A new study suggests that social and communication skills in some kids with autism may improve over time with therapy, but other kids will continue having problems functioning as they get older.
Not surprisingly, kids who had milder symptoms when they were first diagnosed tended to be doing better a few years later than those who started out with more severe autism.
But among close to 7 000 children followed by researchers, there was also a group of so-called "bloomers" who started out with lots of communication and social problems but made fast gains during their elementary-school years.
"There's a wide variety of children with different kinds of symptoms that fall within this (autism) umbrella," said Christine Fountain, the lead author of the study and an autism researcher at Columbia University in New York. "We were interested in how these symptoms play out over time."
The new findings, published in Pediatrics, come just a few days after the Centers for Disease Control and Prevention released new data suggesting that one in 88 kids in the United States now has an autism spectrum disorder, which includes less-debilitating conditions such as Asperger's syndrome.
Using data from California centres responsible for testing and treating kids with autism, Fountain and her colleagues tracked kids ages two to 14 who'd had at least four evaluations. During those approximately annual evaluations, staff recorded kids' symptoms of social and communication difficulties as well as their repetitive behaviours.
The researchers found that especially when it came to social and communication scores, most kids improved over time - though some much faster than others.
White kids have less autism symptoms
White kids, and those whose parents were more educated, tended to have less severe autism symptoms during treatment. They were also more likely to be among the 10% or so of kids deemed bloomers, whose symptoms improved dramatically between ages three and 12.
Kids who had other intellectual disabilities along with autism weren't likely to have very large improvements. "The conclusion is, if you have mental retardation as a co-occurring condition with autism, your prognosis is worse," said Johnny Matson, who studies autism spectrum disorders and intellectual disabilities at Louisiana State University in Baton Rouge.
That's not new, he said previous studies have shown that kids with autism and a normal IQ improve more from intensive therapy than those who have both autism and intellectual disabilities. Unlike social and communication skills, repetitive behaviours didn't tend to improve or worsen much over time among the majority of kids in the study.
Most kids will improve
The gaps in improvement based on parents' race and education are probably about access to good-quality treatment, according to Matson. The good news is, "those gaps are narrowing very rapidly", he said, because of laws requiring insurance companies to cover intensive treatment for all autistic kids.
Matson, who wasn't involved in the new study, had some doubts about the specific "symptom trajectories" the researchers used to separate kids, and said a lot of autism assessments aren't done correctly to begin with – which makes interpreting changes over time difficult.
"I think all (kids with autism) are going to improve, it's just a matter of how much they're going to improve," Matson added. "I don't believe you can cure autism. Having said that, you can make it a lot better," especially if kids with autism continue to get therapy as they get older.
Still, another autism specialist not involved in the research said the different patterns in improvement -- or lack thereof – jibe with his own experience.
"We deal with this problem every day, and we sense that there are different patterns or trajectories... in the kids as they develop," said Dr Andrew Zimmerman, from the Lurie Center for Autism at Massachusetts General Hospital for Kids in Lexington.
"For some kids, you work very hard and you do a lot of therapy and nothing happens or very little, and then some kids seem to do really well," Zimmerman said.
Equal access to autism treatment
Fountain said the findings suggest that providing equal access to the best autism treatment for minority and less well-off kids will be important going forward. Some states including California provide services to all kids with autism regardless of their ability to pay, she added, but others don't.
Kids' specific conditions and symptoms may play a role in their long-term improvement, but the treatment they get at certain points in development is also likely to be important, she added.
She and Matson said that parents of children with autism should be persistent in making sure their kids get the help they need, but agreed they can also be optimistic.
"There is a bit of a hopeful note in that we did find that most children get at least a little better over time," Fountain said.Zimmerman agreed, adding that the idea of some kids being bloomers is especially exciting. "There's a lot of hope here," he said.
(Reuters Health, Genevra Pittman, April 2012)
Early, intensive therapy better for kids with autism