At issue are three critical questions:
- Can a child who meets the diagnostic criteria for ASD at a young age cease to meet the diagnostic criteria at an older age? (The "If".)
- What are the traits of the children who have the potential for "recovery"? (The "Who.")
- To what is recovery attributable? (The "How.")
Let's see what us amateurs can glean from the published extracts.If - Given that there are five studies validating the phenomenom, I believe the If question is answered in the affirmative. This blogger doesn't doubt that the phenomenom is real.
Who - As for the Who, this study concludes:
Children who failed to meet diagnostic criteria for ASD at follow-up were more likely to: 1) be 30 months or younger at initial evaluation; 2) have milder symptoms of autism, particularly in the social domain; and 3) have higher cognitive scores at age 2.In other words, these children were on the mild to moderate end of the spectrum to begin with.
How - Now onto the loaded question - the "How." The How is why the MSNBC clip sent me into a tizzy. The How can likely be attributed to either services or maturation. As I have blogged, I think it's maturation, and this study validates my belief:
No differences between children with stable and unstable diagnoses were found for amount of intervention services received.I'm not asserting that services don't help. On the contrary, I believe that services are essential for certain children. Rather, I'm suggesting that full blown "recovery" is a biological destiny that cannot be induced with services, a conclusion supported by the above excerpt.
Now let's loop back to the 2008 study and the most recent study (which is ongoing). Note that Deborah Fein, featured in the MSNBC clip, is involved in both studies. Since the most recent study is ongoing and not yet published, I will attempt to deconstruct the 2008 study, which appears to be substantially similar.
In this blogger's opinion and based only on the abstract, the 2008 study is a bit obtuse and has an editorial bias. The abstract states:
Predictors of recovery include relatively high intelligence, receptive language, verbal and motor imitation, and motor development, but not overall symptom severity.Let's focus verbal or motor imitation, commonly referred to as "mirroring." The absence of mirroring is said to be one of the hallmarks of autism. The 2008 study shows that the presence of mirroring in a child is a predictor of losing the diagnosis. But then it goes on to say that "overall symptom severity" is not a predictor of losing the diagnosis. Really? By implication, the study is asserting that a child can have mirroring skills yet still be "severe" from a symptom severity perspective. I'm not an expert, but that doesn't make sense to me. If a child has mirroring skills, relatively high intelligence and receptive language, then that child is at most moderately impaired, relatively speaking, and to suggest otherwise seems obtuse to me.
Next the study goes on to state:
Controlled studies that report the most recovery came about after the use of behavioral techniques....Possible mechanisms of recovery include: normalizing input by forcing attention outward or enriching the environment; promoting the reinforcement value of social stimuli; preventing interfering behaviors; mass practice of weak skills; reducing stress and stabilizing arousal.The clear implication: ABA ("applied behavior analysis") brings about recovery. I feel a tizzy coming on again. Blood pressure rising. Here is the big flaw: the study doesn't compare the ABA group to a group that didn't receive ABA. Now, you might say, well you are just reading the abstract, which is true. However, Kev from Left Brain/Right Brain reports that he reviewed the entire 28 page study, made the same observation and went so far as to email the study's authors. The authors replied to Kev on an unrelated point but did not address the issue of controlling for services. (See second to last comment from Kev.)
The new, ongoing study reports:
Most of the formerly autistic kids got long-term behavior treatment soon after diagnosis, in some cases for 30 or 40 hours weekly.What we don't know is whether they are following children who were not receiving ABA.
With respect to the 2008 study and the ongoing study, I suspect an editorial bias in favor of services. Which I understand because I'm sure ABA does a lot of good for a lot of children. But editorial bias is not science. Unless they're comparing the beneficial effects of the ABA to a controlled sample (like the Lovaas study did), then it's all smoke and mirrors.