Adaptive trajectories and early risk factors in the autism spectrum: A 15-year prospective study.
Most autistic kids stay on a low adaptive track for fifteen years, so plan long-term teaching now.
01Research in Context
What this study did
Baghdadli et al. (2018) watched the same autistic kids for fifteen years. They looked at how daily-living skills grew from preschool to adulthood.
The team used a case-series design. They tracked adaptive scores year after year to see who stayed flat and who shot up.
What they found
Three out of four children stayed on a low, flat path. Only one in four climbed into higher skill zones by age twenty.
Early risk signs at age five predicted who would stay low.
How this fits with other research
Baghdadli et al. (2012) saw the same two paths in a shorter ten-year run. The 2018 paper adds five more years and shows the split is stable.
Ben-Itzchak et al. (2020) looked at toddlers and also found that kids who start with stronger words and play skills end up higher as teens. Together the three studies say the same thing: early skills lock in the track.
Sievers et al. (2020) narrows the lens. They show that in kids with rare gene changes, the age a child first walks or talks forecasts later skills. This extends the big-cohort story to a precision level you can use when you know the gene subtype.
Why it matters
If most autistic kids stay on a low path, you cannot wait and hope for a late surge. Start teaching daily-living skills early and keep them on the plan through high school. Use the first five years to judge who needs the most hours, then lock those hours in the long-term treatment plan.
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02At a glance
03Original abstract
Little is known about long-term outcomes. We investigate the adaptive trajectories and their risk factors in ASD. Data were obtained from 281 children prospectively followed untill adulthood. The final sample consisted of 106 individuals. Vineland scores were collected at baseline (T1), 3 (T2), 10 (T3), and 15 (T4) years later. A group-based method was used to identify homogeneous patterns of adaptive skills trajectories. Results show that among the children initially categorized as autistic, 82.6% remained over the ADOS diagnostic threshold, 11.9% converted to atypical autism, and 5.4% fell under the ADOS threshold. Most atypical autism diagnoses were unstable. Most (81.7%) autistic participants had an ID at inclusion. At T1, 59.3% were nonverbal, but only 39% at T4. Most changes occurred between 4 and 8 years of age. Approximately 25% of participants exhibited a "high" growth trajectory, in which progress continues throughout adolescence, and 75% a "low" growth trajectory, characterized by greater autistic symptoms, intellectual disability, and lower language abilities reflected by high CARS scores, low apparent DQ, and speech difficulties, which mostly, but not always, predicted low trajectories. Our findings suggest that the adaptive prognosis of autism is mostly poor in this cohort, biased toward intellectual disability. However, changes in diagnostic, speech, and adaptive status are not uncommon, even for indivduals with low measured intelligence or apparent intellectual disability, and are sometimes difficult to predict. Autism Research 2018, 11: 1455-1467. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Most autism diagnoses given before 5 years of age are stable to adulthood, but one-fifth of individuals are no longer considered to be autistic, even in a cohort biased toward apparent intellectual disability. Conversely, atypical autism diagnoses are mostly unstable. One-third of children who are nonverbal at 5 years are verbal within 15 years, mostly before 8 years of age. Concerning adaptive behavior outcomes, only one-fourth of children exhibit a high-growth trajectory through at least 15 years.
Autism research : official journal of the International Society for Autism Research, 2018 · doi:10.1002/aur.2022