Gifted Issues Discussion homepage Forums Twice Exceptional Hyperlexia and academic achievement

I posted about my daughter here but now I have a question about my son.

He was born reading. I don't know exactly when he learned to read. All I know is when he started talking, we realized that he was able to read too. Not just reading, but counting, naming complex shapes, colors etc. He was also diagnosed with PDD-NOS due to his sensory issues and speech delay, but I believe his hyperlexia was a big part of his dx, because of how unusual it was and because there was a distinct difference between his receptive and expressive speech and his decoding ability.

Studies suggest that this isn't a true giftedness and this decoding ability of his is a disability, instead of a superability and testing IQ in these children before the age of 10 isn't recommended because the research shows that the reading ability doesn't continue to advance at the same rate as in the typical children and by the age of 10, the reading advantage is completely gone (Yale). Anecdotaly, the verbal and visual spatial IQ of these children can change dramatically over the years, not because the hyperlexic child gets less intelligent, but because typical children's verbal and visual abilities catch up and get ahead.

After five years of therapy his PDD-NOS dx was removed, based on ADOS, and now at 7, he looks like an NT kid with some weird interests and oversensitive nature. He is 7 now and just finished the 1st grade. So far he does great in all areas, but I just don't know if this is going to stay like that.

If you have a hyperlexic child, what has your experience been like? Can you be hyperlexic and truly gifted? He was never tested and knowing that his IQ may not be stable I just don't want to do it yet.

Sent you a PM, Chicagomom.

I thought this was an interesting article. http://blogs.scientificamerican.com...sorder-hyperlexia-and-einstein-syndrome/ DS9 seems to fit into category 3. He was reading at a third grade level in early kindergarten and he still tests about 3-4 grade levels ahead on reading achievement tests. He tests 98-99th percentile on MAP. Cognitive ability testing also 98th-99th percentile. DD was an early reader as well but in the last several years it has been challenging to get her to read at home so her achievement scores are slipping. She would probably be category 1 (if I had to pick a category) however I think there should be another category, one where children are gifted, the other kids do not catch up, and they don't have autistic traits. There is research stating that most highly gifted kids were early readers. So are they really hyperlexic? Or just gifted?

Often gifted/ASD children look hyperlexic because no one can believe they are comprehending at so young an age. (True hyperlexia is early decoding without comprehension.)

The gifted/ASD may have the very early decoding, *but be reading with comprehension*-- in which case they're not hyperlexic.

The gifted/ASD combination is unusual enough that many providers won't catch it early, and mistake the gifted reading for hyperlexia.

I don't see why gifted/hyperlexia would be impossible-- I would just bet that hyperlexia is overdiagnosed in the ASD population.

The article I posted doesn't really make that clear--that hyperlexia is reading without comprehension. I think in a really young kid, esp. one w/ expressive speech delays, it can be hard to know if they are comprehending. So maybe your DS was actually not hyperlexic. He does sound very similar to my DS and all I can tell you is that his reading has stayed advanced at age 9. I think he had very early reading ability and he was an excellent decoder, but he was never truly hyperlexic.

I have a 16 yo who might have been diagnosed as hyperlexia had we pursued it. She was obsessed with the written word by age about 12 months and reading ability really took off by her 2nd birthday. She was not an early talker, so much of her spoken language development occurred in parallel with reading. By the time she was 4yo, she no longer wanted dh or I to read aloud to her because she could read much faster on her own. She had some other unusual qualities that could raise flags for ASD (extreme stranger anxiety as a baby/toddler, did not speak her first year at preschool,…). For reasons that may not have been entirely rational, we were not keen on pursuing a diagnosis - in any case, it would certainly have been a "high functioning" diagnosis.

But the main thing I wanted to convey is that our experience is another example showing it is possible to be an early reader without hyperlexia. It was clear to us as parents from the start that her reading comprehension was strong, and throughout school she was always off the charts on standardized testing for reading (she took her first SRI Lexile test in 3rd grade and her score was above the college range).

Our approach in the early years was to embrace the joy she found in reading. We put a lot of time and effort into finding/procuring books in line with her interests. Many, many, many books. Today she is an extremely capable hs student (in all subjects). In her case, early reading was a sign of unusually strong cognitive ability that has persisted through the years, judging from hs grades and a recent ACT test.

