A study by pediatricians shows that autism detection criteria cannot pinpoint its existence in some children but they undergo emotional and behavioral symptoms which require special education support.
About one in 14 toddlers diagnosed with autism spectrum disorder (ASD) no longer met the diagnostic criteria in elementary school, but continued to struggle with emotional and behavior symptoms and never received special education support, said a study presented on Sunday, April 26 at the Pediatric Academic Societies (PAS) annual meeting in San Diego.
Previous studies have established that ASD symptoms resolve in some children over time but it is not known whether these kids continued to face cognitive, behavioral or learning deficits.
A team of researchers, led by pediatrician Lisa Shulman, reviewed data on 38 children diagnosed with ASD in 2003-2013 whose symptoms had resolved when they were re-evaluated 4 years later. They were part of 569 children from the Bronx with ASD by a team at a university-sponsored early intervention program.
The children came from racially, ethnically and socio-economically diverse backgrounds, usually under-represented in autism studies. Forty-four percent were Hispanic, 36 percent were Caucasian, 10 percent were African-American and 46 percent were on Medicaid.
Clinicians who made the original diagnosis provided medication and monitored response to treatment. Over time, they observed that ASD symptoms in some children resolved, but most continued to have other learning and emotional or behavioral symptoms needing attention.
“Autism generally has been considered a lifelong condition, but 7 percent of children in this study who received an early diagnosis experienced a resolution of autistic symptoms over time,” said Dr. Shulman from the Children’s Evaluation and Rehabilitation Center.
“The majority of the children at original diagnosis displayed intellectual disability but at the point of resolution of autistic symptomatology displayed normal cognition,” Dr. Shulman added.
Although the social impairment of autism resolved and cognitive functioning (IQ) improved, researchers found that 92 percent of the children had residual learning or emotional/behavioral impairment, with merely three of the 38 kids found to have had no diagnosis.
Language/learning disability was found in 68%, and nearly half of them had externalizing problems such as attention-deficit/hyperactivity disorder or disruptive behaviors. In addition, 24% had internalizing problems such anxiety, obsessive-compulsive disorder or selective mutism.
Finally, three-quarters of the children continued to require academic support like small class setting or resource room.
“When an early ASD diagnosis resolves, there are often other learning and emotional/behavioral diagnoses that remain,” said Dr. Shulman, associate professor of clinical pediatrics at Albert Einstein College of Medicine.