In 1987, psychologist Ole Ivar Lovaas from the University of Los Angeles created a program to conduct a study using Applied Behavioral Analysis (ABA), and treated 19 children with autism (Carpenter, 2015). Lovaas announced that nearly half of the children who participated in the program “recovered” from autism, no longer displaying any symptoms (Carpenter, 2015). However, his report has been scrutinized heavily for its ambiguity and lack of specificity, as it was most likely over-exaggerated. The study was unsuccessful in demonstrating that all autism symptoms had vanished, prompting skepticism about the plausibility of a “cure” to autism. Today, most clinicians and experts still agree that autism is a lifelong condition.
Autism Spectrum Disorder (ASD) is a complex neurological condition characterized by difficulties in social interactions, communication, and repetitive and unusual behaviors (Autism, 2024). Symptoms in early childhood include lack of eye contact, limited language and speech development, and difficulty in using or understanding body language (Autism, 2024). Because autism manifests differently across individuals, ranging from mild difficulties to significant impairments, autism is considered a spectrum disorder. The condition is often misunderstood and has several myths surrounding it, such as that autism is a disease.
Over the decades, significant research has focused on understanding the complexities of ASD. While Lovaas’ study certainly opened doors to exploration in the “recovery” of autism, a study published in the Journal of Child Psychology and Psychiatry further delved into this complex phenomenon (Fein et al., 2013). The research compared three groups: 34 optimal outcome (OO) individuals, 34 typically developing (TD) individuals, and 44 individuals with high-functioning autism (HFA) (Fein et al., 2013). The participants ranged from 8 to 21 years old to ensure a thorough examination of developmental changes (Fein et al., 2013). To further develop findings from previous research on the reduction of symptoms in autism, the goal of the study was to determine whether OO individuals, people who initially were diagnosed with autism and eventually lost the diagnosis, had truly “recovered” from ASD or if they still had small residual symptoms left. Researchers explored subtle differences between OO and TD individuals by examining specific communication, social interaction, and language behaviors. The study used a variety of tests to measure its participants, such as the Autism Diagnostic Observation Schedule (ADOS) and the Reyson Likability Scale (Fein et al., 2013). The ADOS was a major assessment used to diagnose Autism Spectrum Disorder. It involved direct observation of the individual and assessed communication and social interactions. The clinician would mainly observe the participant’s conversing, eye contact, engaging in play, and response to social cues. They desired to discover all the social and communication impairments in the OO group, rather than generalize that the OO individuals had completely lost all symptoms (Fein et al., 2013).
Using the specific tests available to the researchers and heavy analysis, the study determined that overall, OO individuals displayed no significant differences from their TD peers in domains of communication, language, facial recognition, or socialization. In most cases, they were perceived as even more approachable and friendly than TD individuals. Despite these similarities, OO individuals showed mild abnormalities in understanding social relationships, with 35% displaying some difficulties (Fein et al., 2013). They also reported less mature friendships compared to TD peers, indicating possible residual attentional and self-regulatory challenges. However, in comparison to individuals with HFA, OO individuals demonstrated significantly milder social symptoms. Unlike those with HFA, who scored poorly in communication aspects and repetitive behaviors, the test results of OO participants more frequently aligned with the patterns of TD individuals (Fein et al., 2013). In addition, this ground-breaking study highlighted differences across life stages, from childhood to early adolescence and young adulthood. In early childhood, OO individuals often exhibited mild ASD symptoms. Over time, researchers notice that the symptoms seem to evolve into subtler attentional, self-control, and immaturity difficulties, which were the major differences between the OO and the TD group. The study provided evidence that individuals with ASD in early childhood may resolve into attention related deficits, including ADHD. However, overall, OO participants clearly lost their ASD diagnosis and displayed few differences from their TD peers.
Despite the ground-breaking study done by Fein et al., the notion of “recovery” and finding a “cure” from autism remains divisive and controversial. Critics argue that using such hurtful words frames autism as a condition to be“overcome”, stigmatizing individuals with autism (Sarris, 2016). Instead, many advocate for the acceptance, appreciation, and accommodation that enable individuals with ASD to thrive without losing their unique characteristics. In fact, Fein’s use of the term “optimal outcome” instead of “recovery” reflects this belief, emphasizing the importance of acknowledging individual strengths and overcoming challenges (Sarris, 2016). Having autism does not indicate that there is something “wrong” with the individual, but rather that they are different and unique.
The findings from Fein’s research support the existence of optimal outcomes in a small minority of individuals previously diagnosed with autism. While they no longer meet the diagnostic criteria for autism anymore, they may still face subtle difficulties and challenges in social relationships and self-regulation. The possible lingering effects on OO individuals underscore the complexity of the autism spectrum and highlight the importance of further discovery and support of ASD. Fein suggests that future research should focus on comparing OO individuals with individuals with ADHD, as her study showed a possible correlation between a reduction of ASD symptoms and attention deficit (Fein et al., 2013). However, as research advances, a main goal should remain fostering environments that celebrate neurodiversity and provide accessible and specialized interventions and treatments for all individuals with ASD.
References
Carpenter, S. (2015). The children who leave autism behind. Spectrum. https://doi.org/10.53053/koyo9875
Fein, D., Barton, M., Eigsti, I.-M., Kelley, E., Naigles, L., Schultz, R.T., Stevens, M., Helt, M., Orinstein, A., Rosenthal, M., Troyb, E. and Tyson, K. (2013), Optimal outcome in individuals with a history of autism. Journal of Child Psychology and Psychiatry, 54: 195-205. https://doi.org/10.1111/jcpp.12037
Autism. (2024, October 1). Cleveland Clinic. Retrieved December 25, 2024, from https://my.clevelandclinic.org/health/articles/autism
Sarris, M. (2016, January 27). Road to "Recovery": What Does it Mean to Lose an Autism Diagnosis? Kennedy Krieger. Retrieved January 3, 2025, from https://www.kennedykrieger.org/stories/interactive-autism-network-ian/recovery-losing-autism-diagnosis
