Outgrowing the Autism Spectrum Disorder (ASD) diagnosis?
Ah. Yes. What does that really mean anyway? For those of you who follow me, you know the behaviorist in me steers clear of “always” and “never” types of absolute statements, unless there is sufficient data to verify the use of the terms. However, can one outgrow the diagnosis of an ASD? My answer is always, never and never, always. Possibility of maladaptive symptom reduction? Of course.
We still really don’t know what causes ASD’s, so how can we be certain, that it can be “outgrown?” Even though recent research continues to point to genetic influences as the cause of ASD, and even if overt symptoms can be reduced over time, it may be erroneous to make the statement that one has “outgrown the diagnosis.”
Let me take pause in addressing the possibility of epigenetics behind this topic. Instead, I want to talk about the emotional components that those diagnosed with an ASD experience as a result of executive functioning challenges, and how this really may not ever go away. Just because persons who are diagnosed with ASD’s begin to better “blend” and symptom masking can be evident, symptoms being reported to an evaluator can be minimized regarding the actual diagnostic criteria. I think it is important to ask deeper questions. For example, “ What causes you stress?” And, “How hard is it for you to work at (fill in the criteria) that causes you stress? Additionally, if subsequently evaluating for anxiety and depression, it would be curious to explore what the causes of these are. If, at any point in the exploration of feelings and thought processes, executive functioning challenges or looping come into play, it would stand to reason that we may just be looking at less overt struggles. Nevertheless, struggles that are still present. Take sensory issues as another example. Many stimuli can still remain bothersome, although the individual may have developed better coping strategies to handle them.
The other disservice psychologically that this can present is suddenly declaring “typicality” which can create an new expectation which can cause more internal struggle. This could be analogous to the student who has had straight A’s in a foreign language and is then determined “competent” to navigate the native country. I think most people who have had this experience, although exciting, still experience worry about being able to navigate the country successfully outside of the classroom.
In sum, I urge evaluators to proceed with caution regarding how formal assessment results are communicated in evaluation reports, when symptoms of an ASD appear to be significantly reduced. Another question to reflect upon is, who really needs to hear the diagnosis has gone away more – the identified individual or the caregiver? A big wave of children diagnosed at the turn of the century are aging out of services. If you are a parent or caregiver of a person who has been diagnosed with an ASD, who is now an adult, what are your thoughts on this topic? If you are an adult who has been diagnosed with an ASD, how do you feel about this topic?