Wikipedia

Prognosis of autism

Main article: Autism spectrum

There is currently no evidence of a cure for autism.[1][2] The degree of symptoms can decrease, occasionally to the extent that people lose their diagnosis of autism;[3][4] this occurs sometimes after intensive treatment[5] and sometimes not. It is not known how often this outcome happens,[6] with reported rates in unselected samples ranging from 3% to 25%.[3][4] Although core difficulties tend to persist, symptoms often become less severe with age.[7] Acquiring language before age six, having an IQ above 50, and having a marketable skill all predict better outcomes; independent living is unlikely in autistic people with higher support needs.[8]

Developmental course

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There are two possible developmental courses of autism. One course of development is more gradual in nature, with symptoms appearing fairly early in life and persisting.[9] A second course of development is characterized by normal or near-normal development before onset of regression or loss of skills, which is known as regressive autism.[10]

Gradual autism development

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Most parents report that the onset of autism features appear within the first or second year of life.[11][12] This course of development is fairly gradual, in that parents typically report concerns in development over the first two years of life and diagnosis can be made around 3–4 years of age.[9] Overt features gradually begin after the age of six months, become established by age two or three years,[13] and tend to continue through adulthood, although often in more muted form.[7] Some of the early signs of autism in this course include decreased attention at faces, failure to obviously respond when name is called, failure to show interests by showing or pointing, and delayed imaginative play.[14]

Regressive autism development

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Regressive autism occurs when a child appears to develop typically but then starts to lose speech and social skills and is subsequently diagnosed with ASD.[15] Other terms used to describe regression in children with autism are autism with regression, autistic regression, setback-type autism, and acquired autistic syndrome.[16]

Within the regressive autism developmental course, there are two patterns. The first pattern is when developmental losses occur in the first 15 months to 3 years.[17][18] The second pattern, childhood disintegrative disorder (a diagnosis now included under ASD in the DSM, but not the ICD), is characterized by regression after normal development in the first 3 to 4, or even up to 9 years of life.[19]

After the regression, the child follows the standard pattern of autistic neurological development. The term regressive autism refers to the appearance that neurological development has reversed; it is actually only the affected developmental skills, rather than the neurology as a whole, that regresses.

Usually, the apparent onset of regressive autism can be surprising and distressing to parents, who often initially suspect severe hearing loss.[20] Attribution of regression to environmental stress factors may result in a delay in diagnosis.[21]

There is no standard definition for regression.[16] Some children show a mixture of features, with some early delays and some later losses; and there is evidence of a continuous spectrum of behaviors, rather than, or in addition to, a black-and-white distinction, between autism with and without regression.[22] There are several intermediate types of development, which do not neatly fit into either the traditional early onset or the regressive categories, including mixtures of early deficits, failures to progress, subtle diminishment, and obvious losses.

Regression may occur in a variety of domains, including communication, social, cognitive, and self-help skills; however, the most common regression is loss of language.[23][17][18] Some children lose social development instead of language; some lose both.[22] Skill loss may be quite rapid, or may be slow and preceded by a lengthy period of no skill progression; the loss may be accompanied by reduced social play or increased irritability.[16] The temporarily acquired skills typically amount to a few words of spoken language, and may include some rudimentary social perception.[22]

The prevalence of regression varies depending on the definition used.[22] If regression is defined strictly to require loss of language, it is less common; if defined more broadly, to include cases where language is preserved but social interaction is diminished, it is more common.[22] Although regressive autism is often thought to be a less common (compared with gradual course of autism onset described above), this remains an area of ongoing debate;[23] some evidence suggests that a pattern of regressive autism may be more common than previously thought.[24] There are some who believe that regressive autism is simply early-onset autism which was recognized at a later date. Researchers have conducted studies to determine whether regressive autism is a distinct subset of ASD, but the results of these studies have contradicted one another.[15]

Differential outcomes

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There continues to be a debate over the differential outcomes based on these two developmental courses. Some studies suggest that regression is associated with poorer outcomes and others report no differences between those with early gradual onset and those who experience a regression period.[25] While there is conflicting evidence surrounding language outcomes in autism, some studies have shown that cognitive and language abilities at age 2+1⁄2 may help predict language proficiency and production after age 5.[26] Overall, the literature stresses the importance of early intervention in achieving positive longitudinal outcomes.[27]