You might be interested in this older thread:
http://giftedissues.davidsongifted.org/BB/ubbthreads.php/topics/162404/Re_Hyperlexia.html

As a 2-year-old reader with a son who was a 2-year-old reader, and someone who's spent lots of time reading hyperlexia and autism research... I believe the research isn't good enough to tell us parents what to expect for our particular children. Anything is possible.

Hyperlexia has maybe dozens of studies at most, mostly with tiny sample size. The hyperlexia studies don't even agree on a common definition of "hyperlexia."

If your child is doing great at age 7 (my son is about that age too for what it's worth) he'll probably keep doing well, surely? But it's more useful to look at kids individually than to rely on categories like autism and hyperlexia.

My interpretation when some of those papers say the other kids catch up is that there's a kind of plateau where reading skills are as good as it's useful for them to be, and at that point kids switch from "learning to read" to "reading to learn." This doesn't mean that hyperlexic kids regress, or that they can't also be good at "reading to learn," it's just that being advanced at reading stops distinguishing them once other kids make it up to the plateau too. At that point, other traits matter more than reading ability.

My son was also a 2-year-old fluent reader (1-year-old beginning reader), lots of social and sensory kind of issues, and he's doing very well now in 1st grade. He had a decoding-vs-comprehension gap for a while but in his case I think it was mostly because preschoolers don't understand the world. His comprehension is good now that he's older. He had an IQ test as part of a school assessment at age 3 and he was very good at the nonverbal (block design) part but had trouble with the verbal part. These days he's quite advanced in math as well as reading. He isn't a social butterfly but seems happy.

FWIW I was a 2-year-old reader carrying around toy letters all the time and the whole deal. I've had a lot of social trouble/disinterest throughout life, but was always very good at school-type things and went to a bunch of gifted enrichment stuff. As an adult I am a happy and well-adjusted person. But I expect my parents were pretty worried about me sometimes as a child and every part of school besides the academic work was an ordeal for me.

For some context: Phonetic decoding skills pretty much max out late in middle school. NT readers make the learning-to-read/reading-to-learn transition usually during fourth grade, which is generally when we denominate them fluent readers. So yes, NT readers do "catch up" to very early readers, if we are discussing only phonetic decoding skills.

Comprehension, vocabulary development, and content knowledge are another discussion.

Much depends on the definition of hyperlexia, and whether it specifically excludes high-level reading comprehension.

Chicagomom I don't have answers but I have the same questions about my son who is nearly 6. He got an autism dx very young (18 months) and more recently the paed added adhd and he started ritalin. He had an iq test at 5.0 before starting school (SBV) and had a quite a spikey profile (131 for verbal, 122 for performance, but quite a spread with the highest score of 144 for fluid reasoning, lowest at 111 for knowledge - 128 overall, but of course he is very young.). On the Celf language assessment around the same time he had no scores below 50th centile and half his scores were above the 90th centile... but on the 'bus test' (narrative retell) he did score a bit delayed. Hyperlexia wasn't so much on my radar before school started. He wasn't a self-taught reader, he learned to read at 4 through Reading Eggs (completed the program). He started kindy this year in a mainstream school with an aid. His teacher was impressed with initial reading assessment and thought comprehension was quite strong (he has had weekly speech therapy for years, and he had a few years of aba therapy too). They started him on high level readers (equivalent of about 7.5 then jumped up levels to equivalent of about 9 very very quickly. His decoding skills seem unlimited but his comprehension has not kept up I don't think and I do think I need to address this early next term and say we go back down at least 10 levels). t's very variable based on the reader but I do think i can see hyperlexia now at times (quite fluent word reading when fluent comprehension is missing) and if i look at his early development i can definitely see elements of it (the asd obviously, the very strong memory for things like flash cards, shapes, colours, letters, numbers etc all of which he could remember almost on one showing). His biggest weaknesses these days in terms of asd are social (he is very verbal and responsive but definitely struggles with the complex social elements of communication stiill, especially with peers). Like you I wonder about what his type of profile will look like as he gets older... we are currently using this resource on advice from a speechy and I do think it's been helpful https://www.redshelf.com/book/14625...johnson-carolyn-logiudice-and-jane-orman

Is there a good test of comprehension for 6 year olds apart from language assessments like Celf?

