| Autism outcomes - Autism is a developmental disorder that is usually diagnosed during early childhood...Bright Tots - Information on child development. |
Autism symptoms are usually diagnosed during early childhood. However, the impairments of autism are considered to last a lifetime, and continue to create challenges for the affected individual and his or her family. Adolescence is a time of stress and confusion; and it is no less so for teenagers with autism. Like all children, they need help in dealing with their prepubescent development.
While some symptoms of autism improve during the teenage years, some get worse. Increased autistic or aggressive behavior may be one way some teens express their worries and embarrassment. The teenage years are also a time when children become more socially sensitive. At the age that most teenagers are concerned with acne, popularity, grades, and dates, teens with autism may become exceedingly aware that they are different from their peers. They may notice that they lack friends. And unlike their schoolmates, they aren't dating or planning for a career. For some, the despair that comes with such realization motivates them to learn new behaviors and gain better social skills. Despite its early emergence, autism is believed to be a lifelong condition; however, little is known about the symptoms at the root of autism in adolescence and adulthood.
Studies on the Autism and Symptoms
Few studies address the developmental path of autism symptoms from childhood through adolescence and into adulthood. In general, studies have focused on age related differences and changes in the severity of the symptoms of autism, asking (1) whether symptoms decrease, remain stable, or become more severe over the life course and (2) whether individuals continue to meet the diagnostic criteria for having an autism diagnosis after the early childhood years.
Studies regarding changes in autistic symptoms have extended four decades, and therefore they differ in the diagnostic observation through time. Despite inconsistencies in diagnostic practices, as well as differences in plan, sample, and evaluation, the gathered evidence signifies that the major symptoms of autism decrease to some degree during adolescence and young adulthood. Recent studies provide a fine distinction in description of symptom change, suggesting that development may be divided, with improvement in only some behaviors that characterize autism and with different timing of improvement in behaviors.
In the course of progress in autistic symptoms during adolescence and adulthood, there can be a period of little or no growth or decline. Even periods of aggravation along the way, and for some individuals, symptoms may not subside or even may worsen. For example, in a study of 23 people between the ages of 16 and 23 years diagnosed with autism as part of a population epidemiological survey (the field of medicine that deals with the study of the causes, distribution, and control of disease in populations) it was found that 35% of the individuals experienced temporary (1-2 years) periods of frustration in behavioral symptoms (aggression, hyperactivity, insistence on sameness), and 22% displayed continuing deterioration throughout puberty in these same areas of behavior plus loss of language skills and cognitive abilities. A small percentage of individuals experienced the onset of seizures in puberty. Improvement is typically seen in terms of the acquisition of new skills and a decline in difficult behaviors.
Autism and Changes in Communication
Studies on autistic symptoms in communication show areas of improvements, though not seen for all individuals and even in those who do improve, changes are rarely significant enough to move the individual into the normal range of functioning. Other researchers have also documented the improving, but lasting, symptoms of autism. There are also considerable differences in the course of change in communicative behaviors. For example, speech symptoms that are the “classic” signs of autism (e.g., pronoun reversal, phrases) improve the most, whereas failure in pointing to express interest and use of gestures to communicate are less likely to improve from childhood. Early language achievements have been found to be a predictor of outcomes in adolescence and adulthood. Adults with autism who had better early language skills were more successful than those who had little communication skills during childhood. A study found that the presence of social language at age 5 or 6 years contributed to better outcomes in adolescence and adulthood.
Duration of Autistic Symptoms and Behavior
Studies on autistic symptoms and behavior have shown that few if any individuals who receive a diagnosis of autism in childhood recover fully and achieve levels of functioning typical of their age peers. For example, one study used ratings of the Childhood Autism Rating Scale (CARS) to decide on the appropriateness of the autism diagnosis in a clinical study of 59 adolescents, who as children had received an autism diagnosis also using the CARS. More than 80% of the children who met criteria for autism before age 10 continued to do so after age 13, although the group as a whole showed improvement on most features of behavior.
Retrospective studies on symptoms of autism provide a similar picture. In an analysis of 76 adolescents and adults with autism, found that 82% of the individuals who qualified for a diagnosis of autistic disorder based on the retrospective reports of caregivers still qualified based on responses about current functioning. Individuals who outgrow the ASD diagnosis are mainly those who are initially diagnosed as having Asperger’s Syndrome or PDD-NOS. Even among those with high functioning autism, however, most continue to meet criteria for the diagnosis in adolescence and adulthood. Change in diagnostic status among more severely affected individuals may be less likely.
In all only a small percentage of individuals show improvement in autistic symptoms during the adolescent and adult years that is of sufficient extent to prove the diagnosis of autism invalid. Those most likely to “outgrow” the diagnosis are those who as children displayed the least severe symptoms. In fact, it is amazing that as many as between 10% and 20% outgrow the diagnosis, as autism is perhaps among the most severe and persistent of the developmental disorders. However, given this severity and frequency, its stability throughout the life course is not a surprising finding.
Autism Symptoms in Adulthood
Reports on autistic symptoms during adulthood show 72% of the adults with autism have little independence in basic daily living skills. Few adults with autism live independently, marry, go to college, work in competitive jobs, or develop large network of friends. The majority remain dependent on their families or professional service providers for assistance with tasks of daily living. Even among those who work, jobs are often insufficiently paid and do not provide enough for their cost of living expense. Furthermore, adults with autism tend to have poorer outcomes than others with disabilities. However, higher functioning individuals are able to live independently, work in competitive jobs, and may have a network of social relationships.
Clinical research on improvements in autistic symptoms emphasize the importance of the family and formal service supports for adults with autism. There is a growing research suggesting that casual support from family and friends is associated to better outcomes for adults with psychiatric disabilities. It is quite possible that adequate functioning in adulthood for individuals with autism may depend as much on the amount of support offered by families, friends, and service providers as on basic intelligence and language skills. More research on the contributions of familial, formal supports and other methods used for individuals with autism are important to develop new and effective interventions and services created for their unique needs in adolescence and adulthood.
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