Background Although Autism Spectrum Disorders (ASDs) are generally considered lifelong disabilities, literature suggests that a minority of individuals with an ASD will lose the diagnosis. However, the existence of this phenomenon, as well as its frequency and interpretation, is still controversial: were they misdiagnosed initially, is this a rare event, did they lose the full diagnosis but still suffer significant social and communication impairments or did they lose all symptoms of ASD and function socially within the normal range? Methods The present study documents a group of these optimal outcome individuals (OO group, n=34) by comparing their functioning on standardized measures to age, sex, and nonverbal IQ matched individuals with high-functioning autism (HFA group, n=44) or typical development (TD group, n=34). For this study, ‘optimal outcome’ requires losing all symptoms of ASD in addition to the diagnosis, and functioning within the non-autistic range of social interaction and communication. Domains explored include language, face recognition, socialization, communication, and autism symptoms. Results OO and TD groups’ mean scores did not differ on socialization, communication, face recognition, or most language subscales, 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 social domain, but had equally severe difficulties with communication and repetitive behaviors. Conclusions Although possible deficits in more subtle aspects of social interaction or cognition are not ruled out, the results substantiate the possibility of optimal outcome from autism spectrum disorders and demonstrate an overall level of functioning within normal limits for this group.

Objective Autism spectrum disorders (ASDs) were once considered lifelong disorders, but recent findings indicate that some children with ASDs no longer meet diagnostic criteria for any ASD and reach normal cognitive function. These children are considered to have achieved ‘optimal outcomes’ (OO). The present study aimed to retrospectively examine group differences in the intervention history of children and adolescents with OO and those with high-functioning autism (HFA) Method The current study examined intervention histories in 34 individuals with OO and 44 individuals with HFA (currently ages 8-21), who did not differ on age, sex, nonverbal IQ or family income. Intervention history was collected through detailed parent questionnaires. Results Children in the OO group had earlier parent concern, received earlier referrals to specialists, and earlier and more intensive intervention than those in the HFA group. Substantially more OO children received Applied Behavior Analysis (ABA) therapy than HFA children, although the intensity of ABA did not vary between groups. Children in the HFA group were more likely to have received medication, especially anti-psychotics and anti-depressants. There were no group differences in the percent of children receiving special diets or supplements. Conclusion These data suggest that OO individuals generally receive earlier, more intense interventions and more ABA, while HFA individuals receive more pharmacologic treatments. While the use of retrospective data is a clear limitation to the current study, the substantial differences in reported provision of early intervention, and ABA in particular, are highly suggestive and should be replicated in prospective studies.

This study examines the academic abilities of children and adolescents who were once diagnosed with an autism spectrum disorder (ASD), but who no longer meet diagnostic criteria for this disorder. These individuals have achieved social and language skills within the average range for their ages, receive little or no school support and are referred to as having achieved “optimal outcomes” (OO). Performance of 32 individuals who achieved OO, 41 high-functioning individuals with a current ASD diagnosis (HFA), and 34 typically-developing peers (TD) was compared on measures of decoding, reading comprehension, mathematical problem solving and written expression. Groups were matched on age, sex and nonverbal IQ; however, the HFA group scored significantly lower than the OO and TD groups on verbal IQ. All three groups performed in the average range on all subtests measured and no significant differences were found in performance of the OO and TD groups. The HFA group scored significantly lower on subtests of reading comprehension and mathematical problem solving than the OO group. These findings suggest that the academic abilities of individuals who achieved OO are similar to those of their TD peers, even in areas where individuals who have retained their ASD diagnoses exhibit some ongoing difficulty.

Since ASD is often comorbid with psychiatric disorders, children who no longer meet criteria for ASD (optimal outcome; OO) may still be at risk for psychiatric disorders. A parent interview for DSM-IV psychiatric disorders (K-SADS-PL) for 33 OO, 42 high-functioning autism (HFA) and 34 typically developing (TD) youth, ages 8–21, showed that OO and HFA groups had elevated current ADHD and specific phobias, with tics in HFA. In the past, the HFA group also had elevated depression and ODD, and the OO group had tics. The HFA group also showed subthreshold symptoms of specific and social phobias, and generalized anxiety. Psychopathology in the OO group abated over time as did their autism, and decreased more than in HFA.

Restricted and Repetitive Behaviors (RRBs) are core features of Autism Spectrum Disorders (ASDs). Efforts to understand the purpose of RRBs have raised questions about the significance of the presence of RRBs in the long-term outcome of children with ASDs. Some studies have reported that the presence of RRBs during preschool years is a negative prognostic indicator for later childhood (e.g., Charman et al., 2005), while others have failed to replicate this finding (e.g., Bopp et al., 2009). This study examined the effect of RRBs on later functioning in 40 children with ASDs. RRBs were examined at ages 1-2 and 3-5 years using direct observation and parent report. These scores were used to predict cognitive functioning, adaptive abilities, and ASD symptomatology at age 8-10 years. The results suggest that RRBs observed early in the preschool period do not predict later functioning. However, when RRBs are observed at age 3-5 years, they appear to be useful prognostic indicators. Specifically, more severe preoccupations with parts of objects, sensory interests and stereotyped motor movements observed between 3-5 years of age predicted less developed cognitive and adaptive skills, as well as greater ASD symptom severity at age 8-10 years. The relationship between RRBs in the late preschool period and school age outcome is not as strong as the relationship between cognitive functioning in the late preschool period and school age outcome. However, overall, these findings indicate that exhibiting RRBs in the late preschool period does appear to be a negative prognostic indicator for school-age outcome.