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Growing out of autism?

by on 2013/09/23

Recent coverage of a study that has examined communication problems in children with high functioning autism spectrum disorder (ASD) has led to the conclusion that children with the disorder can outgrow their communication problems. When we actually look at the study itself, however, it is not designed to make such definitive conclusions.

Who conducted the study and what did they do?

Eight authors from different institutions published the study in the Journal Cerebral Cortex, on August 28, 2013. The first and corresponding author John J. Foxe, is based at the Department of Pediatrics, Albert Einstein College of Medicine, New York.

John J. Foxe, Sophie Molholm, Victor A. Del Bene, Hans-Peter Frey, Natalie N. Russo, Daniella Blanco, Dave Saint-Amour, & Lars A. Ross (in press). ‘Severe Multisensory Speech Integration Deficits in High-Functioning School-Aged Children with Autism Spectrum Disorder (ASD) and Their Resolution During Early Adolescence’. Cerebral Cortex. doi: 10.1093/cercor/bht213

The researchers examined ‘multisensory speech integration’ (observing the speaker’s face as they talk, which is believed critical to normal communication)  in subgroups of children with high functioning autism aged 7-9, 10-12, and 13-15. While they found robust and relatively severe deficits in multisensory speech perception in younger children with ASD, no evidence of such impairment was observed in children with ASD in the 13-15 years age group.          

What are the limitations of this study?  

The study employed a cross-sectional design meaning that the same group of children weren’t followed up over time – so the differences between the younger children and the teenage sample reflected differences between different children. This means that differences between them therefore may not have just been down to age.

While the researchers had an initial sample of 84 children with ASD, exclusion of younger children in analyses and the division of the sample into 3 age groups for analyses meant that comparisons were based on around 20 children in each group.  With a relatively small sample size such as this, differences between the children other than age are very likely to have influenced the results in a design where different children are compared to each other (between subjects design) rather than the same children who are studied over time (within subjects design).

Analyses are restricted to an assessment of how children with ASD performed as a group. ASD is a highly heterogeneous disorder – which means that children show huge variability in various aspects of functioning. It may be that a small number of the children in the group of 21 children aged 13-15 years with ASD drove this finding, rather than all 21 showing improvement in multisensory speech perception. The analyses conducted do not allow us to determine whether a few members or all of the sample members were responsible for this finding of intact functioning in this area of communication by age 13.

Media reporting on the study     

Several media outlets (e.g. Science Daily) reported the study as showing evidence that children with autism can outgrow difficulties they have with understanding visual cues and sounds. The Examiner omitted the ‘can’ and reported more directly that ‘High Functioning Kids With Autism Outgrow Communication Problems’. The study is not designed to allow this definitive conclusion. Various groups e.g. the British Psychological Society made submissions to the Leveson Inquiry that raised concerns about the press coverage given to vulnerable groups such as those with mental health issues and disabilities. Particular care needs to be taken when reporting on research with vulnerable groups, such as children with ASD. This is imperative when headlines are used that are potentially misleading about key characteristics of a disorder/condition.   The Science Media Centre guidelines specifically warn about the care needed in reporting headlines.

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