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Research: Recovery, Optimal Outcome, & Diagnostic Stability

Posted: Wed Oct 24, 2012 8:58 pm
by Winnie
Fein et al have been in the news regarding their research on recovered children:

http://www.washingtonpost.com/wp-dyn/content/article/2008/11/14/AR2008111403006.html


Another article about the same study:

http://www.webmd.com/brain/autism/news/20090511/researchers-see-recovery-from-autism


The Fein et al paper (as presented at IMFAR):

https://imfar.confex.com/imfar/2009/webprogram/start.html#srch=words%7CCognitive%20and%20Behavioral%20Profiles%20of%20Children%20Who%20Recover%20From%20Autism%7Cmethod%7Cand%7Cpge%7C1 (click on 'abstract book,' after this loads, study is found on page 2)

Cognitive and Behavioral Profiles of Children Who Recover From Autism

D. Fein , Psychology, University of Connecticut, Storrs, CT
M. Barton , Department of Psychology, University of Connecticut, Storrs, CT
I. M. Eigsti , Psychology, University of Connecticut, Storrs, CT
L. Naigles , Developmental Psychology, University of Connecticut, Storrs, CT
M. Rosenthal , Psychology, University of Connecticut, Storrs, CT
K. Tyson , Psychology, University of Connecticut, Storrs, CT
E. Troyb , Psychology, University of Connecticut, Storrs, CT
M. Helt , Psychology, University of Connecticut, Storrs, CT

Although Autism Spectrum Disorders (ASD) are generally lifelong, scattered evidence over the past 30 years indicates that between 3% and 25% of children can lose their ASD diagnosis and enter the normal range of cognitive, adaptive and social skills. Predictors of recovery include normal intelligence, receptive language, imitation, and motor development. Earlier age of diagnosis and treatment, and PDD-NOS rather than Autistic Disorder are also favorable. Seizures, mental retardation and genetic syndromes are unfavorable signs.

The purpose of our ongoing study is to document this phenomenon in a more rigorous way, explore any residual vulnerabilities, examine history and treatment factors, and assess structural and functional brain parameters in the “optimal outcome” children to see if they still show ASD features.

We will report on some cognitive testing and psychiatric co-morbidities in three groups: The “optimal outcome” (OO) group, a group with high-functioning autism (HFA), and a control group with typical development (TD), all matched for age and performance IQ. Age range of participants is 9-18.

On the Wechsler Abbreviated Intelligence Scales, the groups were matched for PIQ; there were then no significant differences on VIQ or any subtest. Furthermore, the intellectual functioning in all 3 groups was above average (mean IQ about 115). On the BRIEF (a parent report measure of executive functioning), the OO group was solidly average on every subscale. The TD group was also unimpaired on every scale, and tended to do somewhat better than average, consistent with their high IQ’s. The HFA group, in contrast, showed elevated scores on shifting, emotional control, initiating, working memory, and self-monitoring.

Of 23 typical controls, 3 had a disorder diagnosable by the K-SADS (2 with phobias, and one with depression, all in the past). In contrast, both the HFA and OO groups showed significant psychopathologies: 11 of the 15 HFA subjects (73%) showed a diagnosable disorder, of which 9 were current. Prominent were depression, various forms of anxiety disorder, tics, ADHD, and ODD. In the OO group, 16 of the 22 subjects (73%) showed a diagnosable disorder, of which 8 were still current. Prominent were ADHD, ODD, tics, and phobias, with one case each of depression and ODD. Psychiatric co-morbidity was, therefore, strikingly similar between the HFA and OO groups.

Finally, on retrospective measures of head circumference growth, the rate of head growth followed by deceleration was greater in the OO and HFA groups than in the TD group, and not different from each other.

Results so far, therefore, indicate that cognitive and executive functioning in the OO group has really normalized, while the HFA group continue to show the expected executive deficits. Above average IQ may help the OO children to compensate. Early biological markers do not differentiate the OO from the HFA group, suggesting that any early structural or inflammatory process was not different for the OO than for other children with ASD. Psychiatric co-morbidity appears to persist in the OO children, perhaps suggesting that it represents an independent vulnerability and is not secondary to their autistic symptomatology.

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Here are some other research papers that involve progress and change in diagnosis over time:


J Autism Dev Disord. 2008 Jul;38(6):1081-91. Epub 2007 Dec 6.

Stability of the autism diagnostic interview-revised from pre-school to elementary school age in children with autism spectrum disorders.

Moss J, Magiati I, Charman T, Howlin P.

Department of Community Health Sciences, St George's, University of London, London, UK. jo.moss@iop.kcl.ac.uk

This study examined the stability of scores on the ADI-R from pre-school to elementary school age in children with autism spectrum disorders (ASD). Participants were 35 children who, at T1, all had a clinical diagnosis of ASD. On initial assessment (mean age 3.5 years; SD 0.6 years), all met ADI-R algorithm criteria for autism. ADI-R assessments were repeated at follow up (FU; mean age 10.5 years; SD 0.8 years). Changes in ADI-R total, domain and ADI-R algorithm item scores were assessed. Twenty-eight children continued to score above the ADI-R cut-off for autism at FU, although significant decreases in ADI-R domain and item scores were also found. In conclusion while classification of children according to ADI-R criteria generally remained stable between pre-school and elementary school age, many children demonstrated significant improvements in symptom severity.

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J Autism Dev Disord. 2008 Apr;38(4):606-15. Epub 2007 Oct 9.

Diagnostic stability in very young children with autism spectrum disorders.

Kleinman JM, Ventola PE, Pandey J, Verbalis AD, Barton M, Hodgson S, Green J, Dumont-Mathieu T, Robins DL, Fein D.

Department of Psychology, University of Connecticut, 406 Babbidge Rd., Storrs, CT 06269-1020, USA.

Autism Spectrum Disorders (ASD) diagnosis in very young children may be delayed due to doubts about validity. In this study, 77 children received a diagnostic and developmental evaluation between 16 and 35 months and also between 42 and 82 months. Diagnoses based on clinical judgment, Childhood Autism Rating Scale, and the Autism Diagnostic Observation Schedule were stable over time. Diagnoses made using the Autism Diagnostic Interview were slightly less stable. According to clinical judgment, 15 children (19%) moved off the autism spectrum by the second evaluation; none moved onto the spectrum. Results indicate diagnostic stability at acceptable levels for diagnoses made at age 2. Movement off the spectrum may reflect true improvement based on maturation, intervention, or over-diagnosis at age 2.

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J Child Psychol Psychiatry. 2007 Aug;48(8):793-802.

Variability in outcome for children with an ASD diagnosis at age 2.

Turner LM, Stone WL.

University of North Carolina at Chapel Hill, NC 27599-3367, USA. lauren_turner@med.unc.edu

BACKGROUND: Few studies have examined the variability in outcomes of children diagnosed with autism spectrum disorder (ASD) at age 2. Research is needed to understand the children whose symptoms - or diagnoses - change over time. The objectives of this study were to examine the behavioral and diagnostic outcomes of a carefully defined sample of 2-year-old children with ASD, and to identify child and environmental factors that contribute to variability in outcomes at age 4. METHODS: Forty-eight children diagnosed with autism or pervasive developmental disorder not otherwise specified (PDDNOS) at age 2 were followed to age 4. Diagnostic measures included the Autism Diagnostic Observation Schedule - Generic (ADOS-G) and clinical diagnosis at ages 2 and 4, and the ADI-R at age 4. RESULTS: Diagnostic stability for an ASD diagnosis (autism or PDDNOS) was 63%, and for an autism diagnosis was 68%. Children who failed to meet diagnostic criteria for ASD at follow-up were more likely to: 1) be 30 months or younger at initial evaluation; 2) have milder symptoms of autism, particularly in the social domain; and 3) have higher cognitive scores at age 2. No differences between children with stable and unstable diagnoses were found for amount of intervention services received. Among the children with unstable diagnoses, all but one continued to have developmental disorders, most commonly in the area of language. CONCLUSIONS: The stability of ASD was lower in the present study than has been reported previously, a finding largely attributable to children who were diagnosed at 30 months or younger. Implications for clinical practice are discussed.

