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8/18/2019 Outgrowing Autism_ a Closer Look at Children Who Read Early or Speak Late - Scientific American Blog Network

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Guest Blog

Some of these children may never have had autism in the rst place, despite being diagnosed with it

Outgrowing Autism? A Cl oser Lookat Children Who Read Early or

Speak Late

By Darold A. Treffert on December 9, 2015

S U B S C R I B E

http://blogs.scientificamerican.com/guest-blog/outgrowing-autism-a-closer-look-at-children-who-read-early-or-speak-late/http://blogs.scientificamerican.com/guest-blog/outgrowing-autism-a-closer-look-at-children-who-read-early-or-speak-late/http://www.scientificamerican.com/author/darold-a-treffert1/http://blogs.scientificamerican.com/guest-blog/


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For illustration purposes only. Abeleao ©iStock.com

The headlines read “New study suggests autism can be outgrown”, or

“outgrowing autism: a doctor’s surprise and wonder.” The stories are

A D V E RT I S E M E N T


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based on studies reporting that 7-9% of children with a documented

early autistic syndrome disorder (ASD) have no symptoms of the

disorder on follow-up later in childhood or adolescence. That is good

news. The question is how to account for it.

Is it possible to simply “outgrow” autism? Was the initial diagnosis

wrong? Did some interventions work? Or might there be other

explanations for this welcome news?

"In an earlier column titled “Oops. When “autism” isn’t autistic

disorder,” I outlined three types of hyperlexia, or precocious reading

ability, which is sometimes an element of a diagnosis of ASD. Type 1 are

neurotypical children who simply read way ahead of their chronological

age. Listening to a 4 year old reading books to his or her nursery school

classmates is a startling experience.

Type 2 are children in which intense fascination with letters and

numbers, along with early reading and remarkable memory represent

‘splinter skills’ as a part of autistic syndrome disorder (ASD)

Type 3 are children who likewise show intense fascination and

preoccupation with numbers and letters very early, along with

precocious reading skills and remarkable memory. They do have

“autistic-like” symptoms or behaviors but those disappear over time as

the child gets older. The outcome in these children is much more

http://blogs.scientificamerican.com/mind-guest-blog/oops-when-autism-isnt-autistic-disorder-hyperlexia-and-einstein-syndrome/


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positive than those with ASD to their benefit and the great relief of their

parents.

Following the “Oops” article I received numerous reports from parents

who identified with hyperlexia 3. “You just described my child,” the

puzzled, and relieved parents would write as they read the case

examples in my Wisconsin Medical Journal article in December, 2011. I

reviewed those reports and recently did an analysis of 165 of them withthe following findings:

In all the cases there had been a confusing journey of various

diagnoses, sometimes ASD/Aspergers or its variants, or else a wide

range of others from hyperactivity to anxiety disorder to speech

delay.

Age of onset of hyperlexia skills was 24.6 months

Age of first professional contact was 44 months

Certain features caught the parent’s attention in the hyperlexia 3

group as being different from ‘autism’ as usually described. For

example their child demonstrated less withdrawal, more eye contact,

the ability to seek and give affection and in general overall increased

social proficiency.

Additionally while some “autistic-like” behaviors were present such

as repetitive behaviors, insistence on sameness, occasional

stimming, echolalia and increased sensory sensitivity, those

https://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/110/6/281.pdf


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It is impossible, of course, to make a diagnosis of the child based only

on parent description. But from reading those reports, many of them

very detailed, there was a clear impression that in some cases the

hyperlexia was indeed a “splinter skill” manifestation of autism

spectrum disorder (hyperlexia 2). But in many others, the increased

social proficiency particularly, and disappearance of many “autistic-

like” symptoms along with more positive outcomes suggested

placement in a separate, hyperlexia 3 group.

In all of medicine the first step in treatment is to make the correct

diagnosis. The only way to do that is with an in-person comprehensive

evaluation by a multi-disciplinary team, including developmental

specialists, neuropsychologists, and speech, language and occupationaltherapists, to name some. That will be the follow-up to this present

study.

symptoms disappeared as the child grew older

11 cases that mentioned adult outcomes indicated 9 persons were

attending college and having successful, independent lives. They

continued to be exceptional readers which helped their collegiate

performance and aided their careers. 2 cases were described as

needing supervision because of continued autistic characteristics

Having an ASD diagnosis applied to their child at any point was asource of great distress for all parents.


