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Posts Tagged ‘outgrow autism’

We came across a new video about autism recovery that we are excited about! One of our parents actually found it first. When the mom talked about it, I just assumed it was another CARD video as they have been the predominant leaders in this area. Interestingly, it was not from CARD but rather a professionally produced video from UCONN!

We have been a fan of Dr. Fein since we first learned that she studied children on the spectrum. See one of our previous posts here. She is not a behavior analyst but rather a licensed clinical psychologist. She is not in the business of ABA but rather a professor in clinical psychology. You can read more about her here.

So…..now for the video. We hope it inspires you as much as it does us!

http://medvideos.org/video/215/is-it-possible-to-recover-from-autism

 

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Here at Applied Behavioral Strategies, our mission is to improve the quality of life through effective intervention. One way we hope to do that is by reviewing research articles for our readers. Today’s article is titled,”Six Developmental Trajectories Characterize Children With Autism”. Christine Fountain served as the lead author along with Alix S. Winter and Peter S. Bearman. The journal called Pediatrics published the study. The original paper is available online now, and will come out in paper in May, 2012.

This paper has received quite a bit of press lately so we thought that we could shed some light on the study for our readers. We want to point out that the National Institutes of Health (NIH) funded the study as part of their early career awards for new scientists.

Study Purpose

The authors noted that the purpose of the study was to “describe the typical longitudinal developmental trajectories of social and communication functioning in children with autism and to determine the correlates of these trajectories”. In reader terms that means that this is not an experimental study but rather a correlational study. The authors did not apply any treatments, they merely looked for patterns and relationships in existing data.

Study Methodology

The authors examined data from a group of children in California. They analyzed data from the age of diagnosis until the children turned 14. The California Department of Developmental Services (DDS) provided the data set to the authors. This is important because the data are most likely skewed as every parent does not necessarily register their child with the state. For example, parents who are living in the state illegally are not likely to register their children. Additionally, it is highly unlikely that wealthy families took the time to register their children (think Hollywood, movie stars, secrets). Finally, parents who are not connected to community resources, may not find out that such a service exists. Thus, we must look at this study as extremely limited in validity because the sample is biased from the start.

Study Sample

The authors analyzed data from 6, 975 children. The authors also noted if any of the children had a diagnosed intellectual disability. The diagnoses were all completed by California DDS psychologists.

The authors examined the birth records of the children paying attention to several factors:

  • maternal age at birth
  • maternal education
  • maternal race and ethnicity
  • place of birth
  • child’s gender and birth weight
  • and whether Medi-Cal (California’s Medicaid program) paid for the birth (a loose indicator of Socio-economic Status

 Measures

A somewhat standardized measure was used to identify the functioning level of the child. The measure was also completed the DDS staff an it was completed annually. The measure included several questions about social skills, several questions about communication skills, and several questions about adaptive behavior. These items were used to examine improvement or change over time.

It is important to note that the authors did not contact the children or their parents at any point in this study. Additionally, the authors did not attempt to document what types of intervention the children received to address the autism. This is incredibly important

because some interventions have been proven to have long-term effectiveness for children with autism. If children were receiving this intervention, the data in the study would be impacted. If you are interested in reading about the effective intervention, you can read this, or this, or even this.

Results

Children with autism do NOT bloom like flowers!The authors then ran some statistical analyses on the data set (scores from the measure that was completed approximately annually). The authors summarized their findings.

  1. Many of the children showed substantial improvement over time.
  2. Some children changed quickly and greatly while others remained “flat lined” or experienced little growth over time.
  3. Children who appeared to be “high functioning” at the beginning tended to improve more rapidly.
  4. The most rapid development occurred before age 6 (note: this is consistent with the original studies on ABA).
  5. The authors then identified a group of “bloomers” that started out fairly low at first but then improved at a rapid pace appearing similar to the higher functioning individuals
  6. The authors reported that the repetitive behaviors remained fairly stable over time across groups.
  7. Sadly, the lower functioning group tended to be non-white, Medi-Cal recipients, with mothers who were younger and foreign-born.
  8. And not surprisingly, the higher functioning group tended to be born to older, more educated, white mothers, and they were less likely to be a Medi-Cal recipient.

Important Points

This peer-reviewed published paper is an absolute joke. It is horrifying (and embarrassing) to think that a person with advanced training in research would publish a disgrace of a paper. The authors failed to consider the fact that these children were most likely receiving intervention paid for by DDS. The Center for Autism and Related Disorders has 12 offices in California and they regularly provide ABA services to children using funds from DDS. Why was this important point not mentioned?

Even more disgraceful is the fact that this study was funded by the NIH! Clearly, our tax-payer dollars are not being used to fund important research. Why did the authors ask important research questions like:

  • How much intervention were the bloomers receiving compared to the other groups?
  • What type of intervention if any were the children of non-white, low-income, and uneducated mothers receiving?
  • Does more intervention lead to better outcomes?

