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8/18/2019 Outgrowing Autism_ a Closer Look at Children Who Read Early or Speak Late - Scientific American Blog Network
1/15
Guest Blog
Some of these children may never have had autism in the rst place, despite being diagnosed with it
Outgrowing Autism? A Cl oser Lookat Children Who Read Early or
Speak Late
By Darold A. Treffert on December 9, 2015
S U B S C R I B E
http://blogs.scientificamerican.com/guest-blog/outgrowing-autism-a-closer-look-at-children-who-read-early-or-speak-late/http://blogs.scientificamerican.com/guest-blog/outgrowing-autism-a-closer-look-at-children-who-read-early-or-speak-late/http://www.scientificamerican.com/author/darold-a-treffert1/http://blogs.scientificamerican.com/guest-blog/
8/18/2019 Outgrowing Autism_ a Closer Look at Children Who Read Early or Speak Late - Scientific American Blog Network
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For illustration purposes only. Abeleao ©iStock.com
The headlines read “New study suggests autism can be outgrown”, or
“outgrowing autism: a doctor’s surprise and wonder.” The stories are
A D V E RT I S E M E N T
8/18/2019 Outgrowing Autism_ a Closer Look at Children Who Read Early or Speak Late - Scientific American Blog Network
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based on studies reporting that 7-9% of children with a documented
early autistic syndrome disorder (ASD) have no symptoms of the
disorder on follow-up later in childhood or adolescence. That is good
news. The question is how to account for it.
Is it possible to simply “outgrow” autism? Was the initial diagnosis
wrong? Did some interventions work? Or might there be other
explanations for this welcome news?
"In an earlier column titled “Oops. When “autism” isn’t autistic
disorder,” I outlined three types of hyperlexia, or precocious reading
ability, which is sometimes an element of a diagnosis of ASD. Type 1 are
neurotypical children who simply read way ahead of their chronological
age. Listening to a 4 year old reading books to his or her nursery school
classmates is a startling experience.
Type 2 are children in which intense fascination with letters and
numbers, along with early reading and remarkable memory represent
‘splinter skills’ as a part of autistic syndrome disorder (ASD)
Type 3 are children who likewise show intense fascination and
preoccupation with numbers and letters very early, along with
precocious reading skills and remarkable memory. They do have
“autistic-like” symptoms or behaviors but those disappear over time as
the child gets older. The outcome in these children is much more
http://blogs.scientificamerican.com/mind-guest-blog/oops-when-autism-isnt-autistic-disorder-hyperlexia-and-einstein-syndrome/
8/18/2019 Outgrowing Autism_ a Closer Look at Children Who Read Early or Speak Late - Scientific American Blog Network
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positive than those with ASD to their benefit and the great relief of their
parents.
Following the “Oops” article I received numerous reports from parents
who identified with hyperlexia 3. “You just described my child,” the
puzzled, and relieved parents would write as they read the case
examples in my Wisconsin Medical Journal article in December, 2011. I
reviewed those reports and recently did an analysis of 165 of them withthe following findings:
In all the cases there had been a confusing journey of various
diagnoses, sometimes ASD/Aspergers or its variants, or else a wide
range of others from hyperactivity to anxiety disorder to speech
delay.
Age of onset of hyperlexia skills was 24.6 months
Age of first professional contact was 44 months
Certain features caught the parent’s attention in the hyperlexia 3
group as being different from ‘autism’ as usually described. For
example their child demonstrated less withdrawal, more eye contact,
the ability to seek and give affection and in general overall increased
social proficiency.
Additionally while some “autistic-like” behaviors were present such
as repetitive behaviors, insistence on sameness, occasional
stimming, echolalia and increased sensory sensitivity, those
https://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/110/6/281.pdf
8/18/2019 Outgrowing Autism_ a Closer Look at Children Who Read Early or Speak Late - Scientific American Blog Network
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It is impossible, of course, to make a diagnosis of the child based only
on parent description. But from reading those reports, many of them
very detailed, there was a clear impression that in some cases the
hyperlexia was indeed a “splinter skill” manifestation of autism
spectrum disorder (hyperlexia 2). But in many others, the increased
social proficiency particularly, and disappearance of many “autistic-
like” symptoms along with more positive outcomes suggested
placement in a separate, hyperlexia 3 group.
In all of medicine the first step in treatment is to make the correct
diagnosis. The only way to do that is with an in-person comprehensive
evaluation by a multi-disciplinary team, including developmental
specialists, neuropsychologists, and speech, language and occupationaltherapists, to name some. That will be the follow-up to this present
study.
symptoms disappeared as the child grew older
11 cases that mentioned adult outcomes indicated 9 persons were
attending college and having successful, independent lives. They
continued to be exceptional readers which helped their collegiate
performance and aided their careers. 2 cases were described as
needing supervision because of continued autistic characteristics
Having an ASD diagnosis applied to their child at any point was asource of great distress for all parents.
