Skip to main content

School-Aged Functioning of Children Diagnosed with Autism Spectrum Disorder Before Age Three: Parent-Reported Diagnostic, Adaptive, Medication, and School Placement Outcomes

Journal of Autism and Developmental Disorders volume 44, pages 1357–1372 (2014)Cite this article

Abstract

Eighty children with early autism spectrum disorder (ASD) diagnoses (under 36 months) were identified using a chart abstraction protocol applied to early intervention charts. Parents filled out questionnaires by mail when the children were school-aged (ages 6–16 years). Similar to previous studies, approximately 20 % no longer had ASD diagnoses; the other participants were assigned to Moderate/Severe versus Mild ASD outcome groups. These three groups were compared across several variables, including diagnostic features and functional features including adaptive behavior, social experiences, medication use, and school placement. The findings expand our knowledge about outcomes in longitudinal studies of children with ASD, as well as provide support for using relatively indirect methods (chart review, parent questionnaire) to gather this type of information.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  • Akshoomoff, N. A., Stahmer, A. C., Corsello, C., & Mahrer, N. E. (2010). What happens next? Follow-up from the children’s toddler school program. Journal of Positive Behavior Interventions, 12, 245–253.

    PubMed Central  PubMed  Article  Google Scholar 

  • Aman, M. G., Lam, K. L., & Collier-Crespin, A. (2003). Prevalence and patterns of use of psychoactive medicines among individuals with autism in the Autism Society of Ohio. Journal of Autism and Developmental Disorders, 33, 527–534. doi:10.1023/A:1025883612879.

    PubMed  Article  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (text revision, 4th ed.). Washington, DC: Author.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

    Google Scholar 

  • Arnold, L., Aman, M. G., Cook, A. M., Witwer, A. N., Hall, K. L., Thompson, S., et al. (2006). Atomoxetine for hyperactivity in autism spectrum disorders: Placebo-controlled crossover pilot trial. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1196–1205. doi:10.1097/01.chi.0000231976.28719.2a.

    PubMed  Article  Google Scholar 

  • Avchen, R., Wiggins, L. D., Devine, O., Van Naarden Braun, K., Rice, C., Hobson, N. C., et al. (2011). Evaluation of a records-review surveillance system used to determine the prevalence of autism spectrum disorders. Journal of Autism and Developmental Disorders, 41, 227–236. doi:10.1007/s10803-010-1050-7.

    PubMed  Article  Google Scholar 

  • Boyd, B. A., Odom, S. L., Humphreys, B. P., & Sam, A. M. (2010). Infants and toddlers with autism spectrum disorder: Early identification and early intervention. Journal of Early Intervention, 32(2), 75–98. doi:10.1177/1053815110362690.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2007). Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, 14 sites, United States, 2002. Morbidity and Mortality Weekly Report, 56, 12–28.

    Google Scholar 

  • Centers for Disease Control and Prevention. (2009). Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, United States, 2006. Morbidity and Mortality Weekly Report, 58, 1–24.

    Google Scholar 

  • Centers for Disease Control and Prevention. (2012). Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, 14 sites, United States, 2008. Morbidity and Mortality Weekly Report, 61, 1–19.

    Google Scholar 

  • Charman, T., Taylor, E., Drew, A., Cockerill, R., Brown, J., & Baird, G. (2005). Outcome at 7 years of children diagnosed with autism at age 2: Predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time. Journal of Child Psychology and Psychiatry, 46, 500–513. doi:10.1111/j.1469-7610.2004.0037.x.

    PubMed  Article  Google Scholar 

  • Chawarska, K., Klin, A., Paul, R., Macari, S., & Volkmar, F. (2009). A prospective study of toddlers with ASD: Short-term diagnostic and cognitive outcomes. The Journal of Child Psychology and Psychiatry, 50(10), 1235–1245. doi:10.1111/j.1469-7610.2009.02101.x.

    Article  Google Scholar 

  • Cicchetti, D., Bronen, R., Spencer, S., Haut, S., Berg, A., Oliver, P., et al. (2006). Rating scales, scales of measurement, issues of reliability: Resolving some critical issues for clinicians and researchers. Journal of Nervous and Mental Disease, 194, 557–564. doi:10.1097/01.nmd.0000230392.83607.c5.

    PubMed  Article  Google Scholar 

  • Cicchetti, D. V., & Heavens, R. (1981). A computer program for determining the significance of the difference between pairs of independently derived values of kappa or weighted kappa. Educational and Psychological Measurement, 41, 189–193. doi:10.1177/001316448104100119.

