A review of: Molly Helt, Elizabeth Kelley, Marcel Kinsbourne, Juhi Pandey, Hilary Boorstein, Martha Herbert, Deborah Fein (2008). Can Children with Autism Recover? If So, How? Neuropsychology Review DOI: 10.1007/s11065-008-9075-9

In this fascinating analytical review of the scientific literature in autism, the authors examined empirical evidence that some people with autism “recover” and no longer meet the diagnosis of autism. The general view in the scientific community has been that autism is a life-long condition and that treatment interventions are most often designed to 1) minimizing maladaptive symptoms (e.g., self-injurious behaviors) and 2) maximizing cognitive/behavioral/social functioning (e.g., increasing adaptive social behaviors or language). But what happens when these interventions are sufficiently effective in minimizing or eliminating symptoms to the extent that the person no longer meets the DSM-IV criteria for autism? Has the person recovered?

The authors first provided a specific working definition of “recovery” before embarking on an exploration of the available literature. The authors argued that to be considered “recovered” a person:

1. has a clear history of autism
2. must be learning and applying skills at a developmental level that is within the range expected in typically developing persons of the same age.
3. must not meet DSM-IV symptom criteria for ASDs

Based on their current research program, they further expanded this definition to include a more detailed set of criteria, namely, a “recovered” person:

1. must not meet ASD cutoff on social or communication domain on the ADOS
2. must not receive special education services targeted to remediate key features of autism (if any special education services are received they must target non-autism features such as attention, learning disabilities, etc)
3. must be functioning within a regular education classroom WITHOUT individualized assistance
4. IQ must be 80 or greater
5. Vineland communication and socialization scales must be within the normal range (78 or above)

A critical component of this definition of recovery is that it is not limited to DSM-IV based symptoms of autism, but it also addresses key areas of functioning. This is critical, because it prevents using the label of ‘recovered’ in cases when the effects of the treatment are limited to reducing symptoms, with little change in the functional limitations of the condition.

The authors then conducted a narrative review of the available scientific literature and concluded that there is compelling evidence showing that between 3% and 20% of children diagnosed with autism may eventually meet the criteria for “recovered”. This wide range is likely the result in differences between the studies in the nature of the population examined, and the presence or absence of factors that are believed to contribute, or hamper, the possibility of recovery. That is, the authors also found that a number of baseline factors (i.e. present while the person met diagnostic criteria) facilitated recovery rates, including:
1. high intelligence
2. presence of receptive language
3. verbal and motor imitation
4. early age of diagnosis
5. PDD-NOS diagnosis

A number of factors limited the possibility of recovery, including:
1. seizures
2. mental retardation
3. genetic syndromes

Although these findings are interesting, I believe an additional contribution of this study is their presentation of the possible mechanisms by which treatment interventions may lead to recovery in autism. These mechanisms can be seen as a road map that helps parents, educators, and clinicians better understand how treatment modalities can be targeted to the specific deficits of each child. These mechanisms include:

1. Normalizing input through attention
2. Promoting the reinforcement value of social stimuli
3. Early intervention provides enriched environments
4. Early intervention provides mass practice and trials
5. Compensatory processes
6. Suppression of interfering behaviors

Next week I will describe these 6 processes in detail.

ResearchBlogging.org

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3 Responses to Recovering from Autism. Part I

  1. Nestor

    Thank you for another professional, objective and non-ideological translation of autism research.

    Your blog should be required reading for all “autism bloggers”.

    Harold Doherty

  2. RAJ says:

    Losing a diagnosis and recovery does happen and much more freqeuntly as the article sttes (up to 25%).My daughter, diagnosed with PDD/Nos in 1988 lost her diagnosis in 1994. She has completly recovered having graduated magna cum laude with a degree in communication arts, Seured a regular job all bt herself. She is very socially active and has a wonderful boy friend who is a delight to our entire family.

    The critical initiative in the US is early diagnosis and intense early intervention which should be a high priority in the future andit looks like clinicians, pediatric neurologists are all headed in that direction.

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