8/18/2019 Outgrowing Autism_ a Closer Look at Children Who Read Early or Speak Late - Scientific American Blog Network
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In the meantime, unfortunately, there continues to be a misconception
in the literature and on the internet, that hyperlexia is always part of
autism spectrum condition. That same misconception applies to
children who speak late (“Einstein syndrome”), as vividly pointed out in
Stephen Camarata’s book “Late-Talking Children: A Symptom or a
Stage?” His experience with children who speak late mirrors my
experience with children who read early.
While early diagnosis and intervention is to be applauded for children
with developmental issues of all sorts, caution is warranted when
applying an ASD diagnosis to children who read early or speak late, and
at least a differential diagnosis by those familiar with hyperlexia or
Einstein syndrome should be used until the natural history of the
disorder reveals, finally, its true nature.
When a child exhibits hyperlexia 2 or 3, the same intervention tools are
used to deal with the autistic, or autistic-like symptoms to the extent
they are present. But the distinction between hyperlexia 2 and 3
becomes a critical one when it comes to vital educational decisions and
placements. Hyperlexia 3 children do not do well in typical “special
education” classes, and require instead different placements. Hence the
cautious, informed diagnostic route.
Some will argue that the various interventions and treatments are
responsible for that 6-7% of children who “outgrow” their autism. That
b b b
8/18/2019 Outgrowing Autism_ a Closer Look at Children Who Read Early or Speak Late - Scientific American Blog Network
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may be true in some instances, but among my 165 cases are a number
of children, now adult, with sufficient outcome and follow-up to
conclude that those with what turned out to be hyperlexia 3 did not
have ASD in the first place, the initial diagnosis notwithstanding. In
these follow-up cases were a number of ‘success stories’ of very positive
outcomes from grateful parents. But one was a first person account
from a woman, now an adult, who recounted her journey with
hyperlexia 3, asking now that she is rid of the symptoms of autism, how does she get rid of the medical history of “autism” that follows her.
My position is that “outgrowing” autism is most often the situation in
which a diagnosis of ASD was prematurely and mistakenly applied,
especially in children who read early or spoke late. Granted that early
distinction can be a very difficult one since separating ‘’autistic-like”
symptoms from ASD itself can be difficult in those early years.
Hopefully as we study more children with hyperlexia or speaking late,
we will become better at that.
In the meantime a cautious differential diagnostic approach, along with
careful, watchful observation over time is advised especially when early
reading or late speaking are the presenting symptoms.
Those children who are in the hyperlexia 3 group do not “outgrow”
their autism. They did not have ASD in the first place. That is a
meaningful distinction between the two groups. Fortunately hyperlexia
3 hild d ll h l d h f i
8/18/2019 Outgrowing Autism_ a Closer Look at Children Who Read Early or Speak Late - Scientific American Blog Network
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3 children do very well over the long term and that, of course, is very
good news for them, their parents and the rest of us as well.
Meanwhile I will keep collecting reports from parents, which come to
me almost daily, for further analysis and study because the success
stories are very relevant and encouraging indeed.
References:
Camarata, S. (2015) Late-talking children: A symptom or a stage? MIT
Press Cambridge, MA
Fine, D et al (2013) Optimal outcome in individuals with a history of
autism Journal of Child Psychology and Psychiatry 54:195-205
Shulman, L Outgrowing autism: A doctor’s surprise and wonder The
Doctors Blog, Albert Einstein College of Medicine May 5, 2015
Treffert, D (2011) Hyperlexia 3: Separating ‘autistic-like’ behaviors
from Autistic Disorder; assessing children who read early or speak late
WMJ 110:281-286
The views expressed are those of the author(s) and are not necessarily those of Scientic American.
8/18/2019 Outgrowing Autism_ a Closer Look at Children Who Read Early or Speak Late - Scientific American Blog Network
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A B O U T T H E A U T H O R ( S )
Darold A. Treffert
Dr. Darold Treffert met his first savant in 1962 and has been intrigued
with those spectacular "islands of genius" seen in these extraordinary
people ever since. His work has appeared in several previous Scientific
A D V E RT I S E M E N T
American and MIND articles and it two books: Extraordinary People:
8/18/2019 Outgrowing Autism_ a Closer Look at Children Who Read Early or Speak Late - Scientific American Blog Network
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American and MIND articles and it two books: Extraordinary People:
Understanding Savant Syndrome (2006) and Islands of Genius: The
Bountiful Mind of the Autistic, Acquired and Sudden Savant (2010). He
also maintains an internationally respected website on savant syndrome,
autism and related conditions at www.savantsyndrome.com hosted by the
Wisconsin Medical Society.
Recent Articles
Accidental Genius
Tapping Your Inner Rain Man
Islands of Genius
L A T E S T N E W S
http://www.scientificamerican.com/article/islands-of-genius-2002-06/http://www.scientificamerican.com/article/tapping-your-inner-rain-man/http://www.scientificamerican.com/article/accidental-genius/https://www.wisconsinmedicalsociety.org/professional/savant-syndrome/
8/18/2019 Outgrowing Autism_ a Closer Look at Children Who Read Early or Speak Late - Scientific American Blog Network
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S U S T A I N A B I L I T Y
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S U S T A I N A B I L I T Y
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E V O L U T I O N
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P R E V I O U S
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