Friday, 1 August 2014

Restricted and repetitive behaviours disappeared? More optimal outcome and autism

Today I'm bringing to your attention the paper by Eva Troyb and colleagues [1] and the quite dramatic assertion: "Reports of current behavior indicated that RRB's [restricted and repetitive behaviors] had almost totally disappeared in the OO [optimal outcomes] group". RRBs just in case you might not know include quite an array of behaviours, some of which might not be considered 'disabling' such as the presence of certain circumscribed interests. Others, such as an insistence of sameness and the presence of often rigid routines, can have a rather more profound effect on quality of life.
Where's my hat? @ Wikipedia 

For those who might not know, optimal outcome in relation to cases of autism spectrum disorder (ASD) refers to the idea that for some (emphasis on some) diagnosed as being on the autism spectrum, the label of autism or ASD is not as immutable as was once thought. The latest Troyb paper adds to a growing body of literature in this area coincidentally talked about in this piece appearing recently in the New York Times.

I've covered this emerging area of work for some time on this blog and so present a brief history so far...

  • beginning with the concept of differing developmental trajectories being present across the very heterogeneous autism spectrum (see here),
  • then there was the publication of the paper by Deborah Fein and colleagues [2] first discussing optimal outcome and autism (see here),
  • further research on the nature of optimal outcome followed and how it might impact on some of the psychology associated with autism (see here),
  • optimal outcome, by any other name, was described by other independent research groups (see here),
  • and then focus shifted to a possible role for intervention as being associated with optimal outcome (see here).

I might add that whilst I have indicated the Fein paper was the first to describe optimal outcome in respect of ASD, there have been some rumblings down the ages in the autism research peer-reviewed literature about remission of core symptoms. Take for example the paper by Gajzago & Prior [3] from 1974 reporting on 2 children "thought to be classical cases of Kanner syndrome" who went on to be "functioning adequately both intellectually and socially and are progressing normally at local schools". Mention of the word 'recovery' in the title of that paper, sandwiched in between quotation marks, hints at how delicate a subject symptom remission was even in those times.

I will, as I always seem to do on this topic, reiterate that when talking about optimal outcome and autism we are not talking about some universal concept occurring across the entire autism spectrum. For the majority of those diagnosed as being on the autism spectrum, their strengths and difficulties are a lifelong feature albeit fluctuating and changing/adapting as a consequence of factors like maturation, the presence of comorbidity and the environment they find themselves in. The group which do seem to fit into the concept of optimal outcome however, represent an important part of that autism spectrum insofar as increasing our knowledge about just how heterogeneous a condition autism really is [4] and how, far from being a singular condition, autism is perhaps better reflected in the description of the more plural autisms (see here). 


[1] Troyb E. et al. Restricted and Repetitive Behaviors in Individuals with a History of ASDs Who Have Achieved Optimal Outcomes. J Autism Dev Disord. 2014 Jul 17. [Epub ahead of print]

[2] Fein D. et al. Optimal outcome in individuals with a history of autism. J Child Psychol Psychiatry. 2013 Feb;54(2):195-205.

[3] Gajzago C & Prior M. Two Cases of "Recovery" in Kanner Syndrome. Arch Gen Psychiatry. 1974;31(2):264-268.

[4] Kohane IS. An Autism Case History to Review the Systematic Analysis of Large-Scale Data to Refine the Diagnosis and Treatment of Neuropsychiatric Disorders. Biol Psychiatry. 2014 Jun 12. pii: S0006-3223(14)00422-3. 

---------- Troyb E, Orinstein A, Tyson K, Eigsti IM, Naigles L, & Fein D (2014). Restricted and Repetitive Behaviors in Individuals with a History of ASDs Who Have Achieved Optimal Outcomes. Journal of autism and developmental disorders PMID: 25030967