Some children who are diagnosed with autism at an early age will ultimately shed all signs and symptoms of the disorder as they enter adolescence or young adulthood, a new analysis contends.
Whether that happens because of aggressive interventions or whether it boils down to biology and genetics is still unclear, the researchers noted, although experts suspect it is most likely a combination of the two.
The finding stems from a methodical analysis of 34 children who were deemed "normal" at the study's start, despite having been diagnosed with autism before the age of five.
Reason for the research
"Generally, autism is looked at as a lifelong disorder," said study author Deborah Fein, a professor in the departments of psychology and pediatrics at the University of Connecticut. "The point of this work was really to demonstrate and document this phenomenon, in which some children can move off the autism spectrum and really go on to function like normal adolescents in all areas, and end up mainstreamed in regular classrooms with no one-on-one support.
"Although we don't know exactly what percent of these kids are capable of this kind of amazing outcome, we do know it's a minority," she added. "We're certainly talking about less than 25% of those diagnosed with autism at an early age.
"Certainly all autistic children can get better and grow with good therapy," Fein said. "But this is not just about good therapy. I've seen thousands of kids who have great therapy but don't reach this result. It's very, very important that parents who don't see this outcome not feel as if they did something wrong."
Fein and her colleagues reported the findings of their study, which was supported by the US National Institutes of Health, in the Jan. 15 issue of the Journal of Child Psychology and Psychiatry.
The 34 individuals previously diagnosed with autism (most between the ages of two and four) were roughly between the ages of eight and 21 during the study. They were compared to a group of 44 individuals with high-functioning autism and a control group of 34 "normal" peers.
In-depth blind analysis of each child's original diagnostic report revealed that the now-"optimal outcome" group had, as young children, shown signs of social impairment that was milder than the 44 children who had "high-functioning" autism. As young children, the now-optimal group had suffered from equally severe communication impairment and repetitive behaviors as those in the high-functioning group.
That said, the optimal group retained none of the telltale signs of autism with respect to impaired social skills, communication behaviors or the ability to recognize faces. What's more, all were enrolled in school settings that did not cater in any special way to the needs of children with autism.
Fein stressed that her group's work is ongoing, and the team will analyze brain imaging information that might reveal some of the structural shifts under way among the formerly autistic group. The researchers also will look at various types of therapies the children had received following their initial diagnosis, to determine what kind of intervention seemed to have the greatest positive impact.
"We do have data on this, but we haven't looked at it yet," Fein said. "From 40 years of clinical experience, it seems to me that behavioral interventions are the ones that are most likely to produce this outcome.
"But I want to point out that this is the result of years of hard work," she added. "This is not anything that happens overnight. I would say that at minimum we're talking about two to three years of intensive therapy to produce this outcome, but it could also be five years. It's variable.
"The other important thing to say," Fein said, "is that, even for the minority of children who experience this outcome, you don't want to let go of therapy prematurely. Although we haven't seen any kids whose autism has come back, we don't really know that that can't happen. Children who go on to lose the symptoms of autism will still continue to be at risk for certain things, like attention problems and anxiety, so intervention of some sort may be needed on a continual basis.
"Apart from that, I would tell parents that with all of this an early diagnosis and early intervention is very, very important," Fein added. "If a parent out there has any questions about their child and autism they should not wait and see. If a doctor tells you to wait, you should not. Get an evaluation."
Geraldine Dawson, chief science officer for Autism Speaks, said the study provides concrete support for what many on the front lines of autism have been witnessing.
"Clinicians have long observed that a minority of children who originally received a diagnosis of autism spectrum disorder will lose that diagnosis," she said.
"We still don't know what factors account for why some children lose their diagnosis, whereas others continue to have significant challenges," Dawson added. "However, it is likely that a combination of both early intervention and inherent biological factors play a role."
For more on autism, visit the U.S. National Institutes of Health.
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