Our son was reading early in his second year and sounds exactly like the "hyperlexia III" in this article - including being very affectionate and attention-seeking. But he also scores well into the autism range on multiple autism diagnostic assessments, with two different diagnostic teams saying he has "clear," though not severe, autism.
Needless to say, during the diagnostic process we took a lot of interest in the academic paper that Dr. Treffert wrote, which his blog post summarizes.
Here are some of my current thoughts.
First, the "true" meaning of Dr. Treffert's article may have to do with competing ideas around the definition of autism itself. Recent research seems to support the idea that the "autism spectrum" is really a human spectrum which shades into average with no bright line (that is, the distribution of "autistic traits" is not bimodal). There was also a recent study of "optimal outcome" - that some children with autistic traits don't turn out to be meaningfully disabled when they are older.
Autism appears to be more like IQ, which comes in degrees, than it is like a syndrome that one has or does not have.
Dr. Treffert's article seems to imply that autism is more of a bright-line thing, rather than a set of normally-distributed dimensional traits. He seems to interpret "optimal outcome" as "never really had autism" rather than "coped well with autism."
But not all experts - or even the majority - seem to accept this premise. I don't think the two highly-qualified diagnostic teams who assessed our son necessarily knew what he meant when he suggested getting experts to distinguish autistic-like from autistic. Their approach was more that if it quacks like a duck, it is a duck.
Based on the paper, when he says kids turned out to be fine, there's no real way to tell whether they turned out to be completely typical on autistic traits (distributed around the 50th percentile) or whether they just moved from the 99th percentile (which is about where these traits become diagnosable as autism) to say the 97th percentile.
If you think of autism as a normally distributed trait, then a child might move from 99th percentile (diagnosable) to 97th (still a little different, but not meeting diagnostic criteria) over time. Does this mean they never had autism in any sense? Does it mean autism-related information and interventions no longer apply in any way?
In the paper this scientific american post is based on, Dr. Treffert actually says that the hyperlexia III kids should receive the same kind of help as kids with autism, while waiting to see if the autism-like troubles go away. So his distinction between kinds of hyperlexia doesn't seem actionable, for now. It doesn't change what he suggests one do with a preschooler who has autistic traits.
I also discovered a number of experts calling it a "myth" that autistic children cannot be affectionate... while Dr. Treffert suggests that affectionate tendencies may be the way to distinguish hyperlexia II and III (autism vs. not). Again, the paper seems to relate to a different take on the definition of autism itself.
The statistical power of a study of "hyperlexia III" would be much stronger if it looked at dimensional measures rather than simply autism-or-not-autism. Though this anecdote-and-case-study-based paper is interesting, it is really only a hint at a study worth doing, not a study in itself. A full study should measure autistic traits dimensionally at say age of diagnosis and then some years later.
One also has to remember that intelligence, and early reading, are powerful coping tools for an autistic person. In the words of Hans Asperger, "Normal children acquire the necessary social habits without being consciously aware of them, they learn instinctively. It is these instinctive relations that are disturbed in autistic children. Social adaptation has to proceed via the intellect."
When relying on the intellect, the power of the intellect matters. An autistic child who is able to read has a huge leg up, because they can communicate and acquire knowledge despite likely difficulty with verbal language.
Writing is a much more autism-friendly language format than conversation and gives an autistic child an accommodating way to learn language - we've seen this with our son. A smart, early-reading child with the same degree of autism as an average-IQ non-reading child may have far fewer visible problems.
(To be clear, this is just my speculation, but I have read at least some research that traits such as affectionateness and learning to read improve prognosis and also improve responsiveness to intervention.)
The effective severity of autism - degree of disability - has a lot to do with traits other than autism itself. Intelligence or other compensating strengths, for example.
When I was a child I was also an early reader (age 2), just like my son, and I am a perfectly happy and successful adult who would never claim disability. However, I have to admit that I have never really had close friends and struggled in my youth because of it, and that reading about autism (of the HFA/Aspie variety) is like reading about my own childhood. Moreover on assessments such as Simon Baron-Cohen's (systemizing, reading the mind in the eyes, cognitive empathy) I score at the "HFA adult" average. So there are measurable autistic traits here, quite possibly diagnosable, but I'm also just fine. Those things are not mutually exclusive.
I think it's possible for a kid to be just fine in all important senses, but still need some extra help paying attention to and relating to peers. Autism is not a yes-or-no question where kids are either badly disabled or not.
Even a person with almost-autism (say 95th percentile on autistic-like traits) could probably stand some extra tutoring in the area of peer interaction, just as a kid on the 95th percentile of trouble with reading could probably use some extra tutoring on reading.
Did I turn out fine without a diagnosis of autism? Sure. Would I have benefited from some of the extra help our son is getting? I really think so, that's why we're getting it for him.
For purposes of qualifying for accommodations or disability payments, society wants to put people in the "broken" or "not broken" buckets, and some professionals may still want to define autism as "disabled enough to fail at daily living."
But for purposes of understanding ourselves and our children, and for research purposes, it's much more useful to recognize shades of gray - and that understanding of autistic traits may tell us useful things, even when they are not disabling.
"Twice exceptional" people - autism paired with visual, analytical, or verbal talents - may in fact have a kind of superpower. Their other talents can compensate for the autism, while the autism gives them advantages such as intense focus and independent thinking.
If we realize that autism is dimensional, then we won't think it's such a big deal what side of the diagnostic line they are on. Think about IQ; nothing magic happens when go from 71 IQ to 69, or 129 IQ to 131. There's not a bright line there.
Anyway. I think the best way to understand Dr. Treffert's post is to think of the three types of hyperlexia as points on a spectrum. I'm sure you can find people who fall everywhere in between those points.
Sorry for a long post, I have just put a lot of thought into Dr. Treffert's paper.
