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.
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.