Identifying autism symptom severity trajectories across childhood.
Autism severity moves up or down for half of kids through age 11—plan to reassess yearly and adjust services.
01Research in Context
What this study did
Einat and colleagues tracked 461 autistic children for up to eight years.
Kids were first tested between ages 3 and 11, then again years later.
Each time, clinicians scored core autism symptoms with the same tools.
The team asked: how many kids get better, worse, or stay the same?
What they found
Half of the children changed enough to move into a new severity group.
Twenty-seven percent improved, 24 percent worsened, 49 percent held steady.
Girls were more likely to shift, usually toward greater severity.
Parents with less schooling also saw more symptom change in either direction.
How this fits with other research
Solomon et al. (2018) mapped IQ paths in the same age span.
They also found four groups: gain, loss, stable-low, stable-average.
Together the studies show that both IQ and autism traits can move.
Tan et al. (2021) report that 30 percent of toddlers lose skills.
That early loss predicts who later climbs in severity, linking the two papers.
Brignell et al. (2024) tracked language from 5 to 11 years.
They found fast catch-up when starting point was low, echoing the idea that baseline scores, not diagnosis, steer growth.
Why it matters
For BCBAs, the message is clear: schedule fresh assessments every year.
A child labeled mild at four may need more support by seven.
Watch girls and families with less education especially closely.
Update goals, hours, and parent training whenever scores shift.
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02At a glance
03Original abstract
An individual's autism symptom severity level can change across childhood. The prevalence and direction of change, however, are still not well understood. Nor are the characteristics of children that experience change. Symptom severity trajectories were evaluated from early to middle childhood (approximately ages 3-11) for 182 autistic children. Symptom severity change was evaluated using individual change scores and the Reliable Change Index. Fifty-one percent of participants experienced symptom severity change: 27% of children decreased in severity, 24% increased and 49% were stable. Symptom severity decreases were more common during early childhood. Severity increases occurred at both early and middle childhood but increase in social affect severity was especially prominent during middle childhood. Most children experienced significant change during only one period and remained stable during the other. Girls decreased more and increased less in symptom severity than boys. Children that increased in severity decreased in adaptive functioning across childhood. Exploratory analyses indicated that a decrease in severity was associated with higher parental education level and older parental age at the time of the child's birth. Conversely, increase in autism severity was associated with lower parental education level and younger parental age at the child's birth. These findings extend recent observations that symptom severity change is more likely than previously appreciated. An understanding of the role of both biological and sociodemographic factors in determining a child's symptom trajectory may factor into future decisions on allocation and type of interventions distributed to young autistic children. LAY SUMMARY: We studied whether a child's autism severity changed from initial diagnosis until middle childhood (ages 3-11). We found that 27% of the children decreased in severity, 24% increased and the rest stayed the same. Symptom severity decreases were more common during early childhood while severity increases were more prominent during middle childhood. We also found that girls were more likely to decrease than boys. Whether a child decreased or increased is related, in part, to parental characteristics.
Autism research : official journal of the International Society for Autism Research, 2022 · doi:10.1002/aur.2674