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Retrospective analysis of some children reveals deficits in the first year of life while those with less severe symptoms may not be diagnosed until their first years of school or, in the case of higher functioning persons with ASD, even later. It is not un-common (15–22%) for deterioration in functioning with the on-set of puberty, characterized by mood lability, aggressiveness and hyperactivity. It has also been suggested that low IQ, female sex, epilepsy and family history of mood difficulties may be risk factors for this pubertal deterioration. Others have reported that some individuals with ASD improve during their teen years.
Episodes of depression are common for patients with ASD in their teens, especially among those with Asperger’s syndrome. It has been hypothesized that this may be a function of these pa-tients’ better recognition of their social inadequacies. This may also lead to subsequent demoralization and dysphoria.
Epilepsy presents in a bimodal fashion, with many chil-dren first experiencing seizures before starting school, and an-other group having their onset at the time of puberty; overall, 25 to 30% of patients will experience seizures before the age of 30. It should be noted that there is an inverse correlation between the incidence of seizures and cognitive level.
Long-term follow-up studies predict for a poor or very poor long-term outcome for up to 75% of cases, and a good out-come (using social life, and school or vocational functioning as outcome measures) in only 5 to 15%. It appears that IQ is the best predictor of outcome. There is wide variability in final outcome, with most patients with low IQs unable to live independently, and with many high functioning patients able to work (sometimes very successfully) and live independently, as well as raise children.
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