Father holds daughter's hand while walking outside.Share on Pinterest
Early intervention following an autism diagnosis at 12 to 26 months could mitigate symptoms of autism in young children. Westend61/Getty Images
  • A new study finds a significant number of young children with autism may no longer meet the criteria of the condition by age 7.
  • This is likely due to early interventions that can help mitigate symptoms.
  • Autism, or autism spectrum disorder, covers a broad range of conditions that revolve around challenges with social skills, repetitive behavior, speech, and nonverbal communication.
  • Autism affects 1 in 36 children in the U.S.

New research suggests that some toddlers diagnosed with autism may not meet the condition’s diagnostic criteria by age 7. The study, published in JAMA Pediatrics, looked at 213 children diagnosed with autism at 12 to 36 months of age and reevaluated them at 5 to 7 years old after some form of treatment.

Nearly 40% of children studied were no longer considered autistic by age 7. In the study, they are referred to as having non-persistent autism spectrum disorder.

Autism, or autism spectrum disorder (ASD), covers a broad range of conditions that revolve around challenges with social skills, repetitive behavior, speech, and nonverbal communication.

Autism affects 1 in 36 children in the United States, according to the Centers for Disease Control and Prevention.

To meet the criteria for an ASD diagnosis, a child must have persistent challenges in each of three areas of social communication and interaction, plus at least two of four types of restricted, repetitive behaviors, according to the CDC.

The study found that children who received therapy and treatment for their ASD dropped some of these required areas, which means they could no longer be categorized as having ASD.

Persistent deficits in social communication could mean failure of typical back-and-forth conversation, poorly integrated verbal communication, abnormalities in eye contact and body language, difficulty in understanding relationships or difficulty making friends.

Restricted patterns of behavior, interests, or activities could mean repetitive motor movements or use of objects, insistence on sameness and inflexible adherence to routines, highly restricted and fixated interests that are abnormally intense, and hyper- or hyperactivity to sensory input.

The objective of the study was to determine the frequency with which children who are diagnosed with ASD at 12 to 36 months of age continue to meet the criteria at 5 to 7 years of age, and whether interventions can help with ASD persistence.

“While prior research has shown that there can be changes in whether or not children meet diagnostic criteria for ASD over time, this study included young children diagnosed with a DSM-5 clinical ASD diagnosis and followed until age 5-7 years old, which is older than some of the other studies,” said Dr. Elizabeth Harstad, study author and assistant professor of pediatrics at Harvard Medical School.

The team looked at 213 children that had been diagnosed with ASD between the ages of 12 to 36 months.

“In contrast to previous studies, this study found that 37.1% of children initially diagnosed with autism between 12-36 months did not meet the criteria between the age of 5 to 7 years,” said Dr. Dyan Hes, a pediatrician at Northwell Lenox Hill Hospital.

“The results demonstrated that two factors were associated with the group that had non-persistent ASD. Both higher baseline adaptive skills between the ages of 12 to 36 months and female sex were associated with non-persistent ASD.”

Hes was not involved in the study.

This means that the kids who no longer met the diagnostic criteria for ASD were more likely to be girls or at baseline to have better communication and decision-making skills.

“As is recommended for young children with an ASD diagnosis, all children in this study received some type of intervention after ASD diagnosis, and 94% received ASD-specific interventions, such as Applied Behavioral Analysis,” said Harstad.

“For young children with a clinical diagnosis of ASD, behavioral interventions such as this are recommended to help children with their social communication skills and other areas of development. Children may also benefit from speech and occupational therapies and interventions to find their optimal ways to communicate, whether through speech, gestures, signs, augmentative communication, and/or other strategies,” Harstad added.

Applied behavioral analysis (ABA) is a therapy based on the science of learning and behavior. It includes behavior training like positive reinforcement and Antecedent-Behavior-Consequence (ABCs).

An antecedent (A) is something, such as a request or command, that occurs before a behavior or may trigger a behavior.

Behavior (B) is the response to the antecedent.

The consequence (C) is what happens immediately after the behavior.

ABC analysis aims to understand how certain behaviors serve an individual with ASD and how certain consequences could affect a change in behavior.

“Of note, there was no correlation with the intensity of behavioral interventions in the 18 months after ASD diagnosis and non-persistent ASD,” said Hes. “Children in the study with higher adaptive skills under 36 months of age also required fewer hours of behavior intervention as they got older.”

This does not mean that ABA therapy for ASD does not help, but it suggests there are other factors that may predict non-persistent ASD.

“This study reinforces the idea that a diagnosis of ASD early on needs to be reevaluated as the child ages,” Hes said. “It is more fluid for some children, and they may not meet the ASD criteria as they become school age.”

One point the researchers make is it is important for children with autism to have continued assessments throughout their development. The diagnosis may evolve over time and the treatment must evolve with them.

Doctors are still trying to understand why some children develop autism. However, according to the National Institute of Environmental Health Sciences, risk factors for autism may include:

There is no medical test to diagnose ASD. Doctors have to study a child’s developmental history and behavior. Autism can be diagnosed at 18 months or earlier.

Developmental screening is one of the key ways to diagnose autism.

The American Academy of Pediatrics (AAP) recommends developmental and behavioral screening at 9 months, 18 months, and 30 months. The AAP also recommends screening all children for ASD at 18 and 24 months.

A new study published in JAMA Pediatrics found that 37% of children diagnosed with autism at 12 to 36 months no longer met the criteria of the condition by age 7.

Experts say early intervention following an autism diagnosis is key for managing symptoms.