My DD was a very early reader...picking out words at 17 months, 2nd grade level by 24 months, Rainbow Fairy books at 30 months. She loved books and would reenact the stories she read. She had great comprehension given her life experiences and age. She had a phenomenal memory which helped her learn to read by sight words. It seemed her mission in life was to read by 2. By 24 months she was typing short sentences on the computer.
Was she hyperlexic? No one ever assessed her, but in recent years she has been dx with Aspergers.
She does have a very high IQ (170 ex norms), so I now believe she is highly gifted with ASD, but also a highly precocious reader.

Academically, she is doing very well, her WIAT scores came at a time when school was failing her, but since then, she has taken off and is still 5 or so grades ahead of where she should be.

Thank you everybody for answering.

Our psychologist (the one who diagnosed him with PDD-NOS in the past) is licensed as a homeschool test administator and at the end of the year he gave him an above-grade Iowa-CogAT combo test, normed for the end of grade 2, when my son just finished the first grade. The above-grade test was to avoid hitting a ceiling. This is something he does a lot for all of his PDD-NOS patients as he doesn't trust the school academic assessments. We just got the results:

Well, here are his Iowa:
Vocabulary - 92%ile (3.6 grade equivalent)
Reading comprehension - 96%ile (3.7)
Spelling - 99%ile (4.5)
Math concepts - 99%ile (4.2)
Math problems - 97%ile (3.8)
Math computations - 99%ile (3.4)

But his CogAT isn't nearly as strong:
Verbal - 62%ile
Quantitative - 86%ile
Nonverbal - 92%ile
Composite - 86%ile

The test is above-grade, so I am not sure how much this contributed to the results, but it is obvious that his fluid intelligence isn't as strong as crystallized. His "predicted national percentile rank" was in the 70%ile based on Cogat, when his actual are all in the 95+%ile. Is this his PDD coming through like that - not being enough abstract and being too literal? Or his high achievement scores are "just" his hyperlexia, when his Cogat scores represent his actual intelligence?

My daughter's Cogat scores are in some cases several standard deviations below her WISC-V subscores, so I am not sure how much I trust it. But I see a lot of gifted kids here do really well on it, so I just don't know.

Not surprisingly, most of the hyperlexia research and even the posts here focus on the very young children. There is very little in terms of "what to expect" for older kids who grow out of their ASD label. The hyperlexia-IQ research shows no increase in IQ compared to average, but the research mostly focuses on ASD population with and without hyperlexia.

The hyperlexia clinic in Illinois (CSLD) says that recruiting kids for hyperlexia type 3 studies is very challenging because they are very rare and difficult to identify at a young age (differentiate them from ASD kids), so a large practical longitudinal study has never been done.

CogAT: flip through a few CogAT threads here, and you'll see that many children with very high WISC scores perform markedly lower on the CogAT, so while some do well, quite a few do not.

Keep in mind also that the CogAT primary level is entirely pictorial (no reading or calculating), with a significant listening comprehension component, and not insubstantial social comprehension demands, on the verbal portion. If you reference some of the hyperlexia links mentioned earlier, remember that deficits in listening comprehension are often paired with hyperlexic behaviors, so that reading is a more effective channel for accessing environmental input than listening is. Bing. Poor performance on the CogAT verbal, and high reading comprehension scores.

And if one were to interpret the scores as given, it would suggest that his fluid reasoning is quite a bit better than his concrete intelligence, actually, as the highest score was in nonverbal, which is usually most closely associated with fluid reasoning.

Oh, and CogAT is normed by age, typically, but can be reported on grade norms. You would have to consult your evaluator or evaluation report to determine which was used in this case.

Caveat on the ITBS: Notice how low the ceiling is on the ITBS grade 2, especially in math, making the grade equivalents even less reliable than their general level of unreliability, and suggesting that the percentile differences between math areas are also not significant (probably reflective of a difference in one or two items). For example, the grade equivalent of the 99th %ile in math computations is only about half a year beyond the 50th %ile, and clearly doesn't include mastery of all multiplication facts. I wouldn't read too much into concrete skill/abstract application achievement differences.

Do you normally see a big jump between Grade 2 Cogat and later years for hyperlexic kids, when Cogat goes from picture-based to reading-based? Do NT children stay on the same percentile (+/-error) between pictorial and word-based Cogat? I am not sure I understand this at all. Why do they use a picture-based test at all for 2nd graders? How does it predict any future academic performance? Is WISC-V verbal comprehension section pictorial? Are there any good reads on this?

