Among 34 children who were no longer classified as having an ASD by ratings scales and clinical assessment, most had similar scores on socialization, communication and language as their typically-developing peers. Only a few still had problems with face recognition, they reported. “The results clearly demonstrate the existence of a group of individuals with an early history of ASD, who no longer meet criteria for any ASD, and whose communication and socialization skills … are on par with that of typically-developing individuals,” they wrote.
ASDs are generally considered life-long disabilities, but recent evidence has suggested that a minority of patients will lose their diagnosis.
How often this happens — and whether it truly does — is still controversial. Some studies have put that figure between 3% and 25%. Fein and colleagues looked at 34 children ages 8 to 21, who were free of symptoms and, therefore, also free of their ASD diagnosis. They conducted tests in language, face recognition, socialization, communication, and autism symptoms domains in these children.
Overall, they found that communications scores didn’t differ between the newly “undiagnosed” children and their normal peers. Likewise, there was little difference in most socialization scores — though seven of the cases were judged to have their social functioning mildly affected by conditions such as anxiety, depression, or impulsivity.
Facial recognition scores didn’t differ significantly between the two groups, but Fein and colleagues noted that three of the cases had below-average scores on this measurement.Generally, the kids who lost their diagnosis had somewhat milder AS D symptoms in early childhood, but the researchers questioned the reliability of those assessments, which were largely based on parent recollection — a factor that “may have been colored” by the child’s outcome, they wrote.
But even though the children’s impairments were no longer detected, Fein and colleagues cautioned against drawing firm conclusions noting that it was still possible that subtle residual deficits remained. Studies would need to examine peer interaction and quality of friendships in order to fully assess normal social functioning, they wrote.
Their study also couldn’t address several important questions about losing an ASD diagnosis. For instance, how many children with ASD can achieve similar outcomes, and what intervention — if any — can produce the greatest likelihood of achieving this outcome?
Researchers are also interested in assessing to what extent brain structure and function have completely normalized in these patients. The study was also limited by a lack of diversity among the participating families, which were largely from the northeastern U.S., and thus may be limited in generalizability. These families were generally highly involved in their children’s treatment, which may have maximized the chances of losing the diagnosis, they wrote.
Whether such an outcome is “more likely for children whose families have fewer social stresses and more resources can only be answered by an epidemiological scale prospective study,” they concluded. The study was supported by the National Institutes of Health. The researchers reported no conflicts of interest.