Sadly, the results of this lame “study” found themselves all over the media: here, here, and here just to name a few.

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We must help educate the public that ABA intervention works. Children do not outgrow autism and they do not magically “bloom” like spring flowers. Their growth is the result of hard-working parents, teachers, and therapists. Please get the facts straight.

Of course, if you have a topic that you would like for us to review, please let us know by posting in the comments below or you may always reach us at info at applied behavioral strategies dot com

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One of the popular topics this week has been the discussion about children outgrowing their autism diagnosis. If you have missed these discussions, you may catch yourself up by visiting here, here, and here.

Before we jump in to the original article on which all of this discussion is based, we would like to point out that we have already discussed how children with autism can recover from autism. If you missed that post, you may read it here.

Ok, so what is all this talk about “outgrowing autism”?

We prefer to go to the original source to make sure people are accurately reporting what was published. Heather A. Close, Li-Ching Lee, Christopher N. Kaufmann, and Andrew W. Zimmerman authored the paper. The journal Pediatrics published the paper which is available online now and will be available in hard copy in February 2012.

Purpose

The authors set out to describe characteristics and co-occurring conditions in young children, children, and adolescents.The authors also stated that they wanted to describe how characteristics and conditions may cause a change in the diagnosis of ASD.

Participants

The authors actually sought participants who either: a) currently had an autism spectrum disorder (ASD) diagnosis; or b) who had an ASD diagnosis in the past but no longer carry such a diagnosis. Interestingly, the authors did not speak to any of the participants directly. Rather, they pulled the data from a database that was collected as part of the 2007 National Survey of Children’s Health.

Method

To complete the study, the authors opened the 2007 database and retrieved answers to two questions.

  1. Has a doctor or other health care provider ever told you that the child had ASD?
  2. Does that child currently have autism or ASD?

Once the authors retrieved the data for parents who responded to the two questions, the authors created two groups with the data. One group with a current diagnosis of ASD and a second group of children who do not have an ASD diagnosis but whose parents were once told that the child had ASD.

The authors then ran a number of statistical analyses with the data based on three age ranges of children.

  1. young children aged 3–5
  2. children aged 6–11
  3. adolescents aged 12–17

The authors also examined the data set to determine if any of the following conditions co-occurred in the children:

  • attention-deficit/hyperactivity disorder
  • learning disability
  • developmental delay
  • speech problems
  • hearing problems
  • anxiety
  • depression
  • behavioral or conduct problems
  • seizures or epilepsy

Results

Finding #1: Young children ages 3-5 with a current diagnosis of ASD were more likely to have a current learning disability. Might we add here that learning disabilities are often not diagnosed until age 8 or 9. Thus, we find it hard to believe that children ages 3-5 were diagnosed with learning disabilities. Perhaps they had developmental delays but the authors did not state that.

Finding 2: Young children ages 3-5 with a current ASD diagnosis were more likely to have current co-occurring conditions than children without a current ASD diagnosis.

Finding 3: Children ages 6-11 with a current diagnosis of ASD were more likely to have a past speech problem and current anxiety.

Finding 4: Adolescents age 12-17 with a current diagnosis of ASD were more likely to have current speech problems and 10 times more likely to have current seizures or epilepsy. Note: We would hope that the children have current speech problems since the definition of ASD diagnosis requires that speech problems be present!

Comments

Honestly, it is surprising that such a low-quality study would find itself in a prestigious peer-reviewed journal such as Pediatrics. It is even more surprising that it would receive subsequent attention from the press. This type of study hardly qualifies as a master’s thesis, let alone a study that is covered in national news.

The authors did not conduct an experiment. The authors did not verify if the children actually had autism. The authors did not review records to determine if a diagnosis existed in the child’s history. The authors based their entire paper on someone else’s data set.

The original data set the authors utilized is also full of issues. The authors noted that the majority of respondents were white, non-Hispanic, and that most of them had health insurance for at least one year. Not to mention that at 61% of the respondents had incomes over 200 times above the poverty level. Thus, the study results are skewed towards white, middle and upper-class families.

Finally, the authors based all of their conclusions and findings on parent report. Please do not think that we do not believe parents. We do. However, a parent may think their child has ADHD or learning problems but that does not mean that an actual diagnosis of ADHD or learning disability exists. Thus, when the authors discuss how other conditions may impact the autism diagnosis, they are merely speculating as their study did not prove, or control for the other conditions.

The bottom line here is that children in this study who had a history of ASD, may or may not have even had an ASD to begin with. The authors failed to verify this information. Moreover, the authors failed to ask if the children received intensive early intervention or biomedical intervention that may have resulted in recovery from autism.

Finally, the authors never stated that children outgrow autism. The authors themselves state that the children who no longer have a diagnosis could have been:

  • misdiagnosed in the first place
  • responsive to early intervention
  • or they may have experienced developmental changes

So, we are asking you to please check the facts before spreading rumors. Children do not outgrow autism.

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