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Thursday, September 10, 2015

Optimal Outcomes Update

In The Politics of Autism, I talk about outcomes.

Siri Carpenter writes at Slate about the "optimal outcomes" study.
More evidence that some children can outgrow an autism diagnosis followed. In a 2014 study in the Journal of Child Psychology and Psychiatry, [Catherine] Lord and her colleagues reported results from 85 children with autism they had followed from ages 2 through 19. The team found that of the 32 children in the study who do not have an intellectual disability, eight—all boys, and just 9 percent of the original 85 children—no longer met diagnostic criteria for autism by age 19 and required no extra support. (Six of the eight boys in this “very positive outcome” group retained their diagnoses until they were at least 14.)

Fein’s and Lord’s studies don’t offer many clues as to why some children outgrow their autism. Those in Fein’s optimal outcome group had slightly milder social symptoms in early childhood than did their peers whose autism did not change, but their early profiles were otherwise largely the same. Similarly, Lord and her colleagues found that children who later lost their diagnoses were no less impaired than others at age 2.

* * *

Early access to treatment may have something to do with these outcomes: In an analysis last year, Fein’s group found that, on average, children in the optimal outcome group had received earlier and more intensive therapy than children who kept their autism diagnoses. About 40 percent of children in the optimal outcome group received ABA therapy between ages 2 and 2 1/2, compared with only 4 percent of children who did not lose their diagnoses. In Lord’s study, all eight children who no longer met autism criteria had received treatment by age 3, compared with only half the children who continued to have symptoms.

Because neither Fein’s nor Lord’s studies randomly assigned children to receive early intervention or not, it’s impossible to say whether or how much the therapy plays a role, however. “Most kids are not going to make this dramatic progress and lose the diagnosis, even with the earliest, most intense services,” cautions Fein.
One more time: The study does not use terms such as "outgrow" or "grow out of," which would suggest that the process is automatic, like losing baby teeth. The New York Times quotes lead author Deborah Fein:
Dr. Fein emphasized the importance of behavioral therapy. “These people did not just grow out of their autism,” she said. “I have been treating children for 40 years and never seen improvements like this unless therapists and parents put in years of work.” [emphasis added]