Academic performance

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The number of students identified and served as eligible for autism services in the United States has increased from 5,413 children in 1991–1992 to 370,011 children in the 2010–2011 academic school year.[28] The United States Department of Health and Human Services reported approximately 1 in 68 children are diagnosed with autism at age 8, and onset is typically between ages 2 and 4.[28]

The increasing number of students diagnosed with autism in the schools presents significant challenges to teachers, school psychologists, and other school professionals.[28] These challenges include developing a consistent practice that best support the social and cognitive development of the increasing number of autistic students.[28] Although there is considerable research addressing assessment, identification, and support services for autistic children, there is a need for further research focused on these topics within the school context.[28] Further research on appropriate support services for students with ASD will provide school psychologists and other education professionals with specific directions for advocacy and service delivery that aim to enhance school outcomes for students with ASD.[28]

Attempts to identify and use best intervention practices for students with autism also pose a challenge due to over dependence on popular or well-known interventions and curricula.[28] Some evidence suggests that although these interventions work for some students, there remains a lack of specificity for which type of student, under what environmental conditions (one-on-one, specialized instruction or general education) and for which targeted deficits they work best.[28] More research is needed to identify what assessment methods are most effective for identifying the level of educational needs for students with ASD. Additionally, children living in higher resources settings in the United States tend to experience earlier ASD interventions than children in lower resource settings (e.g. rural areas).[29]

A difficulty for academic performance in students with autism is the tendency to generalize learning.[30] Learning is different for each student, which is the same for students with autism. To assist in learning, accommodations are commonly put into place for students with differing abilities. The existing schema of these students works in different ways and can be adjusted to best support the educational development for each student.[31]

The cost of educating a student with autism in the US would be about $20,600 while educating an average student would be about $12,000.[32]

Though much of the focus on early childhood intervention for autism has centered on high-income countries like the United States, some of the most significant unmet needs for autistic individuals are in low- and middle-income countries.[29] In these contexts, research has been more limited but there is evidence to suggest that some comprehensive care plans can be successfully delivered by non-specialists in schools and in the community.[29]

Adulthood

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Many autistic people face significant obstacles in transitioning to adulthood.[33] Autistic people may face socialization issues, which may impact relationships such as community participation, employment, independent living, friendships, dating and marriage, and having children. Some autistic adults are unable to live independently.[34]

Employment

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The majority of the economic burden of autism is caused by lost productivity in the job market.[35] Compared to the general population, autistic people are more likely to be unemployed and to have never had a job. About half of people in their 20s with autism are not employed.[36]

In various developed countries, the autism unemployment rate can range from 62% to as high as 85%.,[37][38][39][40] although in some it can be as low as 25%.[41] While employers state hiring concerns about productivity and supervision, experienced employers of autistics give positive reports of above average memory and detail orientation as well as a high regard for rules and procedure in autistic employees.[42]

From the perspective of the social model of disability, much of this unemployment is caused by the lack of understanding from employers and coworkers.[43][44] Adding content related to autism in existing diversity training can clarify misconceptions, support employees, and help provide new opportunities for autistic people.[45] As of 2021, new autism employment initiatives by major employers in the United States continue to grow, as the initiative "Autism at Work" grew to 20 of the largest companies in the United States.[46] However, special hiring programs remain largely limited to entry-level technology positions, such as software testing, and exclude those who have talents outside of technology. An alternative approach is systemic neurodiversity inclusion. Developing organizational systems with enough flexibility and fairness to include autistic employees improves the work experience of all employees.[47][48]