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In the meantime, unfortunately, there continues to be a misconception

in the literature and on the internet, that hyperlexia is always part of

autism spectrum condition. That same misconception applies to

children who speak late (“Einstein syndrome”), as vividly pointed out in

Stephen Camarata’s book “Late-Talking Children: A Symptom or a

Stage?” His experience with children who speak late mirrors my

experience with children who read early.

While early diagnosis and intervention is to be applauded for children

with developmental issues of all sorts, caution is warranted when

applying an ASD diagnosis to children who read early or speak late, and

at least a differential diagnosis by those familiar with hyperlexia or

Einstein syndrome should be used until the natural history of the

disorder reveals, finally, its true nature.

When a child exhibits hyperlexia 2 or 3, the same intervention tools are

used to deal with the autistic, or autistic-like symptoms to the extent

they are present. But the distinction between hyperlexia 2 and 3

becomes a critical one when it comes to vital educational decisions and

placements. Hyperlexia 3 children do not do well in typical “special

education” classes, and require instead different placements. Hence the

cautious, informed diagnostic route.

Some will argue that the various interventions and treatments are

responsible for that 6-7% of children who “outgrow” their autism. That

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may be true in some instances, but among my 165 cases are a number

of children, now adult, with sufficient outcome and follow-up to

conclude that those with what turned out to be hyperlexia 3 did not

have ASD in the first place, the initial diagnosis notwithstanding. In

these follow-up cases were a number of ‘success stories’ of very positive

outcomes from grateful parents. But one was a first person account

from a woman, now an adult, who recounted her journey with

hyperlexia 3, asking now that she is rid of the symptoms of autism, how does she get rid of the medical history of “autism” that follows her.

My position is that “outgrowing” autism is most often the situation in

which a diagnosis of ASD was prematurely and mistakenly applied,

especially in children who read early or spoke late. Granted that early

distinction can be a very difficult one since separating ‘’autistic-like”

symptoms from ASD itself can be difficult in those early years.

Hopefully as we study more children with hyperlexia or speaking late,

we will become better at that.

In the meantime a cautious differential diagnostic approach, along with

careful, watchful observation over time is advised especially when early

reading or late speaking are the presenting symptoms.

Those children who are in the hyperlexia 3 group do not “outgrow”

their autism. They did not have ASD in the first place. That is a

meaningful distinction between the two groups. Fortunately hyperlexia

3 hild d ll h l d h f i


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3 children do very well over the long term and that, of course, is very

good news for them, their parents and the rest of us as well.

Meanwhile I will keep collecting reports from parents, which come to

me almost daily, for further analysis and study because the success

stories are very relevant and encouraging indeed.

References:

Camarata, S. (2015) Late-talking children: A symptom or a stage? MIT

Press Cambridge, MA

Fine, D et al (2013) Optimal outcome in individuals with a history of

autism Journal of Child Psychology and Psychiatry 54:195-205

Shulman, L Outgrowing autism: A doctor’s surprise and wonder The

Doctors Blog, Albert Einstein College of Medicine May 5, 2015

Treffert, D (2011) Hyperlexia 3: Separating ‘autistic-like’ behaviors

from Autistic Disorder; assessing children who read early or speak late

WMJ 110:281-286

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


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A B O U T T H E A U T H O R ( S )

Darold A. Treffert

Dr. Darold Treffert met his first savant in 1962 and has been intrigued

with those spectacular "islands of genius" seen in these extraordinary

people ever since. His work has appeared in several previous Scientific

A D V E RT I S E M E N T

American and MIND articles and it two books: Extraordinary People:


10/15

American and MIND articles and it two books: Extraordinary People:

Understanding Savant Syndrome (2006) and Islands of Genius: The

Bountiful Mind of the Autistic, Acquired and Sudden Savant (2010). He

also maintains an internationally respected website on savant syndrome,

autism and related conditions at www.savantsyndrome.com hosted by the

Wisconsin Medical Society.

Recent Articles

Accidental Genius

Tapping Your Inner Rain Man

Islands of Genius

L A T E S T N E W S

http://www.scientificamerican.com/article/islands-of-genius-2002-06/http://www.scientificamerican.com/article/tapping-your-inner-rain-man/http://www.scientificamerican.com/article/accidental-genius/https://www.wisconsinmedicalsociety.org/professional/savant-syndrome/


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E V O L U T I O N

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