"Recovery" from the diagnosis of autism - and then?

BACKGROUND: The aim of this study was to follow up the 17 children, from a total group of 208 children with autism spectrum disorder (ASD), who "recovered from autism". They had been clinically diagnosed with ASD at or under the age of 4 years. For 2 years thereafter they received intervention based on applied behavior analysis. These 17 children were all of average or borderline intellectual functioning. On the 2-year follow-up assessment, they no longer met criteria for ASD. METHODS: At about 10 years of age they were targeted for a new follow-up. Parents were given a semistructured interview regarding the child's daily functioning, school situation, and need of support, and were interviewed using the Vineland Adaptive Behavior Scales (VABS) and the Autism - Tics, Attention-deficit/hyperactivity disorder (AD/HD), and other Comorbidities (A-TAC) telephone interview. RESULTS: The vast majority of the children had moderate-to-severe problems with attention/activity regulation, speech and language, behavior, and/or social interaction. A majority of the children had declined in their VABS scores. Most of the 14 children whose parents were A-TAC-interviewed had problems within many behavioral A-TAC domains, and four (29%) had symptom levels corresponding to a clinical diagnosis of ASD, AD/HD, or both. Another seven children (50%) had pronounced subthreshold indicators of ASD, AD/HD, or both. CONCLUSION: Children diagnosed at 2-4 years of age as suffering from ASD and who, after appropriate intervention for 2 years, no longer met diagnostic criteria for the disorder, clearly needed to be followed up longer. About 3-4 years later, they still had major problems diagnosable under the umbrella term of ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations). They continued to be in need of support, educationally, from a neurodevelopmental and a medical point of view. According to parent interview data, a substantial minority of these children again met diagnostic criteria for ASD

Children with borderline intellectual functioning and autism spectrum disorder: developmental trajectories from 4 to 11 years of age

Background: Studies on autism have tended to focus either on those with intellectual disability (ie, those with intellectual quotient [IQ] under 70) or on the group that is referred to as “high-functioning”, that is, those with borderline, average or above average IQ. The literature on cognition and daily functioning in autism spectrum disorder combined specifically with borderline intellectual functioning (IQ 70–84) is limited. Methods: From a representative group of 208 preschool children diagnosed with autism spectrum disorder, those 50 children in the group with borderline intellectual functioning at ages 4.5–6.5 years were targeted for follow-up at a median age of 10 years. A new cognitive test was carried out in 30 children. Parents were interviewed with a semi-structured interview together with the Vineland Adaptive Behavior Scales (n=41) and the Autism-Tics, attention-deficit/hyperactivity disorder (AD/HD) and other comorbidities inventory (A-TAC) (n=36). Results: Most children of interviewed parents presented problems within several developmental areas. According to A-TAC and the clinical interview, there were high rates of attention deficits and difficulties with regulating activity level and impulsivity. Vineland Adaptive Behavior Scales composite scores showed that at school age, a majority of the children had declined since the previous assessment at ages between 4.5 and 6.5 years. Almost half the tested group had shifted in their IQ level, to below 70 or above 84. Conclusion: None of the children assessed was without developmental/neuropsychiatric problems at school-age follow-up. The results support the need for comprehensive follow-up of educational, medical and developmental/neuropsychiatric needs, including a retesting of cognitive functions. There is also a need for continuing parent/family follow-up and support

Autism With and Without Regression : A Two-Year Prospective Longitudinal Study in Two Population-Derived Swedish Cohorts