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Eur Child Adolesc Psychiatry. 2007 Sep;16(6):405-10. Epub 2007 Mar 30.

Stability and change of IQ scores in preschool children diagnosed with autistic spectrum disorder.

Dietz C, Swinkels SH, Buitelaar JK, van Daalen E, van Engeland H.

Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, P.O. 85500, 3508 GA, Utrecht, The Netherlands. cdietz@umcutrecht.nl

AIM: To investigate cognitive development in preschool-age children diagnosed with Autistic Spectrum Disorder (ASD; N = 39) compared with that of children diagnosed with mental retardation (MR; N = 14) and normally developing children (NC; N = 36). METHOD: In a prospective longitudinal study, cognitive development was tested at age 24 months (T1; SD = 6 months) and 43 months (T2; SD = 5). RESULTS: Group IQ scores were stable between T1 and T2 as evidenced by high correlations (r = .81, P < .01) and consistency of average group scores. At the same time however, about a third of children with ASD showed an increase of cognitive scores of 15 points or more. This increase of IQ was correlated with lower scores at the early screening of autistic traits (ESAT) at T1, higher IQ level at T2 and higher expressive language skills at T2. Intensity of treatment was not related to IQ increase. CONCLUSIONS: High correlations between cognitive scores in preschool children with ASD suggest that measurements of cognitive function are valid at this age. We found indications of both stability and change of IQ scores. Findings suggest that some children with ASD show catch-up intellectual development. To the best of our knowledge, this increase in IQ scores cannot be attributed to treatment effects.

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Autism spectrum disorder in the second year: stability and change in syndrome expression.
Chawarska K, Klin A, Paul R, Volkmar F.

Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut 06511, USA. Katarzyna.Chawarska@Yale.edu

OBJECTIVES: Increasing numbers of young children referred for a differential diagnosis of autism spectrum disorders (ASD) necessitates better understanding of the early syndrome expression and the utility of the existing state-of-the art diagnostic methods in this population. METHOD: Out of 31 infants under the age of 2 years referred for a differential diagnosis, 19 were diagnosed with autism, and 9 with pervasive developmental disorder - not otherwise specified (PDD-NOS) when reassessed at 3 years. We examined 1) the symptoms of ASD in the second year and changes in the syndrome expression by the age of three; 2) relationship between expert-assigned clinical diagnosis and diagnostic classification based on Autism Diagnostic Observation Schedule-Generic (ADOS-G) and Autism Diagnostic Interview-Revised (ADI-R) in the second year; 3) the relationship between direct observation and parental report of ASD symptoms. RESULTS: Symptoms of autism and PDD-NOS in the second year were pronounced and stability of the clinical diagnosis was high. The agreement between clinician-assigned autism but not PDD-NOS diagnosis and the ADOS-G was high. However, sensitivity of the ADI-R diagnostic classification of autism was poor. Comparison of concurrent parental report and direct observation revealed discrepancies in severity ratings of key dyadic social behaviors. Changes in communication reflected acquisition of language accompanied by the emergence of unusual language characteristics. Symptoms of social dysfunction were relatively stable over time, and so was the severity of stereotyped behaviors. CONCLUSIONS: The study provides support for stability of clinical diagnosis and syndrome expression in the second year and highlights advantages and limitations of the ADI-R and ADOS-G for diagnosing and documenting symptoms of ASD in infants.

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Autism. 2006 May;10(3):243-65.

Follow-up of children with autism spectrum disorders from age 2 to age 9.

Turner LM, Stone WL, Pozdol SL, Coonrod EE.

Vanderbilt University, Nashville, USA. lauren_turner@med.unc.edu

The purpose of the present study was to examine the developmental outcomes of children 7 years after their initial diagnosis. Children diagnosed with autism or PDD-NOS at age 2 received follow-up evaluations at age 9. Diagnostic stability was high, with 88 percent of the sample obtaining autism spectrum diagnoses at age 9. Cognitive scores improved considerably for a large segment of the sample, with over 50 percent obtaining scores in the average range at follow-up. Language outcomes were also positive at follow-up; 88 percent of the sample demonstrated at least some functional language, and 32 percent were able to engage in conversational exchanges. Early characteristics that predicted outcome status were: age of diagnosis, age 2 cognitive and language scores, and total hours of speech-language therapy between ages 2 and 3.These findings highlight the potential long-term benefits of both early identification and early intervention, and provide additional evidence for the importance of promoting public awareness of the early signs of autism.

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Study Reveals Children Recover From Autism With Intensive Three-Year Behavioral Therapy
Center for Autism and Related Disorders Releases Results From Three-Year Study

PHOENIX, Nov. 12, 2010 /PRNewswire/ -- A landmark study proves that children are capable of recovery from autism, or of making substantial gains in cognitive and adaptive functioning, as well as language skills, according to results released last night by Dr. Doreen Granpeesheh, founder of the Center for Autism and Related Disorders, Inc. (CARD).

The three-year study, which the State of Arizona funded and CARD, the world's largest provider of early intensive behavioral intervention for children with autism, conducted, evaluated the effects of behavioral intervention for 14 young children with autism using a version of Applied Behavior Analysis (ABA) that blends structured teaching with play-based behavioral intervention. Today, 43 percent of the study's participants no longer display clinical symptoms of autism and most of the participants demonstrate significant improvements in functioning.

http://www.prnewswire.com/news-releases/study-reveals-children-recover-from-autism-with-intensive-three-year-behavioral-therapy-107483288.html

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Wed Oct 24, 2012 9:01 pm
by Winnie
J Autism Dev Disord. 2007 Jan;37(1):98-107. Epub 2007 Jan 6.

Predictors of optimal outcome in toddlers diagnosed with autism spectrum disorders.

Sutera S, Pandey J, Esser EL, Rosenthal MA, Wilson LB, Barton M, Green J, Hodgson S, Robins DL, Dumont-Mathieu T, Fein D.

SourceDepartment of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA. saasha.sutera@uconn.edu

Abstract
A diagnosis of autism spectrum disorder (ASD) is usually taken to be permanent. In this study, 13 two-year-old children with ASD lost the diagnosis by age 4, at which time they scored within the normal range on standardized measures of cognitive and adaptive functioning. No differences were found in symptom severity, socialization, or communication between children who lost the ASD diagnosis and children who did not, but children with PDD-NOS were significantly more likely than those with full autistic disorder to move off the spectrum. The clearest distinguishing factor was motor skills at age 2. Results support the idea that some toddlers with ASD can lose their diagnosis and suggest that this is difficult to predict.