References

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  1. ^ Myers SM, Johnson CP (November 2007). "Management of children with autism spectrum disorders". Pediatrics. 120 (5): 1162–1182. doi:10.1542/peds.2007-2362. PMID 17967921.
  2. ^ Levy SE, Mandell DS, Schultz RT (November 2009). "Autism". Lancet. 374 (9701): 1627–1638. doi:10.1016/S0140-6736(09)61376-3. PMC 2863325. PMID 19819542. (Erratum: doi:10.1016/S0140-6736(11)61666-8,  [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61666-8/fulltext ])
  3. ^ a b Helt M, Kelley E, Kinsbourne M, Pandey J, Boorstein H, Herbert M, Fein D (December 2008). "Can children with autism recover? If so, how?". Neuropsychology Review. 18 (4): 339–366. CiteSeerX 10.1.1.695.2995. doi:10.1007/s11065-008-9075-9. PMID 19009353. S2CID 4317267.
  4. ^ a b Fein D, Barton M, Eigsti IM, Kelley E, Naigles L, Schultz RT, et al. (February 2013). "Optimal outcome in individuals with a history of autism". Journal of Child Psychology and Psychiatry, and Allied Disciplines. 54 (2): 195–205. doi:10.1111/jcpp.12037. PMC 3547539. PMID 23320807.
  5. ^ Orinstein AJ, Helt M, Troyb E, Tyson KE, Barton ML, Eigsti IM, et al. (May 2014). "Intervention for optimal outcome in children and adolescents with a history of autism". Journal of Developmental and Behavioral Pediatrics. 35 (4): 247–256. doi:10.1097/DBP.0000000000000037. PMC 4487510. PMID 24799263.
  6. ^ Rogers SJ, Vismara LA (January 2008). "Evidence-based comprehensive treatments for early autism". Journal of Clinical Child and Adolescent Psychology. 37 (1). Taylor & Francis: 8–38. doi:10.1080/15374410701817808. PMC 2943764. PMID 18444052.
  7. ^ a b Rapin I., and D. Allen (1983). "Developmental language disorders: Nosologic considerations", in U. Kirk (ed.), Neuropsychology of language, reading, and, spelling (pp. 155–184). Academic Press.
  8. ^ Tidmarsh L, Volkmar FR (September 2003). "Diagnosis and epidemiology of autism spectrum disorders". Canadian Journal of Psychiatry. 48 (8): 517–525. doi:10.1177/070674370304800803. PMID 14574827. S2CID 38070709.
  9. ^ a b Tracy A Becerra-Culqui; Frances L Lynch; Ashli A Owen-Smith; Joseph Spitzer; Lisa A Croen (1 October 2018). "Parental First Concerns and Timing of Autism Spectrum Disorder Diagnosis". Journal of Autism and Developmental Disorders. 48 (10): 3367–3376. doi:10.1007/S10803-018-3598-6. ISSN 0162-3257. PMID 29754290. Wikidata Q88651632.
  10. ^ Dwyer P, Ryan JG, Williams ZJ, Gassner DL (April 2022). "First Do No Harm: Suggestions Regarding Respectful Autism Language". Pediatrics. 149 (Suppl 4). American Academy of Pediatrics (AAP). doi:10.1542/peds.2020-049437n. PMC 9066426. PMID 35363298.
  11. ^ Zwaigenbaum L, Bryson S, Lord C, Rogers S, Carter A, Carver L, et al. (May 2009). "Clinical assessment and management of toddlers with suspected autism spectrum disorder: insights from studies of high-risk infants". Pediatrics. 123 (5): 1383–91. doi:10.1542/peds.2008-1606. PMC 2833286. PMID 19403506.
  12. ^ Lord C (November 1995). "Follow-up of two-year-olds referred for possible autism". Journal of Child Psychology and Psychiatry, and Allied Disciplines. 36 (8): 1365–82. doi:10.1111/j.1469-7610.1995.tb01669.x. eISSN 1469-7610. ISSN 0021-9630. OCLC 01307942. PMID 8988272.
  13. ^ Rogers SJ (June 2009). "What are infant siblings teaching us about autism in infancy?". Autism Research. 2 (3): 125–137. doi:10.1002/aur.81. PMC 2791538. PMID 19582867.
  14. ^ Zwaigenbaum L (October 2001). "Autistic spectrum disorders in preschool children". Canadian Family Physician. 47 (10): 2037–42. PMC 2018435. PMID 11723598.
  15. ^ a b Stefanatos GA (December 2008). "Regression in autistic spectrum disorders". Neuropsychology Review. 18 (4): 305–319. doi:10.1007/s11065-008-9073-y. PMID 18956241. S2CID 34658024.
