When I was training to be a clinical psychologist, telling parents that their child had autism was a regular part of my job. Now that I'm a parent, I understand better the pained expression that came over their faces as they contemplated this news. Among the many questions taking shape in their minds, I can imagine the one looming largest: Could their child ever be like other children?
A recent study, published in February in the Journal of Child Psychology and Psychiatry, suggests that for some people, the answer is yes. The researchers found that some individuals who had been diagnosed with autism as young children no longer had symptoms—such as difficulty interacting and communicating with others, rigid adherence to rituals and routines, and repetitive movements of their bodies and objects—when they were older.
This finding is not the first to suggest that some young adults with autism lose their symptoms. A 2008 literature review reported that 3 to 25 percent of affected people eventually recover. But the recent study was especially rigorous. The researchers recruited three groups of eight- to 21-year old subjects: 34 of them had apparently recovered from autism, 44 had high-functioning autism, and another 34 were control subjects with no developmental issues.
An expert diagnostician thoroughly reviewed the early records of all recovered participants to confirm that they truly had autism when they were younger, and she correctly rejected 24 reports from kids with nonautism diagnoses (such as language disorders) that had been slipped in as foils, verifying that her diagnostic technique was sound. These measures made researchers confident that the now typically functioning children had not initially been misdiagnosed. The team also set a relatively high bar for recovery: participants not only had to be free of autism symptoms, as indicated by a battery of tests—they also had to have typically developing friends and be fully included in regular education classrooms.
The study's findings were encouraging: those who recovered were on a par with the typically developing individuals and better than the group with high-functioning autism in their social and communication skills and in their ability to go about daily life, such as taking care of themselves and doing housework. These findings, according to some experts, represent a watershed moment in autism research, “clearly demonstrating the possibility of leaving behind the symptoms of [autism] and emerging into a state of healthy functioning,” writes University of California, Davis, psychologist Sally Ozonoff, who was not involved in the study.
Not Autistic, Not Quite Typical
As exciting as these results might be, I believe we should interpret them with caution. For one thing, about 20 percent of those in the recovered group still showed mild difficulties with eye contact, gestures and facial expressions. According to the study authors, “these difficulties were judged ... not to have an autistic quality.” But those doing the judging were not “blind,” as researchers are in rigorous clinical trials—they knew if a participant was typically developing, had autism or had supposedly recovered.
It is easy to imagine how this knowledge could have colored their interpretations of participants' behaviors. Even if those in the recovered group did actually lose their symptoms, “the majority still have serious issues,” including depression, anxiety and inattention, notes Elizabeth Kelley, a psychologist at Queen's University in Ontario and one of the study's authors.
Kelley points out another limitation of the study: it looked back at recovery after it had happened. The retrospective design cannot reveal what proportion of kids will shed their diagnosis or why. Parents often try a variety of interventions, including behavioral treatment, speech and occupational therapy, and medication—and they do not always keep detailed records. Until researchers report on the outcomes of children they starting following very early in life, “we have no idea why some people recover,” Kelley says.