Trajectories of Symptom Severity in Children with Autism: Variability and Turning Points through the Transition to School.

Only children with complete data at all four visits were analyzed, and 43% of ADOS severity scores at the age 10 visit were missing among children with at least three scores, so the groups may not represent all children with autism. The clustering did not account for the services children received, and the paper notes that almost all children in the sample could access specialized services such as speech and language or applied behavioral therapy during preschool, so service effects cannot be separated from trajectory. The trajectory groups were derived from autism severity measures and age at assessment, so they may not capture change in other developmental domains. Turning points were identified from assessments at mean ages of 41, 56, 80, and 129 months, so additional turning points between visits could have been missed. Information about school settings was collected from caregivers in a non-standardized open-ended questionnaire, so the study cannot systematically compare the timing or nature of transition into school.

The supplied text lists funding from Canadian Institutes of Health Research, Autism Speaks, Government of British Columbia, Kids Brain Health Network, Sinneave Family Foundation, and Alberta Innovates Health Solutions. It does not provide author conflict of interest declarations.

Do not conclude that the transition to school causes improvement to plateau. The study is observational, did not account for services, and used only children with complete data, so it cannot show cause. Do not use the groups to predict an individual child's outcome, because individual children varied substantially within each group.