Can children outgrow autism?

A study recently published in the Journal of Child Neurology suggests that children may outgrow autism. We spoke to Dr. J. Thomas Megerian, pediatric neurologist and clinical director of the Thompson Autism Center at CHOC Children’s, about what parents should know about these findings.

What can providers tell parents about the study’s findings?

Many parents ask me, “Will my child outgrow autism?” and I always tell them that what we hope for is that with services and growth, the child will improve so much that after as little as a few years, they no longer meet the criteria for Autism Spectrum Disorder (ASD). Outgrowing the label may mean they have learned to compensate or overcome some challenges like socialization or repetitive movements. They may have little features left of ASD, and what symptoms they do have, may cease to interfere with their development or daily lives. When they have progressed to the point where they have outgrown the label, any remaining traits may be so small that only a parent would notice, but a new person who has just met the child wouldn’t pick up on anything.

However, I advise my patients’ parents that if and when their child outgrows the label of autism, they may still have other co-occurring issues like anxiety, attention deficit hyperactivity disorder (ADHD) or learning disabilities that require ongoing care.

So yes, indeed this study should give parents hope surrounding a child’s ability to outgrow the autism label, despite their other potential ongoing issues.

In some instances, schools may suggest a decrease in services because a child has improved and outgrown the label of autism. That same child may still be struggling with organization or learning certain subjects. Parents may be in a position to say that just because their child has outgrown the autism label doesn’t mean they do not have a need for additional support.

What does life look like for a child previously diagnosed with autism who is no longer on the spectrum?

Learning disabilities, obsessive compulsive disorder, and attention deficit disorder are common among children with ASD. Rates of other disorders are common among children with autism, including: gastrointestinal disorders, ear infections, seizures and anxiety. They may clear up later in life or become better managed, but they don’t necessarily go away at the same time as their autism label.

Residual symptoms of these co-occurring diagnoses may last into adulthood. For example, a child may outgrow their ASD label but still have anxiety that can be managed by cognitive behavioral therapy.

Why is early detection and early intervention of autism so important?

Early detection and intervention help many kids outgrow the autism label in the future due to improvements with socialization and repetitive behavior. It’s important for people to remember that just because they have lost the autism label doesn’t mean they don’t have other diagnoses or disorders that may require ongoing treatment.

There’s no question that early intervention makes a big difference in helping kids with the potential to outgrow their ASD diagnoses achieve that milestone even sooner. The trajectory has changed for many of those kids.

CHOC pediatrician talks adolescent sleep hygiene on SiriusXM’s “Doctor Radio” show

CHOC Children’s pediatrician Eric Ball, M.D., was a guest on SiriusXM’s Doctor Radio show to discuss sleep hygiene among adolescents—an often misunderstood topic.

Dr. Eric Ball, Pediatrics

“As a pediatrician, I have this conversation several times per day,” says Ball. “Many people don’t realize teens need more sleep than the average adult.”

Dr. Ball explained that adolescence is a tricky time in terms of sleep habit changes. Puberty transforms the average teen from a morning person to a night owl, and their sleep schedules need to reflect that.

Part of the issue, he says, is that schools have not yet adjusted to reflect this need; 43% of American high schools start before 8 a.m., he notes, but that ideally should be 8:30 a.m. or later. Dr. Ball has advocated for California state legislation that would mandate such a start time among high schools.

On the show, Dr. Ball also shared a few tips to help teens improve their sleep hygiene.

7 ways pediatricians can help parents manage their teen’s sleeping habits:

  1. Encourage parents to limit screen time after dark
    “I’m happy my kids are involved in their culture and keeping in touch with friends,” says Dr. Ball. “But bright light tells your brain it’s noon and not 10 p.m., so there’s no melatonin surge telling your brain it’s time for bed.” Blue light glasses may help, but it’s much safer and healthier to simply shut off the screens and focus on relaxation once the sun goes down.

  2. Suggest parents develop a “digital curfew”
    It is much easier to limit screen time if parents replace that time with something fun. Suggest family meditation or a starting a membership to a meditation app that teens can use on their own, if they prefer. If parents have a young child prone to waking up during the night, encourage them to try guided imagery to teach their child to put themselves back to sleep.




  3. Help parents start a sleep diary
    Sleepfoundation.org has a sleep diary function parents can easily introduce to their kids. It is a quick and simple way to keep track of sleeping habits, see where problems arise and work alongside their child to improve those habits.