    Article  Google Scholar 

  • Cicchetti, D. V., & Sparrow, S. A. (1981). Developing criteria for establishing interrater reliability of specific items: Applications to assessment of adaptive behavior. American Journal of Mental Deficiency, 86, 127–137.

    PubMed  Google Scholar 

  • Cohen, H., Amerine-Dickens, M., & Smith, T. (2006). Early intensive behavioral treatment: Replication of the UCLA model in a community setting. Journal of Developmental and Behavioral Pediatrics, 27, S145–S162.

    PubMed  Article  Google Scholar 

  • Cox, A., Klein, K., Charman, T., Baird, G., Baron-Cohen, S., Swettenham, J., et al. (1999). Autism spectrum disorders at 20 and 42 months of age: Stability of clinical and ADI-R diagnosis. Journal of Child Psychology and Psychiatry, 40, 719–732.

    PubMed  Article  Google Scholar 

  • Donner, A., & Eliasziw, M. (1992). A goodness-of-fit approach to inference procedures for the kappa statistic: Confidence interval construction, significance testing and sample size estimation. Statistics in Medicine, 11, 1151–1519.

    Article  Google Scholar 

  • Eaves, L., & Ho, H. (1997). School placement and academic achievement in children with autistic spectrum disorders. Journal of Developmental and Physical Disabilities, 9, 277–291.

    Article  Google Scholar 

  • Eaves, L. C., & Ho, H. H. (2004). The very early identification of autism: Outcome to age 4 ½–5. Journal of Autism and Developmental Disorders, 34, 367–378.

    PubMed  Article  Google Scholar 

  • Fein, D., Barton, M., Eigsti, I., Kelley, E., Naigles, L., Schultz, R. T., et al. (2013). Optimal outcome in individuals with a history of autism. Journal of Child Psychology and Psychiatry, 54, 195–205.

    PubMed Central  PubMed  Article  Google Scholar 

  • Fein, D., Dixon, P., Paul, J., & Levin, H. (2005). Brief report: Pervasive developmental disorder can evolve into ADHD: Case illustrations. Journal of Autism and Developmental Disorders, 35, 525–534. doi:10.1007/s10803-005-5066-3.

    PubMed  Article  Google Scholar 

  • Fleiss, J. L. (1981). Balanced incomplete block designs for inter-rater reliability studies. Applied Psychological Measurement, 5, 105–112. doi:10.1177/014662168100500115.

    Article  Google Scholar 

  • Fombonne, E. E. (2002). Epidemiological trends in rates of autism. Molecular Psychiatry, 7, S4–S6. doi:10.1038/sj.mp.4001162.

    PubMed  Article  Google Scholar 

  • Gillberg, C., Ehlers, S., Schaumann, H., Jakobsson, G., Dahlgren, S., Lindblom, R., et al. (1990). Autism under age 3 years: A clinical study of 28 cases referred for autistic symptoms in infancy. Journal of Child Psychology and Psychiatry, 31(6), 921–934. doi:10.1111/j.1469-7610.1990.tb00834.x.

    PubMed  Article  Google Scholar 

  • Gilliam, J. E. (1995). Gilliam Autism Rating Scale. Austin, TX: Pro-Ed.

    Google Scholar 

  • Harris, S. L., & Handleman, J. S. (2000). Age and IQ at intake as predictors of placement for young children with autism: A four-to-six-year follow-up. Journal of Autism and Developmental Disorders, 30, 137–142.

    PubMed  Article  Google Scholar 

  • Helt, M., Kelley, E., Kinsbourne, M., Pandey, J., Boorstein, H., Herbert, M., et al. (2008). Can children with autism recover? If so, how? Neuropsychology Review, 18, 339–366. doi:10.1007/s11065-008-9075-9.

    PubMed  Article  Google Scholar 

  • Jonsdottir, S. L., Saemundsen, E., Asmundsdottir, G., Hjartardottir, S., Asgeirsdottir, B. B., Smaradottir, H. H., et al. (2007). Follow-up of children diagnosed with pervasive developmental disorders: Stability and change during the preschool years. Journal of Autism and Developmental Disorders, 37, 1361–1374. doi:10.1007/s10803-006-0282-z.

    PubMed  Article  Google Scholar 

  • Kelley, E., Paul, J. J., Fein, D., & Naigles, L. R. (2006). Residual language deficits in optimal outcome children with a history of autism. Journal of Autism and Developmental Disorders, 36, 807–828. doi:10.1007/s10803-006-0111-4.

    PubMed  Article  Google Scholar 

  • Kleinman, J. M., Ventola, P. E., Pandey, J., Verbalis, A. D., Barton, M., Hodgson, S., et al. (2008). Diagnostic stability in very young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 606–615. doi:10.1007/s10803-007-0427-8.

