Social Functioning in Individuals with a History of Autism Spectrum Disorders Who Achieved Optimal Outcomes

Autism spectrum disorders (ASDs) were once considered lifelong disorders, but recent findings indicate that some children with ASDs no longer meet diagnostic criteria for any ASD and reach normal cognitive function. The current study examined social functioning in 24 of these individuals (ages 8-21), called ‘optimal outcome’ (OO), who did not differ on age, sex, and nonverbal IQ to 29 individuals with high-functioning autism (HFA) and 26 typically developing (TD) individuals. The groups were compared on a measure of other psychiatric disorders that have symptoms which may result in social difficulties and on a measure of overall likability. Results indicated that the HFA group scored worse than the OO and TD groups on domains of withdrawal/depression, immaturity, attention problems, and self-control problems. The OO group, in turn, displayed more difficulties with immaturity, attention problems, and self-control problems than the TD group. However, the OO group was rated by peers to be at least as likable as the TD participants, and were even rated as friendlier, warmer, and more approachable. The HFA group, on the other hand, was rated by peers to be less likable in all aspects than the OO and TD participants. These data suggest that OO individuals have no readily observable social skill deficits, at least when interacting with a trained adult. However, the presence of more difficulties with immaturity, attention problems, and self-control problems in the OO adolescents indicate that they are exhibiting mild social difficulties which are more consistent with those seen in attention-deficit/hyperactivity disorder (ADHD) than in autism spectrum disorders (ASDs)

Residual Communication and Social Deficits in Individuals with a History of Autism Spectrum Disorders Who Achieved Optimal Outcomes

Autism spectrum disorders (ASDs) were once considered lifelong disorders, but a small body of research indicates children with ASDs are capable of gaining skills, such that they no longer meet diagnostic criteria for any ASD. These individuals are considered to have achieved an optimal outcome. This study examined communication and social functioning in a group of adolescents with a history of autism spectrum disorders who have achieved optimal outcomes. Thirty-two such individuals between the ages of eight and twenty-one were matched on age, sex, and nonverbal IQ to 33 individuals with high-functioning autism and 25 typically developing adolescents. The groups were compared on measures of autism symptomatology, adaptive functioning, and pragmatic language. Results indicated that the optimal outcome adolescents were functioning quite well in both the communication and social domains. However, some exhibited subtle residual social deficits, including restricted of a range of directed facial expressions, limited insight in social relationships, and poorer quality of rapport, as compared to the typically developing individuals. Importantly, the optimal outcome adolescents performed better than the adolescents with high-functioning autism on all areas assessed. Thus, the optimal outcome individuals were not experiencing any impairing communication or social deficits

Language comprehension and brain function in individuals with an optimal outcome from autism

Although Autism Spectrum Disorder (ASD) is generally a lifelong disability, a minority of individuals with ASD overcome their symptoms to such a degree that they are generally indistinguishable from their typically-developing peers. That is, they have achieved an Optimal Outcome (OO). The question addressed by the current study is whether this normalized behavior reflects normalized brain functioning, or alternatively, the action of compensatory systems. Either possibility is plausible, as most participants with OO received years of intensive therapy that could alter brain networks to align with typical function or work around ASD-related neural dysfunction. Individuals ages 8 to 21 years with high-functioning ASD (n = 23), OO (n = 16), or typical development (TD; n = 20) completed a functional MRI scan while performing a sentence comprehension task. Results indicated similar activations in frontal and temporal regions (left middle frontal, left supramarginal, and right superior temporal gyri) and posterior cingulate in OO and ASD groups, where both differed from the TD group. Furthermore, the OO group showed heightened “compensatory” activation in numerous left- and right-lateralized regions (left precentral/postcentral gyri, right precentral gyrus, left inferior parietal lobule, right supramarginal gyrus, left superior temporal/parahippocampal gyrus, left middle occipital gyrus) and cerebellum, relative to both ASD and TD groups. Behaviorally normalized language abilities in OO individuals appear to utilize atypical brain networks, with increased recruitment of language-specific as well as right homologue and other systems. Early intensive learning and experience may normalize behavioral language performance in OO, but some brain regions involved in language processing may continue to display characteristics that are more similar to ASD than typical development, while others show characteristics not like ASD or typical development