Linking risk factors and outcomes in autism spectrum disorder: is there evidence for resilience?

Abstract

Autism spectrum disorder (referred to here as autism) is one of several overlapping neurodevelopmental conditions that have variable impacts on different individuals. This variability results from dynamic interactions between biological and non-biological risk factors, which result in increasing differentiation between individuals over time. Although this differentiation continues well into adulthood, the infancy period is when the brain and behavior develop rapidly, and when the first signs and symptoms of autism emerge. This review discusses advances in our understanding of the causal pathways leading to autism and overlapping neurodevelopmental conditions. Research is also mapping trajectories of brain and behavioral development for some risk groups, namely later born siblings of children with autism and/or infants referred because of developmental concerns. This knowledge has been useful in improving early identification and establishing the feasibility of targeted interventions for infant risk groups before symptoms arise. However, key knowledge gaps remain, such as the discovery of protective factors (biological or environmental) that may mitigate the impact of risk. Also, the dynamic mechanisms that underlie the associations between risk factors and outcomes need further research. These include the processes of resilience, which may explain why some individuals at risk for autism achieve better than expected outcomes. Bridging these knowledge gaps would help to provide tools for early identification and intervention that reflect dynamic developmental pathways from risk to outcomes.

Autism spectrum heterogeneity: fact or artifact?

“…However, the two positions should still compete for the truth. The absence of a categorical limit and the multiplicity of aetiologies and risk factors reported previously [21][22][23] anticipate the current state of knowledge. To be able to determine whether autism has a natural basis or not, the two positions should be given equal weight, as the validity of either is still undecidable in the current state of autism diagnosis.…”

Epidemiology of Autism Spectrum Disorders: A Review of Worldwide Prevalence Estimates Since 2014

“…Current literature suggests that several environmental factors could affect brain development and differentiation over perinatal period resulting in neurodevelopmental disorders emerging at different time life. These studies overall focus on dynamic interactions between biological and non-biological risk factors [68]. As for ASD, CHARGE (Childhood Autism Risks from Genetics and the Environment) study is an excellent example of epidemiological study contributing to the understanding of which factors can increase the risk of ASD.…”

Adaptation and validation of the Genetic Counseling Outcome Scale for autism spectrum disorders and related conditions

“…This time‐intensive care pathway is experienced as a ‘diagnostic odyssey’ to individuals with ASD and their families due to uncoordinated and delayed access to the needed multiple specialties and settings (Lappé et al, 2018). This not only leaves individuals and families distressed, confused, and frustrated, but hinders immediate access to further care (Lappé et al, 2018) potentially exacerbating the autistic person’s developmental trajectory (Elsabbagh, 2020).…”