Peer reviewedPublisher PD

Early intervention in 208 Swedish preschoolers with autism spectrum disorder

A B S T R A C T Early intervention has been reported to improve outcome in children with autism spectrum disorders (ASDs). Several studies in the field have been randomized controlled trials (RCTs). The aim of this study was to assess ASD outcome in a large naturalistic study. Two hundred and eight children, aged 20-54 months, with a clinical diagnosis of ASD were given intervention and monitored prospectively in a naturalistic fashion over a period of 2 years. The toddlers were considered representative of all but the most severely multiple disabled preschool children with ASD in Stockholm county. They fell into three cognitive subgroups: one with learning disability, one with developmental delay, and one with normal intellectual functioning. Data on intervention type and intensity were gathered prospectively in a systematic fashion. Intervention was classified into intensive applied behaviour analysis (ABA) and non-intensive, targeted interventions, also based on ABA principles. Children were comprehensively assessed by a research team before the onset of intervention, and then, again, 2 years later. Change in Vineland adaptive behaviour scales composite scores from intake (T1) to leaving the study (T2) was set as the primary outcome variable. The research team remained blind to the type and intensity of interventions provided. One hundred and ninety-eight (95%) of the original samples stayed in the study throughout the whole 2-year period and 192 children had a complete Vineland composite score results both at T1 and T2. Vineland composite scores increased over the 2-year period. This increase was accounted for by the subgroup with normal cognitive functioning. There was no significant difference between the intensive and nonintensive groups. Individual variation was considerable, but no child in the study was ''problem-free'' at follow-up. Our data do not support that children with ASD generally benefit more from the most intensive ABA intervention programs than from less intensive interventions or targeted interventions based on ABA.

Autism spectrum disorders - first indicators and school age outcome

Background: Studies of early indicators, diagnostic stability and outcome at mid-school age in children referred early in life for a suspected autism spectrum disorder (asd) have been few. Aims: To examine early indicators of asd and eight-year stability of asd diagnoses, comorbidity, cognitive levels and overall clinical profiles, in children diagnosed with asd in preschool age after receiving early intervention. Methods: A community-based cohort of 208 preschool children with asd were followed prospectively. Records from Child Healthcare Centers were reviewed regarding regulatory problems (rp) during infancy. When the children were about 11 years, parents of 128 of the children participated in the Autism-Tics, ad/hd and other Comorbidities (a-tac) Telephone Interview. A subgroup of 50 children with asd who had had borderline intellectual functioning (bif) – were targeted for a new cognitive test. Another subgroup of 17 children who had “grown out of autism” (i.e. had no longer met diagnostic criteria for asd at a previous follow-up) were separately targeted for followup. Parental telephone interviews in these subgroups also included the Vineland Adaptive Behavior Scales and a semi-structured interview regarding the child’s daily functioning. Results: Early rp had been significantly more common in children later diagnosed with asd. Approximately 90% of children with an early diagnosis of asd still met criteria for asd at midschool age. A similar rate also had combinations of other developmental/neuropsychiatric disorders; attention problems, speech-/language diiculties and/or learning problems. Co-occurring disorders were particularly prevalent in children with asd and intellectual disability. Half of the children in the group still met criteria for bif, 20% had mild id (intellectual disorder), while 30% had cognitive results in the average iq range. The vast majority of the children who had “grown out of autism” still had major problems at follow-up, and some of them had indications of again meeting full criteria for a diagnosis of asd. Conclusion: Early rp should be considered a possible marker for asd. Almost all children with a preschool diagnosis of asd had remaining neurodevelopmental problems eight years later, findings that support the concepts of essence (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations) and Autism Plus. The results underscore the need for follow-up assessments, educational adaptations and longer-term parental support targeted to this patient group

Depressioner och ångestsyndrom bland barn och unga förknippade med långsiktiga konsekvenser – en nationell registerstudie

