Social/Emotional Functioning in Optimal Outcome Children with a History of Autism Spectrum Disorders

Background:  Although ASD’s are usually considered a life-long set of disorders, and are so for the majority, a number of such individuals can lose symptoms and gain skills so that they no longer meet criteria for any ASD. The present paper is part of a larger project in which a group of such individuals are being studied in multiple domains, including neuropsychological, psychiatric, and social functioning, and brain structure and function.  The goal is to document the possibility of an outcome of ASD in which social and cognitive functioning is typical, to examine any residual vulnerabilities, and to explore mechanisms of “optimal outcome” by tracking history, intervention and structural and functional imaging differences from individuals with persisting ASD.

Objectives:  The aim of this paper is to present findings on social and emotional functioning, including adaptive social and communication scores, ADOS scores, face recognition, and psychiatric vulnerabilities.

Methods:  Participants were 44 individuals with high-functioning autism (HFA), 34 individuals with optimal outcome (OO), and 34 individuals with typical development (TD). Age range was 8-21, with an average age of 13 years in all groups. All participants had verbal IQ, performance IQ and full-scale IQ in the normal range (>77).  HFA participants met criteria for an ASD on the ADOS and by best estimate clinical judgment. OO participants did not meet criteria for an ASD on any ADOS domain  or by clinical judgment, were functioning in a regular education classroom with no one-on-one assistance and no special services for social skills, had Vineland Communication and Socialization scores in the normal range, and had an early history of ASD supported by early expert diagnosis and current blind review of early records.

Results: ADOS Social and Communication totals did not differ between OO and TD groups. One social item (insight into relationships) was significantly higher (more abnormal) in the OO than the TD group, and one item showed a trend (eye contact). No Communication items differed between OO and TD groups.  The Social Communication Questionnaire Lifetime Version suggested that the OO group had slightly milder clinical presentation in early childhood and the ADI-R suggested that this difference was only in the social domain. Facial Recognition score was average for the OO group and not significantly different from the TD group, while the HFA group’s average score was below average. The OO group did not differ from the TD group on any Vineland domain.  Both the OO and HFA groups were vulnerable to current and past attention problems and specific phobias, with the HFA group also vulnerable to depression, tics, obsessive-compulsive disorder, and oppositional-defiant disorder.

Conclusions: Data support the existence of a group of individuals with a clear history of ASD and outcome in the normal range of social functioning and communication. They are vulnerable to attention difficulties and phobias, and appear to have had slightly milder social deficits in early childhood.