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Outgrowing Autism? Outgrowing the Symptoms, Outgrowing the Clunky Autistic Spectrum

Posted Feb 16 2012 11:34am
Who could resist this beauty at only $112. 
Can kids "outgrow" autism?

A new study shows that almost one-third of children once diagnosed on the autism spectrum loose the diagnosis. 

The study published in February's journal of Pediatric also shows that "outgrowing" autism may be related to the number and severity of the child's other psychological and physical conditions present at the time of the original diagnosis.  Conditions from attention deficit hyperactivity disorder, learning disabilities, depression, anxiety to epilepsy, seizures, speech and hearing impairments.

Researchers from Johns Hopkins Bloomberg School of Public Health looked at data from almost 1,400 children aged 3 to 17 with either a past or current autism diagnosis.  Parents were called and asked  whether their kids had an autism diagnosis.  Yeah, I know, imagine getting that call about 5:30 pm between homework, piano and baking the allergy-free brownies for the birthday snack at school. For one, whose kid doesn't have some attention deficits by that hour?  I start exhibiting a little borderline personality.

Anyhow it's a wonder anyone answered but many reported that indeed their child no longer had an autism diagnosis
25% of parents with 3 to 5 year olds
33% of parents with 6 to 11 year olds
35% of parents with 12 to 17 year olds 

Interesting data in and of itself, no? Remember all the kids at one point were put on the spectrum. Note the older children seem to loose the diagnosis.  It's unclear why.  In fact this study didn't address the why but there are some clues about which children tend to shed the autism. 

Kids with two or more "co-occurring" conditions (in addition to autism) were 5 times more likely to still have the diagnosis
Among preschoolers, kids who were diagnosed with a current diagnosis of autism were almost five times more likely to have two or more other conditions than those kids who had a previous diagnosis of autism. Learning disabilities and developmental delays were the most significant predictors of having a current autism diagnosis in 3- to 5-year-olds. Why Some Children May "Outgrow" Autism, WebMD, January 23
This is probably not much of a surprise to parents with children on the spectrum or who are familiar with the compilation of disorders and symptoms aka the Diagnostic and Stastical Manual of Mental Disorders (DSM).  Symptoms tend to overlap across disorders.  Inattention, for instance, pops up in ADHD and autism check-lists as does many other symptoms.  Also, the younger the child, the trickier to suss out the primary disorder so to speak. Some kids get slapped with a label of two that doesn't quite fit. Over time one diagnosis becomes a better fit.  Consider hearing impairments that in preschoolers can look very much like autism (i.e. a child with social/communication impairments).  So some "outgrow" autism simply by being misidentified early on. 

No doubt some "outgrow" it by showing improvements (i.e. reduction of symptoms).  The link between co-occurring disorders and autism, thus, probably has something to do with treatment too.  Children improve in many realms thanks to treatment - targeting not just the other conditions but autism too. The more treatment, the fewer symptoms.  

In any event, this study shows the type and number of co-occurring conditions predict whether children will retain an autism diagnosis or "outgrow" it.  But not why kids seemingly "outgrow" it according to study author Li-Ching Lee, PH.D., ScM, associate scientist at the Johns Hopkins Bloomberg  School of Public Health:     
"We don't know what changed the diagnosis. However, we want to deliver the message that it's important to look at the other coexisting conditions, evaluate them before you make a diagnosis, and also recognize these conditions vary by development age."  Medline Plus, NIH
In other words, clinicians out there, try to be more accurate in doling out the diagnoses. 

As if psychologists and psychiatrists aren't going to be confused enough with the new autism definitions featured in the imminent DSM-V . Seems we as a society have outgrown the expanded Autistic Spectrum, especially Aspergers and Pervasive Developmental Disorder. 

By the way, can you imagine the work researchers will have in future decades trying to do this kind of study after the new DSM comes out with a narrower definition of autism?  Comparisons across time are going to present a real head ache.  It's already confusing - for a little sample read this recent piece in the New York Times.  Asperger's History of Overdiagnosis, January 31.

For those of you in need of comic relief, check out this graphic ode to pseudo-science featuring autism quack and de-licensed doc Andrew Wakefield.  The Red Flags of Quackeryv2.0.   Brought to my attention by autism guru Liz Ditz

Heather A. Close, Li-Ching Lee, Christopher N. Kaufmann, and Andrew W. Zimmerman. Co-occurring Conditions and Change in Diagnosis in Autism Spectrum Disorders. Pediatrics Vol. 129 No. 2 February 1, 2012 pp. e305-316. doi: 10.1542/peds.2011-1717
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