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Abstract | Summary
| Original Article
Regression and word loss in autistic spectrum disorders
Lord C, Shulman C, DiLavore P
Journal of Child Psychology and Psychiatry 2004; 45(5): 936-955
Bottom Line
Does the loss of words acquired during the first two years
signal later development of an autistic spectrum disorder?
- Some parents have reported that their children
with autism stopped talking during their first two years.
- This study showed that there is a minority
of children who lose their ability to talk and to use
other social behaviours around the age of 1 or 2.
- Loss of words that have been used on a daily
basis and to mean the same thing is a red flag that there
may be serious developmental problems that require investigation.
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Question: Does the loss of words acquired during the first
two years signal later development of an autistic spectrum disorder?
Background: Parents and clinicians have reported that there
is a group of children with autistic spectrum disorders who lose
the use of language after having acquired meaningful words during
their first two years. Parents have dated the onset of their children’s
condition to this apparent sudden regression. Researchers have
disputed the suddenness of this process, but it is apparent that
some children do lose the ability to communicate. This study looked
at this phenomenon in children who were part of a longitudinal
study.
Design: Time series (as part of a longitudinal study).
Setting: Four TEACCH centres in North Carolina.
Participants: The participants consisted of three groups of children:
- 110 children referred to a clinical centre with symptoms suggestive
of autism or other communication disorders who were seen at 2,
3, and 4 or 5 years of age;
- 21 children with developmental delays who were tested at 2 and
then at 4 or 5 years of age; and
- 33 typically developing children aged 20 to 32 months who were
tested only once at entry to the study.
Assessment of prognostic factors: Diagnosis of
an autistic spectrum disorder (ASD) and loss of previously acquired
meaningful language.
Main Outcome Measures: Communication loss
as defined as: 1) loss
of words, 2) fluctuating word loss, 3) loss of vocalization, and
4) no word loss.
Main Results: In children diagnosed with autism,
a single period of word loss or a history of early repeated
word losses was specific
to children with ASDs. Most children who experienced word loss
reached a plateau of word acquisition and use in their first and
second years and then began to lose these skills. The losses were
frequently associated with social interaction and communication
abnormalities.
Conclusions: This study does provide evidence that
there is a minority of children with ASDs whose early development
is characterized
by word loss and social skills loss. It is often thought that development
prior to regression is perfectly normal, but it is likely that
there were subtle signs that the child’s earlier development
was not typical. In fact, in this study it was noted that the word
loss was preceded by a leveling off of vocabulary growth and the
use of speech. The pattern noted in this study, in which the child
has acquired spontaneously, and consistently used, a small number
of words meaningfully and then loses these words, is not seen in
other developmental disorders, but also is not seen in all children
with an ASD. The authors indicate that word loss may be a red flag
that should initiate investigation and interventions. It is important
to note that this pattern of word loss can appear regardless of
the severity of the child’s condition, and it does not indicate
a poor prognosis.
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