Psychiatric Disorders in Optimal Outcome Children with a History of Autism Spectrum Disorders

Background:

Children with Autism Spectrum Disorders (ASDs) exhibit symptoms that, historically, have been considered part of a lifelong disorder. ASDs are defined by marked deficits in social interaction, communication, and repetitive or stereotyped patterns of behavior. A small, but growing body of research indicates that, through intensive early intervention, children with ASDs may show notably reduced problems in language, cognition, and social interaction and may even lose their ASD diagnosis. Fein, Dixon, Paul, & Levin (2005) suggest that one outcome of children with ASD may be a resolution of symptoms into ADHD. Although researchers have found evidence for an array of co-occurring psychiatric disorders in children with ASD, few studies have explored the psychiatric histories of children who lose their ASD diagnosis.

Objectives:

The current study examines the prevalence of psychiatric disorders (other than ASD) in this small subset of children who were diagnosed with ASD before age 5, but who no longer meet criteria for an ASD diagnosis and are placed in mainstream classrooms. This study refers to children in this group as optimal outcome (OO) children.  

Methods:

We compared prevalence rates for psychiatric disorders in 20 typically developing children (mean age = 13.23), 11 children with high-functioning autism (HFA) (mean age = 13.09), and 17 OO children (mean age = 12.91). Groups did not differ in gender (p = .33), age (p = .50), or WASI full-scale IQ (p = .68). We administered The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) to children’s parents in order to compare lifetime rates of different disorders across the three different groups.

Results:

Overall, one or more psychiatric disorders were present in 3/17 of control children (total 4 past, 0 present diagnoses), in 9/11 of HFA children (14 past, 12 current), and in 14/17 of OO children (15 past, 9 current). Notably, two out of 20 (10%) of control children, 3/11 of HFA children (27%), and 10/17 (59%) of OO children met diagnostic criteria for a past or present specific phobia (e.g., animal type, loud noises). No control children, 5/11 (45%) of HFA children, and 4/17 (24%) of OO children met diagnostic criteria for a past or present tic disorder or Tourette’s disorder. One control child out of 20 (5%), 3/11 (27%) of HFA children, and 1/17 (6%) of OO children met criteria for past or present Major Depressive Disorder. No control children, 3/11 (27%) of the HFA children, and 7/17 (41%) of the OO children met criteria for past or present ADHD. Although the DSM-IV does not allow a diagnosis of ADHD along with ASD, evidence of ADHD symptoms in these children is of interest because of treatment implications.

Conclusions:

These preliminary results suggest that these Optimal Outcome children display a history of psychiatric disorders more than their typically developing peers. OO children may show vulnerability to additional psychiatric conditions to a similar extent compared to HFA children. However, further research including a larger HFA sample is needed to support this conclusion.