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Outgrowing Autism? A Closer Look

at Children Who Read Early or
Speak Late
Some of these children may never have had autism in the rst place, despite being
diagnosed with it

By Darold A. Treert on December 9, 2015

For illustration purposes only.

Abeleao iStock.com

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TheheadlinesreadNewstudysuggestsautismcanbeoutgrown,or
outgrowingautism:adoctorssurpriseandwonder.Thestoriesare

basedonstudiesreportingthat79%ofchildrenwithadocumented
earlyautisticsyndromedisorder(ASD)havenosymptomsofthe
disorderonfollowuplaterinchildhoodoradolescence.Thatisgood
news.Thequestionishowtoaccountforit.
Isitpossibletosimplyoutgrowautism?Wastheinitialdiagnosis
wrong?Didsomeinterventionswork?Ormighttherebeother
explanationsforthiswelcomenews?
"InanearliercolumntitledOops.Whenautismisntautistic
disorder,Ioutlinedthreetypesofhyperlexia,orprecociousreading
ability,whichissometimesanelementofadiagnosisofASD.Type1are
neurotypicalchildrenwhosimplyreadwayaheadoftheirchronological
age.Listeningtoa4yearoldreadingbookstohisorhernurseryschool
classmatesisastartlingexperience.
Type2arechildreninwhichintensefascinationwithlettersand
numbers,alongwithearlyreadingandremarkablememoryrepresent
splinterskillsasapartofautisticsyndromedisorder(ASD)
Type3arechildrenwholikewiseshowintensefascinationand
preoccupationwithnumbersandlettersveryearly,alongwith
precociousreadingskillsandremarkablememory.Theydohave
autisticlikesymptomsorbehaviorsbutthosedisappearovertimeas
thechildgetsolder.Theoutcomeinthesechildrenismuchmore

positivethanthosewithASDtotheirbenefitandthegreatreliefoftheir
parents.
FollowingtheOopsarticleIreceivednumerousreportsfromparents
whoidentifiedwithhyperlexia3.Youjustdescribedmychild,the
puzzled,andrelievedparentswouldwriteastheyreadthecase
examplesinmyWisconsinMedicalJournalarticleinDecember,2011.I
reviewedthosereportsandrecentlydidananalysisof165ofthemwith
thefollowingfindings:
Inallthecasestherehadbeenaconfusingjourneyofvarious
diagnoses,sometimesASD/Aspergersoritsvariants,orelseawide
rangeofothersfromhyperactivitytoanxietydisordertospeech
delay.
Ageofonsetofhyperlexiaskillswas24.6months
Ageoffirstprofessionalcontactwas44months
Certainfeaturescaughttheparentsattentioninthehyperlexia3
groupasbeingdifferentfromautismasusuallydescribed.For
exampletheirchilddemonstratedlesswithdrawal,moreeyecontact,
theabilitytoseekandgiveaffectionandingeneraloverallincreased
socialproficiency.
Additionallywhilesomeautisticlikebehaviorswerepresentsuch
asrepetitivebehaviors,insistenceonsameness,occasional
stimming,echolaliaandincreasedsensorysensitivity,those

symptomsdisappearedasthechildgrewolder
11casesthatmentionedadultoutcomesindicated9personswere
attendingcollegeandhavingsuccessful,independentlives.They
continuedtobeexceptionalreaderswhichhelpedtheircollegiate
performanceandaidedtheircareers.2casesweredescribedas
needingsupervisionbecauseofcontinuedautisticcharacteristics
HavinganASDdiagnosisappliedtotheirchildatanypointwasa
sourceofgreatdistressforallparents.
Itisimpossible,ofcourse,tomakeadiagnosisofthechildbasedonly
onparentdescription.Butfromreadingthosereports,manyofthem
verydetailed,therewasaclearimpressionthatinsomecasesthe
hyperlexiawasindeedasplinterskillmanifestationofautism
spectrumdisorder(hyperlexia2).Butinmanyothers,theincreased
socialproficiencyparticularly,anddisappearanceofmanyautistic
likesymptomsalongwithmorepositiveoutcomessuggested
placementinaseparate,hyperlexia3group.
Inallofmedicinethefirststepintreatmentistomakethecorrect
diagnosis.Theonlywaytodothatiswithaninpersoncomprehensive
evaluationbyamultidisciplinaryteam,includingdevelopmental
specialists,neuropsychologists,andspeech,languageandoccupational
therapists,tonamesome.Thatwillbethefollowuptothispresent
study.