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Wed Oct 24, 2012 9:02 pm
by Winnie
Stability and Predictors of the Developmental Course of ASD From Childhood to Adolescence

S. C. Louwerse1, M. L. Eussen1,2, P. de Nijs1, A. R. Gool3, F. Verheij1, F. C. Verhulst1 and K. Greaves-Lord1,4, (1)Department of Child & Adolescent Psychiatry and Psychology, Erasmus MC - Sophia's Children’s Hospital, Rotterdam, Netherlands, (2)Yulius, Dordrecht, Netherlands, (3)Yulius, Rotterdam, Netherlands, (4)Academie, Yulius, Rotterdam, Netherlands
Background: Studies regarding the stability of ASD from childhood until adolescence are sparse. The few studies available mostly included individuals with classical autistic disorder (AD) combined with mild to severe mental retardation, and concluded that autism is stable throughout life. Currently, the conceptualisation of autism is much broader and more insight is needed on the developmental course of individuals at the higher functioning end of the autism spectrum (ASD).
Objectives: The first aim of this study was to examine the diagnostic stability of ASD from middle childhood to adolescence. The second aim was to investigate putative predictors from childhood for further developmental course into adolescence.

Methods: A follow-up study was performed on a sample of originally 242 clinically referred, 6 to 12 year old children (T1: n=142 ASD, n=100 with subclinical ASD symptoms). Seven years later, at T2, 170 adolescents (n=113 of the original ASD group and n=57 of the ‘sub-ASD’ group) took part in diagnostic assessment with the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview (ADI-R). Four developmental course groups were computed based on best estimate clinical consensus classifications during childhood and adolescence; 1) persistent ASD, 2) individuals who improved from an ASD classification to subclinical ASD symptoms (‘improvers’), 3) persistent sub-ASD, 4) individuals who declined from subclinical ASD symptoms to an ASD classification (‘decliners'). The relative amount of individuals in these groups was regarded (aim 1). To evaluate predictors of developmental course (aim 2), T1 cognitive functioning, language abilities, and severity within symptom ASD domains were compared between the persistent ASD group and improvers (predictors of improvement) and between the persistent sub-ASD group and decliners (predictors of decline).

Results: 74% of the individuals received an ASD classification at both time points, whereas in 26% of the cases functioning improved. 68% of the participants who showed subclinical ASD symptoms during childhood also did not have an ASD classification during adolescence, but 32% declined into a full ASD classification. The individuals who improved showed better language and communication skills during childhood than the persistent ASD group. Individuals that declined into an ASD classification had worse language and communication skills during childhood than the individuals with subclinical ASD symptoms during both assessment waves. Social problem levels during childhood were also marginally different between the groups (p=.06). Cognitive functioning was not predictive of improvement or decline.

Conclusions: In higher functioning individuals, ASD is not as stable from childhood to adolescence as was previously found for more severe autism cases. More than one fourth of the ASD cases no longer meet diagnostic criteria in adolescence, but also one third of the individuals that did not meet full diagnostic criteria during childhood, did meet these criteria during adolescence. Therefore, it is important to re-evaluate the diagnosis of individuals who showed milder forms of ASD during childhood once they have reached adolescence. Language ability is an important prognostic factor regarding further developmental course into adolescence, since limited speech predicts decline, but good pragmatic language ability predicts improvement.

https://imfar.confex.com/imfar/2012/webprogram/Paper10330.html

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Fri Jan 18, 2013 10:14 pm
by Winnie
Optimal outcome in individuals with a history of autism

Deborah Fein1,6,
Marianne Barton1,
Inge-Marie Eigsti1,
Elizabeth Kelley2,
Letitia Naigles1,
Robert T. Schultz3,
Michael Stevens4,
Molly Helt1,
Alyssa Orinstein1,
Michael Rosenthal5,
Eva Troyb1,
Katherine Tyson1

Abstract

Background:  Although autism spectrum disorders (ASDs) are generally considered lifelong disabilities, literature suggests that a minority of individuals with an ASD will lose the diagnosis. However, the existence of this phenomenon, as well as its frequency and interpretation, is still controversial: were they misdiagnosed initially, is this a rare event, did they lose the full diagnosis, but still suffer significant social and communication impairments or did they lose all symptoms of ASD and function socially within the normal range?

Methods:  The present study documents a group of these optimal outcome individuals (OO group, n = 34) by comparing their functioning on standardized measures to age, sex, and nonverbal IQ matched individuals with high-functioning autism (HFA group, n = 44) or typical development (TD group, n = 34). For this study, ‘optimal outcome’ requires losing all symptoms of ASD in addition to the diagnosis, and functioning within the nonautistic range of social interaction and communication. Domains explored include language, face recognition, socialization, communication, and autism symptoms.

Results:  Optimal outcome and TD groups’ mean scores did not differ on socialization, communication, face recognition, or most language subscales, although three OO individuals showed below-average scores on face recognition. Early in their development, the OO group displayed milder symptoms than the HFA group in the social domain, but had equally severe difficulties with communication and repetitive behaviors.

Conclusions:  Although possible deficits in more subtle aspects of social interaction or cognition are not ruled out, the results substantiate the possibility of OO from autism spectrum disorders and demonstrate an overall level of functioning within normal limits for this group.

Continues -- full text of study: http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12037/full

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Sun Feb 24, 2013 1:16 am
by Winnie
The Autism Gap: What Works

12:27 AM, Feb 22, 2013 | 4 comments

Jaye Watson


EMORY, Ga. -- "Every family we meet is struggling."

As the Assistant Director of the Emory Autism Center, Michael Morrier says he gets more than a half dozen calls from desperate parents every day.

"I get phone calls from parents, probably seven a day, that want to know what we offer and we tell them, and they say 'I can't afford that.'"

But for those who can afford the $25,000 dollar a year tuition, The Walden Early Childhood Center at the Emory Autism Center can be life changing for a child with autism.

"In each class, one third of the children have a diagnosis of autism and two thirds are typically developing children." Morrier explains, "Deficits in social behavior are sort of the hallmark of autism. So we feel in order to teach normalized social behavior you need to have normalized social behavior models."

This early intervention program is so effective that a third who graduate from it are indistinguishable from their peers.

Article continues, with video: http://www.11alive.com/news/article/278819/40/The-Autism-Gap-What-Works

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Sun Feb 24, 2013 1:18 am
by Winnie
J Autism Dev Disord. 2011 Sep;41(9):1267-76. doi: 10.1007/s10803-010-1155-z.

Is pervasive developmental disorder not otherwise specified less stable than autistic disorder? A meta-analysis.

Rondeau E, Klein LS, Masse A, Bodeau N, Cohen D, Guilé JM.

Source

Université de Montréal and Hôpital Rivière-des-Prairies, 7070, boulevard Perras, Montréal, QC H1E 1A4, Canada.

