Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition that manifests uniquely in each individual. Given the growing prevalence of ASD and the increasing focus on early diagnosis, it becomes imperative to gain insight into the long-term trajectories for children diagnosed with ASD at a young age.
Recent research has shed light on the persistence of ASD and the factors associated with changes in diagnosis over time. Intriguingly, this diminished persistence appears to correlate with factors such as intelligence, adaptive behaviour, and gender, particularly among females.
It's not surprising that girls on the autism spectrum quickly learn to mask their autistic traits. However, the question arises: is this masking a positive development?
The concern lies in the potential repercussions of pressuring young girls to conform to neurotypical behaviours and potentially losing their autism diagnosis later in life due to their adeptness at mimicking social norms. Does this represent a healthy approach, or does it result in a loss of essential support systems and advocacy?
This trend may inadvertently render women and girls on the autism spectrum less visible and less likely to receive the support they genuinely require simply because their expression of autism differs from that of other genders. Below, you'll find a concise summary of the new study from JAMA for your reference:
The Study
A cohort study conducted by researchers aimed to determine the frequency with which children diagnosed with ASD between the ages of 12 and 36 months continued to meet diagnostic criteria for ASD at 5 to 7 years of age. They also investigated whether baseline child-specific and demographic characteristics and interventions received were associated with ASD persistence.
Methodology
The study involved a natural history cohort of children who had received a clinical ASD diagnosis between the ages of 12 and 36 months. At 5 to 7 years of age, these children underwent a research diagnostic assessment. The research assessment included the administration of the Autism Diagnostic Observation Schedule–2, Autism Diagnostic Interview–Research, and a cognitive measure. The main outcome measure was the persistence of ASD diagnosis based on current functioning.
Findings
Out of the 213 participants diagnosed with ASD at the initial clinical assessment, 79 (37.1%) did not continue to meet diagnostic criteria for ASD at the research assessment. This group was classified as having nonpersistent ASD. Notably, all children with nonpersistent ASD had an IQ of at least 70, while there was a bimodal distribution of IQ for those with persistent ASD.
Factors Associated with Nonpersistent ASD
The study identified two factors that were associated with nonpersistent ASD. Higher baseline adaptive skills and female sex were found to be associated with a decreased likelihood of ASD persistence. Children with higher baseline adaptive skills had increased odds of being in the nonpersistent ASD group, while female children were also more likely to have nonpersistent ASD.
Interventions Received
All children in the study received some form of intervention, with the majority receiving ASD-specific intervention, particularly applied behavioural analysis. However, the study did not find a significant association between the type or intensity of interventions received and the persistence of ASD.
Implications and Conclusion
The findings of this cohort study suggest that an ASD diagnosis in a child younger than 3 years may not always persist. Child-specific factors, such as baseline adaptive skills and sex, were found to be associated with the persistence of ASD. These findings highlight the importance of considering individual characteristics when predicting long-term outcomes for children with ASD. It is important to note that this study provides valuable insights into the persistence of ASD, but further research is needed to fully understand the underlying mechanisms and identify additional factors that may contribute to changes in diagnosis over time. Early intervention and ongoing support remain crucial for all children diagnosed with ASD, regardless of the potential for changes in diagnosis.
Additional Research and Future Directions
While this study focused on the persistence of ASD in children diagnosed at a young age, future research could explore the long-term outcomes of individuals diagnosed later in life or during adolescence. Understanding the trajectory of ASD across different age groups can provide valuable insights into the potential for changes in diagnosis and inform intervention strategies. Further investigations could also explore the role of genetic factors, environmental influences, and the interplay between genetic and environmental factors in the persistence or remission of ASD. Additionally, longitudinal studies tracking individuals with ASD from early childhood to adulthood can provide a comprehensive understanding of the developmental course of the condition and its impact on various aspects of life.
In conclusion, while autism spectrum disorder is often considered a lifelong condition, this cohort study suggests that an ASD diagnosis in a child younger than 3 years may not always persist. Child-specific factors, such as baseline adaptive skills and sex, appear to be associated with the persistence of ASD. However, more research is needed to understand the factors influencing changes in diagnosis over time fully. Early intervention and ongoing support remain crucial for all individuals diagnosed with ASD, regardless of the potential for changes in diagnosis.
I think that if female autism is determined not to persist because we train ourselves like laboratory animals to adapt to the status quo, we will disappear even further from the true all-encompassing spectrum of autism. We become even more invalidated and hushed from our lived experience. Girls on the spectrum exist; stop trying to mould us into the conventional diagnostic criteria and listen and observe who we are so we can be who we really are, not what you expect us to be.
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