Hyperactivity hint: Children who outgrow their autism diagnosis may still have difficulty maintaining focus.



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Children who officially lose their autism diagnosis show no residual signs of the condition, a new study suggests1. The findings support the idea that these children no longer have autism features.

“They really are indistinguishable from their typically developing peers,” says study investigator Inge-Marie Eigsti, associate professor of psychology at the University of Connecticut in Storrs. “They don’t have any [autism] symptoms at all.”

The study, published 18 August in the Journal of Autism and Developmental Disorders, is the latest effort to document the characteristics of children with a so-called ‘optimal outcome.’ These children were diagnosed with autism before age 5 but no longer meet criteria for the condition.

Eigsti and her colleagues compared 22 of these children with 27 children who have autism and 23 typical children — all 8 to 18 years old. The groups did not differ significantly in the proportion of boys and girls or in average intelligence.

The researchers evaluated autism features in the children using a standard diagnostic test. As part of the test, the children told stories and acted out tasks such as brushing their teeth. Nine untrained undergraduate students then watched video clips of these tasks. The students were unaware of the children’s diagnoses and used a standard scale to rate how extroverted, agreeable, conscientious, neurotic and open to experience each child seemed.

Studies suggest that people with autism tend to be less extroverted, agreeable, conscientious and open — and more neurotic — than typical people are.

In the new study, children in the optimal outcome group scored about the same as typical children on the personality trait test. The students rated both groups of children as more agreeable, conscientious and open to experience, and less neurotic, than those in the autism group.

Somewhat surprisingly, they judged the children who used to have autism as more talkative and assertive, and less reserved, than the children in the typical group.

“That really is the opposite of having social impairment,” says Lisa Shulman, associate professor of clinical pediatrics at Albert Einstein College of Medicine in New York, who was not involved in the study. “The kids really seem to no longer have any elements of autism.”

Subtle signs:

The students also looked for subtle, autism-like traits that together constitute the ‘broad autism phenotype.’ They used a test that measures aloofness, difficulty communicating in a social setting and trouble adjusting to change.

Children with autism scored high on this test, whereas those in the optimal outcome group scored about the same as controls.

Some of the children in the optimal outcome group do have issues, however. Compared with the typical children, they tend to be more easily distracted and sidetracked in conversation. They are also more animated when talking and dwell on certain topics.

These characteristics are similar to those of children with attention deficit hyperactivity disorder (ADHD). The finding is consistent with studies suggesting that some children who outgrow autism end up with ADHD.

“The symptoms of autism may morph into symptoms of ADHD instead for some kids in this optimal outcome sample,” Eigsti says.

The researchers relied on medical records to verify that children in the optimal outcome group once had autism. Because of this, they cannot rule out the possibility that the children were initially misdiagnosed, Schulman says. Studies that follow children with autism from the time of their diagnosis may help to confirm or refute the new findings, she says.