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‘Optimal Outcomes’ Rare but Real in Autism

Study confirms that a tiny subset of children entirely overcome disabilities; intensive early therapy may be key
December 01, 2013


A “Top Ten Advances in Autism Research 2013” Selection
See all the year’s “Top Ten” here.


Anecdotally, parents and professionals have long suggested that a small minority of children with autism make such great strides that they appear “cured.” Did these children “recover” from autism? Were they misdiagnosed in the first place?

In January, a landmark study provided some answers. Deborah Fein and colleagues at the University of Connecticut studied 34 children and young adults (ages 8 to 21) who had been diagnosed with autism before age 5 but no longer had symptoms. All were doing well in mainstream classrooms without additional support.

When originally diagnosed, all these children had significant language delays: no words at 18 months and not even simple phrases at age 2. The researchers confirmed the accuracy of the children’s original diagnoses in two ways. First they reviewed the written records of the evaluations. Then they removed the ASD diagnosis from the records and presented only the behavior information to independent experts for a second review.

During the study, the participants underwent another full assessment. This included standardized tests of language, communication, face recognition and social interaction. Overall, they scored in line with a comparison group of 34 age-matched individuals without autism. And they scored significantly better than a second comparison group of individuals on the less severely disabled end of the autism spectrum.

“While only a small minority of children with autism will achieve such an optimal outcome, this study confirms what experts and parents have been long telling us,” says child psychologist Lauren Elder, Autism Speaks assistant director for dissemination science. “Individuals with autism have a wide range of outcomes – from significant disability to indistinguishable from typically developing children.”

Importantly, it doesn’t appear that these children simply outgrew their autism by chance, Dr. Elder points out. Most of those in the optimal outcome group had some form of early intervention therapy.

What factors might explain or even predict such optimal outcomes? Dr. Fein has already begun a follow-up study to identify whether certain types of early intervention may be key. In addition, her January report noted that the children in the optimal-outcome group originally had milder social deficits and slightly higher IQs than those in the study’s autism comparison group – though their early communication problems and repetitive behaviors had been just as severe.