By Brian Udell, M.D.
As in any medical condition, it is entirely fair for parents to inquire about the timing of improvements, after undertaking biomedical intervention to improve signs and symptoms in their children who are affected with ASD. “How will we know if it’s working? When will my child get better?”
Factors affecting speed of recovery
How severely the child scores, according a standardized test for autism, is a major factor in assessing the time it may take for reversal of symptoms. For those in denial, this can be a wake-up call. For the parent who ‘already knew’, it represents a starting point. The time that it will take to observe improvement is generally proportional; from mildly affected to very disturbed development, taking from 6 months to many years until improvement is noted.
Perhaps interestingly, children who score very ‘low’ (few autistic characteristics) may turn out to take more time than might be expected. That could be due to the mysterious nature of their particular developmental delay, and ‘putting our finger’ on how to address individual obstacles takes investigation and various trials.
The degree of a child’s inability to communicate – from the severity of speech apraxia to social isolation – is proportional to the time it will take for advancement. Whether due to biomedical intervention, or just maturation, it becomes extremely worrisome if this achievement takes more than 18 months. After initiating biomedical intervention, kids who simply begin to even copy the therapist will make faster gains.
Self-injurious behaviors and aggression greatly impede advancement in all domains. Such conduct is frequently gut-related, so a thorough workup and effective treatment should take precedence over any other interventions. The time it takes to get this system under control is predictive of speedier success.
Factors not necessarily related to timing of improvement
Intelligence is not in question for most patients. In fact, it seems that the brightest kids are the most likely to manipulate their family and therapists, sometimes slowing down their own improvement. Often, behavioral intervention (of some type) is key to achieving compliance and self-control.
Sensory issues may continue for many years, even after the children are mostly ‘better’. In fact, this may be the lingering issue for which parents seek treatment, and a major cause of inattention and social anxiety.
Immaturity is common, leading to tantrums and issues with self-control, and proceeds slower than neurotypical children. Peer pressure from role models and family members accelerates this troublesome problem.
It is sometimes difficult to get our heads around the chronicity of this developmental condition. All children experience good days/ bad days; it appears exaggerated with ASD, and some medical problems recur (yeast, e.g.).
When first diagnosed, if a parent could be certain that their child may only experience leftover sensory, hyperactive, or focus issues, they would probably be okay with that future. Not all patients suffer even those lingering difficulties.
Many families have witnessed accelerated development resulting from biomedical intervention. Parents, teachers, and even doctors will avow visible progress.
Autism is a collection of conditions that emanate from a variety of sources. As the diagnosis becomes more precise, outcomes will be based on information, such as genetics, metabolism, and immune function, and expected outcomes will become more accurate, as well.
I advise parents to watch for little goals. ‘Recovery’, ‘reversal’, ‘optimal outcome’, ‘normal’ are journeys that begin with small steps.
Frustrating as it may be, regardless of speed, it is the sustained, forward trajectory of development that appears to be of upmost importance as parents consider, “Will my child make it?”