Recovery

We Have Seen Recovery

Recovery from autism is still a controversial topic, and many in the autism field are still afraid to discuss it. We at CARD have seen recovery for decades, and we make it happen for some of the individuals who we treat. We are not the only ones. Treatment providers all over the country, who have been doing top-quality ABA treatment for individuals with autism for a minimum of 30 hours per week for two or more years, have been recovering individuals for years.

What do we mean when we say an individual has recovered from autism?

At CARD, when we say a individual has recovered from autism we mean that the individual no longer displays clinically significant impairments related to autism. In other words, there is nothing left to treat, and the individual is doing just fine. Of course, it’s not enough just to take our word for it, so here is how we measure it. There are three main pieces to how we measure recovery from autism:

  • The individual scores in the average range or higher on valid standardized tests of intelligence, language, socialization, and daily living skills
  • The individual is earning passing grades in a regular education classroom, with no specialized supports, whatsoever
  • The individual is evaluated by a medical doctor or psychologist who is an expert in diagnosing autism, and the clinician’s conclusion is that the individual no longer qualifies for any diagnosis on the autism spectrum

You may have noticed that we use the word recovery in some of the marketing and public relations materials for CARD and Skills®, and you might be wondering if we are saying that CARD services or Skills® is going to recover individually. We are not saying that, and there is currently no guarantee that any treatment in the world can recover individually from autism. Skills® is the best quality multidisciplinary system in the world for designing treatment plans and tracking progress in ABA programs. Top-quality, early intensive ABA treatment is what brings about recovery in some portion of individuals with autism, so if your team is using Skills® and your team is doing professional-quality ABA treatment, starting before the age of 4, with 30 or more hours per week of therapy, continuing for 2 or more years, your individual may have a chance at recovery.

Any scientists reading this might be wondering about the research. Every single published study on the outcomes of behavioral intervention for individuals with autism, that included a control group, that started treatment before the age of 5, implemented more than 25 hours per week of treatment, and that continued treatment for 2 or more years, reported that at least some of their participants achieved functioning in the average range on at least some of their outcome measures. In most of these studies, some percentage of the individuals achieved average functioning on all of the outcomes. More scientifically rigorous research is still needed on recovery from autism, and it is currently underway here at CARD and at a few other centers, but the evidence currently available already strongly supports recovery.

Some people acknowledge that individuals with autism may be able to achieve a completely non-impaired functioning, but they believe the individuals must still have autism. If the individual no longer qualifies for the diagnosis and does not have any challenges left for us to treat (other than any other typically developing individual might), then it’s difficult to see the value in maintaining an autism diagnosis. There may well be something still different biologically or physiologically, but if there is no longer any clinically significant impairment in language, socialization, and stereotyped behavior, then the individual no longer has autism, even if the individual has some sort of impaired physiology.

Another issue that needs to be discussed is that by recovering individuals from autism, we are not removing their unique perspectives on life or their unique personality. We are simply teaching skills, providing tools, and creating opportunities. We are not trying to make anyone “normal”; we don’t even believe in normal. We believe in teaching skills that make every individual stronger and more independent.

Unfortunately, right now, the research has not been done, yet, to allow us to predict exactly who will recover and who will not. As long as we are able to start intensive treatment, and by intensive we mean 30 or more hours per week, before the age of 5 or so, we are aiming for recovery with every individual. We know we will not achieve it in every case, but the worst possible outcome is that the individual learns lots of useful life skills. The fact that most individuals will still not recover from autism does not mean they do not deserve a shot at getting the best treatment possible and learning the most they can.

Butter, E. M., Mulick, J. A., Metz, B., et al. (2006). Eight case reports of learning recovery in children with pervasive developmental disorders after early intervention. Behavioral Interventions, 21, 227-243.

Fein, D., Barton, M., Eigsti, I., Kelley, E., Naigles, L., Schultz, R., Stevens, M., Helt, M., Orinstein, A., Rosenthal, M., Troyb, E., &, Tyson, K. (2013). Optimal outcome in individuals with a history of autism. Journal of Child Psychology and Psychiatry, DOI: 10.1111/jcpp.12037.

Granpeesheh, D. (2008). Recovery from autism: Learning why and how to make it happen more. Autism Advocate, 50, 54-58.

Granpeesheh, D., Tarbox, J., Dixon, D., Carr, E., & Herbert, H. (2009). Retrospective Analysis of Clinical Records in 38 Cases of Recovery from Autism. Annals of Clinical Psychiatry, 21, 195-204.

Helt, M., Kelley, E., Kinsbourne, M., et al. (2008). Can children with autism recover? If so, how? Neuropsychology Review, 18, 339-366.

Kelley, E., Naigles, L., & Fein, D. (2010). An in-depth examination of optimal outcome in children with a history of autism spectrum disorders. Research in Autism Spectrum Disorders, 4, 526–538.