Most Children Who Lose Autism Diagnosis Still Struggle

April 26, 2015—(BRONX, NY)—Seven percent of toddlers diagnosed with autism spectrum disorder (ASD) no longer met the diagnosis several years later, although most continued to have emotional, behavioral or learning problems according to a study presented April 26 at the Pediatric Academic Societies annual meeting in San Diego.

Lisa Shulman, M.D.Previous studies have shown that ASD symptoms resolve in some children over time. But it wasn’t clear from those studies whether such children continue to have cognitive, behavioral or learning deficits.

Led by developmental pediatrician Lisa Shulman, M.D., researchers reviewed data on 38 children diagnosed with ASD in 2003-2013 whose symptoms had resolved when they were re-evaluated an average of four years later. The children were among 569 children living in the Bronx who had been diagnosed with ASD by a multidisciplinary team at a university-affiliated early intervention program.

The 38 children came from racially, ethnically and socioeconomically diverse backgrounds that are generally underrepresented 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 originally diagnosed these children with ASD also provided interventions and monitored response to treatment. Over time, they noted that although the children’s ASD symptoms had resolved, most of them still had other learning and emotional/behavioral symptoms needing attention.

“When an early ASD diagnosis resolves, there are often other learning and emotional/behavioral diagnoses that remain.”

-- Lisa Shulman, M.D.

“Autism generally has been considered a lifelong condition, but seven percent of children in this study who received an early diagnosis, experienced a resolution of autistic symptoms over time,” said Dr. Shulman, director of Infant and Toddler Services and the Rehabilitation, Evaluation and Learning for Autistic Infants and Toddlers program at the Children’s Evaluation and Rehabilitation Center/Rose F. Kennedy Center at Albert Einstein College of Medicine/Children’s Hospital at Montefiore.

While most of the 38 children displayed intellectual disability when originally diagnosed with ASD, nearly all of them had normal cognition by the time their ASD symptoms had resolved. However, 92 percent of the children still had residual learning and/or emotional/behavioral impairment.

More specifically, the researchers observed language/learning disability in 68 percent of the children. Nearly half of them had “externalizing” problems such as attention-deficit/hyperactivity disorder or disruptive behaviors, while 24 percent had “internalizing” problems such as anxiety, obsessive-compulsive disorder or selective mutism. Only three of the 38 children whose ASD had resolved were found to have no other problems. Nearly three-quarters of the children continued to require academic supports, such as a 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 and attending physician, Children’s Hospital at Montefiore. “Understanding the full range of outcomes in this scenario is important information for parents, clinicians and the educational system.”

The study was supported by a grant from the Children’s Evaluation and Rehabilitation Center/ Rose F. Kennedy Intellectual and Developmental Disabilities Research Center.

The Pediatric Academic Societies (PAS) are four individual pediatric organizations that co-sponsor the PAS Annual Meeting: the American Pediatric Society, the Society for Pediatric Research, the Academic Pediatric Association and the American Academy of Pediatrics. Members of these organizations are pediatricians and other healthcare providers who practice in the research, academic and clinical arenas. The four sponsoring organizations are leaders in the advancement of pediatric research and child advocacy within pediatrics, and all share a common mission of fostering the health and well-being of children worldwide.