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News

Compulsions, anxiety replace autism in some children

by  /  2 January 2017
Long view: Children who lose their autism diagnosis early in life may benefit from continued psychiatric care.

Lynn Koenig / Getty Images

Most children who lose their autism diagnosis develop related psychiatric conditions, according to a new study1. The findings suggest that doctors should continue to monitor children once diagnosed with autism.

An estimated 9 percent of children with autism achieve a so-called ‘optimal outcome.’ But nearly all of these children years later develop related conditions such as obsessive-compulsive disorder, attention deficit hyperactivity disorder, anxiety and depression, the new study suggests.

“The majority of the group with a past history of autism are vulnerable to developing other psychiatric disorders,” says lead investigator Nahit Motavalli Mukaddes, professor of child and adolescent psychiatry at the Istanbul Institute of Child Psychiatry in Turkey.

Other studies have reported psychiatric issues in children who lose their autism diagnosis, but at much lower rates. The new study examined children living in Turkey, so the high rates may reflect cultural differences, sociopolitical stress or variations in how psychiatric conditions are diagnosed and treated, says Inge-Marie Eigsti, associate professor of psychology at the University of Connecticut in Storrs, who was not involved in the new study.

The team looked at 21 boys and 5 girls who had received an autism diagnosis as preschoolers but lost it at least two years before the start of the study. The children ranged from 6 to 16 years of age.

The researchers reviewed the children’s medical records to verify their initial autism diagnosis. They then evaluated the children clinically to confirm that they no longer meet the criteria for autism. They also reviewed results of the Childhood Autism Rating Scale and the Social Communication Questionnaire, two parent questionnaires.

Watchful waiting:

The researchers looked for other psychiatric diagnoses in the children’s medical records. They also evaluated the children in the clinic and looked at reports from the children and their parents.

All of the children have communication and social skills in the typical range, consistent with other studies.

“It is very important to have this confirmed with a completely different sample and from a very different culture,” says Deborah Fein, professor of psychology at the University of Connecticut in Storrs, who was not involved in the new study.

To the researchers’ surprise, 24 of the 26 children had been treated for a psychiatric condition at some point; 21 met the researchers’ criteria for a psychiatric condition other than autism. The results were published 12 November in Pediatrics International.

More than half of the children met the diagnostic criteria for attention deficit hyperactivity disorder at the time of the study. Nearly half had a specific phobia — severe anxiety about an object or situation, such as spiders or heights. Roughly one in five of the children had obsessive-compulsive disorder.

The findings suggest that children who lose their autism diagnosis would benefit from continued care.

“Even when we stop their special education programs, we need to continue their psychiatric and mental health follow up for a long time,” Mukaddes says.

Her team plans to continue following the children to track their diagnoses in early adulthood.


References:
  1. Motavalli Mukaddes N. et al. Pediatr. Int. Epub ahead of print (2016) PubMed
  • Megan M

    Has it occurred to the researchers that it may be the process of “recovering” from autism (that is, getting to “optimal outcome”) that may be causing the anxiety and compulsions? Many autistic adults who appear “normal” to an outside observer actually report being overwhelmed by the demands of keeping up appearances. That is to say, maintaining the “act” of normality itself creates intense anxiety.

    • Planet Autism

      And they are still in fact autistic of course. Autism is a lifelong condition.

  • James B

    OK, I was going to say what Megan M. said below. I am 51, Asperger’s/ASD. Diagnosed age 45. I “lost”/”recovered [from]” my major affect as a child because of brutal adult authority figure behavioural repression. Anxiety and depression disorders, indeed…

    I suggest the authors of this study watch the following video, then they might get some insight into so-called “recovering”. ASD is not a disease or a condition! It is a different way of having your brain work – no more normal or abnormal than an electric car vs a gas car – same shape and purpose, different ways of doing the same thing because the internals are different

    Aspies don’t have emotions…??? (TheAnMish)
    https://www.youtube.com/watch?v=IFxWdpuyY6o

  • chris turner

    This is a very ignorant unbalanced article.
    Whats the incentive to perpetrate such discriminatory nonsense?

  • Peter Peter

    This is good news from the point of my research. It confirms an article in 2010 where the concern was that there has been a big increase in older children who hallucinated and also had these types of symptoms gong to the emerge dept of hospitals; and so they did a scientific study on it to see if the hallucinations caused the symptoms or was the symptoms a mental illnesses causing the hallucinations? So, they took a wait and see attitude and I thought that they would publish another paper on it by now but I have never seen it if they did, This one however is just as good.
    My theory was and is that hallucinations cause these Disorders but we do not see hallucinations in younger children as all we see is the reaction v/v SIDs, ASD, etc but in the older children who were hallucinating, other symptoms would be there. Incidentally we never see another persons hallucination and all we really ever see is their reaction.
    This article confirms that even when the Autism diagnoses does not no longer apply; there is a mental illness; and for those that know about the usual mental illnesses; they usually are caused by negative events namely chronic and or trauma,tic events in children but they occur in adults. Now however they are occurring in older children, this group that we’re once diagnosed with Autism; and the group that were hallucinating and went to all the emerge units of hospitals. So, I got it once again. More proof; and someday my theory and free iBooks will have to be accepted if of course they stay where they are and if oc course anyone is reading them?

    • Planet Autism

      Autism is lifelong. You didn’t get it. Masking behaviours or learning patterns of social behaviour to follow, is not losing your autism. A diagnosis is just a clinical opinion based on the behaviours. Modifying those behaviours does not mean the underlying autism (with associated brain wiring) has gone.

  • Planet Autism

    Erm, hate to state the obvious, but it’s because they are still autistic! Your own article right below the above states the brain differences are still there! https://spectrumnews.org/news/autisms-brain-signature-lingers-even-after-loss-of-diagnosis/

  • Han-Lin Yong

    Could compulsions could be very similar to stimming except that it’s redirected? When stimming is suppressed, other forms of stimming that’s considered socially appropriate may appear. We know that autism has no cure. We can get better at “passing” and treating the symptoms over the years but that’s not the same thing as being less autistic.

  • Han-Lin Yong

    Is it possible that they’re anxious because they’re more aware of their struggles? If no one mentioned that I shouldn’t wear a sweater and jeans at a job fair, I probably won’t feel anxious even though everyone else follows a business casual style. My brain may respond to social cues differently than non-autistic brains. Clothing style is one of the things I struggle with which can actually be an upside if you’re an audience.

    Since their struggles persist after “outgrowing” autism, I agree that support is still needed. A possible problem with being high functioning is that their disability is much easier to overlook. Apparently, whether you’re high or low functioning, the employment rate is similar and their other struggles are no less. If both groups got all the help they need, would their employment rates increase?
    https://spectrumnews.org/news/people-with-milder-forms-of-autism-struggle-as-adults/

    Some people think ABA might be harmful but its benefits, such as improved IQ, seem to suggest that therapies, when the brain is more plastic, should be done. I don’t like windows of fast learning being missed. Even Carly Fleischmann had lots of different therapies.
    https://www.autismspeaks.org/about-us/press-releases/early-intervention-toddlers-autism-highly-effective-study-finds

    • Han-Lin Yong

      Also, “passing” can be very stressful.

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