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Beyond Kanner and Asperger, Part 7: ASD in 3D

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Dr. Coplan introduces his 3D model encompassing ASD, IQ, and Time (Age).

In the preceding posts in this thread, I dealt with items 1- 6 in my list of basic principles:

  1. Atypicality exists in various degrees, from profound to minimal.

  2. There is no clear boundary between atypical and “normal.” Rather, atypical traits are distributed throughout the entire population.

  3. General Intelligence (IQ) is a separate property from atypicality.

  4. Atypicality of any degree can co-exist with any level of general intelligence.

  5. At any given age, the clinical picture is determined by the joint impact of the degree of atypicality and the level of general intelligence.

  6. Atypicality has a natural history of improvement over time, irrespective of treatment.

And if you have looked at the second video in this series, you already know what’s coming:

  1. Long-term outcome is primarily determined by the joint impact of the degree of atypicality and level of general intelligence. The higher the IQ, the faster and more completely atypicality fades, as time passes.

Leo Kanner’s original 11 subjects underwent dramatic improvement, even in the absence of treatment, over the first 5 years under his observation (1938-43). In 1971 he attempted to trace this original 11 children. Several could not be located. Several were living in institutions or on “work farms.” One had earned a college degree, and was employed as a bank teller (although still living with his parents). “Donald is an excellent bridge player,” his mother wrote to Kanner in 1971, “but he never initiates a game.” In 2005, Donald, by then a senior citizen, was the subject of a fascinating interview in The Atlantic.

In the decades since Kanner’s original paper, there have been numerous look-back studies conducted on adults who had been diagnosed as autistic in childhood. I have reviewed these date in Appendix II of our book, Making Sense of Autistic Spectrum Disorder. The conclusion, based on roughly a thousand children grown to adulthood, is that the single best predictor of long term outcome is nonverbal IQ. I have also conducted research into this subject myself (Modeling Clinical Outcome of Children With Autistic Spectrum Disorders. James Coplan and Abbas F. Jawad. Pediatrics 2005 116: 117-122). My co-author and I were able to develop a mathematical formula that was able to predict the outcome of children with ASD, based on their nonverbal IQ at the time of diagnosis. We need to be careful here: “Predict” is a statistical term, and a bit slippery. If I have a fair coin, I can confidently predict that over a large number of flips, the results will be very close to half heads and half tails. However, on any given flip, my odds of predicting what will happen are no better than 50-50. So when I say that my formula could predict outcome, it doesn’t mean that I could look into a crystal ball for each child and tell their future. Rather, I was able to say that over large numbers of children, I could make the general statement that children with an initial nonverbal IQ of 70 or greater, on average, experienced a reduction in their scores on the Childhood Autism Rating Scale of so many points per year – irrespective of treatment – while children with initial nonverbal IQ’s below 70, on average, experienced no such reduction in CARS scores (the CARS score is like golf: the better you are doing, the lower your score).

Imagine your child’s atypicality as being like a chunk of ice: It can be a big piece, the size of an iceberg, or a very little piece, small enough to fit into a drinking glass. Now, think of your child’s IQ as the water temperature: low IQ = low water temperature; high IQ = high water temperature. The warmer the water, the faster the ice melts. An iceberg floating in the Caribbean (if we could magically drag it there) will melt faster than an identical iceberg drifting across the Arctic. The same relationship holds true for atypicality and IQ. Look back at the movie. Child A and Child B start out with the same degree of atypicality (the same position on the X axis – in this example, both children start with moderate atypicality). All that differs between them is their level of nonverbal IQ: In child A’s case, IQ=100, while for child B, IQ = 50. Over large numbers of children, the outcomes depicted in the movie are reliably true: Children similar to Child A will shed many of their atypical features. Some will fall below the threshold for a diagnosis of ASD. (Does this mean they are “cured”? That’s the story for another thread.) Children akin to Child B are in a much tougher spot: their atypicality generally persists, substantially intact. Thus, having an IQ of 70 or above confers a double benefit (IQ 70 is a benefit in and of itself; reduction in atypicality is a second benefit), while having an IQ below inflicts a double whammy (IQ <70 is a problem in and of itself, and it also negatively impacts the natural history of ASD).

Remember, however, that these are generalizations – true in the broad sense, but difficult to pin down in any particular child. It’s also true that it may not be possible to estimate a child’s IQ at the first visit (or the second, or the third…). I have had pleasant and unpleasant surprises in my career. I tried not to give parents false hope, but at the same time not to falsely extinguish hope, and always to remind parents that “I am not the Wizard.” But even though I couldn’t always pin down a child’s exact location on the 3D graph on Day One, the graph itself forms a useful frame of reference for what is to come.

More next time.

James Coplan, MD is an Internationally recognized clinician, author, and public speaker in the fields of early child development, early language development and autistic spectrum disorders. Join Dr. Coplan on Facebook and Twitter. Have a question for Dr. Coplan? Ask the doctor.


One response to “Beyond Kanner and Asperger, Part 7: ASD in 3D”

  1. Jenifer Kates says:

    Dr. Coplan,
    I am looking for someone to give an IQ test for my 8 year old autistic daughter. She is semi-verbal (speech is unintelligible to strangers) and had an IQ test from our school district (Downingtown, PA) in preschool before entering kindergarten and had a score of 78, although much of the test was eliminated due to her lack of speech. Are there any evaluators you could recommend to give her an updated and appropriate IQ test? We live in Chester Springs, PA.
    Thank you,
    Jenifer Kates

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