Could My Child Outgrow Autism?

teens. teens

From time to time, stories emerge of individuals who appear to have simply "outgrown" an early diagnosis of autism. Could these stories be true?

According to the DSM-5 (the diagnostic manual that currently describes mental and developmental disorders in the United States and many other nations), the answer is no. That's because, according to the manual: "Manifestations of the social and communication impairments and restricted/repetitive behaviors that define autism spectrum disorder are clear in the developmental period. In later life, intervention or compensation, as well as current supports, may mask these difficulties in at least some contexts. However, symptoms remain sufficient to cause current impairment in social, occupational, or other important areas of functioning." 

In other words, says the DSM, autistic symptoms start early and continue throughout life, though adults may be able to "mask" their symptoms -- at least in some situations. But they don't "grow out" of autism.

This statement, though, tells only part of the story.

While children with autism don't appear to just "get better," most do improve over time with therapies and maturity. Some improve a great deal.

Consider this fairly common situation:

A child avoids eye contact, has difficulty with social communication, exhibits repetitive behaviors, dislikes any kind of change, and has sensory challenges -- and so he is diagnosed with autism spectrum disorder.

Then, that child receives intensive therapies and matures.

Now, as a teen or adult, the same person may do a fine job making eye contact. He may be only mildly delayed relative to social communication. Perhaps he has expanded his interests, and learned to manage his sensory challenges.

No, he's not the homecoming king. Yes, he needs more help than the average person with "reading" a social situation. But if he were evaluated today, his symptoms would not rise to the level of an autism spectrum diagnosis. 

Has he "grown out of" autism?

By the book (the DSM, to be precise), such people are is still autistic -- but they are "masking" their difficulties.

This interpretation is shared by many functional adults who were diagnosed with autism as children. They say "inside I'm still autistic -- but I've learned to change my behaviors and manage my feelings." In other words, there is some basic difference that makes autistic people autistic -- and that basic difference doesn't go away, even if behavioral symptoms disappear.

Then there are parents, therapists, and adults who have a very different point of view. Their perspective: if a person no longer exhibits sufficient symptoms for an autism diagnosis, then she has outgrown (or been cured of) autism. In other words, the therapies worked and the autism is gone.

Who is right? When symptoms are no longer apparent to an outside observer, have they been "outgrown?" "cured?" "masked?" 

As with so many things related to autism, there is no absolutely correct answer to this question.  And the uncertainty extends into the professional realm. Yes, there are practitioners who will remove the autism label, saying "the autism is gone." And yes, there are practitioners who will keep the label, saying "autism never truly disappears, though its symptoms may not be evident."  By choosing your practitioner carefully, you may be able to get the answer you prefer!

Continue Reading