  16. ^ a b c Halsey NA, Hyman SL (May 2001). "Measles-mumps-rubella vaccine and autistic spectrum disorder: report from the New Challenges in Childhood Immunizations Conference convened in Oak Brook, Illinois, June 12-13, 2000". Pediatrics. 107 (5): E84. doi:10.1542/peds.107.5.e84. PMID 11331734.
  17. ^ a b Martínez-Pedraza F, Carter AS (July 2009). "Autism spectrum disorders in young children". Child and Adolescent Psychiatric Clinics of North America. 18 (3): 645–63. doi:10.1016/j.chc.2009.02.002. PMC 3166636. PMID 19486843.
  18. ^ a b Werner E, Dawson G, Munson J, Osterling J (June 2005). "Variation in early developmental course in autism and its relation with behavioral outcome at 3-4 years of age". Journal of Autism and Developmental Disorders. 35 (3): 337–50. doi:10.1007/s10803-005-3301-6. PMID 16119475. S2CID 22485657.
  19. ^ "Autism spectrum disorder – childhood disintegrative disorder: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 8 May 2020.
  20. ^ Annio Posar; Paola Visconti (23 September 2020). "Is it autism? Some suggestions for pediatricians". Türk pediatri arsivi Turkish Pediatrics Archive. 55 (3): 229–235. doi:10.14744/TURKPEDIATRIARS.2020.59862. ISSN 1306-0015. PMC 7536466. PMID 33061749. Wikidata Q100648906.
  21. ^ Johnson CP, Myers SM (November 2007). "Identification and evaluation of children with autism spectrum disorders". Pediatrics. 120 (5): 1183–1215. doi:10.1542/peds.2007-2361. PMID 17967920. S2CID 218028. Archived from the original on 8 February 2009.
  22. ^ a b c d e Ozonoff S, Heung K, Byrd R, Hansen R, Hertz-Picciotto I (December 2008). "The onset of autism: patterns of symptom emergence in the first years of life". Autism Research. 1 (6): 320–328. doi:10.1002/aur.53. PMC 2857525. PMID 19360687.
  23. ^ a b CDC (18 August 2016). "Part II: A Closer Look". Centers for Disease Control and Prevention. Retrieved 15 September 2022.
  24. ^ Ozonoff S, Iosif AM (May 2019). "Changing conceptualizations of regression: What prospective studies reveal about the onset of autism spectrum disorder". Neuroscience and Biobehavioral Reviews. 100: 296–304. doi:10.1016/j.neubiorev.2019.03.012. PMC 6451681. PMID 30885812.
  25. ^ Mash EJ, Barkley RA (2003). Child Psychopathology. New York: The Guilford Press. pp. 409–454. ISBN 9781572306097.
  26. ^ Ellis Weismer S, Kover ST (December 2015). "Preschool language variation, growth, and predictors in children on the autism spectrum". Journal of Child Psychology and Psychiatry, and Allied Disciplines. 56 (12): 1327–37. doi:10.1111/jcpp.12406. eISSN 1469-7610. ISSN 0021-9630. OCLC 01307942. PMC 4565784. PMID 25753577.
  27. ^ Dawson G, Osterling J (1997). "Early Intervention in Autism". In Guralnick MJ (ed.). The effectiveness of early intervention. Baltimore: Brookes. pp. 307–326. ISBN 1-55766-255-X. OCLC 34411043. ERIC ED414694.
  28. ^ a b c d e f g h Stichter JP, Riley-Tillman TC, Jimerson SR (December 2016). "Assessing, understanding, and supporting students with autism at school: Contemporary science, practice, and policy". School Psychology Quarterly. 31 (4): 443–449. doi:10.1037/spq0000184. PMID 27929316.
  29. ^ a b c Hahler EM, Elsabbagh M (1 March 2015). "Autism: A Global Perspective". Current Developmental Disorders Reports. 2 (1): 58–64. doi:10.1007/s40474-014-0033-3. ISSN 2196-2987. S2CID 73214418.
  30. ^ Lawson W (2001). Understanding and Working With the Spectrum of Autism: An Insider's View. London UK, & Philadelphia PA: Jessica Kingsley Publishers. pp. 33. ISBN 978-1853029714.
  31. ^ McLeod S (6 April 2022). "Jean Piaget's Theory of Cognitive Development". Simply Psychology. Archived from the original on 1 June 2022. Retrieved 19 February 2019.
  32. ^ "Facts and Statistics". Autism Society. Archived from the original on 30 October 2019. Retrieved 6 November 2019.