  4. Have parents to work backwards to find the best bedtime
    Parents can start by figuring out what time their teen needs to wake up to get to school on time. Work backwards from there to find an appropriate bedtime. Then, keep working backwards to see how to fit in after-school necessities like homework, sports, social time and family time. The key is making bedtime the priority.

  5. Make sure parents focus on weekend sleep hygiene, too
    Sleeping in a little on weekends is fine, says Dr. Ball, but teens should avoid sleeping hours into the day. Helping adolescents develop more consistent sleep hygiene throughout the week and weekend is critical.

  6. Tell parents to avoid melatonin unless necessary
    Sometimes kids with autism spectrum disorder or who have attention deficit hyperactivity disorder require the aid of melatonin, but in other cases, says Dr. Ball, it’s best for doctors to use it as a last resort. “If teens have poor sleep hygiene, there’s not enough melatonin in the world to fix that,” he says. “It becomes a crutch, and then you’re treating the symptoms—not the cause.”

  7. Urge parents to prioritize sleep
    Adolescents in competitive schools or programs tend to prioritize just about everything other than sleep, but no amount of studying will prepare a kid to perform their best the way good sleep will. Remind busy and high-achieving kids that sleep is not a luxury but a necessity, and that an extra half hour of studying likely won’t make the difference that eight hours of sleep will.

CHOC ENT study finds kids more often exposed to loud noises, infrequently use hearing protection

A new study co-authored by a CHOC Children’s otolaryngologist finds that nearly a quarter of U.S. children are at increased risk for hearing loss due to exposure to loud sounds and infrequent hearing protection use.

Dr. Jay Bhatt and his co-authors examined the incidence and gender differences in pediatric recreational and firearms noise exposure in the United States. The study, published in the May 2019 issue of the otolaryngology journal “Laryngoscope,” is the largest evaluation of loud noise exposure patterns and the use of hearing protection in children to date. 

Drawing on data gathered by the National Health Interview Series (NHIS), the study makes several key findings:

  • The most common source of recreational noise was personal music players, now used by up to 90% of school children
  • One in five children have been exposed to firearm noise, with boys significantly more likely to have exposure than girls.
  • Only 16% of children always used hearing protection in the last 12 months during explosive sound exposures, and girls were less likely to use protection than boys.
  • Up to 96% of parents perceived their children to be at no to minimal risk of hearing loss from excessive noise.
  • The prevalence of pediatric loud noise exposure is the likely cause of the noise-induced hearing loss noted in one in five adults ages 20 to 29.

The gender disparities found by the study underscore the importance of hearing protection education to not just boys, who are more frequently exposed to loud noises, but also girls, who are less frequently exposed but less likely to wear hearing protection, the authors write.

Further, public health initiatives could identify children and families at risk for loud noise exposure and provide appropriate counseling to prevent hearing related consequences as adults.

Learn more about otolaryngology at CHOC Children’s.

In the Spotlight: Chenue Abongwa, M.D.

Chenue Abongwa, M.D., joined CHOC Children’s in October 2018 as a pediatric neuro-oncologist at the Hyundai Cancer Institute. After finishing medical school at the Universite de Yaounde in Cameroon, he completed his pediatrics residency at Brookdale University Hospital in New York, his pediatric hematology/oncology fellowship at University of Iowa Hospitals and his neuro-oncology fellowship at Children’s Hospital of Los Angeles. We chatted with him about his time at CHOC so far.

Dr. Chenue Abongwa, Pediatric Neuro-Oncology

What drew you to medicine? Pediatrics specifically?

I was drawn to medicine earlier in my childhood. My mother worked as a nurse, and I often accompanied her when she did house calls to visit children and was very impressed by her dedication and desire to help sick children. I wanted to be like her when I grew up.

What about CHOC stuck out to you?

I initially heard about CHOC in 2013 when I was a fellow in pediatric hematology/oncology and came across a well-written web guideline on febrile neutropenia. This prompted me to seek information about the institution and about the team. I was very impressed by the institutional vision, dynamism, patient-centeredness and search for excellence. I applied without hesitation when the opportunity came.

Are you or do you plan to be involved with any special projects or groups at CHOC?

I am currently involved in several divisional clinical projects based on COG (Children’s Oncology Group) and will be joining some committees.

Can you share some of your goals at CHOC?

My goals are to initially build a strong clinical base by working in the neuro-oncology team in the short term. I hope in the long term to be actively involved in quality improvement, research and teaching.

What do you want your patients and their families to know about CHOC? 

