Autism, optimal outcome and the broader autism phenotype

"Overall, OO [optimal outcome] individuals are not showing BAP [broader autism phenotype] characteristics, but may be subject to other mild ADHD [attention-deficit hyperactivity disorder]-like characteristics."

So said the findings reported by Joyce Suh and colleagues [1] who continue a research voyage based on the examination of a group of children who were very much once on the autism spectrum but no longer meet the diagnostic criteria for the label: those with so-called optimal outcome.

Including the godmother of optimal outcome (OO) research, Deborah Fein, on the authorship list, the Suh paper adds a further level of evidence that 'loss of diagnosis' might actually mean loss of the broader autism characteristics that make up the BAP description too. Looking at a small group of children classified as OO (n=22) and comparing them with a similar number of "high functioning individuals with ASD (HFA)... and typically developing (TD) peers" researchers set about comparing and contrasting the groups when it came to the BAP and also the "Big Five personality traits."

As per the opening sentence, those included in the OO grouping seemed to be free of BAP traits; indeed described as "indistinguishable from TD." Again bearing in mind the relatively small participant numbers included for study, the authors did note a few slight differences when comparing the OO group and those 'typically developing peers' in terms of their use of language and also emotional stability. There may be other avenues for further research based on these topics taking into account how OO might also provide protection against some important psychiatric comorbidity traditionally over-represented when it comes to autism (see here).

But yet again, it appears that OO does seem to denote a group of children who were most definitely on the autism spectrum but who now, for whatever reason(s), seem to be relatively symptom free including those symptoms linked to the broader autism phenotype. The sweeping generalisation that all autism is a lifelong condition takes yet another powerful peer-reviewed research hit.

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[1] Suh J. et al. Ratings of Broader Autism Phenotype and Personality Traits in Optimal Outcomes from Autism Spectrum Disorder. J Autism Dev Disord. 2016 Aug 18.

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Suh J, Orinstein A, Barton M, Chen CM, Eigsti IM, Ramirez-Esparza N, & Fein D (2016). Ratings of Broader Autism Phenotype and Personality Traits in Optimal Outcomes from Autism Spectrum Disorder. Journal of autism and developmental disorders PMID: 27538964