Trajectories in Symptoms of Autism and Cognitive Ability in Autism From Childhood to Adult Life: Findings From a Longitudinal Epidemiological Cohort

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The lack of a significant change in the SRS raw scores indicates that the number of symptoms remains stable over time, although the type may alter. This stability contrasts with our findings in relation to IQ and is also at variance with a number of longitudinal studies reporting a reduction in autism symptoms from childhood through adolescence or adulthood, as measured on the ADI-R7x7Woodman, A.C., Smith, L.E., Greenberg, J.S., and Mailick, M.R. Change in autism symptoms and maladaptive behaviors in adolescence and adulthood: the role of positive family processes. J Autism Dev Disord. 2015;
45: 111–126
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In multivariate analyses, only the baseline SCQ and SDQ total problems scores remained predictive of intercept, with higher scores predicting greater autism symptoms. As the lifetime SCQ is another continuous measure of autism symptoms, albeit reflecting early development as well as contemporaneous state, its predictive relationship is unsurprising. The mechanism for the SDQ prediction is more speculative. Although people with autism are known to have higher rates of mental health problems, the link between scores on the two domains cross-sectionally is inconsistent.40x40Gadow, K.D., DeVincent, C.J., Pomeroy, J., and Azizian, A. Psychiatric symptoms in preschool children with PDD and clinic and comparison samples. J Autism Dev Disord. 2004;
34: 379–393
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Our finding that mainstream school placement was associated with a decrease in adult autism symptoms remained significant in both multivariate and propensity analysis aimed at accounting for possible confounding for factors influencing placement. This is consistent with other studies; in a latent profile analysis, the longitudinal Adolescents and Adults With Autism study showed that inclusive secondary education was linked to membership in a group with fewer autism symptoms over time (as well as higher adaptive function and lower maladaptive behavior) and with greater improvement over time.46x46Woodman, A.C., Smith, L.E., Greenberg, J.S., and Mailick, M.R. Contextual factors predict patterns of change in functioning over 10 years among adolescents and adults with autism spectrum disorders. J Autism Dev Disord. 2016;
46: 176–189
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A surprising negative finding was the absence of an effect of IQ on either intercept or slope in the final autism symptom model. In univariate analyses, higher IQ was associated with a relative improvement in autism symptoms but failed to survive multivariate analysis. Several studies have previously reported that higher IQ is linked to better adult outcomes specifically in terms of autism symptoms.28x28Billstedt, E., Gillberg, I.C., and Gillberg, C. Autism in adults: symptom patterns and early childhood predictors. Use of the DISCO in a community sample followed from childhood. J Child Psychol Psychiatry. 2007;
48: 1102–1110
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We found no relationship of language level to either intercept or slope of autism symptoms, despite wide variation in language ability. Several,28x28Billstedt, E., Gillberg, I.C., and Gillberg, C. Autism in adults: symptom patterns and early childhood predictors. Use of the DISCO in a community sample followed from childhood. J Child Psychol Psychiatry. 2007;
48: 1102–1110
Crossref | PubMed | Scopus (152)
| Google ScholarSee all References

For both outcomes, we found no evidence of an effect of the family variables, including maternal mental health problems, parental educational level, and neighborhood deprivation. However, factors that are potentially more precisely measured or more proximal, such as quality of parent–child relationships, have shown longitudinal prediction to reduced autism symptoms and maladaptive behaviors, albeit inconsistently,7x7Woodman, A.C., Smith, L.E., Greenberg, J.S., and Mailick, M.R. Change in autism symptoms and maladaptive behaviors in adolescence and adulthood: the role of positive family processes. J Autism Dev Disord. 2015;
45: 111–126
Crossref | PubMed | Scopus (44)
| Google ScholarSee all References

In summary, the finding that mean IQ increases from late childhood to adult life points to ongoing development in the second decade of life and the importance of future research to identify experiences and interventions promoting cognitive development in people with autism. In particular, the role of educational and social experiences, for both cognitive and social communicative development, in adolescence and adult life needs further study to improve our understanding of how best to support people with autism across the life span.

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