March 3, 2018

holding handsAlthough autism is defined as a lifelong condition, there is a growing realisation that there may be some children / adults who no longer fit the clinical description having previously been diagnosed on the autism spectrum. Some of this group have been labelled as presenting with optimal outcome as a consequence of their moving outside the diagnostic boundaries for autism and functioning in the ‘typical’ range on various measures.

Debate still continues as to how widespread the phenomenon of optimal outcome is and the whether losing the diagnosis of autism actually translates into improved outcomes in terms of education, employment and personal prospects. What is becoming clear is that in amongst the various developmental trajectories of autism, symptom presentation is dynamic and optimal outcome where it does occur may eventually force a more plural definition of the condition.

Two papers have extended the inquiry into this area of autism research, hinting that intervention may play some role in the developmental history of those fulfilling the description of optimal outcome. The paper by Mukaddes and colleagues* based in Turkey concluded that “a group of children with an autism diagnosis could lose the diagnosis of autism upon early intervention”. Their study, based on the quite detailed analysis of a cohort of children “who lost their diagnosis and achieved an optimal outcome” reported that whilst cognitive and early language ability “are the most powerful factors contributing to optimal outcomes” intervention in the form of ABA (Applied Behaviour Analysis) and a derivative, Pivotal Response Training, might also play a role.

A second paper by Orinstein and colleagues** based at the University of Connecticut in the United States also looked at the potential impact from intervention on optimal outcome concluding that “OO [optimal outcome] individuals generally receive earlier, more intense interventions, and more ABA”. Compared with a group described as presenting with high-functioning autism, they reported that more children with optimal outcome received ABA than those in the high-functioning autism group. The administration of various medications was also more likely to figure in the medical history of the high-functioning autism group.

At first glance, the combined results of these two studies may seem to offer a glowing reference for the usefulness of ABA and related interventions. Both sets of authors caution however regarding the type of study they used and the need for more prospective research including appropriate control groups. Importantly too, neither study reported any biochemical, imaging or genetic findings which may also provide information about the mechanisms of optimal outcome and further new targets for investigation.


* Mukaddes NH. et al. Characteristics of Children Who Lost the Diagnosis of Autism: A Sample from Istanbul, Turkey. Autism Res Treatment. 2014: 472120.

** Orinstein AJ. et al. Intervention for optimal outcome in children and adolescents with a history of autism. J Dev Behav Pediatr. 2014 May;35(4):247-56.

Read more about these studies:


About the author 

Paul Whiteley Ph.D.

Researcher based in North East England. An academic background in psychology with a special interest in developmental psychology focused specifically on the autism spectrum and related conditions. Postgraduate degrees based on research examining the safety and efficacy of a gluten- and casein-free (GFCF) diet applied to autism and the potential importance of various comorbidity to the health and wellbeing of those on the autism spectrum, with a continuing research interest in these areas. Keen blogger and amateur science writer (but no formal qualifications in these areas). Science is based on probability.

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