February 22, 2024

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40% of Early Diagnosed Autism Cases No Longer Meet Criteria by Age 6

40% of Early Diagnosed Autism Cases No Longer Meet Criteria by Age 6



40% of Early Diagnosed Autism Cases No Longer Meet Criteria by Age 6

A groundbreaking discovery by a top children’s hospital reveals that nearly 40% of children diagnosed with autism no longer meet the criteria by the age of 6!

Autism Spectrum Disorder (ASD) is a common, highly hereditary neurodevelopmental disorder.

Global statistics indicate that the prevalence of autism is around 1%, with a rising trend in recent years.

As early diagnosis continues to improve and gain attention, more toddlers are being diagnosed with autism before the age of 3. However, the long-term development of these children’s conditions as they grow remains poorly understood.

Recently, a research team led by Elizabeth Harstad at Boston Children’s Hospital published a significant study in the renowned journal “JAMA Pediatrics.”

Based on long-term follow-up data from 213 children diagnosed with autism between the ages of 1 and 3, the study found that an astonishing 37.1% of these children no longer met the autism criteria by the age of 6. Moreover, girls or children with strong adaptive skills at baseline were more likely to shed the “label” of autism.

40% of Early Diagnosed Autism Cases No Longer Meet Criteria by Age 6

Screenshot source: JAMA

This research implies that not all children diagnosed with autism continue to meet the diagnostic criteria as they grow older, challenging our perception of autism as a static condition.

To understand how the condition evolves as children diagnosed with autism between 1 and 3 years old age, Harstad’s team recruited 213 children aged between 5 and 7, diagnosed with autism according to the DSM-5 criteria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) through multidisciplinary assessments at ages 1-3 (average age of diagnosis: 24.6 months).

40% of Early Diagnosed Autism Cases No Longer Meet Criteria by Age 6

Research flow chart

Of these children, 36 were girls (16.9%) and 177 were boys (83.1%). By the age of 5-7, all children completed the study assessments (average assessment age: 74.3 months).

Overall, when these children reached the age of 6, 134 children (62.9%) still met the DSM-5 criteria for autism (persistent autism), while surprisingly, 79 children (37.1%) no longer met the criteria (non-persistent autism).

40% of Early Diagnosed Autism Cases No Longer Meet Criteria by Age 6

The situation of children with non-persistent/persistent autism

The assessment results revealed that the IQ of all non-persistent autism children was not lower than 70. In contrast, among children with persistent autism, IQ showed a bimodal distribution (46 with IQ < 70, 88 with IQ ≥ 70). Additionally, adaptive skills and language scores were significantly lower in children with persistent autism compared to those with non-persistent autism.

From a clinical intervention perspective, all children in the study received at least one intervention, with 94.4% receiving autism-specific interventions. Notably, intervention intensity did not correlate with the persistence of autism.

40% of Early Diagnosed Autism Cases No Longer Meet Criteria by Age 6

Changes in intervention intensity

In the study’s conclusion, the team explored risk factors related to the persistence of autism. Results showed that compared to children with persistent autism, non-persistent autism children had higher baseline adaptive skills (with a 15-point increase in baseline adaptive skills, the probability of persistent autism decreased by 20-26%) and were more likely to be girls.

risk factor analysis

In summary, this large-scale study by Harstad’s team indicates that 37.1% of children diagnosed with autism between 1 and 3 years no longer meet the criteria by the age of 6. This proportion is significantly higher than previously expected (around ten percent).

Despite potential skepticism about early diagnosis due to such a high proportion, Harstad emphasizes that the children recruited for this study received diagnoses through multidisciplinary consultations, minimizing the possibility of misdiagnosis.

Harstad suggests that if these study findings are replicated in other samples, it indicates that early childhood autism might need to be transformed into “early autism features” requiring treatment and monitoring, rather than a static diagnosis.

Moreover, there is a need to identify biomarkers in early stages that can differentiate non-persistent and persistent autism for better precision in diagnosis and treatment.

40% of Early Diagnosed Autism Cases No Longer Meet Criteria by Age 6

Reference:
[1]. Lord C, Brugha TS, Charman T, et al. Autism spectrum disorder. Nat Rev Dis Primers. 2020;6(1):5. doi:10.1038/s41572-019-0138-4
[2]. Harstad E, Hanson E, Brewster SJ, et al. Persistence of Autism Spectrum Disorder From Early Childhood Through School Age. JAMA Pediatr. 2023;177(11):1197-1205. doi:10.1001/jamapediatrics.2023.4003

(source:internet, reference only)


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