Autism spectrum disorder symptoms from ages 2 to 19 years: Implications for diagnosing adolescents and young adults.
Vanessa H Bal, So-Hyun Kim, Megan Fok and 1 others
PMID 30101492WHAT IT FOUND
Caregiver-reported social-communication symptoms often decreased from age 2 to 19, especially when phrase speech emerged.
Minimally verbal participants improved less, and facial expression problems persisted. Caregiver interview scores may miss adult ASD symptoms.
Key findings
01Caregiver-reported social-communication symptoms declined over the study period in all language groups, with a more modest decline in the minimally verbal group.
02The timing of symptom improvement often matched the timing of phrase speech onset.
03Among young adults with ASD diagnoses at age 19, 11 of 80 had no caregiver-reported current symptoms in at least one social-communication subdomain.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This was a single cohort of children referred for possible ASD before 37 months in the early 1990s, so it may not represent children referred today. Symptom change was based on caregiver report, which can be shaped by caregiver expectations and observation rather than only the child's actual abilities. Many analyses used imputed item-level data, and children with imputed data at age 19 were more likely to be non-white and have lower maternal education. Very few participants acquired phrase speech early, so the study could not examine changes in verbal communication items such as conversation or social chat. Treatment comparisons were post hoc, few participants received ABA or mentored parent-implemented structured teaching, and intervention targets were not known. Assessments were not evenly spaced in adolescence, so the exact age of symptom changes is uncertain.
Declared interests
The supplied metadata lists NIH extramural research support. The article text provided does not include a separate conflict-of-interest declaration.
The easy way to misread this
Do not read decreasing caregiver-reported symptom scores as evidence that autism severity has lessened or that treatment caused improvement. The study did not test treatment effects, treatment comparisons showed no differences, and most participants continued to meet ASD criteria at age 19.