Abstract

We reviewed the stability of the diagnosis of pervasive developmental disorder not otherwise specified (PDD-NOS). A Medline search found eight studies reiterating a diagnostic assessment for PDD-NOS. The pooled group included 322 autistic disorder (AD) and 122 PDD-NOS cases. We used percentage of individuals with same diagnose at Times 1 and 2 as response criterion. The pooled Relative Risk was 1.95 (p < 0.001) showing that AD diagnostic stability was higher than PDD-NOS. When diagnosed before 36 months PDD-NOS bore a 3-year stability rate of 35%. Examining the developmental trajectories showed that PDD-NOS corresponded to a group of heterogeneous pathological conditions including prodromic forms of later AD, remitted or less severe forms of AD, and developmental delays in interaction and communication.

http://www.ncbi.nlm.nih.gov/pubmed/21153874

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Fri May 03, 2013 12:33 pm
by Winnie
Paper presented at May 2013 IMFAR:

Peers' Evaluation of Stories Told by Optimal Outcome Children with a History of Autism Spectrum Disorders

J. Suh1, I. M. Eigsti2, L. Naigles1, M. Barton2, A. Orinstein1, K. E. Tyson1, E. Troyb1, M. Rosenthal3, M. Helt1, R. T. Schultz4, M. C. Stevens5, E. A. Kelley6 and D. A. Fein2, (1)University of Connecticut, Storrs, CT, (2)Clinical Psychology, University of Connecticut, Storrs, CT, (3)Child Mind Institute, New York, NY, (4)Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, (5)Institute of Living, Hartford Hospital / Yale University, Hartford, CT, (6)Queen's University, Kingston, ON, Canada

Background: A study is following children who have a history of autism spectrum disorder (ASD), but who no longer meet diagnostic criteria for such a disorder. These children have achieved social and language skills within the average range for their ages and receive little or no school support. Several recent studies suggest that this small subset of children, once diagnosed with ASDs, achieve "optimal outcomes" (OO; Sutera et al., 2007; Helt et al., 2008; Kelley, Naigles, & Fein, 2010); however, pragmatic language skills may continue to show subtle impairments.

Objectives: Narratives are a highly sensitive tool for examining language skills. In order to assess potentially very subtle variability in pragmatic language ability, we asked high school students to read transcriptions of the Tuesday story and to evaluate them qualitatively for "story goodness."

Methods: Forty-five participants with high-functioning autism (HFA; n=15), typical development (TD; n=15) or OO (n=15) completed the Tuesday story narration. Participants were matched on age (mean=12.8, range 9-15) and verbal IQ. Narratives were transcribed by coders naïve to diagnosis. Transcriptions were read by five adolescents (ages 15-17), naïve to diagnosis, who rated the narratives on a five-point scale (1= poor, 5= excellent) according to: overall quality of story, story flow, comprehension, sophistication of language, correct use of grammar, story imagery, energy level, engagement level of the story, clarity of story content, and presence of oddity in wordings and themes.

Results: ANOVA tested for group differences in peer story ratings. The OO and HFA groups' ratings were significantly lower than TD group for: overall narrative quality [M(SD)= 3.1 (0.5), 3.0 (0.5), and 3.5(0.5) for OO, HFA, and TD, respectively; p= .03]; story flow [2.9 (0.7), 2.7 (0.6), and 3.4 (0.4); p < .01]; and comprehension [3.1 (0.5), 3.1 (0.5), and 3.7 (0.4); p < .01]. The HFA group received significantly lower scores than both OO and TD groups for sophistication of language [3.4 (0.5), 3.0 (0.5), and 3.4 (0.3); p= .04]. The HFA group received significantly lower scores than the TD group on grammatical structure; the OO group did not differ from either group [3.1 (0.4), 2.9 (0.4), and 3.3 (0.3); p= .02]. There were no group differences in any other narrative characteristics.

Conclusions: Tuesday narrations were evaluated in a previous study (Suh et al., 2012, INS presentation) for subtle aspects of pragmatic language such as clarity of pronoun use; the OO and TD groups did not differ on these measures. In this analysis, however, the OO group's narrations were evaluated by peers as having lower overall quality, overall flow, and being harder to comprehend relative to TD counterparts. Further data are being collected from additional raters to insure the reliability of rating scales. Despite having language and social skills in the average range, pragmatic language skills in OO may retain subtle deficits that are perceptible to untrained, lay interlocutors. This is meaningful, as peer interpretation of communications is crucial for social inclusion. We discuss implications of why these aspects of pragmatic language are so resistant to improvement.

https://imfar.confex.com/imfar/2013/webprogram/Paper13337.html

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Fri May 03, 2013 12:38 pm
by Winnie
Paper being presented at May 2013 IMFAR:

Neural Activation to Sentences in Individuals with High-Functioning Autism, Typical Development, and Autism Spectrum Disorder Optimal Outcome

I. M. Eigsti1, M. C. Stevens2, R. T. Schultz3, L. Naigles4, E. A. Kelley5, A. Orinstein4, K. E. Tyson4, E. Troyb4, M. Barton6 and D. A. Fein6, (1)Psychology, University of Connecticut, Storrs, CT, (2)Institute of Living, Hartford Hospital / Yale University, Hartford, CT, (3)Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, (4)University of Connecticut, Storrs, CT, (5)Queen's University, Kingston, ON, Canada, (6)Clinical Psychology, University of Connecticut, Storrs, CT

Background: Previous functional neuroimaging research has found that youth diagnosed with autism abnormally engage parietal and occipital brain regions associated with visuospatial processing when reading sentences that do not require imaginative visualization (Kana et al, 2006).

Objectives: The current study used fMRI to compare three groups during processing of sentences that involve low or high levels of visual imagery for reading comprehension: participants with high functioning autism (HFA), typical peers (TD), and individuals with a history of autism spectrum disorder (ASD), but who no longer meet diagnostic criteria for such a disorder (i.e., “optimal outcome” - OO).

Methods: Groups of youth with HFA (n=23), TD (n=21), and OO (n=17) of equivalent mean age (13 years) and gender proportion completed an event-related fMRI task involving Yes/No responses to low-imagery or high-imagery sentences (e.g., “the number six can be rotated to make the number nine”).

Brain regions that survived FDR “whole-brain” corrections where high imagery activation was greater than low imagery for all groups (via SPM8 conjunction analysis; p<.001 uncorrected) were selected as 5mm radius regions-of-interest (ROIs). Extracted mean data from ten ROIs (left Broca's area, left fusiform, right and left IFG/precentral, right and left IPL/postcentral gyrus, right and left SMA, and right and left posterior MTG) were examined using 2 (high vs low imagery) × 3 (group) multivariate repeated-measures ANOVA.

Results: Our comparison of high vs low imagery conditions closely replicated previous findings. There was a multivariate effect of group (p=.001), but not imagery × group (p=.521). Univariate tests showed that average task activation in left inferior frontal gyrus and supplementary motor area had abnormally high HFA activity; OO activation fell between TD and HFA, and did not significantly differ from TD or HFA. Groups differed in right postcentral/inferior parietal lobule (IPL) and bilateral posterior superior temporal gyrus (BA 37) activation. In the latter regions, TD’s either showed no activity or “deactivated” to sentence stimuli, while OO showed abnormally high activation (even greater than HFA hyper-activation). Supplemental analyses found several additional group effects throughout the brain when examining either high imagery or low imagery conditions. The majority of these differences outside of a priori ROIsoccurred near the edges of activated regions, implicating additional ASD abnormality in the extent of activated cortex.

