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"Outgrowing" Autism: What the Media Missed

Posted Jan 24 2013 10:31am
Is it possible for children to outgrow autism?  Good question.

By now many of you know about the new study suggesting kids diagnosed early in life might be able to "outgrow" it.  Maia Szalavitz covered the study at Time Healthland
The new research, published in the Journal of Child Psychology and Psychiatry and led by Deborah Fein of the University of Connecticut, involved 34 people ages 8 to 21 who had been diagnosed with autism but no longer met criteria for the condition. The initial diagnosis had to be made in writing by a doctor or psychologist specializing in autism before the child turned five. And, to make sure they were studying severe cases, researchers included only children who had not spoken before 18 months or did not use phrases before age 2. New Study Suggests Autism Can be ‘Outgrown’, Time Healthland

Good article.  Important topic.  Pretty good study
Children were diagnosed by age 5.
Children had mild social interaction deficits and rather severe communication and behavioral repetition. So in some way did have "milder" symptoms.

Researchers pulled diagnoses from medical records (not just parent's say so).

Current autism symptoms assessed by interviewing and observing children/young adults.
Those who outgrew autism had higher than average IQs.

A few things the media might have missed
Very small number of kids.  Only 34 children who "outgrew" it here. This is a pilot study, part of a much more ambitious project. I do wonder why more kids weren't included. Is this because outgrowing it was so rare they couldn't find any more suitable participants? The authors don't clarify this in the paper.  Basically the purpose of this small study was to verify there are kids out there who exhibited autism early on that currently don't fit the diagnosis.

Retrospective study.  Researchers gathered up kids who appeared to display autistic behavior and compared their current status to other kids who still had symptoms.  It would have been a much stronger study if researchers gathered kids early in life and watched them until age 18 to see who showed changes (.e. a prospective study).  

It's a subtle point but imagine why it might be a concern.  You're a researcher. You want to know whether reports about outgrowing autism are valid.  You have to find kids who once had it but are now over it so to speak. The quickest way to study it? Troll through your database to find kids who were once diagnosed but now do not have a diagnosis.  You check them against a group that still has symptoms. Check out all the kids for current symptoms. Boom. One group appears to have "outgrown" it.  

In a way the researchers cherry-picked their own evidence ( who outgrew it) because otherwise they'd have to wait another 10 years to check out kids just diagnosed.  They basically said let's see who no longer has autism (no longer qualified under the diagnosis AND showed normal scores on a range of social and communication skills). How? Find kids who no longer have autism! The authors acknowlegde this approach has some limitations
A general point that should be noted is that by defining the OO (outgrew autism) group as having scores within the normal range on specific cognitive and adaptive measures, we reduced the likelihood of finding OOTD differences (difference between the kids who still had autism and those who "outgrew" it.
Did kids really have autism? The study speaks to the question of whether kids were initially misdiagnosed.  Here's some good evidence kids who appeared to outgrew it were not misdiagnosed.  I'm not sure many media articles stressed this point. It's not fool-proof evidence. Again if researchers rounded up 3, 4 or 5-year olds and double and triple-checked their diagnoses then it would be even better.

Limited evidence from other studies suggest this phenomenon (outgrowing autism) is very rare.

Did kids naturally outgrow autism? The term "outgrowing" suggests kids naturally developed better communication and behavioral skills when in fact anecdotal evidence and again some evidence from this study shows kids who "outgrow" it participate in many interventions. 

Personally I don't really like the term but somehow "cure" sounds even worse.  Do you have a better term or phrase? Overcome? Developed more people skills?

Read it for freeOptimal outcome in individuals with a history of autism. Journal of Child Psychology and Psychiatry. 2013 Feb;54(2):195-205. Fein D, Barton M, Eigsti IM, Kelley E, Naigles L, Schultz RT, Stevens M, Helt M, Orinstein A, Rosenthal M, Troyb E, Tyson K.

doi: 10.1111/jcpp.12037

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