Social Functioning in Individuals with a History of Autism Spectrum Disorders Who Have Achieved Optimal Outcomes

Background: A study is currently following children and adolescents who have a history of autism spectrum disorder (ASD), but who no longer meet diagnostic criteria for the disorder. These individuals have achieved social and language skills within the average range for their ages and receive little or no school support. Several recent studies suggest that this small subset of children, once diagnosed with ASD, achieve an "optimal outcome (OO)" (Sutera et al., 2007, Kelley et al., 2010, and Helt et al., 2008).

Objectives: Despite no longer meeting diagnostic criteria for an ASD, OO individuals may exhibit subtle deficits in the social domain.  This study examines social functioning by assessing autism symptomatology and adaptive skills in a group of OO individuals.

Methods: The Autism Diagnostic Observation Schedule (ADOS) was conducted with 32 OO individuals (M(age)=12.9), 33 individuals with high-functioning autism (HFA) (M(age)=13.4), and 25 typically developing (TD) peers (M(age)=13.9).  Parents of participants completed the Vineland Adaptive Behavior Scales (Vineland) interview. The groups were matched on age, sex and nonverbal IQ; however, the groups differed significantly on verbal IQ (M(OO)=112.7, M(HFA)=103.0, M(TD)=112.1, p<.05). 

Results: Higher scores on the ADOS indicate more abnormal behavior. There was a statistically significant difference between the groups on the ADOS social algorithm total, F(2, 87)=127, p<.001.  The mean ADOS social algorithm total for the HFA group (M=7.00) was significantly greater than the OO (M=1.41) and TD groups (M=0.32), which were also significantly different from each other. However, the OO group mean was still well below the ADOS ASD cutoff of 4.  Exploratory t-tests were conducted to determine if the OO and TD groups differed on specific ADOS social items. Of the 11 ADOS social items, only 3 differed significantly between the OO and TD groups. There was a significant difference in scores (M(OO)=0.25, M(TD)=0.040, p=.020), and frequency of behavioral abnormality (χ²(1,57)=4.65, p=.031) for facial expressions directed to others.  When the OO and TD groups were compared on insight into the nature of social relationships, there was a significant difference in scores (M(OO)=0.41, M(TD)=0.080, p=.010), and the difference in frequency of abnormality approached significance (χ²(1,57)=5.77, p=.056).  Quality of rapport was significantly poorer in the OO than TD group, both in terms of mean difference (M(OO)=0.31, M(TD)=0.080, p=.024) and frequency of abnormality (χ²(1,57)=4.56, p=.033).  The HFA group had higher group means and greater frequency of abnormality than the OO group on all three of these items. On the Socialization domain of the Vineland, the OO group (M=102) was not significantly different from the TD group (M=102), and both groups scored better than the HFA group (M=77.6; F(2,86)=47.4, p<.001).

Conclusions: These results suggest that, relative to TD peers, OO individuals did not demonstrate deficits in social adaptive functioning skills and were well below ASD cutoff on the social domain of the ADOS.  However, some OO individuals continue to exhibit subtle residual deficits in specific aspects of social functioning, which indicate that these skills may be the most complex within the social domain.