Autism is generally considered to be a lifelong condition. While treatment can certainly be effective, the goal is often described more in terms of symptom reduction rather than a true recovery (in which no criteria of the disorder are met). A small but intriguing study by Fein and colleagues, however attempts to document a group of previously autistic children who no longer manifest any significant effects of the condition.
This study examined 34 youth between 8 and 21 years of age who previously met full criteria for rigorously diagnosed autism but presently had no signs of an autistic spectrum disorder. This group was designated the “Optimal Outcome” group and they were compared on a number of measures to an age, sex, and nonverbal IQ group of individuals with high functioning autism and a group with typical development. All subjects has full scale IQs above 77.
With some small exceptions on certain subscales, the Optimal Outcome individuals looked indistinguishable from the control group and performed better than the high functioning autism group on measures of language and communication, social ability, and facial recognition. Compared to the other autistic group, the Optimal Outcome group appeared to have somewhat milder autistic symptoms earlier in childhood, particularly with regard to social behaviors. The Optimal Outcome group also had a mean IQ in the high average range.
The authors concluded they were able to demonstrate the presence of a minority subgroup of autistic individuals who later in life had no significant autistic impairments and cognitive ability within the normal range. The authors qualified that there data were not equipped to answer the question of how many children diagnosed with autism will no longer meet criteria prospectively or what factors might predict this optimal outcome. Additional neuroimaging and intervention data are currently being analyzed by this group.
With evidence that autism truly is a spectrum condition with the continuum existing not only throughout the diagnosis but into the “normal” range as well, it remains to be seen the degree to which these youth no longer “have” autism versus them dropping below diagnostic cutoffs through compensatory strategies. While the authors were careful not to use words such as “cure” or “outgrow,” the same unfortunately cannot be said about some media reports since the study’s publication.
Fein D, Optimal outcome in individuals with a history of autism. J Child Psychol Psychiatry 2013;54:195-205