Adaptive trajectories and early risk factors in the autism spectrum: A 15‐year prospective study

Abstract

Little is known about long‐term outcomes. We investigate the adaptive trajectories and their risk factors in ASD. Data were obtained from 281 children prospectively followed untill adulthood. The final sample consisted of 106 individuals. Vineland scores were collected at baseline (T1), 3 (T2), 10 (T3), and 15 (T4) years later. A group‐based method was used to identify homogeneous patterns of adaptive skills trajectories. Results show that among the children initially categorized as autistic, 82.6% remained over the ADOS diagnostic threshold, 11.9% converted to atypical autism, and 5.4% fell under the ADOS threshold. Most atypical autism diagnoses were unstable. Most (81.7%) autistic participants had an ID at inclusion. At T1, 59.3% were nonverbal, but only 39% at T4. Most changes occurred between 4 and 8 years of age. Approximately 25% of participants exhibited a “high” growth trajectory, in which progress continues throughout adolescence, and 75% a “low” growth trajectory, characterized by greater autistic symptoms, intellectual disability, and lower language abilities reflected by high CARS scores, low apparent DQ, and speech difficulties, which mostly, but not always, predicted low trajectories. Our findings suggest that the adaptive prognosis of autism is mostly poor in this cohort, biased toward intellectual disability. However, changes in diagnostic, speech, and adaptive status are not uncommon, even for indivduals with low measured intelligence or apparent intellectual disability, and are sometimes difficult to predict. Autism Research 2018, 11: 1455–1467. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Most autism diagnoses given before 5 years of age are stable to adulthood, but one‐fifth of individuals are no longer considered to be autistic, even in a cohort biased toward apparent intellectual disability. Conversely, atypical autism diagnoses are mostly unstable. One‐third of children who are nonverbal at 5 years are verbal within 15 years, mostly before 8 years of age. Concerning adaptive behavior outcomes, only one‐fourth of children exhibit a high‐growth trajectory through at least 15 years.

ECHO Autism Transition: Enhancing healthcare for adolescents and young adults with autism spectrum disorder

“…Content was based on the current available evidence and best-practice approaches for healthcare for youth and adults with ASD (e.g. Azad, Singh, Kalb, Pinkett-Davis, & Landa, 2019; Baghdadli et al, 2018; Holmes, Strassberg, & Himle, 2019; Lee, Heerwagen, & Loftin, 2019; Nicolaidis, Kripke, & Raymaker, 2014; Roux et al, 2015; Sala, Hooley, Attwood, Mesibov, & Stokes, 2019; Saqr et al, 2018; Seltzer et al, 2004; Walter, Johnson, & Schomberg, 2009). Didactic topics included the following: What is Autism?, Psychiatric Co-occurring Conditions, Medical Co-occurring Conditions, Behavior Management in Primary Care, Supporting Families through Transition to Adulthood, Healthcare Transition Planning (Role of the PCP), Life Skills Development, Supporting the Self-Advocate, Guardianship, Special Education Transition to ADA, Housing and Community Supports for Adults with Autism, and Relationships and Sexuality in Autism.…”

Fifteen-Year Prospective Follow-Up Study of Adult Outcomes of Autism Spectrum Disorders Among Children Attending Centers in Five Regional Departments in France: The EpiTED Cohort

“…showed that a high proportion of the children with ID did not change over time but that the intellectual, linguistic, and adaptive functioning at preschool-age was incompletely predictive of their outcome. When examining the adaptive trajectories built on the basis of VABS from preschool age (T1) to young adulthood (T4), we found that about 80% of the subjects had a very slow growth between T1 to T4, and that 20% had a faster growth rate (Baghdadli et al 2018). Participants belonging to the slow growth group, who represented the majority of the cohort, had a relatively flat and linear slope, with a low adaptive functioning at adulthood in the domains of communication, daily living skills, and socialisation.…”

“…The variables collected at T1 that predicted the developmental trajectories in the domains of communication, daily living skills, and socialisation, were the degree of autism and the intellectual level (Baghdadli et al 2012(Baghdadli et al , 2018.…”

Research, Clinical, and Sociological Aspects of Autism

“…The finding that some children experience a period of typical development and then regress into autism ( 62 ) is becoming more readily discussed in research and clinical circles, albeit not universally so. Similarly, the belief that autism is a lifelong condition for all is also not borne out by the peer-reviewed literature ( 63 ). Terms such as optimal outcome ( 64 ) might not be wholly appropriate, but do nonetheless, shed light on an important phenomenon noted in at least some cases of autism where diagnostic cut-off points are reached at one point but not another.…”