Developmental Changes of Autistic Symptoms, ADHD Symptoms, and Attentional Performance in Children and Adolescents with Autism Spectrum Disorder.
Toddler pointing, showing, and response to joint attention plus higher IQ strongly predict the best teen outcomes in autism.
01Research in Context
What this study did
Yu-Wen et al. (2023) followed the same kids with autism from toddlerhood to adolescence. They looked at early pointing, showing, and response to joint attention. They also tracked early IQ scores and social-affect symptoms.
The team wanted to see which toddler signs best predict the ‘best outcome’ group in the teen years.
What they found
Kids who became the top-performing teens had two things in common. First, as toddlers they pointed, showed toys, and followed your finger when you pointed. Second, their early IQ scores were higher and their social delays were milder.
These early social acts were stronger predictors than any other toddler measure.
How this fits with other research
The same cohort was studied at age 9 by Ohan et al. (2015). That paper showed half the kids reached average IQ by mid-childhood. The new paper adds four more years and shows the same early signs still matter.
Fusar-Poli et al. (2017) seems to disagree. They found almost no adaptive gains over ten years in autistic adults with intellectual disability. The key difference is IQ range. Yu-Ju et al. looked at the full spectrum, while Laura et al. focused on people who also had ID. Skills stay flat when IQ is below 50, but can grow when early IQ is near average.
Sievers et al. (2020) extend the idea. They spell out what ‘best outcome’ looks like for different IQ bands. For cognitively able adults it means paid work and close friends. For less able adults it means daily skills above an eight-year level.
Why it matters
Watch toddler pointing, showing, and response to joint attention like a hawk. These cheap, quick probes forecast who may need lighter supports later. If a child shows all three plus near-average IQ, push for full inclusion and higher-level social goals. If these signs are missing, plan for more intensive, long-term teaching and don’t expect fast adaptive jumps.
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02At a glance
03Original abstract
This study is one of a very few prospective long-term studies in autism spectrum disorder (ASD). The study compared outcome trajectories in three adolescent groups (T2): "best outcome" (BO, n = 11) did not meet cut-off points for ASD and IQ scores ≥85; high functioning (HF-ASD, n = 14); and lower functioning (LF-ASD, n = 43). Additionally, the study searched for characteristics at toddlerhood (T1) that may predict belonging to the above groups. The study included 68 adolescents (63 males) diagnosed with ASD at toddlerhood (mean age: 13:10 years), mean follow-up time was 11:7 years. Participants underwent comprehensive assessments at T1 and T2. Different trajectories were found for the three defined groups. The BO group improved significantly in cognitive ability, autism severity, and adaptive skills in comparison to no improvement for the LF-ASD group or partial progress for the HF-ASD group. At toddlerhood, better cognition and less severe autism social affect symptoms were generally associated with a better outcome. Early social behaviors including better "pointing," "facial expression directed to others," "showing," and "response to joint attention" were associated with membership in the BO group. In addition, the BO group had the lowest prevalence of significant T2 inattention and anxiety symptoms. No significant differences between the three outcome groups were noted in the birth and prevalence of medical problems. Higher cognitive ability and better T1 showing and pointing behaviors predicted better outcome. The study points to the change in autism severity over time and to the prognostic value of early developmental abilities, social engagement behaviors, and the existence of comorbidities. Autism Res 2020, 13: 1130-1143. © 2020 International Society for Autism Research and Wiley Periodicals LLC. LAY SUMMARY: This long-term study compared characteristics of toddlers diagnosed with autism spectrum disorder (ASD) in three outcome groups in adolescence: best outcome (BO-average IQ/not meeting criteria for ASD), high-functioning ASD, and low-functioning ASD (LF-ASD). At toddlerhood, the BO group displayed less severe autism symptoms, mostly in sharing interests, compared to the LF-ASD group. The BO group had fewer inattention and anxiety symptoms than the two ASD groups. Additionally, early cognitive level and social engagement behaviors predicted outcome in ASD.
Journal of autism and developmental disorders, 2023 · doi:10.1002/aur.2313