The Autism Society Event and Education Recordings Archive

The popular consensus is that children with autism do not recover. However, 20 years of research on early intensive applied behavior analytic (ABA) treatment has demonstrated that some children achieve age-appropriate functioning. In addition, numerous anecdotal reports have observed remediation of autism following treatment with various complementary alternative medicines. In this paper, we propose a definition of recovery from autism. In addition, we review treatment research and examine whether our definition of recovery have been produced in sound scientific studies. The overarching consensus within the medical community is that recovery from autism does not occur. However, 20 years of research on early intensive applied behavior analytic (ABA) treatment for children with autism has consistently demonstrated that a significant proportion of children make dramatic gains, including achieving a level of functioning indistinguishable from typically developing children of the same age. In addition, numerous anecdotal reports have claimed to have observed remediation of autism following treatment with various complementary alternative medicines (CAMs). Recovery from autism is a topic which is central to research and practice in autism but is nevertheless ill-defined and under-researched. Defining recovery from autism is important for several reasons. Put simply, a definition is necessary in order for researchers and clinicians to know it when they see it. A definition of recovery is a critical prerequisite to designing and implementing research on interventions that claim to produce recovery, as well as to evaluating past research which has claimed to have produced recovery. In this position paper, we propose a working definition of recovery from autism. In addition, we review the current status of research on autism treatment and examine the extent to which the components of our definition of recovery have been produced in sound scientific studies.

Our definition of recovery from autism is as follows: An individual may be said to have recovered from autism if that individual had a confirmed diagnosis of autism, then experienced a treatment of some sort, and subsequently meets all of the following criteria: 1) does not meet the diagnostic criteria of the DSM-IV R, according to a clinician with a significant history of diagnosing autism, 2) achieves scores in the average range on standardized tests of intelligence, social skills, language, and adaptive functioning, and 3) is achieving passing grades in a typical educational placement, without special supports of any kind.

In order to set up our discussion of recovery, we address three broad but foundational topics. First, we discuss the concept of disorder and the evolution of the concept in medical and psychological science. Second, we discuss the evolution and current status of the concepts of cure, recovery, remediation, and remission. Third, we briefly address current theories on the etiology of autism. Given that autism is currently diagnosed only on the basis of the behavior of the individual, our definition of recovery is similarly based – and therefore does not depend on the validity of any particular theory of the etiology of autism. Nevertheless, the notion that learning via early intensive ABA therapy can produce recovery begs the question of how a disordered physiology can interact with the environment in a non-disordered manner, so the issue will be addressed.

We review autism treatment research. We review measures currently being used in treatment research as an indicator of what the scientific community views as meaningful markers of progress for individuals with autism. We also review the extent to which existing published treatment gains do and do not approach our proposed criteria for recovery. We find that several controlled studies and several descriptive case studies in the peer-reviewed literature report results approaching our definition of recovery, for at least a proportion of participants. The most commonly reported outcome measure is IQ. Educational placement is also often reported.

We find that the scientific evidence that some proportion of children achieve functioning in the average range post-treatment is sufficient to assert that recovery from autism exists, at least for some proportion of subjects who receive early intensive ABA therapy. The exact proportion of children who recover is not yet known. It is also not yet known what factors predict those that achieve best outcome versus those who do not. Given the quantity of evidence now available, we conclude that it is not longer a tenable position to deny that recovery from autism exists.

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