SammanfattningAndelen unga som insjuknar i depressioner och ångestsyndrom har ökat i Sverige enligt inrapporterade diagnoser till Socialstyrelsen. Det finns farhågor att en ökande andel kan drabbas av långtgående hälso- och socioekonomiska konsekvenser. Socialstyrelsen har här närmare studerat långsiktiga konsekvenser avseende hälsa och socioekonomiska förhållanden för barn 10 -17 år och unga vuxna 18-24 år med nydiagnostiserade depressioner och ångestsyndrom. Data från myndighetens hälsodataregister och dödsorsaksregister har samkörts med uppgifter från Statistiska centralbyrån. En registerbaserad prospektiv kohortstudie genomfördes med en uppföljningstid på tio år. Uppföljning av de som tidigt fått en diagnos visade att gruppen hade en ökad risk vad gäller suicidförsök och suicid, i mindre omfattning var yrkesaktiva och i högre grad beroende av inkomster från sjukersättning, sjukpenning och ekonomiskt bistånd. Sådana konsekvenser aktualiserar behovet av tidiga insatser vid psykisk ohälsa. Att andelen unga som insjuknar i depressioner och ångestsyndrom har ökat i Sverige ställer också krav på att hälso- och sjukvården kan möta behovet hos ett ökande antal unga som söker vård.AbstractAn increasing number of young people in Sweden are diagnosed with depression and anxiety disorders. There is concern that a significant proportion may suffer long-term health and socioeconomic consequences.The objective was to characterise long-term health and socioeconomic consequences more thoroughly among young people diagnosed with depression or anxiety. Data regarding psychiatric care, prescribed antidepressants and various forms of welfare support were obtained from national registers held by Statistics Sweden and the National Board of Health and Welfare in Sweden. Children 10-17 years and young adults 18-24 years firstly diagnosed with depression or anxiety in 2008 were followed up until 2018. A significant proportion of young people diagnosed with depression or anxiety run the risk of long-term health and socioeconomic consequences. Young people diagnosed with depression or anxiety were found to have an increased risk of both suicide attempts and suicide. They were to a greater extent not yet established in the labour market and dependent on different sickness benefits due to illness. Such consequences raise the need to work with early intervention in mental illness.The fact that the number of young people diagnosed with depression and anxiety has increased requires that health care can meet the needs of an increasing number of young people seeking medical care

“Recovery” from the diagnosis of autism – and then?

BACKGROUND: The aim of this study was to follow up the 17 children, from a total group of 208 children with autism spectrum disorder (ASD), who “recovered from autism”. They had been clinically diagnosed with ASD at or under the age of 4 years. For 2 years thereafter they received intervention based on applied behavior analysis. These 17 children were all of average or borderline intellectual functioning. On the 2-year follow-up assessment, they no longer met criteria for ASD. METHODS: At about 10 years of age they were targeted for a new follow-up. Parents were given a semistructured interview regarding the child’s daily functioning, school situation, and need of support, and were interviewed using the Vineland Adaptive Behavior Scales (VABS) and the Autism – Tics, Attention-deficit/hyperactivity disorder (AD/HD), and other Comorbidities (A-TAC) telephone interview. RESULTS: The vast majority of the children had moderate-to-severe problems with attention/activity regulation, speech and language, behavior, and/or social interaction. A majority of the children had declined in their VABS scores. Most of the 14 children whose parents were A-TAC-interviewed had problems within many behavioral A-TAC domains, and four (29%) had symptom levels corresponding to a clinical diagnosis of ASD, AD/HD, or both. Another seven children (50%) had pronounced subthreshold indicators of ASD, AD/HD, or both. CONCLUSION: Children diagnosed at 2–4 years of age as suffering from ASD and who, after appropriate intervention for 2 years, no longer met diagnostic criteria for the disorder, clearly needed to be followed up longer. About 3–4 years later, they still had major problems diagnosable under the umbrella term of ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations). They continued to be in need of support, educationally, from a neurodevelopmental and a medical point of view. According to parent interview data, a substantial minority of these children again met diagnostic criteria for ASD

Preschoolers with Autism Spectrum Disorder followed for 2 years: those who gained and those who lost the most in terms of adaptive functioning outcome

Clinical predictors of 2-year outcome in preschoolers with ASD were studied in a population-based group of very young children with ASD (n = 208). Children who gained the most (n = 30) and lost the most (n = 23), i.e., increased or decreased their adaptive functioning outcome according to the Vineland Composite Score between study entry (T1) and follow-up (T2), 2 years later were compared. Individual factors that differed significantly between the two outcome groups were cognitive level, age at referral, not passing expected milestones at 18 months, autistic type behavior problems and regression. However, logistic regression analysis showed that only cognitive level at T1 (dichotomized into IQ < 70 and IQ ≥ 70) made a unique statistically significant contribution to outcome prediction (p = <.001) with an odds ratio of 18.01. The findings have significant clinical implications in terms of information at diagnosis regarding clinical prognosis in ASD