Regression in Children with ASD: Clinical Profile and Short Term Outcome.

Background:  The phenomenon of developmental regression in children with Autism Spectrum Disorder (ASD) is well studied. Much is known about the prevalence of regression, age of onset and pattern of regression. Few studies have been conducted on the outcome of intervention on children with ASD and developmental regression. The findings from these studies are inconclusive. Present study compared the impact of parent training intervention on young children with ASD and history of regression (ASD-r) to children with ASD and no history of regression (ASD-nr).

Objectives:  To assess the short term outcome of children with ASD with/without regression after receiving a two week in-patient, parent training.

Methods:  The participants were children (aged 3- 10 years) diagnosed with Autism Spectrum Disorder according to DSM-V. Children and their parents were admitted in the in-patient child psychiatry facility for 2-3 weeks. Detailed baseline assessments were done using Childhood Autism Rating Scale 2^ndedition (CARS- 2), Indian Scale for Assessment of Autism (ISAA), Vineland Social Maturity Scale (VSMS), Family Interview for Stress and Coping -ASD (FISC-ASD), Autism Parenting Stress Index (APSI) and Autism Treatment Evaluation Checklist (ATEC). Detailed history of child’s development and regression was obtained from the parents. Regression here was defined as loss of a previously acquired skill anytime during the child’s development. Parents received daily individualised sessions aimed at home based training. FISC-ASD was re-administered at the time of discharge. APSI and ATEC were re-administered over telephone after three months of discharge from the hospital.

 Results:  Out of twenty children (M=16, F=4) recruited in the study, seven children (all males) had history of developmental regression. The mean age at recognition of regression was 24.57 (months) ± 10.72. Out of seven children with regression, four children had regression on the background of delayed development. Four children had regression of language and social milestones, two had regression in all developmental areas and only one child had regression in language. No precipitating factor was reported by parents around the time of regression. Workup for degenerative disease was nil contributory in all these cases. Rate of perinatal complications and co-morbid disorders were lower in children with ASD-r as compared to children with ASD-nr. Baseline scores of CARS – 2, ISAA, VSMS, FISC-ASD, ATEC and APSI were same for children with ASD-r and ASD-nr. Children with ASD-r had statistically significant lower scores on post intervention ATEC as compared to children with ASD-nr.

Conclusions:  Present study included clinic based sample of twenty children with ASD, out of whom 28% had history of developmental regression. Children with ASD and regression had similar functioning at baseline and had reduced autistic symptoms on three month follow up as compared to children with ASD and no history of regression. Small sample size, lack of an independent blind rater and post intervention assessment over telephone are the main limitations of this study. Strength of the study is the prospective nature of follow up. Long term follow up of these children is planned.