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. 2020 Jul;61(7):760-767.
doi: 10.1111/jcpp.13180. Epub 2020 Jan 19.

The adult outcome of children referred for autism: typology and prediction from childhood

Andrew Pickles  1 , James B McCauley  2 , Lauren A Pepa  3 , Marisela Huerta  4 , Catherine Lord  2
Affiliations

The adult outcome of children referred for autism: typology and prediction from childhood

Andrew Pickles et al. J Child Psychol Psychiatry. 2020 Jul.

Abstract

Background: Autism Spectrum Disorder is highly heterogeneous, no more so than in the complex world of adult life. Being able to summarize that complexity and have some notion of the confidence with which we could predict outcome from childhood would be helpful for clinical practice and planning.

Methods: Latent class profile analysis is applied to data from 123 participants from the Early Diagnosis Study (Lord et al., Archives of General Psychiatry, 2006, 63, 694) to summarize in a typology the multifacetted early adult outcome of children referred for autism around age 2. The form of the classes and their predictability from childhood is described.

Results: Defined over 15 measures, the adult outcomes were reduced to four latent classes, accounting for much of the variation in cognitive and functional measures but little in the affective measures. The classes could be well and progressively more accurately predicted from childhood IQ and symptom severity measurement taken at age 2 years to age 9 years. Removing verbal and nonverbal IQ and autism symptom severity measurement from the profile of adult measures did not change the number of the latent classes; however, there was some change in the class composition and they were more difficult to predict.

Conclusions: While an empirical summary of adult outcome is possible, careful consideration needs to be given to the aspects that should be given priority. An outcome typology that gives weight to cognitive outcomes is well predicted from corresponding measures taken in childhood, even after account for prediction bias from fitting a complex model to a small sample. However, subjective well-being and affective aspects of adult outcome were weakly related to functional outcomes and poorly predicted from childhood.

Keywords: Childhood; EDX; adult outcome; autism spectrum disorders; prediction.

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Figures

Figure 1
Figure 1
Latent class profiles for the complete set of 15 adult outcome measures. Variable labels identify reversed scales and the percentage of the variance of that variable explained by the latent classes. The legend shows the prevalence of the latent classes as proportions of the original cohort recruits
Figure 2
Figure 2
Median and spread of prediction performance for children assigned to each adult‐outcome class: 1 = Best outcome, 2 = High‐IQ ASD, 3 = Low‐IQ ASD without behavioural problems, 4 = Low‐IQ ASD with behavioural problems
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