Regressive and Early Onset Autism Spectrum Disorders: A Comparison of Developmental Trajectories, Autistic Behaviors, and Medical Histories

Reports of early regression, or skill loss, in individuals with autism spectrum disorders (ASDs) have been reported since the condition was first described but this has been an area of controversy. This study examines the rates and types of regression in a community-acquired sample of 163 children (mean age=26.3 months) diagnosed with an ASD after a comprehensive evaluation; 96 were seen for a re-evaluation at approximately age 4. The 130 males and 33 females were diagnosed at the initial evaluation with Autistic Disorder (45.4%), PDD-NOS (42.3%), or ASD-low mental age (12.3%), a research category for children who met the criteria for an ASD with a developmental level below 12 months. The overall regression rate was 38.7%; the mean age of language loss was 17.1 months while the mean age of other loss was 15.9 months. Those with Autistic Disorder displayed higher rates of overall regression, as well as losses of specific skills, while the lowest rate was in those classified as ASD-low mental age. Although there was a trend for the composite cognitive score to be lower in the regression group at both evaluations, there were no significant differences in specific cognitive skills or any adaptive skills; however, floor effects may have been a factor. Children who regressed displayed significantly higher mean number of ASD symptoms, especially stereotyped and repetitive behaviors, which were higher at both evaluations. Notably, children with regression presented differently in their first year than those with early onset ASD; they had significantly fewer feeding problems and met all of their developmental milestones at an earlier mean age. In summary, the regression and early onset groups appear to differ from each other in many significant ways, with more typical early development followed by a more impaired later presentation in the regression group.

Can children with autism recover? If so, how

generally assumed to be lifelong, we review evidence that between 3 % and 25 % of children reportedly lose their ASD diagnosis and enter the normal range of cognitive, adaptive and social skills. Predictors of recovery include relatively high intelligence, receptive language, verbal and motor imitation, and motor development, but not overall symptom severity. Earlier age of diagnosis and treatment, and a diagnosis of Pervasive Developmental Disorder-Not Other-wise Specified are also favorable signs. The presence of seizures, mental retardation and genetic syndromes are unfavorable signs, whereas head growth does not predict outcome. Controlled studies that report the most recovery came about after the use of behavioral techniques. Residual vulnerabilities affect higher-order communication and at-tention. Tics, depression and phobias are frequent residual co-morbidities after recovery. Possible mechanisms of recovery include: normalizing input by forcing attention outward or enriching the environment; promoting the reinforcement value of social stimuli; preventing interfering behaviors; mass practice of weak skills; reducing stress and stabilizing arousal. Improving nutrition and sleep quality is non-specifically beneficial