    PubMed Central  PubMed  Article  Google Scholar 

  • Kogan, M. D., Blumberg, S. J., Schieve, L. A., Boyle, C. A., Perrin, J. M., Ghandour, R. M., et al. (2009). Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007. Pediatrics, 124, 1395–1403. doi:10.1542/peds.2009-1522.

    PubMed  Article  Google Scholar 

  • Logan, S. L., Nicholas, J. S., Carpenter, L. A., King, L. B., Garrett-Mayer, E., & Charles, J. M. (2012). High prescription drug use and associated costs among Medicaid-eligible children with autism spectrum disorders identified by a population-based surveillance network. Annals of Epidemiology, 22, 1–8. doi:10.1016/j.annepidem.2011.10.007.

    PubMed Central  PubMed  Article  Google Scholar 

  • Lord, C. (1995). Follow-up of two-year-olds referred for possible autism. Journal of Child Psychology and Psychiatry, 36, 1365–1382. doi:10.1111/j.1469-7610.1995.tb01669.x.

    PubMed  Article  Google Scholar 

  • Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., & Pickles, A. (2006). Autism from 2 to 9 years of age. Archives of General Psychiatry, 63, 694–701.

    PubMed  Article  Google Scholar 

  • Malhi, P., & Singhi, P. (2011). Follow up of children with autism spectrum disorders: Stability and change in diagnosis. Indian Journal of Pediatrics, 78, 941–945.

    Google Scholar 

  • Martin, A., Scahill, L., Klin, A., & Volkmar, F. R. (1999). Higher-functioning pervasive developmental disorders: Rates and patterns of psychotropic drug use. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 923–931. doi:10.1097/00004583-199907000-00024.

    PubMed  Article  Google Scholar 

  • Michelotti, J., Charman, T., Slonims, V., & Baird, G. (2002). Follow-up of children with language delay and features of autism from preschool years to middle childhood. Developmental Medicine and Child Neurology, 44, 812–819. doi:10.1017/S0012162201002985.

    PubMed  Article  Google Scholar 

  • Moore, V., & Goodson, S. (2003). How well does early diagnosis of autism stand the test of time? Follow-up study of children assessed for autism at age 2 and development of an early diagnostic service. Autism, 7, 47–63. doi:10.1177/1362361303007001005.

    PubMed  Google Scholar 

  • Moss, J., Magiati, I., Charman, T., & Howlin, P. (2008). Stability of the autism diagnostic interview-revised from preschool to elementary age in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 1081–1091. doi:10.1007/s10803-007-0487-9.

    PubMed  Article  Google Scholar 

  • Rondeau, E., Klein, L. S., Masse, A., Bodeau, N., Cohen, D., & Guilé, J. (2011). Is pervasive developmental disorder not otherwise specified less stable than autistic disorder? A meta-analysis. Journal of Autism and Developmental Disorders, 41, 1267–1276. doi:10.1007/s10803-010-1155-z.

    PubMed  Article  Google Scholar 

  • Rosenberg, R. E., Kaufmann, W. E., Law, J., & Law, P. A. (2011). Parent report of community psychiatric comorbid diagnoses in autism spectrum disorders. Autism Research & Treatment, 1–10. doi:10.1155/2011/405849.

  • Rosner, B. (1995). Fundamentals of biostatistics. Belmont, CA: Duxbury Press.

    Google Scholar 

  • Scambler, D., Hepburn, S., & Rogers, S. (2006). A two-year follow-up on risk status identified by the checklist for autism in toddlers. Journal of Developmental and Behavioral Pediatrics, 27, S104–S110.

    PubMed  Article  Google Scholar 

  • Schopler, E., Reichler, R. J., & Renner, B. R. (1988). Childhood Autism Rating Scale. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Smith, T., Groen, A., & Wynn, J. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105, 269–285.

    PubMed  Article  Google Scholar 

  • Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (1984). Vineland Adaptive Behavior Scales. Circle Pines, MN: American Guidance Services.

    Google Scholar 

  • Sparrow, S., Cicchetti, D., & Balla, D. (2005). Vineland Adaptive Behavior Scales-II (Survey Form). Circle Pines, MN: American Guidance Services.

    Google Scholar 

  • Stone, W. L., Lee, E. B., Ashford, L., Brissie, J., Hepburn, S. L., Coonrod, E. E., et al. (1999). Can autism be diagnosed accurately in children under 3 years? Journal of Child Psychology and Psychiatry, 40, 219–226.

