Optimal outcome in individuals with a history of autism

Abstract

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.

Autism spectrum disorder severity reflects the average contribution of de novo and familial influences

“…This bears not only great relevance toward our understanding of the biological predictors of ASDs, but may also be useful in predicting clinical trajectories. For example, ASD cases with de novo LOF mutations in target genes of the fragile X mental retardation protein have a mean IQ an SD below that of cases without an LOF mutation (P = 0.0005), and higher IQ has been linked to improved adult outcomes in ASD (2,3). These findings also suggest that many ASD statistics reflect an average estimated across different types of cases.…”

“…The most severely impaired individuals-often those with intellectual disabilities, limited speech, and severe behavioral problems-can require lifelong care. At the other end of the functional spectrum, people diagnosed with ASDs can be verbally fluent and academically gifted and can achieve independence in adulthood (2,3). The broad range of cognitive and behavioral profiles seen in diagnosed ASDs has been long viewed as a challenge by the research community (4).…”

1741 – Social cognition in a case of amnesia with neurodevelopmental mechanisms

“…ML did not meet diagnostic criteria for a pervasive developmental disorder. [However, in line with the results of a new small study showing that some individuals with autism spectrum disorder may lose their diagnosis, one could argue that ML might have outgrown a range of symptoms later on (Fein et al, 2013). ]…”

Facilitating Autism Research

“…Onset and course is also quite varied; symptoms may appear during the first year of life (Ozonoff et al, 2010;Zwaigenbaum et al, 2005) or as late as the third year (Ozonoff et al, 2015;Rogers, 2009); some children show regression in language and/or social attainments in the 904 D. Fein and M. Helt second year (Hansen et al, 2008). A minority of children will lose their diagnosis (Anderson, Liang, & Lord, 2014;Fein et al, 2013;Helt et al, 2008), as will a higher proportion of children whose autism was due to environmental deprivation such as congenital blindness (Hobson & Lee, 2010;Hobson, 2014;Jure, Pogonza, & Rapin, 2016) or severe neglect . In some children, RRBs will remit (Esbensen, Seltzer, Lam, & Bodfish, 2009), while other individuals will experience cognitive decline in adolescence or adulthood (Howlin, 2010).…”