Conclusions: In addition to partially replicating previously reported findings, novel results include the finding that ASD youth with optimal outcomes have partial normalization of abnormal activity observed in HFA, including prefrontal cortex activation in Broca’s region and supplementary motor area during sentence comprehension. In addition, OO show exaggerated hyper-activation, greater than both TD and HFA, in posterior brain regions, including those involved with visuospatial processing (right IPL) and object recognition (posterior inferior temporal). The results suggest that during language processing, regardless of visual imagery, activation in the OO group is linked to a mixture of normalization of function in frontal regions and possibly to compensatory over-activation in posterior regions.

https://imfar.confex.com/imfar/2013/webprogram/Paper14009.html

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Fri May 03, 2013 12:46 pm
by Winnie
Another currently being presented at IMFAR:

Social/Emotional Functioning in Optimal Outcome Children with a History of Autism Spectrum Disorders

Saturday, 4 May 2013
Banquet Hall (Kursaal Centre)
12:00
D. A. Fein1, K. E. Tyson2, M. Barton1, I. M. Eigsti3, L. Naigles2, E. Troyb2, A. Orinstein2 and M. Helt2, (1)Clinical Psychology, University of Connecticut, Storrs, CT, (2)University of Connecticut, Storrs, CT, (3)Psychology, University of Connecticut, Storrs, CT

Background: Although ASD’s are usually considered a life-long set of disorders, and are so for the majority, a number of such individuals can lose symptoms and gain skills so that they no longer meet criteria for any ASD. The present paper is part of a larger project in which a group of such individuals are being studied in multiple domains, including neuropsychological, psychiatric, and social functioning, and brain structure and function. The goal is to document the possibility of an outcome of ASD in which social and cognitive functioning is typical, to examine any residual vulnerabilities, and to explore mechanisms of “optimal outcome” by tracking history, intervention and structural and functional imaging differences from individuals with persisting ASD.

Objectives: The aim of this paper is to present findings on social and emotional functioning, including adaptive social and communication scores, ADOS scores, face recognition, and psychiatric vulnerabilities.

Methods: Participants were 44 individuals with high-functioning autism (HFA), 34 individuals with optimal outcome (OO), and 34 individuals with typical development (TD). Age range was 8-21, with an average age of 13 years in all groups. All participants had verbal IQ, performance IQ and full-scale IQ in the normal range (>77). HFA participants met criteria for an ASD on the ADOS and by best estimate clinical judgment. OO participants did not meet criteria for an ASD on any ADOS domain or by clinical judgment, were functioning in a regular education classroom with no one-on-one assistance and no special services for social skills, had Vineland Communication and Socialization scores in the normal range, and had an early history of ASD supported by early expert diagnosis and current blind review of early records.

Results: ADOS Social and Communication totals did not differ between OO and TD groups. One social item (insight into relationships) was significantly higher (more abnormal) in the OO than the TD group, and one item showed a trend (eye contact). No Communication items differed between OO and TD groups. The Social Communication Questionnaire Lifetime Version suggested that the OO group had slightly milder clinical presentation in early childhood and the ADI-R suggested that this difference was only in the social domain. Facial Recognition score was average for the OO group and not significantly different from the TD group, while the HFA group’s average score was below average. The OO group did not differ from the TD group on any Vineland domain. Both the OO and HFA groups were vulnerable to current and past attention problems and specific phobias, with the HFA group also vulnerable to depression, tics, obsessive-compulsive disorder, and oppositional-defiant disorder.

Conclusions: Data support the existence of a group of individuals with a clear history of ASD and outcome in the normal range of social functioning and communication. They are vulnerable to attention difficulties and phobias, and appear to have had slightly milder social deficits in early childhood.

https://imfar.confex.com/imfar/2013/webprogram/Paper14014.html

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Fri May 03, 2013 12:49 pm
by Winnie
Another:

Detail and Gestalt Focus in Spontaneous Descriptions by Individuals with Optimal Outcomes From ASD

Thursday, 2 May 2013: 15:30
Meeting Room 1-2 (Kursaal Centre)
14:30
A. H. Fitch, D. A. Fein and I. M. Eigsti, Clinical Psychology, University of Connecticut, Storrs, CT

Background: Individuals with high-functioning autism (HFA) have consistently been found to focus on details, sometimes at the expense of the whole, or gestalt (Mottron et al., 2003; Happé & Frith, 2006). The tendency to focus on non-central details rather than the gestalt impacts story-telling (Barnes & Baron-Cohen, 2012), verbal memory (Hermelin & O’Connor, 1967), and other communication skills central to social interactions. Detail focus is of particular interest in our study of individuals previously diagnosed with HFA, who no longer meet criteria -- who have achieved a so-called "optimal outcome" (OO).

Objectives: We aimed to identify differences in detail focus for individuals with HFA, OO, and typical development (TD), by evaluating the production, in spontaneous speech, of statements that included person-centered details and gestalt statements (likely to be frequent in the TD group data) as well as non-central details and unrelated statements (likely to be frequent in the HFA data). A central question was whether the OO group's speech would pattern more similarly to the TD or to the HFA group, because the degree of "detail focus" is non-diagnostic but quite prevalent in autism.

Methods: A total of 45 children and adolescents with HFA, OO and TD (15 per group) described a rich visual stimulus (a painting) for ten seconds, while tapping their index finger; there were six such trials. Responses were recorded and transcribed, and each utterance was coded for focus: person, non-central, extrapolation, gist, or nonsense/unrelated. To date, data from 27 participants has been coded (5 HFA, 8 OO, 14 TD).

Results: In this preliminary analysis of a small sample, results nevertheless clearly indicated that the HFA group produced significantly fewer gist statements than the OO group, p = .008; the contrast with TD approached significance, p = .06, with no difference between the OO and TD groups. There was a similar pattern for person-centered details: the HFA group produced significantly fewer than the TD group, p = .002; the contrast with OO approached significance, p = .06, and there was no difference between the OO and TD groups. We also found that both the HFA group and the OO group produced significantly fewer non-central details than the TD group, p< .05, contrary to our predictions.

Conclusions: Results suggest that OO individuals have largely "normalized" in the degree to which they focus on person-centered details and gestalts, such that they are indistinguishable from their TD peers. This is a particularly stringent test of detail/gestalt focus, because participants were describing pictures during a "dual-task" paradigm, which involves a significant cognitive load. These results cannot distinguish between two possibilities: 1) individuals with OO had a more detail-oriented focus, which changed over development, or 2) their different early cognitive style was already less detail-focused, with the implication that this may related to their reduction in symptomatology.

https://imfar.confex.com/imfar/2013/webprogram/Paper13969.html

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Fri May 03, 2013 12:58 pm
by Winnie
Is There an Optimal Developmental Path in Autism?

Saturday, 4 May 2013
Banquet Hall (Kursaal Centre)
10:00

M. Dawson1 and I. Soulières2, (1)Service de Recherche, Centre d'excellence en Troubles envahissants du développement de l’Université de Montréal (CETEDUM), Montreal, QC, Canada, (2)University of Quebec in Montreal, Montreal, QC, Canada

Background: Two striking features of autism are diversity in reported developmental paths and diversity in reported autistic outcomes, from outstanding to extremely poor. Current approaches to autism posit the existence of an optimal developmental path, against which the potential of autistics can be judged and thus their outcomes predicted. However, long-term follow-up studies of diagnosed autistics present a more complex picture (e.g., Howlin, 2011), while existing epidemiology suggests that many older autistics are undiagnosed (e.g., Brugha et al., 2011; Kim et al., 2011). Further, the apparent consensus that early development, particularly speech onset timing, cannot be used for diagnostic subgrouping (APA, 2012) calls into question its ostensibly crucial role in determining autistic outcomes.

Objectives: We aimed to verify whether speech onset timing is related to later (school-aged and older) outcomes of concern in autistic spectrum individuals subgrouped according to presence or absence of speech development anomalies. We also aimed to compare later outcomes as assessed via three different instruments, in autistic children and autistic adults subgrouped in the same way. This study builds on data we presented at IMFAR 2007.

