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A new study suggests that almost all children who lose their diagnosis of autism suffer from other conditions, such as anxiety and language and behavioral disorders.1. Many also need support at the school.
About 9% of children diagnosed with autism later do not meet the criteria for this disease. Reports from parents and some medical records suggest that these children often still have other problems, such as language problems and attention problems.
The new study focused on children with autism diagnosed at the Montefiore Medical Center in New York around the age of 2 and who no longer met the criteria for this condition about four years later. The same team of clinicians evaluated the children at both times. They found that children whose traits have improved enough to lose the label of autism still meet the requirements for other diagnoses.
"They improve socially, are more engaging and are able to keep up with demands. They have also fallen into the normal cognitive range, but they have some problems, "said senior researcher Lisa Shulman, director of clinical services for autism at the Montefiore Children's Assessment and Rehabilitation Center.
Of the 38 children in the study, 17 are Hispanic, 4 African American and 14 Caucasian. This is a much more diverse sample than in previous studies, says Letitia Naigles, a professor of psychological science at the University of Connecticut in Storrs, who did not participate in the study.
The findings underscore the need to monitor children with autism as they grow up and tailor support to their ever-changing needs, she says.
"Let's be vigilant – to see if there are other symptoms and whether they still need support," said Naigles.
Tracking tots:
Shulman and his colleagues reviewed the clinical records of 569 autistic children in Montefiore between 2003 and 2013. They found 38 children diagnosed at 2 and a half years of age on average, but no longer met the criteria. at the age of 6 and a half. , on average.
The researchers looked at children's results on the autism assessment scale in children, a clinician's assessment of autism characteristics. Whenever possible, they also reviewed children's cognitive test scores and the Autism Diagnostic Observation Schedule, a baseline test for autism.
At the initial visit, the children had mild to moderate autism and most had a moderate to severe developmental delay.
At follow-up, they all scored in the typical range of autism trait tests. And to the surprise of the researchers, all 33 children who had cognitive tests at follow-up achieved normal results.
"In addition to going socially in a great direction, their degree of developmental delay has really resolved, so these things go together," says Shulman. She also notes that most children who have lost their diagnosis of autism initially had mild features.
In progress problems:
However, all but 38 out of 38 children have learning or behavior problems in progress: 26 have a language or learning disability, 19 have behavioral problems – hyperactivity disorder with attention deficit, oppositional defiance disorder or disruptive behavior disorder – and 9 have mood disorders, anxiety, obsessive-compulsive disorder or selective mutism.
Of the 34 children for whom education plans were available, 15 were in regular classes and 19 in special classes.
An important limitation of the study lies in the fact that not all autistic children diagnosed at the clinic have returned for a follow-up visit. Those who have not returned may differ significantly from those who have returned – for example, they may not have had problems that would have warranted another visit.
Researchers do not have all the information for each child – another limitation. However, clinicians note in the document that they did not intend to collect children's files for a research study, says Stelios Georgiades, an assistant professor of psychiatry and behavioral neuroscience at McMaster University in Hamilton. in Canada who did not participate in this study.
But their analysis suggests that clinical data can nevertheless be exploited to better understand trajectories of autism. "It shows how much of the clinical data we collect on children can be useful," says Georgiades.
About half of the children participating in the study continue to the Shulman center; his team intends to follow them as they grow up.
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