About one in 14 toddlers diagnosed with autism spectrum disorder (ASD) no longer met the diagnostic criteria in elementary school, but most continued to have emotional/behavior symptoms and required special education supports, according to a study to be presented Sunday, April 26 at the Pediatric Academic Societies (PAS) annual meeting in San Diego.

Previous studies have shown that ASD symptoms resolve in some children over time. It is not clear, however, if these children continue to have cognitive, behavioral or learning deficits.

Researchers, led by developmental pediatrician Lisa Shulman, M.D., reviewed data on 38 children diagnosed with ASD in 2003-’13 whose symptoms had resolved when they were re-evaluated about four years later. The children were among 569 children living in the Bronx who had been diagnosed with ASD by a multidisciplinary team at a university-affiliated early intervention program.

The children came from racially, ethnically and socioeconomically diverse backgrounds, a population generally underrepresented in autism studies. Forty-four percent were Hispanic, 36% were Caucasian, 10% were African-American and 46% were on Medicaid.

Clinicians who made the original diagnosis also provided interventions and monitored response to treatment. Over time, they noted that ASD symptoms in some children resolved, but most continued to have other learning and emotional/behavioral symptoms needing attention.

“Autism generally has been considered a lifelong condition, but 7% of children in this study who received an early diagnosis experienced a resolution of autistic symptoms over time,” said Dr. Shulman, director of Infant and Toddler Services and the Rehabilitation, Evaluation and Learning for Autistic Infants and Toddlers program at the Children’s Evaluation and Rehabilitation Center/Rose F. Kennedy Center at Albert Einstein College of Medicine/Children’s Hospital at Montefiore.

“The majority of the children at original diagnosis displayed intellectual disability but at the point of resolution of autistic symptomatology displayed normal cognition,” Dr. Shulman added.

Although the social impairment of autism resolved and cognitive functioning (IQ) improved, researchers found that 92% of the children had residual learning and/or emotional/behavioral impairment. Only three of the 38 children had no diagnosis.

Language/learning disability was found in 68%, and nearly half had externalizing problems such as attention-deficit/hyperactivity disorder or disruptive behaviors. In addition, 24% had internalizing problems such anxiety, obsessive-compulsive disorder or selective mutism. Finally, nearly three-quarters of the children continued to require academic supports, such as a small class setting or resource room.

“When an early ASD diagnosis resolves, there are often other learning and emotional/behavioral diagnoses that remain,” said Dr. Shulman, associate professor of clinical pediatrics at Albert Einstein College of Medicine and attending physician, Children’s Hospital at Montefiore. “Understanding the full range of possible positive outcomes in this scenario is important information for parents, clinicians and the educational system.”

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