Counseling parents regarding prognosis in autistic spectrum disorder

A triaxial model for autistic spectrum disorder (ASD) is presented, incorpo rating age, degree of intelligence, and severity of autistic features. As t he name implies, ASD can vary in degree of expression from minimal to profo und. Furthermore, the symptoms of ASD change in predictable ways with the p assage of time. For example, echolalia during early childhood may be replac ed by verbal literalism and difficulty with verbal humor during later child hood or adolescence. The prognosis for children with ASD is governed by the joint impact of the degree of expression of ASD and the degree of developm ental delay, if any. All combinations of ASD and intellect are possible (ie , severe ASD plus severe mental retardation, severe ASD plus normal general intelligence, and so forth). The relationship among these 3 parameters-sev erity of ASD, level of general intelligence, and change in symptom expressi on over time, is represented schematically as a 3-dimensional graph. The ut ility of this graph as a counseling tool, and as the basis for future resea rch on the prognosis of ASD are discussed.