Longitudinal change in symptom severity in children with ASD: Results from the ELENA cohort.
Autism severity moves—usually upward in social skills for the youngest—so reassess yearly and treat RRBs on their own track.
01Research in Context
What this study did
Dellapiazza et al. (2024) followed 575 autistic children for three years. They gave the ADOS every year and watched how severity scores moved.
Kids ranged from toddlers to age eleven. The team asked: who gets better, who gets worse, and who stays the same?
What they found
Half the children changed severity level. Social-communication improved in twenty-nine percent. Twenty-two percent worsened overall.
Restricted and repetitive behaviors barely budged. The youngest kids and those diagnosed early were the ones who gained the most social points.
How this fits with other research
Waizbard-Bartov et al. (2022) saw the same fifty-fifty split in an earlier slice of this cohort. The new paper adds three-year detail and toddler data, so it extends, not contradicts, the prior finding.
Seltzer et al. (2003) tracked teens and adults. They also found social skills can improve while repetitive behaviors hold steady. Florine et al. show this pattern starts young and holds.
Pry et al. (2007) sorted kids into four clusters. Florine et al. now do the same with a bigger sample and ADOS calibrated scores, giving you clearer benchmarks.
Why it matters
Expect change. Plan for it. Update the treatment plan every year, especially for kids under five. Target social-communication goals early, but keep separate, explicit programs for repetitive behaviors because those rarely shift on their own.
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02At a glance
03Original abstract
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition and understanding the changes in autism symptoms over time is crucial for tailoring support and interventions. This study therefore aimed to investigate the changes in symptom severity in a large cohort of children with ASD over a three-year follow-up period and identify factors that influence these changes. The study included 575 children diagnosed with ASD, ranging in age from 2 to 12 years, who were assessed at baseline and again 3 years later using the Autism Diagnostic Observational Schedule-2 (ADOS-2). ASD severity changes were investigated using the ADOS calibrated severity score (CSS) scores for total, social affect (SA) and restricted and repetitive behaviors (RRB). Results highlight four distinct patterns: stable high, stable low, increased, and decreased severity. The ADOS CSS total score changed for half of the sample, reflecting an increase in ASD severity for 21.9% and a decrease for 29.1% of children. For the other half, the ADOS CSS score remained stable, either high (34.4%) or low (14.6%). While the majority of previous studies reported stability in ASD severity, our findings revealed significant variability with frequent improvements in SA symptoms whereas RRBs remained stable or worsened. Our findings also showed that an improvement in SA was associated with the youngest group and early diagnosis. However, no clinical or sociodemographic factors were linked to changes in RRB, emphasizing the necessity for RRB-specific therapies. The third six-year follow-up point of the ongoing ELENA cohort study will map the long-term trajectories of the severity of ASD symptoms and their potential risk factors.
Autism research : official journal of the International Society for Autism Research, 2024 · doi:10.1002/aur.3242