Developmental Regression in Children with an Autism Spectrum Disorder
Identified by a Population-Based Surveillance System

Wiggins LD, Rice CE, Baio J

Autism. 2009; 13(4): 357-374.

Question: What is the evidence that some children with autism lose skills and abilities after a period of apparently normal development?

Background: There is a small group of young children in whom their parents have noted a loss of skills and abilities at around age two, who appear to develop symptoms of autism at the same time. It appeared that the children were developing as expected and then suddenly lost their ability to talk or their interest in other people.

Design: This study looked at records of children’s development up to age 8 to determine if some children do lose skills and if there are specific traits seen only in children with apparent regression. Data from the surveillance records maintained by the Metropolitan Atlanta Developmental Disabilities Surveillance Program were used. They contain information derived from area hospitals and clinics, the Georgia Department of Human Resources, private practitioners and from educational and health records. The database holds information about children who have intellectual disabilities, cerebral palsy, hearing loss, vision impairment, and ASDs. Records of children who had the symptoms of Autism Spectrum Disorder were examined by trained specialists

Setting: Centres for Disease Control, Atlanta, Georgia, U.S.A.

Participants: The records of 517 children born in 1992 who met the surveillance program criteria for an ASD were examined by a specialist who used DSM-IV-TR criteria to find children who had a definite diagnosis of autistic disorder, Asperger Syndrome, or PDD-NOS. The records of 285 children meeting these criteria were examined and 49 (17 to 26%) were found to have had symptoms of developmental regression. Of these children 44 were male.

Main Outcome Measures: Evidence of loss of language, social skills, motor delays, seizures or seizure-like behaviours, and restricted interests and activities were noted.

Main Results: Compared to children who had not experienced regression, children who had regressed were more likely to have cognitive impairment and of greater severity, problems with eating and sleep, seizures or seizure-like behavior, and either excessive fear or lack of fear. Children who regressed before age 24 months had more general developmental problems at or before 36 months compared to children who regressed after two years of age.

Conclusions: There is good evidence from this study that regression occurred in about 17 to 26% of children diagnosed with ASD. However, these children had developmental problems prior to the regression, particularly involving motor skills. Their regression is probably related to the severity of their intellectual disability. Regression is more likely to occur in boys than in girls.