Developmental course-outcome: Stability and change in clinical and psychosocial functioning of individuals with autism spectrum disorders

Autism is a neurodevelopmental disorder with lifelong consequences. At the same time, it is presented with a vast variety both on the level of clinical expression and the co-occurrence of abilities and disabilities. Follow up and outcome studies of individuals with autism spectrum disorders are necessary in order to obtain valuable information about prognosis, important clinical aspects as well as their long-term needs. The outcome should be evaluated using standardized measures in several parameters such as language, cognition, behavioural and psychosocial functioning. Although this is an old issue, such studies fulfilling current research criteria on well diagnosed representative samples are relatively few. Comparison between studies is also difficult because of the heterogeneity of subjects, the variability of outcome measures used, and other problems of research design.

Several studies have shown that, in cases where autism coexists with mental retardation, considerable impairments and limitations of psychosocial functioning are expected to persist, and in this case, the outcome is characterized in general as "poor". On the other hand, the quality of life that these individuals can have - provided they are given the constant and suitable family support, accommodation and special education-should be considered as a different issue.

More recent research has focused on individuals with higher functioning. The findings of one of the largest systematic follow-up studies showed that individuals with an IQ of at least 70 have a better chance of living independently as they reach adulthood. Nevertheless, the findings also showed that above this IQ level, outcome can still be very variable. These and other findings indicating stability and change in symptomatology and adaptive functioning during the course are presented. There is also a need for more prospective studies, particularly on children with Asperger syndrome.

Besides, several behavioural complications may occur in adolescence and early adulthood. These may arise from the condition itself (exaggeration of symptoms, psychosocial problems because of increased social demands etc.) or may indicate complication with another psychiatric disorder. Comorbidity is not uncommon particularly in individuals with higher functioning. Referring to clinical reports and experience, some of these clinical problems, including aspects of differential diagnosis and treatment are discussed.

Finally, as children grow up, continuity of care and clinical understanding are very important in order to reach suitable adjustments and to cope with these current needs and difficulties, regardless of severity.

Key words: ┴utism, outcome, developmental course, clinical complications, comorbidity.