Inthemeantime,unfortunately,therecontinuestobeamisconception
intheliteratureandontheinternet,thathyperlexiaisalwayspartof
autismspectrumcondition.Thatsamemisconceptionappliesto
childrenwhospeaklate(Einsteinsyndrome),asvividlypointedoutin
StephenCamaratasbookLateTalkingChildren:ASymptomora
Stage?Hisexperiencewithchildrenwhospeaklatemirrorsmy
experiencewithchildrenwhoreadearly.
Whileearlydiagnosisandinterventionistobeapplaudedforchildren
withdevelopmentalissuesofallsorts,cautioniswarrantedwhen
applyinganASDdiagnosistochildrenwhoreadearlyorspeaklate,and
atleastadifferentialdiagnosisbythosefamiliarwithhyperlexiaor
Einsteinsyndromeshouldbeuseduntilthenaturalhistoryofthe
disorderreveals,finally,itstruenature.
Whenachildexhibitshyperlexia2or3,thesameinterventiontoolsare
usedtodealwiththeautistic,orautisticlikesymptomstotheextent
theyarepresent.Butthedistinctionbetweenhyperlexia2and3
becomesacriticalonewhenitcomestovitaleducationaldecisionsand
placements.Hyperlexia3childrendonotdowellintypicalspecial
educationclasses,andrequireinsteaddifferentplacements.Hencethe
cautious,informeddiagnosticroute.
Somewillarguethatthevariousinterventionsandtreatmentsare
responsibleforthat67%ofchildrenwhooutgrowtheirautism.That

maybetrueinsomeinstances,butamongmy165casesareanumber
ofchildren,nowadult,withsufficientoutcomeandfollowupto
concludethatthosewithwhatturnedouttobehyperlexia3didnot
haveASDinthefirstplace,theinitialdiagnosisnotwithstanding.In
thesefollowupcaseswereanumberofsuccessstoriesofverypositive
outcomesfromgratefulparents.Butonewasafirstpersonaccount
fromawoman,nowanadult,whorecountedherjourneywith
hyperlexia3,askingnowthatsheisridofthesymptomsofautism,how
doesshegetridofthemedicalhistoryofautismthatfollowsher.
Mypositionisthatoutgrowingautismismostoftenthesituationin
whichadiagnosisofASDwasprematurelyandmistakenlyapplied,
especiallyinchildrenwhoreadearlyorspokelate.Grantedthatearly
distinctioncanbeaverydifficultonesinceseparatingautisticlike
symptomsfromASDitselfcanbedifficultinthoseearlyyears.
Hopefullyaswestudymorechildrenwithhyperlexiaorspeakinglate,
wewillbecomebetteratthat.
Inthemeantimeacautiousdifferentialdiagnosticapproach,alongwith
careful,watchfulobservationovertimeisadvisedespeciallywhenearly
readingorlatespeakingarethepresentingsymptoms.
Thosechildrenwhoareinthehyperlexia3groupdonotoutgrow
theirautism.TheydidnothaveASDinthefirstplace.Thatisa
meaningfuldistinctionbetweenthetwogroups.Fortunatelyhyperlexia

3childrendoverywelloverthelongtermandthat,ofcourse,isvery
goodnewsforthem,theirparentsandtherestofusaswell.
MeanwhileIwillkeepcollectingreportsfromparents,whichcometo
mealmostdaily,forfurtheranalysisandstudybecausethesuccess
storiesareveryrelevantandencouragingindeed.
References:
Camarata,S.(2015)Latetalkingchildren:Asymptomorastage?MIT
PressCambridge,MA
Fine,Detal(2013)Optimaloutcomeinindividualswithahistoryof
autismJournalofChildPsychologyandPsychiatry54:195205
Shulman,LOutgrowingautism:AdoctorssurpriseandwonderThe
DoctorsBlog,AlbertEinsteinCollegeofMedicineMay5,2015
Treffert,D(2011)Hyperlexia3:Separatingautisticlikebehaviors
fromAutisticDisorderassessingchildrenwhoreadearlyorspeaklate
WMJ110:281286

The views expressed are those of the author(s) and are not necessarily those of Scientic American.

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ABOUT THE AUTHOR(S)

DaroldA.Treffert
Dr.DaroldTreffertmethisfirstsavantin1962andhasbeenintrigued
withthosespectacular"islandsofgenius"seenintheseextraordinary
peopleeversince.HisworkhasappearedinseveralpreviousScientific

AmericanandMINDarticlesandittwobooks:ExtraordinaryPeople:
UnderstandingSavantSyndrome(2006)andIslandsofGenius:The
BountifulMindoftheAutistic,AcquiredandSuddenSavant(2010).He
alsomaintainsaninternationallyrespectedwebsiteonsavantsyndrome,
autismandrelatedconditionsatwww.savantsyndrome.comhostedbythe
WisconsinMedicalSociety.
Recent Articles
Accidental Genius
Tapping Your Inner Rain Man
Islands of Genius

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