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Can Children with Autism Recover? If So, How?

Posted Dec 02 2008 5:01am

An interesting new study with that very title found its way into my inbox last month. I’ve taken awhile to blog about it whilst I read, re-read, re-re-read, re-re-re-read it (its 23 pages long – 28 with references) and swapped emails with the lead author and approached an understanding of its implications.

Here’s the abstract:

Although Autism Spectrum Disorders (ASD) are generally assumed to be lifelong, we review evidence that between 3% and 25% of children reportedly lose their ASD diagnosis and enter the normal range of cognitive, adaptive and social skills. Predictors of recovery include relatively high intelligence, receptive language, verbal and motor imitation, and motor development, but not overall symptom severity. Earlier age of diagnosis and treatment, and a diagnosis of Pervasive Developmental Disorder-Not Otherwise Specified are also favorable signs. The presence of seizures, mental retardation and genetic syndromes are unfavorable signs, whereas head growth does not predict outcome.

Controlled studies that report the most recovery came about after the use of behavioral techniques. Residual vulnerabilities affect higher-order communication and attention. Tics, depression and phobias are frequent residual co-morbidities after recovery. Possible mechanisms of recovery include: normalizing input by forcing attention outward or enriching the environment; promoting the reinforcement value of social stimuli; preventing interfering behaviors; mass practice of weak skills; reducing stress and stabilizing arousal. Improving nutrition and sleep quality is non-specifically beneficial.

There’s a number of issues that I found interesting about this paper. First was the identities of two of the co-authors – Marcel Kinsbourne (testified for the plaintiffs in the Autism Omnibus) and Martha Herbert (testified that mould causes autism – case lost).

Second was the criteria used to define ‘history of autism’ and also to define ‘current functioning’. Both seemed pretty stringent to me. First ‘history of autism’ (study members were currently aged between 8 – 18 by the way):

By history: (1) The child was diagnosed with an ASD in early childhood (i.e., by age 5) by a specialist (i.e. someone whose practice is at least 50% devoted to autism). (2) There was early language delay (either no words by 18 months or no word combinations by 24 months). (3) Review by one of our team, blind to current group membership, of early reports (age 2–5) and/or videotapes, with diagnostic formulations elided, confirms early ASD.

Second, ‘current functioning’:

By current functioning: (1) The participant does not meet criteria for any Pervasive Developmental Disorder, including PDD -NOS (at least one symptom in social domain plus one additional symptom), which generally means that no social symptom of ASD is present by best clinical judgment. (2) The participant does not meet ASD cutoff on social or communication domain of the Autism Diagnostic Observation Schedule, (3) any special education services the participant receives are to remediate difficulties with attention, organization, or specific academic difficulties and not to address features of autism, (4) the participant is functioning without an individual assistant in a regular education classroom, (5) VIQ, PIQ, and FSIQ are all at 78 or above (1.5 standard deviations below average), (6) Vineland Communication and Socialization Scales are all at 78 or above.

So recovery is indicated by moving from stage 1 to stage 2. I hope others can give their own opinions in the comment section as to how stringent the two criteria are but it seems fairly impressive to me.

So what happened with these kids? How did between 3 – 25% become recovered (by the terms of the study)?

1) Having relativelyhigh intelligence,
2) Having receptive language
3) Displaying verbal and motor imitation
4) Displaying motor developmentbut
5) Earlier age of diagnosis and treatment
6) Having a diagnosis of Pervasive Developmental Disorder-Not Otherwise Specified
7) Use of behavioral techniques (there is a section in the paper expressing caution over the veracity of this finding or at least, its my understanding that there is).

Interestingly, overall symptom severity plays no part in recovery and neither does head growth.

The presence of seizures, mental retardation and genetic syndromes are unfavorable signs.

Something else that seems to play no part:

The recovered children studied by us and others, and described above, however, have generally not received any biomedical intervention.

I was (obviously) particularly interested in this so I asked the author about vaccination status. The reply was:

Complete medical histories were taken, including vaccination status, and had it turned out that our optimal outcome sample hadn’t been vaccinated or had by and large received chelation, we certainly would have reported that…

Its a fascinating paper, not least to me personally as it indicates once and for all that vaccinated kids can (and do) recover without biomedical interventions, thus indicating the vaccination plays no causative role in autism.

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