Methods: We retrieved three data sets from consecutive cases from the Riviere-des-Prairies Hospital database who were six years of age or older and had an autism (with speech development anomalies) or Asperger syndrome (without speech development anomalies; normal-range Wechsler IQ) best estimate clinical diagnosis and ADI-R evaluation above threshold for autism. First and second sets included all individuals with valid age of first words and phrases ADI-R data, as well as Wechsler IQ (first set) or Vineland scores (second set). The third set included all individuals with Wechsler IQ, Raven’s Progressive Matrices, and Vineland adaptive behavior scores.

Results: For autistics (N=90) there was no significant correlation between age at first words or phrases and Wechsler full-scale, verbal, and performance IQ, or (N=61) Vineland scores. There was no significant difference between autistics with 70 or above versus below 70 FSIQ, in age of first words (mean respectively 29.3 versus 32.8 months, p=.46) or phrases (41.7 versus 43.6 months, p=.64). For Asperger individuals (N=39), there was no significant correlation between age of first words and FSIQ, VIQ or PIQ, or between age of first phrases and VIQ. However, there was a significant correlation between age of first phrases and both FSIQ and PIQ. As with autistics, for Vineland scores (N=29) there was no correlation with either age at first words or phrases. Comparisons of Wechsler, Vineland, and Raven scores in autistic and Asperger participants revealed dramatic discrepancies across measures in both adults and children, and higher Wechsler and Raven scores in autistic adults versus children.

Conclusions: Speech onset timing is unrelated to later IQ or adaptive behavior scores in autistic individuals defined by speech development anomalies. Different instruments can give dramatically different portraits of autism spectrum outcomes. Data from short-term studies and/or biased samples (e.g., samples excluding later-diagnosed autistics) may be distorting current conceptions of outcome predictors and limiting our knowledge of how atypical developmental paths lead to outcomes in autism.

https://imfar.confex.com/imfar/2013/webprogram/Paper12274.html

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Wed Feb 05, 2014 8:25 pm
by Winnie
J Autism Dev Disord. 2013 Dec 18. [Epub ahead of print]

School-Aged Functioning of Children Diagnosed with Autism Spectrum Disorder Before Age Three: Parent-Reported Diagnostic, Adaptive, Medication, and School Placement Outcomes.

Towle PO, Vacanti-Shova K, Shah S, Higgins-D'alessandro A.

Abstract

Eighty children with early autism spectrum disorder (ASD) diagnoses (under 36 months) were identified using a chart abstraction protocol applied to early intervention charts. Parents filled out questionnaires by mail when the children were school-aged (ages 6-16 years). Similar to previous studies, approximately 20 % no longer had ASD diagnoses; the other participants were assigned to Moderate/Severe versus Mild ASD outcome groups. These three groups were compared across several variables, including diagnostic features and functional features including adaptive behavior, social experiences, medication use, and school placement. The findings expand our knowledge about outcomes in longitudinal studies of children with ASD, as well as provide support for using relatively indirect methods (chart review, parent questionnaire) to gather this type of information.

http://www.ncbi.nlm.nih.gov/pubmed/24346492


First two pages of full text:
http://link.springer.com/article/10.1007%2Fs10803-013-1997-2#page-1

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Wed May 28, 2014 10:23 am
by Winnie
Recent paper presented at IMFAR: https://imfar.confex.com/imfar/2014/webprogram/Paper16013.html

Intervention History of Children and Adolescents with High-Functioning Autism and Optimal Outcomes

Thursday, May 15, 2014: 10:30 AM

Marquis D (Marriott Marquis Atlanta)

A. Orinstein, M. Helt, E. Troyb, K. E. Tyson, M. L. Barton, I. M. Eigsti, L. Naigles and D. A. Fein, Psychology, University of Connecticut, Storrs, CT

Background: A study is currently following children and adolescents who have a history of autism spectrum disorder (ASD), but who no longer meet diagnostic criteria for the disorder. These individuals have achieved social and language skills within the average range for their ages and receive little or no school support. Several recent studies suggest that this small subset of children, once diagnosed with ASD, achieve an "optimal outcome (OO)" (Fein et al., 2013; Sutera et al., 2007; Kelley et al., 2010; & Helt et al., 2008).

Objectives: The present study aimed to retrospectively examine group differences in the intervention history of children and adolescents with OO and those with high-functioning autism (HFA) to determine if specific early interventions are related to optimal outcomes in childhood and adolescence.

Methods: The current study examined intervention histories in 34 individuals with OO and 44 individuals with HFA (ages 8-21 at time of participation), who did not differ on age, sex, nonverbal IQ or family income. Intervention history was collected through detailed parent questionnaires.

Results: Children in the OO group had earlier parental concern (M(HFA)=22.0 months, M(OO)=16.7 months, t=2.00, p=.052) and received earlier referrals to specialists (M(HFA)=43.9 months, M(OO)=26.1 months, t=3.79, p=.001). The percent of OO children receiving early intervention services was significantly higher than in the HFA group (83 vs. 48%; χ2(1, n=56)=6.73, p=.009), as was the percent who attended preschool (92 vs. 56%; χ2(1, n=58)=8.70, p=.003). Between the ages of 2 and 3 years, OO children received more hours of intervention than the HFA children (ages 2-2.5: M(HFA)=4.1, M(OO)=14.8, p=.006; ages 2.5-3: M(HFA)=7.3, M(OO)=21.1, p=.006). More OO than HFA children received some type of intervention between 2.5 and 3 years of age (HFA=61%, OO=88%, p=.025) and during the second year of preschool (HFA=68%, OO=92%, p=.031). Specifically, more children in the OO group received Applied Behavior Analysis (ABA) than the HFA group for the following age periods: 2-2.5 years (HFA=4%, OO=40%, p=.001), 2.5-3 years (HFA=7%, OO=56%, p<.001), 3-4 years (HFA=32%, OO=60%, p=.042), and 4-5 years (HFA=25%, OO=72%, p=.001). Of the children who received ABA, the intensity did not differ between groups. Children in the HFA group were more likely to have received medication (64% vs. 24%; p=.002), especially anti-psychotics (28% vs. 0%; p=.007) and anti-depressants (41% vs. 4%; p<.001). There were no group differences in the percent of children receiving special diets (HFA=35% vs. OO=23%; p=.32) or supplements (HFA=36% vs. OO=40%; p=.76).

Conclusions: These data suggest that OO individuals generally receive earlier, more intense interventions and more ABA, while HFA individuals receive more pharmacologic treatments. While the use of retrospective data is a clear limitation to the current study, the substantial differences in reported provision of early intervention, and ABA in particular, are highly suggestive and should be replicated in prospective studies.

Abstract: J Dev Behav Pediatr. 2014 May;35(4):247-56. http://www.ncbi.nlm.nih.gov/pubmed/24799263

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Wed May 28, 2014 10:35 am
by Winnie
Autism. 2014 Apr;18(3):233-43. doi: 10.1177/1362361312473519. Epub 2013 Oct 4.

Academic abilities in children and adolescents with a history of autism spectrum disorders who have achieved optimal outcomes.

Troyb E1, Orinstein A, Tyson K, Helt M, Eigsti IM, Stevens M, Fein D.