  33. ^ Hendricks DR, Wehman P (24 March 2009). "Transition From School to Adulthood for Youth With Autism Spectrum Disorders: Review and Recommendations". Focus on Autism and Other Developmental Disabilities. 24 (2): 77–88. doi:10.1177/1088357608329827. S2CID 14636906.
  34. ^ Steinhausen HC, Mohr Jensen C, Lauritsen MB (June 2016). "A systematic review and meta-analysis of the long-term overall outcome of autism spectrum disorders in adolescence and adulthood". Acta Psychiatrica Scandinavica. 133 (6): 445–452. doi:10.1111/acps.12559. PMID 26763353. S2CID 12341774.
  35. ^ Ganz ML (April 2007). "The lifetime distribution of the incremental societal costs of autism". Archives of Pediatrics & Adolescent Medicine. 161 (4): 343–349. doi:10.1001/archpedi.161.4.343. PMID 17404130.
  36. ^ Roux AM, Rast JE, Rava JA, Anderson KA, Shattuck PT (31 August 2015). "Employment Outcomes of Young Adults on the Autism Spectrum". Life Course Outcomes Research Program, A.J. Drexel Autism Institute. Philadelphia, PA: Drexel University.
  37. ^ "Disability, Ageing and Carers, Australia: Summary of Findings, 2018 | Australian Bureau of Statistics". www.abs.gov.au. 2020-09-25. Retrieved 2024-04-11.
  38. ^ "Outcomes for disabled people in the UK - Office for National Statistics". www.ons.gov.uk. Retrieved 2024-04-11.
  39. ^ Lallukka, Tea; Mittendorfer-Rutz, Ellenor; Ervasti, Jenni; Alexanderson, Kristina; Virtanen, Marianna (January 2020). "Unemployment Trajectories and the Early Risk of Disability Pension among Young People with and without Autism Spectrum Disorder: A Nationwide Study in Sweden". International Journal of Environmental Research and Public Health. 17 (7): 2486. doi:10.3390/ijerph17072486. ISSN 1660-4601. PMC 7177271. PMID 32260520.
  40. ^ Zwicker, Jennifer; Zaresani, Arezou; Emery, J. C. Herb (2017-06-01). "Describing heterogeneity of unmet needs among adults with a developmental disability: An examination of the 2012 Canadian Survey on Disability". Research in Developmental Disabilities. 65: 1–11. doi:10.1016/j.ridd.2017.04.003. ISSN 0891-4222. PMID 28412577.
  41. ^ Espelöer, Julia; Proft, Julia; Falter-Wagner, Christine M.; Vogeley, Kai (2023-04-01). "Alarmingly large unemployment gap despite of above-average education in adults with ASD without intellectual disability in Germany: a cross-sectional study". European Archives of Psychiatry and Clinical Neuroscience. 273 (3): 731–738. doi:10.1007/s00406-022-01424-6. ISSN 1433-8491. PMC 10085916. PMID 35567615.
  42. ^ Ohl A, Grice Sheff M, Small S, Nguyen J, Paskor K, Zanjirian A (2017). "Predictors of employment status among adults with Autism Spectrum Disorder". Work. 56 (2): 345–355. doi:10.3233/WOR-172492. PMID 28211841.
  43. ^ Praslova, Ludmila N. (2021-12-13). "Autism Doesn't Hold People Back at Work. Discrimination Does". Harvard Business Review. ISSN 0017-8012. Retrieved 2023-02-08.
  44. ^ Praslova, Ludmila N. (2022-04-01). "Your "Autism Awareness Day" Might Be Excluding Autistic People". Harvard Business Review. ISSN 0017-8012. Retrieved 2023-02-08.
  45. ^ Johnson KR, Ennis-Cole D, Bohamgregory M (21 February 2020). "Workplace Success Strategies for Employees With Autism Spectrum Disorder: A New Frontier for Human Resource Development". Human Resource Development Review. 19 (2): 122–151. doi:10.1177/1534484320905910. S2CID 213995367.
  46. ^ Bernick M (12 January 2021). "The State Of Autism Employment In 2021". Forbes. Retrieved 11 February 2022.
  47. ^ Praslova, Ludmila N. (2022-06-21). "An Intersectional Approach to Inclusion at Work". Harvard Business Review. ISSN 0017-8012. Retrieved 2023-02-08.
  48. ^ Praslova, Ludmila N. (2022). To build a healthy workplace, you need a toxic culture alarm Fast Company, 14 March 2022.
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