When an Early Diagnosis of ASD Resolves, What Remains?

Background: It has been documented that some children with an early diagnosis of Autism Spectrum Disorder (ASD) do not meet criteria for the diagnosis at a later age.  It is unclear, however, if deficits remain overtime when ASD symptomatology resolves.

Objectives: To characterize the residual learning, cognitive, and emotional/behavioral diagnoses and educational needs of a group of school-age children with a history of an early diagnosis of ASD that resolved.

Methods: A chart review of 38 children diagnosed with ASD at a University-affiliated inner-city diagnostic early intervention program between 2003 and 2013 who had follow up evaluations indicating resolution of the original ASD diagnosis.  This group represents 7% of the 569 children diagnosed with ASD by the program during this period.  Original and follow up diagnoses were made by an experienced multidisciplinary team (consisting of developmental pediatrician, psychologist, and speech and language pathologist) based on the DSM-IV criteria, Childhood Autism Rating Scale (CARS) and/or the Autism Diagnostic Observation Schedule (ADOS).  All children had follow up visits and repeat evaluations for diagnostic clarification and/or educational planning an average of 4 years after the original diagnosis.  The initial cognitive assessment was based on the Bayley Scales, and at follow up on the WPPSI, WISC, or Stanford Binet.  Data collected included: demographics, age, cognitive level, CARS, developmental diagnoses and services at original and follow up evaluations.

Results: The mean age at initial diagnosis was 2.6y± 0.9y and at follow up 6.4y± 2.8y.  The sample was 80% male; 44% Hispanic, 36% Caucasian, 10% African American; 46% had Medicaid; and 42% were bilingual.  The mean initial CARS was 32±3 and at follow up 25±4.  The initial ADOS (21/38) categorized 29% as having autism and 67% as ASD and it was negative at follow up when available (23/38).  Initial cognitive testing (29/38) found 33% with intellectual disability, 23% in the borderline range and 44% in the average range and at follow up (33/38) revealed 6% in the borderline range and the rest in the average range.  At follow up, 68% had language or learning disability, 49% were diagnosed with externalizing behavior problems (Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Disruptive Behavior Disorder), 24%  with internalizing problems (mood disorder, anxiety, OCD, selective mutism), 5% with a significant mental health diagnosis (psychosis.nos), and 8% warranted no diagnoses. Twenty six % of the group was in a mainstream academic setting without support, 13% in a mainstream class with paraprofessional support, 29% in an integrated setting/resource room, and 21% in a self-contained class.

Conclusions: When an early ASD diagnosis resolves, at least in the early elementary years, there are often other learning and emotional/behavioral diagnoses that remain.  Understanding the full range of possible positive outcomes in this scenario is important information for parents, clinicians, and the educational system.