Original Article When an Early Diagnosis of Autism Spectrum Disorder Resolves, What Remains? Lisa Shulman, MD 1 , Erin D’Agostino, BA 2 , Samantha Lee, BA 3 , Maria Valicenti-McDermott, MD, MS 1 , Rosa Seijo, MD 1 , Elizabeth Tulloch, PhD 1 , Deborah Meringolo, MA, MS 1 , and Nancy Tarshis, MA, MS, CCC/SLP 1 Abstract A chart review was performed of 38 children diagnosed with autism spectrum disorder (ASD) by 3 years of age at an inner-city developmental program who subsequently experienced resolution of ASD symptomatology and no longer met diagnostic criteria for ASD at follow-up an average of 4 years later. Demographic, developmental/cognitive data, Childhood Autism Rating Scale, and Autism Diagnostic Observation Schedule data as available were reviewed from the initial diagnostic evaluation and at the time of follow-up. Services received by the children between the time of diagnosis and follow-up, educational setting at the time of follow- up, and emotional/behavioral and learning diagnoses made by the multidisciplinary team at follow-up were reviewed. The findings indicate that residual emotional/behavioral and learning problems were present at follow-up in the vast majority of children in this group and that the majority continued to require educational support. Keywords optimal outcomes, autism recovery, residual effects Received July 12, 2018. Received revised January 6, 2019. Accepted for publication February 6, 2019. Although autism spectrum disorder (ASD) has generally been considered a lifelong condition, it has been acknowl- edged for more than 40 years that some individuals with an early diagnosis of ASD do not meet criteria for the diag- nosis at a later age. 1-3 Lovaas used the term recovery to characterize the outcome of this group of children who received intensive behavioral intervention and later could be educationally mainstreamed and had average Intelligence Quotient (IQ). 2 The term optimal outcome was coined by Fein to characterize a group of 34 individuals with early ASD whose later social functioning could not be distin- guished from typical controls and who appeared to be cured of ASD. 4 Follow-up studies have spoken of varying degrees of learn- ing or emotional vulnerability that continue in the “positive outcome” populations, including attention problems 5-7 and lan- guage problems. 8,9 More recently, a long-term follow-up study of 198 children diagnosed with ASD at ages 2 to 4.5 years found that 17 children no longer met the criteria for ASD at the 2-year follow-up. Later, when the children were about 10 years of age, parents were interviewed by phone regarding the children’s school age needs. Based on parent report, all 17 children continued to have some type of ongoing developmen- tal and/or neuropsychiatric challenge. 10 The goals of the current study were to further characterize the residual learning, cognitive, and emotional/behavioral diag- noses as well as the range of educational supports required at school age in a group of children with a history of an early diagnosis of ASD that resolved. Methods The setting for the current study was a university-affiliated inner-city diagnostic Early Intervention program where children with develop- mental disabilities continue to be followed and receive intervention through adulthood. The clinical database indicated that 569 children 1 Department of Pediatrics, Rose F. Kennedy Center Children’s Evaluation and Rehabilitation Center, Albert Einstein College of Medicine/Montefiore, Bronx, NY, USA 2 Geisel School of Medicine at Dartmouth, Lebanon, NH, USA 3 Children’s Hospital of Philadelphia, Philadelphia, PA, USA Corresponding Author: Lisa Shulman, MD, Department of Pediatrics, Rose F. Kennedy Center Children’s Evaluation and Rehabilitation Center, Albert Einstein College of Medicine/Montefiore, 1225 Morris Park Ave, First floor, Bronx, NY 10461, USA. Email: Lisa.shulman@einstein.yu.edu Journal of Child Neurology 1-5 ª The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0883073819834428 journals.sagepub.com/home/jcn