In 1987 Ivar Lovaas published the first comprehensive report of the outcomes of his intensive behavioral intervention for young children with autism (<46 months of age). Lovaas reported that, at the end of treatment, “47% of the experimental group achieved normal intellectual and educational functioning” (p. 7). Anticipating the likely response to what was at the time, an extraordinary claim, Lovaas noted that: “The term normal functioning has been used to describe children who successfully passed normal first grade and achieved an average IQ on the WISC-R” (Lovaas, 1987; p. 8). Despite acknowledging that questions might be raised as to “whether these children truly recovered from autism,” Lovaas went on to apply the term “recovered children,” saying that they “show no permanent intellectual or behavioral deficits and their language appears normal” (p. 8).
In the intervening years, the notion of “recovery” from autism has been highly controversial, in part due to the plethora of fad treatments that have been promulgated, backed by spectacular anecdotal accounts but little evidence that would survive even cursory scrutiny (Ozonoff, 2013).
However, a recent paper published in the Journal of Child Psychology and Psychiatry (Fein et al., 2013) raises once again the prospect of recovery for some individuals with autism, this time with a formidable array of data. Fein and colleagues investigated a sample of 33 individuals who had a documented autism spectrum disorder diagnosis before the age of five years. Designated as a group with “Optimal Outcome” (OO), these individuals ranging in age from 8-21 years no longer met criteria for an ASD diagnosis at the time of the study. The authors reported on the characteristics of OO individuals at the time of diagnosis, as well as current functioning, and compared them to a group of individuals with current diagnoses of High Functioning Autism (HFA) and a group of Typically Developing (TD) individuals.
Fein and colleagues reported that OO individuals “had a clear documented history of ASD” (p. 202). Parents were required to provide a written evaluation report documenting an ASD diagnosis made by a physician or psychologist specializing in autism. All had early language delay (“no words by 18 months or no phrases by 24 months;” p. 197), and Lifetime scores on the Autism Diagnostic Interview – Revised (ADI-R) supported the early diagnosis, although OO individuals had somewhat milder socialization deficits than the HFA individuals.
The authors did not include data on the individuals’ treatment histories, saying only “The children in the current study were predominantly from the northeast US, and therefore tended to get behavioral interventions, although children from other parts of the US and from Canada were also included” (p. 203). They reported that intervention data had been collected and were being examined.
In terms of current presentation, the OO individuals “no longer met criteria for an ASD as per the ADOS and clinical judgment” (p. 202) and their parents reported that they had “typically developing friends” (p. 197). At the time of the study, the OO sample did not differ from their typically developing peers on ADOS Communication and Socialization scores, adaptive behavior or facial recognition, and they had average language scores. However, several in the OO group “were judged to have social functioning mildly affected by non-autism conditions, such as anxiety, depression, or impulsivity” (p. 202).
Other evidence supporting the possibility of “recovery” has also emerged in recent months. Dawson et al. (2012) reported that a developmental behavioral intervention (the Early Start Denver Model) yielded not only gains in IQ, language, and adaptive and social behaviors, but also “normalized patterns of brain activity” (p. 1150). Fountain, Winter, and Bearman (2012) traced the developmental trajectories of a large number of children from diagnosis through age 14 years and identified a group (about 10% of the sample) who “experienced rapid gains, moving from severely affected to high functioning” (p. e1112). While Fountain et al. did not indicate whether any of the children in their sample no longer met diagnostic criteria for an ASD, they were struck by the rapid and substantial improvement of these children (and called them “bloomers”).
These findings suggest that we may be required to alter our long-standing description of autism as a “life-long condition.” While it is misleading to conclude that autism is, as reported in the popular press, “just a phase for some kids,” Fein and colleagues present convincing evidence that, for some children, the core impairment associated with an autism spectrum disorder can be remediated. Naysayers notwithstanding, this is cause for some (restrained) celebration.
Dawson, G., Jones, E.J, Merkle, K., Venema, K., Lowy, R., Faja, S., Kamara, D., Murias, M., Greenson, J., Winter, J., Smith, M., Rogers, S.J., & Webb, S.J. (2012). Early behavioral intervention is associated with normalized brain activity in young children with autism. Journal of the American Academy of Child and Adolescent Psychiatry, 51, pp. 1150-9. doi: 10.1016/j.jaac.2012.08.018
Fein, D., Barton, M., Eigsti, I., Kelley, E., Naigles, L., Schultz, R. T., . . . Tyson, K. (2013). Optimal outcome in individuals with a history of autism. Journal of Child Psychology and Psychiatry, 54(2), 195-205. doi:10.1111/jcpp.12037
Fountain, C., Winter, A. S., & Bearman, P. S. (2012). Six developmental trajectories characterize children with autism. Pediatrics, 129(5), e1112-e1120. doi:10.1542/peds.2011-1601
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3-9. doi:10.1037/0022-006X.55.1.3
Ozonoff, S. (2013). Editorial: Recovery from autism spectrum disorder (ASD) and the science of hope. Journal of Child Psychology and Psychiatry, 54(2), 113-114. doi:10.1111/jcpp.12045