    PubMed  Article  Google Scholar 

  • Sutera, S., Pandey, J., Esser, E. L., Rosenthal, M. A., Wilson, L. B., Barton, M., et al. (2007). Predictors of optimal outcome in toddlers diagnosed with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37, 98–107. doi:10.1007/s10803-006-0340-6.

    PubMed  Article  Google Scholar 

  • Szatmari, P., Bryson, S. E., Streiner, D. L., Wilson, F., Archer, L., & Ryerse, C. (2000). Two-year outcome of preschool children with autism or Asperger’s syndrome. The American Journal of Psychiatry, 157, 1980–1987. doi:10.1176/appi.ajp.157.12.1980.

    PubMed  Article  Google Scholar 

  • Towle, P., Visintainer, P., O’Sullivan, C., Bryant, N., & Busby, S. (2009). Detecting autism spectrum disorder from early intervention charts: Methodology and preliminary findings. Journal of Autism and Developmental Disorders, 39, 444–452. doi:10.1007/s10803-008-0643-x.

    PubMed  Article  Google Scholar 

  • Turner, L. M., & Stone, W. L. (2007). Variability in outcome for children with an ASD diagnosis at age 2. Journal of Child Psychology and Psychiatry, 48, 793–802. doi:10.1111/j.1469-7610.2007.01744.x.

    PubMed  Article  Google Scholar 

  • Turner, L. M., Stone, W. L., Pozdol, S. L., & Coonrod, E. E. (2006). Follow-up of children with autism spectrum disorders from age 2 to age 9. Autism, 10, 243–265. doi:10.1177/1362361306063296.

    PubMed  Article  Google Scholar 

  • van Daalen, E., Kemner, C., Dietz, C., Swinkels, S. N., Buitelaar, J. K., & van Engeland, H. (2009). Inter-rater reliability and stability of diagnoses of autism spectrum disorder in children identified through screening at a very young age. European Child and Adolescent Psychiatry, 18, 663–674. doi:10.1007/s00787-009-0025-8.

    PubMed Central  PubMed  Article  Google Scholar 

  • White, S. W., Scahill, L., Klin, A., Koenig, K., & Volkmar, F. R. (2007). Educational placements and service use patterns of individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37, 1403–1412. doi:10.1007/s10803-006-0281-0.

    PubMed  Article  Google Scholar 

  • Wiggins, L. D., Robins, D. L., & Yeargin-Allsopp, M. (2013). Short report: Improving record—Review surveillance of young children with an autism spectrum disorder. Autism, 17, 623–629. doi:10.1177/1362361312452161.

    PubMed  Article  Google Scholar 

  • Woolfenden, S., Sarkozy, V., Ridley, G., & Williams, K. (2012). A systematic review of the diagnostic stability of autism spectrum disorder. Research In Autism Spectrum Disorders, 6, 345–354.

    Article  Google Scholar 

Download references

Acknowledgments

This work was done while the first author was supported by Grant # T73MC04320 from Department of Health and Human Services Health Resources and Services Administration. It was also part of a doctoral dissertation completed by Karyn Vacanti-Shova, Fordham University. We are grateful for the assistance of graduate students participating on the first author’s research team while completing their Leadership Education in Neurodevelopmental Disabilities fellowship at the Westchester Institute for Human Development.

Author information

Author notes

  1. Karyn Vacanti-Shova

    Present address: Stepping Stones Learning Center, Rochester, NY, USA

  2. Shristi Shah

    Present address: Department of Psychiatry, Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA

Affiliations

  1. Westchester Institute for Human Development, Cedarwood Hall, Valhalla, NY, 10538, USA

    Patricia O. Towle, Karyn Vacanti-Shova & Shristi Shah

  2. School of Health Science and Practice, New York Medical College, Valhalla, NY, USA

    Patricia O. Towle

  3. Department of Psychology, Fordham University, Bronx, NY, USA

    Karyn Vacanti-Shova & Ann Higgins-D’alessandro

Authors
  1. Patricia O. Towle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karyn Vacanti-Shova
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shristi Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ann Higgins-D’alessandro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patricia O. Towle.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Towle, P.O., Vacanti-Shova, K., Shah, S. et al. School-Aged Functioning of Children Diagnosed with Autism Spectrum Disorder Before Age Three: Parent-Reported Diagnostic, Adaptive, Medication, and School Placement Outcomes. J Autism Dev Disord 44, 1357–1372 (2014). https://doi.org/10.1007/s10803-013-1997-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-013-1997-2

Keywords

  • Autism
  • ASD
  • Early diagnosis
  • Longitudinal
  • School-age
  • School placement
  • Adaptive behavior
  • Medication use