Anderson Deborah K, Liang Jessie W, Lord Catherine
Center for Autism and the Developing Brain (CADB), Weill Cornell Medical College, White Plains, NY, USA.
J Child Psychol Psychiatry. 2014 May;55(5):485-94. doi: 10.1111/jcpp.12178. Epub 2013 Dec 9.
The range of outcomes for young adults with Autism Spectrum Disorders (ASD) and the early childhood factors associated with this diversity have implications for clinicians and scientists.
This prospective study provided a unique opportunity to predict outcome 17 years later for a relatively large sample of children diagnosed with ASD at 2 years old. Diagnostic and psychometric instruments were administered between 2 and 19 with data from 2, 3, and 19 included in this study. Clinicians administered tests without knowledge of previous assessments whenever possible. Caregivers provided additional information through questionnaires.
Significant intellectual disabilities at 19 were predicted by age 2 about 85% of the time from VIQ and NVIQ scores together, though prediction of young adult outcome for youths with average or higher intelligence was more complex. By 19, 9% of participants had largely overcome core difficulties associated with ASD and no longer retained a diagnosis. These youths with Very Positive Outcomes were more likely to have participated in treatment and had a greater reduction in repetitive behaviors between age 2 and 3 compared to other Cognitively Able youths (VIQ ≥70) with ASD. Very Positive Outcome youths did not differ phenotypically from Cognitively Able ASD individuals at 2 but both groups differed from Cognitively Less Able individuals (VIQ <70).
Those most at risk for intellectual disabilities and ASD can be reliably identified at an early age to receive comprehensive treatment. Findings also suggest that some cognitively able children with ASD who participate in early intervention have very positive outcomes, although replication with randomized, larger samples is needed. In order to improve understanding of very positive outcomes in ASD, future research will need to identify how variations in child characteristics and environmental factors contribute to the nature and timing of growth across individuals and areas of development.
患有自闭症谱系障碍（ASD）的青少年的预后范围以及与这种多样性相关的幼儿期因素，对临床医生和科学家具有重要意义。
这项前瞻性研究提供了一个独特的机会，可以对相对大量2岁时被诊断为ASD的儿童17年后的预后进行预测。在2至19岁期间使用了诊断和心理测量工具，本研究纳入了2岁、3岁和19岁时的数据。临床医生在尽可能不知道先前评估结果的情况下进行测试。照顾者通过问卷调查提供额外信息。
19岁时的显著智力残疾，约85%可通过2岁时的言语智商（VIQ）和非言语智商（NVIQ）分数共同预测，不过对于智力中等或较高的青少年，预测其成年后的预后更为复杂。到19岁时，9%的参与者已基本克服了与ASD相关的核心困难，不再被诊断为ASD。与其他认知能力正常（VIQ≥70）的ASD青少年相比，这些预后非常好的青少年更有可能接受过治疗，并且在2至3岁之间重复行为减少得更多。预后非常好的青少年在2岁时与认知能力正常的ASD个体在表型上没有差异，但这两组与认知能力较差（VIQ<70）的个体不同。
那些智力残疾和ASD风险最高的人可以在早期被可靠地识别出来，以便接受综合治疗。研究结果还表明，一些参与早期干预的认知能力正常的ASD儿童有非常好的预后，尽管需要通过随机、更大样本的研究来进行验证。为了更好地理解ASD中的非常好的预后，未来的研究需要确定儿童特征和环境因素的差异如何影响个体在不同发展领域的成长性质和时间。
