yet, unanswered questions. As the authors point out:

  • The individuals in the OO group had above average IQ scores. It is possible that this enabled some to "compensate" for (or mask) some of their deficiencies.
  • The study does not tell us how many children with ASD might achieve an optimal outcome.
  • We do not know which intervention, if any, can produce the highest rate of OO. (Intervention data from the OO group was collected and is currently being examined.)
  • It is not clear to what extent brain structure and function have normalised in OO individuals. (MRIs were carried out on a subset of each group and this data is currently being analysed.)
  • It is possible that subtle differences in social behaviour, cognition and communication still exist in those who appear to function normally.
  • It is possible that parents of OO children were generally highly involved in the children’s treatment programmes and their social lives and this may maximise the chance of OO.

As the authors say, more research is needed to explain their findings and to assess how children with an ASD can be best helped to develop their potential. 

It is normally the case that those with more severe symptoms of autism are unresponsive to treatment and are unlikely to experience an improvement similar to that described in this study. They are likely to find it difficult to live independently as adults and may need additional care and assistance. However, with the appropriate care and support, they can enjoy a good quality of life.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on twitter.

Links to the headlines

Children can 'grow out of' autism, psychologists say, challenging the established view that it is a permanent, incurable condition. The Independent, January 15 2013

Children 'may grow out of autism'. BBC News, January 16 2013

Children can grow out of autism: Controversial research suggests not all youngsters have the same fate. Daily Mail, January 16 2013

Links to the science

Fein D, Barton M, Eigsti I, et al. Optimal outcome in individuals with a history of autism. Journal of Child Psychology and Psychiatry. Published online January 16 2013

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Comments

The 4 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Letsbclear said on 19 January 2013

The more parents become informed about autism being a whole body condition, the more we will see children with autism recovering from the condition and leading the whole and rewarding lives they were meant to have.

Ignorance abounds regarding autism, not only amongst some parents but also among those we are told to believe, namely doctors and other clinicians.

Treating Autism's comments are well said.

Children are not receiving what they need. The more parents become informed, the more they will understand what they must give and do for their children and the more we will see recovered children.

The NHS response to Dr Fein's study is no surprise, albeit depressing.

That does not stop researchers and clinicians worldwide who are truly committed to finding an answer to autism, from doing so.

I believe I can safely say that in 10-15 yrs we will be thinking completely differently about autism than we are now. I cannot wait for that day. I cannot wait for the day when parents can express their hearts desire to heal their children (many of whom have suffered environmental assaults due to toxins). There are thousands and thousands of very well informed parents in the UK. Just like there are those who like to refer to autism as something that is 'incurable' - our knowledge too is 'incurable' we are never giving up our knowledge and nothing will stop us in seeking more.

The self fulfilling lies being told about autisim that it is forever, that 'there is nothing to be done', that your child will never do this or never do that - all of that has to stop. With the right treatment and understanding, children are making progress and gains that are amazing.

Yet why should that be amazing? All they needed was the right help, the right medical and educational help.

Funny, we seek 'cures' for things like Alzheimers, Cancer, diabetes, but autism remains a 'forever' thing? I think not. Thank you Dr Fein! Your studies have been a huge contribution!

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User741255 said on 18 January 2013

Claims of recovery from autism abound on the Internet and the media but until recently, the scientific community had not looked seriously at such incredible outcome: A full normalisation of social and behavioural deficits in individuals previously diagnosed with autism.

Where does this leave us with regard to our understanding of the condition, and intervention strategies?

A growing number of studies have demonstrated that autism is a disorder that is triggered by environment factors and that autism is associated with treatable co-morbid health issues. These health issues impact on prognosis, as well as on the behavioural, social and cognitive presentation of the individuals. Clinicians working with children with autism have reported that addressing these co-morbidities leads to significant improvement in functioning and that for as many as 25% of them, it is to such a high degree that the changes are seen as life changing. This study provides further evidence that recovering from autism is indeed possible and opens up the possibility of improvement. As the Editor of the Journal of Child Psychology and Psychiatry puts it, outcomes such as “emergence from isolation into engagement with the world and full participation in an ordinary life, even whilst retaining significant symptoms” are most desirable.

Today in Scottish schools one child in 85 has an autism diagnosis. It is vital for these children that there is a new , more positive, and dynamic approach to this devastating condition.

Autism is treatable.

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User492629 said on 18 January 2013

I really do believe that kids can grow out of autism so doctors should be very careful before they label a child in this way. I personally think labels are very stigmatising to a young child. Why cant they just accept the child for who he/she is . I also feel the same way about ADHD.
Kids are very unpredictable and they all develope at different rates. They just need a lot of love and support, not labels. I really disagree with the current trend of psychoanalysing kids. Childhood is a bit of a mystery, Let it remain that way. Its a very special time.

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Treating Autism said on 17 January 2013

Our charity, Treating Autism, has close to a thousand member families. Many of them have seen incredible changes in their children with ASD diagnoses when using appropriate interventions. Some of these children have completely recovered, and no one, regardless of their expertise in autism, would see any traces of their former diagnoses or symptoms. This type of recovery is still fairly rare, although in a survey conducted of our members, some of whom are adults with ASD treating themselves, 95% of respondents said that interventions had proven beneficial, and 24% responded that biomedical treatments had been 'life-changing'. We know that the sort of 'optimal outcomes' discussed in Fein's research would be a lot more common if people with autism and their families were given the sorts of support--medical and otherwise--that they need, and if professionals were basing their actions on the fact that ASD is not necessarily a life-long diagnosis. Sadly, the vast majority of these families receive little to no appropriate help. We hope, for the sake of our children, many of whom are now adults, that this study and other current research will be taken seriously by the professionals who, by perpetuating the erroneous belief autism is by definition a lifelong disorder, do a disservice to those who might benefit from interventions aimed at addressing core symptoms of autism.

Treating Autism Trustees

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Analysis by Bazian

Edited by NHS Choices

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