Children can outgrow autism, but learning issues can persist

Around 7% of children can outgrow autism by the time they hit elementary school, but learning issues persist.

For some parents, the miracle does occur. Their child, diagnosed with autism spectrum disorder as a toddler, will test as normal (socially and cognitively) once in elementary school. A new study finds that one in every 14 autistic toddlers will no longer meet the diagnostic criteria once they reach elementary school. However, the majority of these exceptional children will continue to display some emotional or behavioral symptoms at that stage and so require some form of special education, note the researchers who spoke at the annual meeting of the Pediatric Academic Societies.

“Understanding the full range of possible outcomes is important for parents, clinicians, and the educational system,” wrote the authors in their presentation abstract.

Surprised by what they had seen in practice, an early intervention program team of doctors and researchers examined the medical records of 38 remarkable children. Part of a group of 569 children total, all had been diagnosed with autism by the team. The total children, who lived in the Bronx, represented a range of racial, ethnic, and socioeconomic backgrounds: just under half were on Medicaid (46 percent), while 44 percent were Hispanic, 36 percent Caucasian, and 10 percent African-American.

Between the years of 2003 and 2013, all these hundreds of children met the diagnostic criteria for autism spectrum disorder, yet, when re-evaluated four years later, 38 (or seven percent) no longer displayed symptoms of the disorder. Importantly, the same intervention team diagnosing the children had provided therapy and treatment and also monitored the children's progress over time.

During the follow-up examination, three of the 38 exceptional children displayed no disabilities of any kind. They had outgrown all of their social, psychological, and cognitive difficulties.

Still, the overwhelming majority (92 percent) of the 38 had residual learning and/or emotional/behavioral problems. Two-thirds displayed a language/learning disability, while nearly half were diagnosed with attention deficit hyperactivity disorder, oppositional defiant disorder, or disruptive behavior disorder. About a quarter showed signs of a mood disorder, an anxiety disorder, obsessive compulsive disorder, or selective mutism.

Despite remaining challenges, it is still both astounding and inspiring that some of the children had overcome a primary hurdle of autism.

“Autism generally has been considered a lifelong condition, but seven percent of children in this study who received an early diagnosis experienced a resolution of autistic symptoms over time,” Dr. Lisa Shulman of the Albert Einstein College of Medicine/Children’s Hospital at Montefiore stated in a press release. Certainly, the hope is these remarkable children may someday surmount their residual challenges as well.

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Why children with ADHD may make poor decisions

A study shows that children with ADHD might make poor decisions due to different learning and decision-making processes.

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders among school children. Pupils with ADHD often make poorer decisions than their unaffected classmates. Researchers from the University of Zurich now discovered that different learning and decision-making mechanisms are responsible for these behaviors, and localized the underlying impairments in the brain.

Which shirt do we put on in the morning? Do we drive to work or take the train? From which takeaway joint do we want to buy lunch? We make hundreds of different decisions every day. Even if these often only have a minimal impact, it is extremely important for our long-term personal development to make decisions that are as optimal as possible. People with ADHD often find this difficult, however. They are known to make impulsive decisions, often choosing options which bring a prompt but smaller reward instead of making a choice that yields a greater reward later on down the line. Researchers from the University Clinics for Child and Adolescent Psychiatry, University of Zurich, now reveal that different decision-making processes are responsible for such suboptimal choices and that these take place in the middle of the frontal lobe.

Mathematical models help to understand the decision-making processes

In the study, the decision-making processes in 40 young people with and without ADHD were examined. Lying in a functional magnetic resonance imaging scanner to record the brain activity, the participants played a game where they had to learn which of two images carried more frequent rewards. In order to understand the impaired mechanisms of participants with ADHD better, learning algorithms which originally stemmed from the field of artificial intelligence were used to evaluate the data. These mathematical models help to understand the precise learning and decision-making mechanisms better. "We were able to demonstrate that young people with ADHD do not inherently have difficulties in learning new information; instead, they evidently use less differentiated learning patterns, which is presumably why sub-optimal decisions are often made," says first author Tobias Hauser.

Multimodal imaging affords glimpses inside the brain

In order to study the brain processes that triggered these impairments, the authors used multimodal imaging methods, where the participants were examined using a combined measurement of functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) to record the electrical activity and the blood flow in the brain. It became apparent that participants with ADHD exhibit an altered functioning in the medial prefrontal cortex -- a region in the middle of the frontal lobe. This part of the brain is heavily involved in decision-making processes, especially if you have to choose between several options, and in learning from errors. Although a change in activity in this region was already discovered in other contexts for ADHD, the Zurich researchers were now also able to pinpoint the precise moment of this impairment, which already occurred less than half a second after a feedback, i.e. at a very early stage.

Psychologist Tobias Hauser, who is now researching at the Wellcome Trust Centre for Neuroimaging, University College London, is convinced that the results fundamentally improve our understanding of the mechanisms of impaired decision-making behavior in people with ADHD. The next step will be to study the brain messenger substances. "If our findings are confirmed, they will provide key clues as to how we might be able to design therapeutic interventions in future," explains Hauser.

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