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Clinical research: Study finds four types of autism severity

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Jessica Wright
4 October 2013

Time course: Most children with autism have persistent symptoms, but some of them worsen or improve over time.

Children with autism who have trouble with daily activities, such as brushing their teeth, and who lag on measures of cognition are the most likely to have persistently severe symptoms. The findings, based on a long-term study of children between 2 and 5 years of age, were published 2 August in the Journal of Autism and Developmental Disorders1.

The study investigated autism severity over time and identified four possible trajectories: persistently severe, persistently moderate, improving and worsening. These results replicate the findings of a 2012 study, which described the same four groups and found that 80 percent of 354 children had stable symptoms.

Both studies use the calibrated severity score, an adaptation of the Autism Diagnostic Observation Schedule (ADOS), a well-established diagnostic test for autism. The severity score controls for age and language ability, allowing researchers to compare symptoms among different ages.

In the new study, researchers recruited 129 children who had been diagnosed with autism. The researchers assessed each child four times, once a year, starting at 30 months of age. Of the 129 children, 101 completed at least three of the four assessments.

As in the previous study, 78 percent of the children had symptoms that were stable over time, with 47 in the persistently severe and 54 in the persistently moderate categories;10 children worsened over time and 18 of them improved.

Children in the persistently severe class had the most significant problems with daily living skills, such as brushing their teeth or dressing themselves, and had the lowest nonverbal cognition scores.

Age, gender, ethnicity and maternal education had no bearing on the severity of symptoms. Interestingly, children in the persistently severe class were the most likely to have undergone intensive behavioral intervention. This is probably because they would be more likely to qualify for these services under Medicare, the researchers say. 

News and Opinion articles on SFARI.org are editorially independent of the Simons Foundation.


1: Venker C.E. et al. J. Autism Dev. Disord. Epub ahead of print (2013) PubMed


Name: Barbara ROdriguez
9 October 2013 - 5:38AM

I had my grandson all summer, i put him on a no sugar no gluten no dairy diet as much as i could, i couldn't believe the difference in him every way, he was so calm, and behaved so good. he lost 20 pounds, now hes been back with his mother who treats him like hes normal, he has gained all his weight back and has adhd so bad hes all over the place yelling in a high pitched voice. its hard to take, mother dosent care. hes fine she says he will grow out of it.

Name: Another Gramma
9 October 2013 - 3:51PM

How very sad. It must be so frustrating for you.

Name: usethebrainsgodgiveyou
4 November 2013 - 1:37PM

I would HOPE that the persistently severe class of children were more apt to qualify for services. Has anyone studied the long term effects of ABA? I was a practitioner for 7 months, 4 of which I refused to send a child to the "time out room". Once I finally did, I would send them there for minor infractions. What it amounted to is you used the time out room, a concrete closet that was not supposed to be locked, although teachers would stand in front to hold it shut. You showed your domination over their will. They weren't allowed to come out until they "cooled down". Some lived in fear of it, others didn't and spent a lot of time there. The teachers weren't evil or mean or cruel people, probably more loving than most people I know. But they did use punishment to shape behavior. The first classes I had were how to take down a child without hurting them or you. I've never confessed this before. I quit, I never did fit in, the kids had no fear of me. A part of me had to see about this ABA that was taking over the nation, with states mandating insurance agencies pay the THOUSANDS of dollars attached to the "professionalization" via Behaviorism of correction. Earlier, this same school had used electric shock, which was more effective than ABA, on teacher confessed. Maybe I am just to naive. Maybe it is necessary. I don't know.

I see that behavior can be a problem for kids who can't be corrected by typical means. Has anyone ever looked into a non-threatening form of oorrection? I wrote an article in Denise Brody's "Elephant in the Playroom" where I discussed the correction method I used with my son. It absolutely changed the feeling of parenting and gave me control. It was the fourth essay in the first section, entitled "Impacting the Bottom Line". Parenting means business, not inducing fear.

In my pollyanna dreams, kids take responsibility for themselves.

Name: tamonetteasd
4 December 2014 - 5:45PM

I had two ASD boys myself. One of my boys was severe and nonverbal. We stayed away from ABA and used play and OT with animals, both strategically. Both my sons are diagnosis free now.

For play to work, you have to really go with it and let them lead, keeping them engaged. As they come up cognitive levels, the behavior can be trying, because they are using new cognitive skills to get what they want, just like other kids.

I believe ABA is inefficient. It doesn't make use of the child's strengths. You need to use what you've got in a severe child, and if you try to focus on unimportant stuff like stereotypy (which they are using to make sense of the world) you are wasting time.

Good instinct to get out of the ABA system. Just because everybody is on the bandwagon, doesn't make it right.

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