Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)


Clinical Psychology

First Advisor

Alice S. Carter

Second Advisor

Abbey Eisenhower

Third Advisor

Angel Fettig


Autism spectrum disorder (ASD) is typically considered to be a lifelong neurodevelopmental disorder and a great deal of research supports the stability of the diagnosis over time (e.g., Chawarska et al, 2007; Eaves & Ho, 2004; Wiggins et al., 2012). However, recent studies have reported a small subset of children, referred to as the “optimal outcome” group, who are diagnosed in early childhood, show improvement over time, and ultimately do not meet criteria for the diagnosis at follow up (e.g., Fein et al., 2013; Kleinman et al., 2008; Ozonoff et al., 2015). The question of diagnostic stability of ASD has become an increasingly active focus of research and is relevant to scientific and clinical issues regarding prevalence, utility of early intervention, families’ experience of the diagnosis, and developmental trajectories of ASD symptoms (e.g., Cox et al., 1999; Lord & Bishop, 2010; Woolfenden et al., 2012). Prior research on the diagnostic stability of ASD has been constrained by small and homogenous samples, short follow up time periods, and inconsistent diagnostic procedures, thus limiting the generalizability of findings. The current study conducted follow up evaluations of 60 children (86.7% male, mean age = 51.3 months) with diverse backgrounds (79.7% racial/ethnic minorities) who received initial ASD diagnoses before 36 months of age, with variability in age at initial diagnosis, age at follow up, and duration of interval between initial diagnosis and follow up evaluation. Seven children (11.7%) did not meet diagnostic criteria for ASD at follow up, a proportion consistent with previous studies. On average, children demonstrated significant cognitive gains and ASD symptom improvement over time. Clinical implications of findings are discussed.


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