Intervention History of Children and Adolescents with High-Functioning Autism and 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)" (Fein et al., 2013; Sutera et al., 2007; Kelley et al., 2010; & Helt et al., 2008).

Objectives: The present study aimed to retrospectively examine group differences in the intervention history of children and adolescents with OO and those with high-functioning autism (HFA) to determine if specific early interventions are related to optimal outcomes in childhood and adolescence.

Methods: The current study examined intervention histories in 34 individuals with OO and 44 individuals with HFA (ages 8-21 at time of participation), who did not differ on age, sex, nonverbal IQ or family income. Intervention history was collected through detailed parent questionnaires. 

Results: Children in the OO group had earlier parental concern (M(HFA)=22.0 months, M(OO)=16.7 months, t=2.00, p=.052) and received earlier referrals to specialists (M(HFA)=43.9 months, M(OO)=26.1 months, t=3.79, p=.001).  The percent of OO children receiving early intervention services was significantly higher than in the HFA group (83 vs. 48%; χ²(1, n=56)=6.73, p=.009), as was the percent who attended preschool (92 vs. 56%; χ²(1, n=58)=8.70, p=.003).  Between the ages of 2 and 3 years, OO children received more hours of intervention than the HFA children (ages 2-2.5: M(HFA)=4.1, M(OO)=14.8, p=.006; ages 2.5-3: M(HFA)=7.3, M(OO)=21.1, p=.006).  More OO than HFA children received some type of intervention between 2.5 and 3 years of age (HFA=61%, OO=88%, p=.025) and during the second year of preschool (HFA=68%, OO=92%, p=.031).  Specifically, more children in the OO group received Applied Behavior Analysis (ABA) than the HFA group for the following age periods: 2-2.5 years (HFA=4%, OO=40%, p=.001), 2.5-3 years (HFA=7%, OO=56%, p<.001), 3-4 years (HFA=32%, OO=60%, p=.042), and 4-5 years (HFA=25%, OO=72%, p=.001). Of the children who received ABA, the intensity did not differ between groups.  Children in the HFA group were more likely to have received medication (64% vs. 24%; p=.002), especially anti-psychotics (28% vs. 0%; p=.007) and anti-depressants (41% vs. 4%; p<.001). There were no group differences in the percent of children receiving special diets (HFA=35% vs. OO=23%; p=.32) or supplements (HFA=36% vs. OO=40%; p=.76).

Conclusions: These data suggest that OO individuals generally receive earlier, more intense interventions and more ABA, while HFA individuals receive more pharmacologic treatments.  While the use of retrospective data is a clear limitation to the current study, the substantial differences in reported provision of early intervention, and ABA in particular, are highly suggestive and should be replicated in prospective studies.