Some autistic children may “bloom” socially with early and the right therapy

By Dr. Ananya Mandal, MDApr 2 2012

According to U.S. researchers this Monday, there are at least 10% autistic children with social and communication problems who benefit from intensive therapy and “bloom” to develop social skills as they grow older.

According to the latest figures from the U.S. Centers for Disease Control and Prevention 1 in 88 U.S. children have autism, a spectrum of disorders that ranges from severe communication and intellectual disability to much milder symptoms seen in children with Asperger's syndrome. Autism is marked by a group of symptoms, all arising from atypical brain development that causes problems with socialization, communication and behavior. Although the disorder can be mild or severe, in general children with autism have trouble communicating and making friends.

In the new study most of the children who benefited were white and came from wealthy homes, likely reflecting difference in access to treatment, and very few had intellectual disabilities in addition to their social problems, the researchers added. “Most children get at least a little better over time,” said Christine Fountain, an autism researcher at Columbia University in New York, whose study was published in the journal Pediatrics.

For their study, Fountain and colleagues studied the different growth trajectories of close to 7,000 autistic children in California, aged 2 to 14 between 1992 and 2001. The children had undergone at least four evaluations in which staff recorded their social and communication difficulties and their repetitive behaviors.

The researchers found that especially when it came to social and communication scores, most children improved over time. Of the children, about 10 percent saw rapid gains, moving from severely affected to high functioning, a group the researchers dubbed "social bloomers."
But they noticed that many of the children that fell into this group had non-Hispanic, white, well-educated mothers. Minority children with less-educated mothers or children with intellectual disabilities were very unlikely to make rapid gains, they said.

The researchers did not have information about the specific treatment each child received. There is limited evidence on what type of autism treatment might be helpful but behavioral therapy typically includes language- and communication-based exercises and some children are also given medication including antidepressants.

Johnny Matson, an autism researcher at Louisiana State University in Baton Rouge, who was not involved with the study, said the findings reinforce prior studies that have found children with autism and a normal IQ improve more from intensive therapy that those who have both autism and intellectual disabilities. He added that the gaps in improvement based on parents' race and education are probably about access to good-quality treatment. But he said “those gaps are narrowing very rapidly” because of laws requiring insurance companies to cover intensive treatment for all children with autism.

Both Fountain and Matson said parents of children with autism should be persistent in making sure their kids get the help they need but agreed they also can be optimistic.

Dr. Rahil Briggs, assistant professor of pediatrics at Albert Einstein College of Medicine, said parents must become aggressive and campaign for their children with autism. “So much can depend on how good that parent is at advocating for the child,” Briggs told Time Healthland. “That puts an incredible burden on parents.”

“Most children need about 30 to 40 hours a week of intervention,” Dr. Tamar Apelian, a staff psychologist at the autism evaluation clinic at the University of California, Los Angeles, told MSNBC. “What's tricky is being able to navigate the system to get the therapy, especially with the state budget crisis. The parents who do this seem to have more means and they can hire an advocate or a lawyer.”

“We deal with this problem every day, and we sense that there are different patterns or trajectories... in the kids as they develop,” said Dr. Andrew Zimmerman, from the Lurie Center for Autism at Massachusetts General Hospital for Kids in Lexington. “For some kids, you work very hard and you do a lot of therapy and nothing happens or very little, and then some kids seem to do really well,” Zimmerman told Reuters Health.

This study comes as a welcome finding on Autism Awareness Day.