Early Characteristics of Children Who Lose Their Autism Diagnosis Between Age Two and Four

Emerging literature indicates that a subset of children with a documented ASD lose their diagnosis and demonstrate cognitive and adaptive abilities within the average range. Multiple factors including symptom severity, cognitive and language abilities, adaptive skills and early intervention may help to predict these highly positive outcomes. Participants in the present study include 207 children diagnosed with an ASD by clinical best estimate at approximately age two (T1) and subsequently re-evaluated at approximately age four (T2). 171 (82.6%) children retained an ASD diagnosis (ASD-ASD) at re-evaluation and 19 children (9.2%) were determined to meet the following criteria for an “Optimal Progress” (OP): met criteria for an ASD using gold standard diagnostic procedures at T1, no longer meet criteria for any ASD at T2, and demonstrated functioning in the average range on standardized measures of cognition, language, communication and social skills. Results indicate that a number of early (T1) child-level factors help to predict OP: a diagnosis of PDD-NOS, fewer restricted, repetitive behaviors (RRBs), less severe autism symptomatology and stronger adaptive skills (but not cognitive or language abilities). These early traits may reflect more intact central nervous system functioning, and/or may provide these children with a greater likelihood of benefiting from interventions and everyday interactions, and in turn, with a greater likelihood of demonstrating OP. In combination with the findings of the current study, future studies should attempt characterize the mechanisms at work in producing these outcomes, including the role of early intervention. In doing so, we can begin to promote an increase in the percentage of children attaining highly positive outcomes from ASD