Some individuals meet gold-standard clinical criteria for ASD prior to age 5 but end up later in development with no symptoms of ASD, and IQ and adaptive skills in the average range. This study evaluates this ?optimal outcome? (OO) in two groups: (1) those who participated in our OO research study as teens, now young adults, allowing us to evaluate how they navigate the difficult transition into independence and young adulthood; and (2) those who were diagnosed by us with ASD at age two and re-evaluated at age four, now in their teens, allowing us to identify which of this cohort has achieved optimal outcome, and thus to identify early predictors of OO. Both cohorts are compared to age-, gender-, and NVIQ-matched individuals with current ASD and with typical development (TD). We hypothesize that the young adults with OO will experience mild delays in adult milestones such as finishing higher education and obtaining competitive employment, along with greater anxiety, especially simple phobias, and ADHD symptoms. We also hypothesize that early childhood predictors of OO will be milder social impairment, higher adaptive skills in social, communication, and motor domains, and fewer repetitive behaviors. We employ fMRI in the second cohort (n=50 per study group, total n=150) to measure the functional connectivity networks that are involved in social and language tasks, and that are observed during resting state, to investigate how neural mechanisms relate to the dramatic symptom change observed in OO. Drawing on prior imaging research, we hypothesize that, compared to both ASD and TD, the OO group will show compensatory (atypical) connectivity of extra-modular prefrontal cognitive control networks and right hemisphere homologues of left-hemisphere language regions during language and social processing and during resting state.
In prior work, we showed that some individuals show clear-cut Autism Spectrum Disorder (ASD) prior to age 5, but later lose all symptoms, and have IQ and adaptive skills that are average or higher; we also showed that they appear to be using unique brain networks to achieve this ?optimal outcome? (OO). We propose here to further study this OO phenomenon in two cohorts of individuals (comparing OO to groups with ASD and typical development): (1) those we studied in our prior research as teens, and who are now young adults, using online assessment to evaluate how they navigate the difficult transition into independence and young adulthood; and (2) confirming the early presentation of ASD in children who were evaluated and diagnosed by at ages 2-4 years, and who are now in their teens, to permit the identification of early childhood predictors of OO. An MRI study of Cohort 2 will also investigate functional connectivity of specific task-engaged social and language and resting-state networks, to study whether individuals with OO show greater atypicality, specify the functional integration of the circuits involved, and to test our proposed model of compensation.