Objective:

Autism spectrum disorder (ASD) is currently considered an early-onset neurodevelopmental condition. Follow-up studies of clinic-ascertained autism suggest that autistic symptoms typically decline with age, although symptom improvement is limited for some. To date there have been no population-based prospective studies investigating the natural history of autistic symptoms from childhood to adulthood. The aim of this study was to characterize the development and heterogeneity of autistic symptoms in a population-based cohort from childhood to age 25.

Methods:

Data were analyzed in a prospective U.K. population-based cohort (ALSPAC). Trajectories were derived using five assessments of the parent-rated Social and Communication Disorders Checklist (SCDC) spanning ages 7–25. Additional measures were used to validate symptom trajectories.

Results:

Three distinct SCDC symptom trajectory classes were identified: low (88.5%), declining (5.0%), and late-emerging (6.5%). Both the declining and late-emerging trajectory classes were associated with child and adult ASD measures, low IQ, communication problems, peer problems, and worse adult functioning compared with the low trajectory class. Male sex was associated with a higher likelihood of being in the declining trajectory class (odds ratio=2.84, 95% CI=2.19, 3.69). This sex difference was not observed in the late-emerging class (odds ratio=1.00, 95% CI=0.80, 1.24) compared with the low trajectory class.

Conclusions:

ASD symptom levels that emerged early tended to decline across development, although impairment was still present in adulthood for some. For others, autistic symptoms emerged across adolescence and adulthood. This challenges our current understanding that ASD symptoms inevitably first manifest early in development.

中文翻译：

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自闭症谱系障碍症状从儿童期到成年早期的可变出现

客观的：

自闭症谱系障碍（ASD）目前被认为是一种早发性神经发育疾病。对临床确定的自闭症的后续研究表明，自闭症症状通常会随着年龄的增长而下降，尽管某些人的症状改善有限。迄今为止，还没有基于人群的前瞻性研究调查自闭症症状从儿童期到成年期的自然史。本研究的目的是描述从儿童到 25 岁的人群队列中自闭症症状的发展和异质性。

方法：

数据在一个前瞻性的英国人群队列 (ALSPAC) 中进行分析。使用跨越 7-25 岁的父母评定的社交和沟通障碍清单 (SCDC) 的五次评估得出轨迹。额外的措施被用来验证症状轨迹。

结果：

确定了三个不同的 SCDC 症状轨迹类别：低 (88.5%)、下降 (5.0%) 和迟发 (6.5%)。与低轨迹类相比，下降和后期出现的轨迹类与儿童和成人 ASD 测量、低智商、沟通问题、同伴问题和更差的成人功能有关。男性与处于下降轨迹类别的可能性较高相关（优势比=2.84, 95% CI=2.19, 3.69）。与低轨迹类别相比，在新兴类别中未观察到这种性别差异（优势比=1.00, 95% CI=0.80, 1.24）。

结论：

早期出现的 ASD 症状水平在整个发育过程中趋于下降，尽管某些人在成年期仍然存在损伤。对于其他人来说，自闭症症状出现在青春期和成年期。这挑战了我们目前的理解，即 ASD 症状不可避免地首先在发育早期表现出来。