Brief Report: Symptom Onset Patterns and Functional Outcomes in Young Children with Autism Spectrum Disorders

Abstract

This study examined the relationship between onset status and current functioning using a recently proposed onset classification system in 272 young children with autism spectrum disorder (ASD). Participants were classified into one of the following groups, based on parent report using the Autism Diagnostic Interview – Revised: Early Onset (symptoms by 12 months, no loss), Delay+Regression (symptoms by 12 months plus loss), Plateau (no early symptoms or loss), and Regression (no early symptoms, followed by loss). Findings indicate that current functioning does not differ according to onset pattern, calling into question the use of onset categorizations for prognostic purposes in children with ASD.

Brain enlargement is associated with regression in preschool-age boys with autism spectrum disorders

“…The rate of regression in our sample of children with autism was 54%, which is similar to that of recent large-scale population-based studies (21,22). Our head circumference findings are consistent with the notion that acceleration of head growth precedes onset of behavioral symptoms (10).…”

Emergence of Autism Spectrum Disorder in Children from Simplex Families: Relations to Parental Perceptions of Etiology

“…Most studies have focused on regression in either language and/or social skills; however, losses may be captured in other skill areas, as well (e.g., motor skills, self-help skills, play). Research on regression has typically adopted the Autism Diagnostic Interview-Revised (ADI-R; Le Couteur et al 2003) definition (Lord et al 2004;Parr et al 2011;Shumway et al 2011), which indicates that loss of skills may only be considered a regression if (a) the developmental skill was consistently demonstrated for at least 3 months, and (b) the loss lasted at least 3 months. The ADI-R was designed to capture regressions in one or more of the following skill areas: language (defined by loss of five or more words), fine motor, gross motor, self-help, constructive or imaginative play, or social interest and responsiveness.…”

“…A second issue with categorization of onset types concerns the distinction between regression (i.e., loss of skills) and plateau (Shumway et al 2011;Siperstein and Volkmar 2004). For children in this latter group, early development is reportedly typical but plateaus within the first few years, such that they do not continue to develop new skills or do not develop them at their former pace; however, previously achieved skills remain intact.…”

“…For children in this latter group, early development is reportedly typical but plateaus within the first few years, such that they do not continue to develop new skills or do not develop them at their former pace; however, previously achieved skills remain intact. Children who demonstrate a plateau pattern of ASD onset are not easily categorized into either the early-or regressive-onset groups, though they represent approximately 15 % of children with ASD (Shumway et al 2011). Historically, these children should have been categorized in the early-onset group because they technically did not show a loss of skills.…”

“…Rates of regressive onset versus early onset do not differ among children with DSM-IV-TR (American Psychiatric Association 2000) diagnoses of Autistic Disorder (AD) versus Pervasive Developmental Disorder-Not Otherwise Specified (PDD NOS; Lord et al 2004;Shumway et al 2011); however, the regressive onset is less frequently reported among those with Asperger's Syndrome (AS; Goin-Kochel and Myers 2005). Though much research related to regression in ASD adopts this dichotomous categorization of onset, emerging reports indicate that this classification system oversimplifies symptom onset, as a wider array of patterns may exist (Shumway et al 2011;Siperstein and Volkmar 2004). That is, rather than simply considering regression in terms of onset, the conceptualization of regression in ASD needs to be broader in scope to include children who display symptoms in the first year of life but who later lose skills.…”