Cognitive, behavioral impairment persists after ASD resolves

SAN DIEGO — When an early autism spectrum disorders diagnosis resolves, in which the child no longer meets the diagnostic criteria, there are frequently learning and emotional/behavioral diagnoses that endure, according to data presented at the Pediatric Academic Societies Annual Meeting.

“Autism generally has been considered a lifelong condition, but 7% of children in this study who received an early diagnosis experienced a resolution of autistic symptoms over time,” Lisa Shulman, MD, from the Albert Einstein College of Medicine/Children’s Hospital at Montefiore, said in a press release. “The majority of the children at original diagnosis displayed intellectual disability but at the point of resolution of autistic symptomatology displayed normal cognition.”

Lisa Shulman

While prior studies have shown that some children with early diagnosis of autism spectrum disorder (ASD) symptoms later do not meet criteria for the diagnosis, it remains indeterminate if these children continue to experience cognitive, behavioral or learning deficits.

To distinguish lasting learning, cognitive, emotional/behavioral diagnoses and educational needs among children with early ASD diagnosis whose symptoms later resolved, Shulman and colleagues reviewed data from 38 children diagnosed with ASD at a university-affiliated inner-city early intervention program from 2003-2013 whose 4-year follow-up evaluations demonstrated resolution of the original ASD diagnosis.

The study population exhibited racially, ethnically and socioeconomically diverse backgrounds, including 45% Hispanic, 36% Caucasian, 10% black and 46% Medicaid recipients.

The original evaluation, based on DSM-IV criteria, Childhood Autism Rating Scale and/or the Autism Diagnostic Observation Schedule, identified 29% of the cohort with autism and 67% with ASD. During initial cognitive testing, 33% of children exhibited intellectual disability, 23% exhibited borderline disability and 44% average.

According to study results, at the 4-year follow-up:

68% of the children demonstrated language/learning disability;
49% demonstrated externalizing problems (attention deficit hyperactivity disorder, oppositional defiant disorder, disruptive behavior disorder);
24% demonstrated internalizing problems (mood, anxiety, obsessive compulsive disorder, selective mutism);
5% exhibited significant mental health diagnosis (psychosis not otherwise specified); and
8% warranted no diagnoses.

The researchers observed that 26% of the children were in mainstream academic settings without support while 13% had educational support, 29% were in integrated settings and 21% were in self-contained classes.

“When an early ASD diagnosis resolves, there are often other learning and emotional/behavioral diagnoses that remain,” Shulman said in the release. “Understanding the full range of possible positive outcomes in this scenario is important information for parents, clinicians and the educational system.” – by Bob Stott

Reference:

Shulman L, et al. Abstract #2750.2. Presented at: Pediatric Academic Societies 2015; April 25-28, 2015; San Diego.

Disclosures: The researchers report no relevant financial disclosures.