Abstract

This study examines the academic abilities of children and adolescents who were once diagnosed with an autism spectrum disorder, but who no longer meet diagnostic criteria for this disorder. These individuals have achieved social and language skills within the average range for their ages, receive little or no school support, and are referred to as having achieved "optimal outcomes." Performance of 32 individuals who achieved optimal outcomes, 41 high-functioning individuals with a current autism spectrum disorder diagnosis (high-functioning autism), and 34 typically developing peers was compared on measures of decoding, reading comprehension, mathematical problem solving, and written expression. Groups were matched on age, sex, and nonverbal IQ; however, the high-functioning autism group scored significantly lower than the optimal outcome and typically developing groups on verbal IQ. All three groups performed in the average range on all subtests measured, and no significant differences were found in performance of the optimal outcome and typically developing groups. The high-functioning autism group scored significantly lower on subtests of reading comprehension and mathematical problem solving than the optimal outcome group. These findings suggest that the academic abilities of individuals who achieved optimal outcomes are similar to those of their typically developing peers, even in areas where individuals who have retained their autism spectrum disorder diagnoses exhibit some ongoing difficulty.

http://www.ncbi.nlm.nih.gov/pubmed/?ter ... al+outcome

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Wed May 28, 2014 10:40 am
by Winnie
Child Neuropsychol. 2014 Jul;20(4):378-97. doi: 10.1080/09297049.2013.799644. Epub 2013 Jun 3.

Executive functioning in individuals with a history of ASDs who have achieved optimal outcomes.

Troyb E1, Rosenthal M, Eigsti IM, Kelley E, Tyson K, Orinstein A, Barton M, Fein D.

Abstract

Executive functioning (EF) is examined among children and adolescents once diagnosed with an autism spectrum disorder (ASD), but who no longer meet diagnostic criteria. These individuals have average social and language skills, receive minimal school support and are considered to have achieved "optimal outcomes" (OOs). Since residual impairments in these individuals might be expected in deficits central to autism, and in developmentally advanced skills, EF was examined in 34 individuals who achieved OOs, 43 individuals with high-functioning autism (HFA), and 34 typically developing (TD) peers. Groups were matched on age (M = 13.49), gender, and nonverbal IQ (NVIQ) but differed on verbal IQ (VIQ; HFA < TD, OO). On direct assessment, all three groups demonstrated average EF; however, the OO and HFA groups exhibited more impulsivity and less efficient planning and problem-solving than the TD group, and more HFA participants exhibited below average inhibition than did OO and TD participants. Parent-report measures revealed average EF among the OO and TD groups; however, the OO group exhibited more difficulty than the TD group on set-shifting and working memory. HFA participants demonstrated more difficulty on all parent-reported EF domains, with a clinical impairment in attention-shifting. Results suggest that EF in OO appears to be within the average range, even for functions that were impaired among individuals with HFA. Despite their average performance, however, the OO and TD groups differed on measures of impulsivity, set-shifting, problem-solving, working memory, and planning, suggesting that the OO group does not have the above-average EF scores of the TD group despite their high-average IQs.

http://www.ncbi.nlm.nih.gov/pubmed/23731181

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Mon Jun 02, 2014 3:57 pm
by Winnie
Autism Res Treat. 2014;2014:472120. doi: 10.1155/2014/472120. Epub 2014 Apr 27.

Characteristics of children who lost the diagnosis of autism: a sample from istanbul, Turkey.

Mukaddes NM1, Tutkunkardas MD2, Sari O3, Aydin A3, Kozanoglu P4.

Abstract

Aim. The aim of this study was to describe a group of children who lost a diagnosis of autism following participation in early educational programs. Method. This is a descriptive study reporting the characteristics of children (n: 39) who lost their diagnosis of autism and explaining the educational programs that these children followed. The data were collected by reviewing the participants' files and through examinations. Results. All of the children were placed at regular psychiatric follow-ups. The mean age at referral was 2.39±0.75 years, whereas the mean age at the time of optimal outcome reported was 5.11 ± 1.95 years. Two of the children were in early intensive behavioral intervention (EIBI), and the rest were in a comprehensive naturalistic behavioral program. The childhood autism rating scale (CARS) total scores at baseline and final were 32.75 ± 3.15 and 18.01 ± 1.76, respectively. The mean IQ of the group at final examination was 116.70 ± 18.88. Conclusion. It could be concluded that a group of children with an autism diagnosis could lose the diagnosis of autism upon early intervention. High IQ and the development of communicative and language skills at an early age could be the most powerful factors contributing to an optimal outcome.

Full text of study:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022169/

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Mon Apr 06, 2015 12:17 am
by Winnie
J Dev Behav Pediatr. 2014 May;35(4):247-56. doi: 10.1097/DBP.0000000000000037.

Intervention for optimal outcome in children and adolescents with a history of autism.

Orinstein AJ1, Helt M, Troyb E, Tyson KE, Barton ML, Eigsti IM, Naigles L, Fein DA.

Abstract

OBJECTIVE:

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. These children are considered to have achieved "optimal outcomes" (OO). The present study aimed to retrospectively examine group differences in the intervention history of children and adolescents with OO and those with high-functioning autism (HFA).

METHOD:

The current study examined intervention histories in 25 individuals with OO and 34 individuals with HFA (current age, 8-21 years), who did not differ on age, sex, nonverbal intelligence, or family income. Intervention history was collected through detailed parent questionnaires.

RESULTS:

Children in the OO group had earlier parental concern, received earlier referrals to specialists, and had earlier and more intensive intervention than those in the HFA group. Substantially more children with OO than HFA received applied behavior analysis (ABA) therapy, although for children who received ABA, the intensity did not differ between the groups. Children in the HFA group were more likely to have received medication, especially antipsychotics and antidepressants. There were no group differences in the percent of children receiving special diets or supplements.

CONCLUSION:

These data suggest that OO individuals generally receive earlier, more intense interventions, and more ABA, whereas HFA individuals receive more pharmacologic treatments. Although the use of retrospective data is a clear limitation to the current study, the substantial differences in the reported provision of early intervention, and ABA in particular, is highly suggestive and should be replicated in prospective studies.

http://www.ncbi.nlm.nih.gov/pubmed/24799263

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Mon Apr 06, 2015 12:20 am
by Winnie
J Autism Dev Disord. 2015 Mar 11. [Epub ahead of print]

Social Function and Communication in Optimal Outcome Children and Adolescents with an Autism History on Structured Test Measures.

Orinstein AJ1, Suh J, Porter K, De Yoe KA, Tyson KE, Troyb E, Barton ML, Eigsti IM, Stevens MC, Fein DA.

Abstract

Youth who lose their ASD diagnosis may have subtle social and communication difficulties. We examined social and communication functioning in 44 high-functioning autism (HFA), 34 optimal outcome (OO) and 34 typically developing (TD) youth. Results indicated that OO participants had no autism communication symptoms, no pragmatic language deficits, and were judged as likable as TD peers. Some group differences were found: OO youth had less insight into social relationships and poorer friendship descriptions than TD youth. OO participants had attention, self-control, and immaturity difficulties that may impact social abilities. However, OO participants were most engaged, friendliest, warmest, and most approachable. Overall, OO participants had no social and communicative impairments, although some exhibited mild social difficulties that often accompany attentional problems.

http://www.ncbi.nlm.nih.gov/pubmed/25758821

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Mon Apr 06, 2015 12:45 am
by Winnie
YALE JOURNAL OF BIOLOGY AND MEDICINE 88 (2015), pp.37-44.

