Psychiatric Symptoms in Youth with a History of Autism and Optimal Outcome.

Orinstein et al. (2015) compared three groups of youth: those who once had autism but no longer meet criteria, youth still diagnosed with high-functioning autism, and typically developing peers. The team used interviews and rating scales to count current psychiatric disorders in each group. They wanted to know if losing the autism label also means losing mental-health risk.

Optimal-outcome youth carried fewer current disorders than the high-functioning autism group, but they still topped typical peers in ADHD and specific phobias. Comorbidity dropped as autism symptoms faded, yet it did not reach zero. In short, remission of autism does not wipe out psychiatric vulnerability.

Badia et al. (2013) mapped the same comorbid terrain in youth who kept their autism diagnosis; Alyssa’s team shows the map still has hills even after the autism road flattens. Green et al. (2015) looked at the mirror image — kids with ADHD who show autism-like traits — and found medium-level ASD symptoms inside an ADHD sample. The two 2015 papers seem to clash: one says ADHD lingers after ASD disappears, the other says ASD traits pop up inside ADHD. The difference is the starting group. Alyssa began with kids who had ASD first; Leigh began with kids who had ADHD first. Together they warn that ASD and ADHD travel together in both directions. Gray et al. (2012) tracked persistent-ASD youth for 18 years and saw only modest psychiatric improvement; Alyssa’s optimal-outcome group achieved bigger gains, showing that losing the diagnosis does shrink risk, just not to zero.

If you work with a child who has “graduated” from autism, keep screening for ADHD and anxiety. Use brief rating scales every six months. Coach families that success means fewer symptoms, not zero risk. When you see ADHD or phobias, treat them the same way you would in any child—early and actively.