Current Literature: 5

Abstract

Background A tertiary neurodisability centre at a major London teaching hospital (Guy's and Thomas’).Aim To review the outcome after 4 years of a cohort of children with severe language delay/disorder and some features of autism, but not sufficient at the time to confirm a diagnosis of autism.Methods The notes of 227 children assessed at the centre between the age of 2 and 5 were examined to select cases. This resulted in 40 children with severe receptive language delay as the primary diagnosis and a nonverbal IQ above 70. One hundred and eight children were excluded as another diagnosis, including autism, had been made and in 79 cases original clinical notes were insufficient for re‐analysis. However further exclusions due to lack of formal IQ scores, changed addresses, refusals and re‐assessment delays left a total of 18 children who participated in the study.Standard measures of performance were used to assess intellectual and language functioning, in addition to clinical evaluation.Results Follow‐up at a mean age of 8 years and 7 months showed that five children now showed sufficient language and social impairments for a diagnosis of childhood autism and the other 13 met criteria for atypical autism although nine of these showed some recovery in their language skills. The severity of social communication impairments and repetitive behaviours in the original notes were associated with the severity of autism when re‐assessed.From parental questionnaires, none of the children was considered to have developed ‘true friendships’ with reciprocal interaction, sharing and coinitiation of activities. Some tried but didn’t succeed while others were ‘loners’ who preferred their own company. All 18 children had a statement. Ten children attended specialist educational provision (six in a language unit, two in an MLD school and two in an autism unit) and the others had help in mainstream.Conclusions The authors thought they would find two groups of children at follow‐up: one with ‘true autism’ and one where improvement had occurred; ‘true language delay’. Instead, they found that all could be given a diagnosis of autism when re‐assessed. They discuss the continuing difficulties of defining childhood developmental disorders at an early age and the difficulties of separating autism from ‘a receptive language disorder with secondary socio‐emotional problems’ as required by ICD‐10.They comment on the apparent importance of repetitive behaviours and the prognosis of children who show impairments in all three ASD areas in the preschool years, even if they are not sufficient to diagnose an ASD at the time. They also comment on the risk to effective education and health support if a diagnosis of autism is not given.