"Sam" (pseudonym) isn't "autistic" any more. Now he has "Asperger's".
He used to have "autism", so what happened? What was the key intervention?
Was it abstention from immunization? No, he gets poked regularly.
An alternative or experimental medication? No, he's never taken any medications (unlike his sib - we treasure medications when they're valuable).
An intense program of behavioral therapy? No, he's mostly inherited the fringes of the home built behavioral program his older brother needs.
Dietary changes then? Vitamins, supplements, abstention from gluten? Well, he only accepts a very limited diet, but it contains a reasonable amount of gluten, wheat, etc. He's finally accepted his sister's daily multivitamin, which might help avert scurvy.
A quiet, calming, nurturing home environment? *Cough*. No.
A brilliant set of therapists and teachers? Actually, we've been pretty lucky with his school teachers and he's had some very good therapists. So points there maybe.
Really, though, as you've probably guessed by now, the "transition" is due to two things:
- The slow change in the definition of "autism".
- The unstudied and mysterious natural history of disorders of the developing brain.
First, the change in definition.
"Sam" had significantly delayed and disordered language development, that, in combination wiht other findings that gave him a "slam dunk" diagnosis of "high functioning" autism. It used to be, "once autism, always autism", even if the subsequent course looked more like Asperger's.
Well, definitions, like species, evolve. The new fashion is to make the labels "descriptive" of the current state, perhaps as part of a recognition that we really don't know what the heck these things are beyond "developmental brain disorder".
It's this kind of change in definition that confounds naive research. It's the first part of "Sam's" reclassification.
The second part of the reclassification is "Sam's" course. In many ways he's done very well. We're happy, but how unusual is that?
We don't know.
We really don't know the "natural history", that is, the expected course, of these disorders. I've been tracking the medical literature on this topic, and there have only been a handful of studies tracking the course of children labeled as "autistic". As in maybe 1-2 half-decent studies.
We don't know if it's common to improve, we don't know if one can see pre-adolescent improvement and then adolescent regression, we don't know much at all.
It's pretty hard to study treatments of a disorder when you don't know how it usually goes!