Increase in Autism Diagnoses in Children: A Closer Look at Persistence and Outcomes

More and more children are being diagnosed with autism. The question is whether this is always correct. New research shows that 37 percent of toddlers who are diagnosed before their third birthday no longer meet the criteria when they start school.

In children up to the age of 6, autism is characterized by difficulty interacting with others, limited interest in the environment, difficulty with changes, a need for rules and a striking over- or insensitivity to some stimuli, such as writes the Dutch Youth Institute. It now appears that these symptoms disappear again in a significant proportion of children as they grow older.

Autism in toddlers
American researchers found this out by examining 213 children who were diagnosed with autism before the age of three. to test again. “We invited children who are now between 5 and 7 years old and who were diagnosed with autism when they were between 12 and 36 months old to participate in a new study,” says lead researcher Elizabeth Harstad of the Boston’s Children Hospital On Scientias.nl. “We gave them standardized tests to measure their cognitive and language skills and their adaptability and to see to what extent they had autism symptoms.” This allowed the researchers to determine the current functioning of the children. “To determine their functioning at the time, we used detailed information from medical records, such as information about their development, adaptive functioning and communication skills.”

Girls vs boys
It showed that 37 percent of the children who were diagnosed with autism at the time now no longer met the criteria. “We found that girls were much more likely to have non-persistent autism. It is not entirely clear why this is the case. Girls may have had more subtle symptoms of autism at the time so when they were tested they may not have met all the criteria for the diagnosis.” But the explanation may also be cultural in nature. “It is possible that the social and cultural environment places more emphasis on the social-emotional functioning of girls than boys, allowing them to work on their social communication skills in more natural settings.”

Adaptive functioning
What the research also showed is that toddlers with higher ‘adaptive functioning’ more often grew out of their autism. Adaptive functioning is a collective name for communication skills, skills to function in daily life and socialization and motor skills. “We obtained information about this by asking parents what the child can do in various areas, such as communicating, taking care of themselves and functioning in the community. Many children with autism are slower in their development when it comes to these types of skills. We do not know what mechanism underlies this. It is possible that these higher adaptive skills indicate better learning ability at a young age.” As a result, these children may be better at ‘unlearning’ their autism.

The children were extensively tested for autism at the age of 5 to 7. Photo: Pixelshot

The usefulness of therapy
Another remarkable result is that there appears to be no connection between the therapy that children received and the extent to which the autism diagnosis persisted. You would expect that the therapy would help some children get rid of their autism. “Almost all children in the study received some form of therapy. We found that they received the most hours of therapy per week a year to a year and a half after diagnosis. We know that interventions are most effective when they take place at a young age. We therefore evaluated whether the amount of therapy in the eighteen months after diagnosis was related to the extent to which the children still had autism. In our model, there was no correlation between the amount of therapy and whether or not a child met the criteria for autism at school age.” That certainly does not mean that the therapy was of no use, Harstad believes. “It is possible that the therapy helped with other outcomes that we did not measure in this study. It is also likely that the therapy helped some children more than others.”

Preliminary diagnosis
The fact that so many small children with autism no longer have autism a few years later does not mean that there was a misdiagnosis at a young age, the researcher believes. “Our study shows that even when children are tested very deeply and extensively for autism, some no longer meet the criteria a few years later. So perhaps we need to reconsider how we approach the diagnosis of autism in children so young. Perhaps it should be more of a provisional diagnosis that provides access to therapy, but also makes it clear that the child needs to be monitored to determine whether he or she still meets the autism criteria a few years later.”

Ongoing supervision
The researcher was surprised that the number of children who outgrew autism was so large. “We found higher rates of non-persistent autism than expected, although there are explanations. For example, there was an earlier study in which children were re-examined at a younger age. It is possible that the fact that we studied children at age 6 rather than around age 4 partly explains why more children in our study had non-persistent autism.”

Finally, the researcher would like to emphasize that children’s development continues to change throughout their lives. “So even if a child does not meet the criteria for autism at the age of 6, he or she may still need support in other areas. Therefore, the child’s development must be monitored in the future. Our study highlights the importance of continued monitoring of the development of all young children diagnosed with autism.”

2023-10-08 12:02:11
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