Can a Child Recover From Autism?
One of the most heated topics in autism is whether some children outgrow their diagnosis. Deborah Fein, a professor of psychology at the University of Connecticut in Storrs, calls this the ‘optimal outcome.’ This small group of children who achieved an optimal outcome has spawned several studies to determine what factors set these children apart.
In a 2013 study, Fein described 34 people who were diagnosed with autism before age 5 but no longer met the criteria for the disorder years later.
When Deborah Fein first met “Catherine,” the 13-month-old child was almost completely nonverbal. She avoided eye contact, did not respond to her name, and displayed little facial expression – all classic signs of autism.
After five months of targeted intervention with a home-based therapist, Catherine, who had a regressive form of autism spectrum disorder, began recovering some of the communication and social skills.
By age three, Catherine was doing well enough to enroll in a private preschool for typically developing children where, with additional support, she continued to progress. By age five, Catherine was enrolled in a public-school kindergarten with no autism diagnosis, no individualized education plan, and no ongoing specialized interventions of any kind.
Fein became intrigued in this group of children from her clinical practice where she saw some children who started out with clear autism, and after a few years lost all the features of autism and began to exhibit symptoms of attention deficit hyperactivity disorder (ADHD).
This phenomenon laid the groundwork for a formal study. The more Fein dug into their clinical histories, the more she realized that the behaviors associated with autism had gone. The children in the optimal outcome group were off the spectrum by all definitions.
Is it possible to predict who will achieve an optimal outcome?
According to Fein, one of the most important findings concerns exposure to interventions. She explained, “The biggest difference emerged between 2 and 3 years of age based on the proportion of children who got Applied Behavior Analysis (ABA — a one-on-one intervention that breaks down skills into manageable parts). Between the ages of 2.5 and 3, about 56 percent of the optimal outcome children got ABA compared with 7 percent of the children [who were diagnosed] with high-functioning autism. That’s a huge difference.” [i]
Are there biological differences between optimal outcome children and others with ASD?
Fein found that:
- Some children with ASD can reach typical levels of social, academic, executive, and communication functioning.
- The OO (optimal outcome) and ASD (autism spectrum disorder) children had similar activations in the studied brain regions. There was no evidence that the OO group had normalized their brains. There were no early brain size differences between the two groups.
- OO children received earlier intervention and more ABA
- There was preliminary evidence of neural compensation, not normalization, with early intervention by the OO group.
- The OO group had no difficulties in social, academic, pragmatic, or repetitive behaviors. There was some ADHD. 
Should I hope for an optimal outcome?
Fein makes it clear that every child’s potential is different. An ‘optimal outcome’ is not the only good outcome an ASD child can achieve. Fein also underscores that ABA therapy is not a magic bullet:
“When they get ABA, some respond very quickly and very well. But many inch along: Their behavior improves and they get skills, but it’s kind of slow. They don’t come anywhere near this kind of optimal outcome.”
The value of early intervention and therapy
Fein makes it clear that we shouldn’t worry about a child’s potential for optimal outcome. All children should receive early high-quality intervention regardless of prognosis. “I wouldn’t want any early intervention system or insurance company to say, ‘Well, this child doesn’t have a good prognosis, so let’s not give him the 30 hours of ABA, let’s give him 2 hours.’ I want to give every child the absolute best and then see how rapidly they can learn.”