The diagnosis of cancer in a child is a very difficult and traumatic experience to children and their families. Being part of their lives in these extremely difficult periods and advocating for these families is a great privilege. Our team here at CHOC, with its focus on patient-centered care, is the right place for these families to be during this time.

What do you like to do outside of CHOC?

I love traveling, watching football and playing chess.

CHOC team using new device to close heart defect in tiny patients

Tiny premature babies who suffer from a common but potentially fatal opening in their hearts are now being treated with a new device by physicians at CHOC Children’s.

The team successfully completed the first procedures March 20 and 21 to close a patent ductus arteriosus (PDA), an opening between two blood vessels of the heart that has failed to close on its own. CHOC became one of the first hospitals to use the Abbott Amplatzer Piccolo™ Occluder since it was approved by the FDA in January.

The Abbott Amplatzer Piccolo™ Occluder is about the size of a pea.

“We’ve never had the capability of doing this here at CHOC,” says Dr. Amir Ashrafi, director of CHOC’s neonatal-cardiac intensive care. “While closing a duct in a catheterization lab is not a new technology, closing a duct in a cath lab in very small babies is a big deal. The fact that we are now going to be one of the centers that are doing this, that is a big deal.”

PDAs are among the most common heart defects in premature babies. The opening, also called a duct or channel, is present in all fetuses and plays a vital role in allowing oxygen-rich blood from the mother to circulate through the unborn child’s body. In most cases, it closes spontaneously after birth. But out of the 60,000 infants born prematurely each year, 1 in 5 (12,000) has a PDA severe enough to require urgent medical attention.

“What happens is that blood goes in the wrong direction, so instead of blood going to the body, it goes into the lungs, so now the lungs get flooded,” Ashrafi says.

Without treatment, a PDA can cause breathing difficulty and a variety of other problems.

“It affects their feeding, because they’re having such a hard time breathing,” says Dr. Gira Morchi, an interventional pediatric cardiologist at CHOC. “It’s a cascade effect. It can affect the GI tract, kidneys, and the brain.  Taking away the extra workload on the body allows for recovery.”

Abbott had previously developed the Amplatzer™ Duct Occluder to treat the same problem in larger pediatric patients. The new, smaller, device – measuring 3 mm by 2 mm – can be used in patients as young as 3 days old and weighing as little as 1.5 pounds, or 700 grams.

The procedure is performed through cardiac catheterization via a small incision made in the baby’s leg, near the groin area, to access a vein leading to the heart. A catheter is inserted, with the device inside. It’s the size of a small pea, and made of tightly woven metal mesh. Cameras and ultrasound guide the operator – in this case, Morchi – “correctly position the device” in the heart, she says. The device is deployed and placed in the opening, where it expands on its own. The device stays in the body, with tissue healing around it.

A cardiac catheterization lab at CHOC Children’s Hospital

The first patient was a girl from Fullerton, Calif., who was born at 28 weeks and weighed 1.1 kilograms. The second patient, a girl from Huntington Beach, was born at 25 weeks and weighed 800 grams. The procedures were conducted when the babies were 2.5kg and 2.4 kg, respectively. The device is approved for much smaller infants than those, but the CHOC team is being selective about its cases.

“We’ll just slowly work our way down,” Ashrafi says. 

Morchi herself has been doing such catheterizations for a decade. “We’re very comfortable with actually doing the procedure, so the real art here is to keep the babies stable while this procedure is happening,” she says. Conditions in the cath lab should closely match those in the NICU, including keeping the temperature warm. “We crank the heat up.”

Start to finish, the baby is in the room for 90 minutes to 2 hours, but the actual procedure only takes 20-30 minutes, she said.

Besides Morchi, the interventional cardiology team also included Dr. Sanjay Sinha and Dr. Mitch Recto.

A closer look at the Abbott Amplatzer Piccolo™ Occluder

The achievement was the result of a 2-year collaboration between CHOC and UC Irvine. Credit also goes to Dr. Evan Zahn of Cedars Sinai Medical Center in Los Angeles, who was an early adopter of the procedure and was lead investigator in the FDA approval study for the Abbott device. The trial included 50 patients at eight facilities in the U.S.

Upon FDA approval of this device, Abbot Vascular recognized CHOC Children’s as one of the first hospitals in America to use this device for those smallest and most vulnerable patients in the hospital. 

“This device offers a new era in treating PDAs, and was successful at CHOC in great part due to a strong effort of collaboration between the cardiologist and the neonatologists,” says Dr. Sinha, a CHOC/UCI pediatric cardiologist.