Toward Optimal Outcome Following Pivotal Response Treatment: A Case Series

Pamela E. Ventola*, Devon R. Oosting, Cara M. Keifer, and Hannah E. Friedman
Yale Child Study Center, New Haven, Connecticut

There is a growing literature on children with autism spectrum disorder (ASD†) who respond favorably to behavioral treatment, which is often termed “optimal outcome.” Rates and definitions of optimal outcome vary widely. The current case series describes an empirically validated behavioral treatment approach called Pivotal Response Treatment (PRT). We present two preschool-aged children who received an intensive course of PRT and seem to be on a trajectory toward potential optimal outcome. Understanding response to treatment and predictors of response is crucial, not necessarily to predict who may succeed, but to individualize medicine and match children with customized treatment programs that will be best tailored to their unique and varied needs.

Historically, autism spectrum disorder (ASD) has been considered a pervasive condition with difficulties in social communication and restrictive and repetitive behaviors persisting into adulthood [1]. Given the heterogeneity
of the disorder, it is not surprising that the outcomes for individuals with ASD are highly variable and can range from serious impairment to nearly typical functioning in adolescence and adulthood [1-5]. While improvements of varying degrees have been observed longitudinally in affected individuals, reports of individuals losing their diagnosis later in life are rare, and the literature supporting such outcomes is sparse [5,6-10].

Lovaas initially introduced the term “best outcome” when describing the 47 percent of his initial cohort of children with ASD who, after intense intervention, were mainstreamed in school and had IQs in the typical range [11]. Subsequent studies have yielded inconsistent support for Lovaas’s rate of best outcome [7,8,12,13]. In the past 2 decades, reported rates of best, or optimal, outcomes in individuals with ASD have ranged from 2 to 25 percent of affected individuals, drastically lower than the 47 percent reported by Lovaas [5,6,9,10,14,15]. One contributing factor to the discrepancy of reported optimal outcome rates is that the term optimal outcome (OO) has not yet been uniformly defined. While Lovaas referred to individuals with average IQ and mainstream classroom placement as best outcome, other researchers have used more stringent criteria for membership in the OO group (i.e., remediation of all ASD symptoms and typical social and communicative functioning) [2,11,16-19].

Recent work by Fein et al. [4] investigated the existence of OO in a group of 34 individuals who once held a diagnosis of ASD but no longer meet diagnostic criteria. Fein et al. clarified the definition of OO by operationalizing it as no longer meeting criteria for ASD, remediation of symptoms of ASD, and achieving social, communicative, and adaptive functioning in the typical range [4]. The characterization of these individuals confirms that OO is a possibility in ASD.

Research investigating potential predictors of optimal outcome in individuals with ASD has consistently demonstrated that average or above average cognitive abilities in early childhood predict better outcomes later in life [3,13,18,20,21]. Other factors likely to predict OO include early diagnosis, early intervention, strengths in receptive language, and an initial diagnosis of Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) or Asperger’s syndrome [2,5,22,23]. Anderson et al. [2] conducted a prospective study of individuals diagnosed
with ASD at 2 years old with follow-up assessments at 3 and 19 years of age. Results indicated that 9 percent
of the sample achieved OO by 19. Importantly, at 2 years old, the OO group did not differ phenotypically from cognitively
able participants who maintained their ASD diagnosis at 19. This study supports the notion that strengths in cognitive and communication abilities are not sufficient in predicting optimal outcome. While these characteristics likely contribute to optimal outcome in individuals with ASD, they do not sufficiently account for the emergence of social competency, independence, and remediation of autistic symptomatology present in the rare optimal outcome cases [14,20,24-27].

Full text of article continues: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345537/pdf/yjbm_88_1_37.pdf

Re: Research: Recovery, Optimal Outcome, & Diagnostic Stabi

Posted: Wed Apr 08, 2015 12:51 pm
by autismnhusa
Winnie wrote:YALE JOURNAL OF BIOLOGY AND MEDICINE 88 (2015), pp.37-44.

Toward Optimal Outcome Following Pivotal Response Treatment: A Case Series

Pamela E. Ventola*, Devon R. Oosting, Cara M. Keifer, and Hannah E. Friedman
Yale Child Study Center, New Haven, Connecticut

There is a growing literature on children with autism spectrum disorder (ASD†) who respond favorably to behavioral treatment, which is often termed “optimal outcome.” Rates and definitions of optimal outcome vary widely. The current case series describes an empirically validated behavioral treatment approach called Pivotal Response Treatment (PRT). We present two preschool-aged children who received an intensive course of PRT and seem to be on a trajectory toward potential optimal outcome. Understanding response to treatment and predictors of response is crucial, not necessarily to predict who may succeed, but to individualize medicine and match children with customized treatment programs that will be best tailored to their unique and varied needs.

Historically, autism spectrum disorder (ASD) has been considered a pervasive condition with difficulties in social communication and restrictive and repetitive behaviors persisting into adulthood [1]. Given the heterogeneity
of the disorder, it is not surprising that the outcomes for individuals with ASD are highly variable and can range from serious impairment to nearly typical functioning in adolescence and adulthood [1-5]. While improvements of varying degrees have been observed longitudinally in affected individuals, reports of individuals losing their diagnosis later in life are rare, and the literature supporting such outcomes is sparse [5,6-10].

Lovaas initially introduced the term “best outcome” when describing the 47 percent of his initial cohort of children with ASD who, after intense intervention, were mainstreamed in school and had IQs in the typical range [11]. Subsequent studies have yielded inconsistent support for Lovaas’s rate of best outcome [7,8,12,13]. In the past 2 decades, reported rates of best, or optimal, outcomes in individuals with ASD have ranged from 2 to 25 percent of affected individuals, drastically lower than the 47 percent reported by Lovaas [5,6,9,10,14,15]. One contributing factor to the discrepancy of reported optimal outcome rates is that the term optimal outcome (OO) has not yet been uniformly defined. While Lovaas referred to individuals with average IQ and mainstream classroom placement as best outcome, other researchers have used more stringent criteria for membership in the OO group (i.e., remediation of all ASD symptoms and typical social and communicative functioning) [2,11,16-19].

Recent work by Fein et al. [4] investigated the existence of OO in a group of 34 individuals who once held a diagnosis of ASD but no longer meet diagnostic criteria. Fein et al. clarified the definition of OO by operationalizing it as no longer meeting criteria for ASD, remediation of symptoms of ASD, and achieving social, communicative, and adaptive functioning in the typical range [4]. The characterization of these individuals confirms that OO is a possibility in ASD.

Research investigating potential predictors of optimal outcome in individuals with ASD has consistently demonstrated that average or above average cognitive abilities in early childhood predict better outcomes later in life [3,13,18,20,21]. Other factors likely to predict OO include early diagnosis, early intervention, strengths in receptive language, and an initial diagnosis of Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) or Asperger’s syndrome [2,5,22,23]. Anderson et al. [2] conducted a prospective study of individuals diagnosed
with ASD at 2 years old with follow-up assessments at 3 and 19 years of age. Results indicated that 9 percent
of the sample achieved OO by 19. Importantly, at 2 years old, the OO group did not differ phenotypically from cognitively
able participants who maintained their ASD diagnosis at 19. This study supports the notion that strengths in cognitive and communication abilities are not sufficient in predicting optimal outcome. While these characteristics likely contribute to optimal outcome in individuals with ASD, they do not sufficiently account for the emergence of social competency, independence, and remediation of autistic symptomatology present in the rare optimal outcome cases [14,20,24-27].

Full text of article continues: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345537/pdf/yjbm_88_1_37.pdf