Most Children with Autism Will Improve with Early Interventions
Autism is considered a wide-spectrum disorder as no two patients have exactly the same symptoms. The disorder is characterized by social and communication difficulties, but patients can be described as either “high functioning” (mild) or “low functioning” (severe). New research has found new hope for patients of children on the lower end of the spectrum. Even those that are severely low-functioning may improve dramatically over time, with some “outgrowing” the diagnosis by their teen years.
Peter Bearman PhD of Columbia University and colleagues examined data on children with autism born in California between 1992 and 2001 and who received a confirmed autism diagnosis by 2006. The analysis included data on 6,975 children who had at least four evaluations completed by the California Department of Developmental Services (DDS). The study represents most of the children who received an autism diagnosis in the state during the time period.
The researchers looked at development in three dimensions: communication, social function, and repetitive behaviors. Intelligence was also included in the analysis.
Autism can cause cognitive deficits in some children but overall, most children in the study – 63% - did not have intellectual disabilities. In fact, several had enhanced intellectual abilities and some affected children had extremely high IQ’s. The researchers found that especially when it came to social and communication scores, most kids improved over time -- though some much faster than others.
"These children follow really different pathways over time, changing at very different paces and according to very different patterns," said study author Christine Fountain, a postdoctoral researcher at Columbia's Institute for Social and Economic Research and Policy. "Most children do get better, at least a little bit."
Autistic children who were high-functioning (can communicate effectively with others, maintain friendships, and are willing to engage in social pursuits) tended to show the most improvement over time. Also, when children were high-functioning in one dimension, they were most likely to be high functioning in at least one of the other two dimensions. Children with high functioning autism tended to have mothers who were older, more educated, white, and less likely to be a Medicaid recipient.
About one-third of the study group was considered low- to low/medium-functioning, meaning that they may have trouble talking, interacting with others and making friends with peers. Even among those who were severely low-functioning, about 10% “bloomed,” meaning they made fast gains during elementary school years and progressing to “high functioning” by age 14.
Unfortunately, though, those who had intellectual disabilities coinciding with an autism diagnosis were much less likely to make significant improvements. Also, children who bloomed tended to have mothers that were not minorities and who were older and more educated. Although the study didn’t specifically examine treatments or interventions, this factor suggests that low-income or minority families may not be receiving the services and support they need.
One downside found in the study was that while communication and social behaviors might improve more dramatically in some children, patterns of repetitive behaviors, which can include hand-flapping and head-banging, tended to remain relatively stable, improving or worsening in only about 15 percent of children over time.
"More work is needed to discover whether these longitudinal patterns will help us not only to understand the diversity of autism but also to better target interventions and improve treatment," conclude the authors.
Fountain C, et al. "Six developmental trajectories characterize children with autism" Pediatrics 2012; DOI: 10.1542/peds.2011-1601.