Do you know in general, how does an above-grade test is scored for younger or older children? Do they norm 2nd grade ITBS separately on 1st graders, 2nd graders and 3rd graders? If the Cogat was actually end-of-the-year grade 2 Cogat but he just finished the 1st, how would they calculate his age score in this case? Do they have norms that go up and down a few years for each test?


That's a very good point. So this is some sort of lingering receptive speech delay? He did have some at the time when he was diagnosed with PDD-NOS, but it was mild enough. His expressive speech delay was much greater - enough to qualify for services. At the same time it is generally said that hyperlexic kids have poor reading comprehension - they can read more than they can understand. If his listening issues are a part of his hyperlexia, then how does his 96%ile reading comprehension come into this? Is it still hyperlexia if his reading understanding is that good?

Why is his quantitative score that much lower than his math concepts etc?

I can't really say normally, as I don't have enough data (not enough cases) to say what is usual in hyperlexic kids. NT kids generally speaking (no LDs or other educationally-relevant disabilities) do about the same on the pictorial and text-based CogAT, by definition (they are the basis of the norms and percentiles). The pictorial test is used in the primary years because of the wide range of reading levels obtained in the non-disabled population in that age group, so that reasoning/learning aptitude and decoding skills are not confounded. By the end of third grade, the majority of children can read fluently. The WISC-V VCI has negligible visuals (none for children who are at least average in intelligence), relying entirely on oral verbal ability. A small amount of receptive language is required (comprehension of single words--one at a time for Vocabulary, and two at a time for Similarities), and a moderate amount of expressive language (to provide the responses; it is possible to obtain maximum scores using only single word responses, though most children use phrases or sentences).

Out-of-level achievement testing usually compares examinees to the standard norm group. So your DC's ITBS scores compare him to children on the average a year older and a grade more experienced. His CogAT should have been calculated on age-norms, using his chronological age peers. They do typically have age norms that extend a bit beyond the typical age range. I don't believe I've seen them more than a year out, though.

Is it still hyperlexia? Depends on which definition of hyperlexia we are using. Listening comprehension is also not the same as reading comprehension, even though both involve language comprehension. I've seen plenty of students who can do one but not the other (both directions).

Quantitative reasoning, like verbal, doesn't actually measure any math skills, just problem-solving related to mathematical thinking. A few possibilities: he may have had difficulty interpreting the questions, been uncomfortable/unfamiliar with the testing procedures, etc.

Thanks again for the information!


I know as a group, the scores will be the same, due to normalization, but at individual level, I don't believe this is true. I bet kids that are great at listening would do better on grade 2 Cogat and kids that are great at reading would do better on later grades. Grade-to-grade repeatibility can't be good. Could you please share any data you have on it? It probably explains why in our school district there are two waves of gifted kids - one in the 2nd grade when everyone is tested and one in the 4th, on the re-test. The second wave is more likely to test well again in the 6th grade for the middle school program.


Do you think hyperlexia 3 even exists? I mean 10% of the ASD cases recover (30% of the HFA cases in some studies), so it stands to reason that some of these cases had hyperlexia (may be even most), but somehow the impression is that it wasn't ASD at all but this hyperlexia 3 instead. Do you believe hyperlexia has anything to do with giftedness or like most professionals in your field you think it is a part of the spectrum?

There is certainly a fair amount of variability on re-administration with CogAT. I definitely have seen scores range widely over the years. The tests are in two-year bands, if I recall correctly, so that a certain number of items overlap from year to year, with the items pretty much turning over entirely by the time you get two years out. Keep in mind, also, regression to the mean and standard error. I believe I've linked this interesting article by the author of CogAT in the past:

https://faculty.education.uiowa.edu/docs/dlohman/Understanding_and_predicting_regression.pdf

in this thread:

http://giftedissues.davidsongifted....sion_to_the_Mean_Why_tes.html#Post230897

Backing up a moment on the question of syndromes existing/not existing, let's remember that there is no definitive physical/chemical/biological/imaging test for ASD, hyperlexia, or many other psychological/psychiatric disorders. We classify collections of symptoms in an attempt to impose our own order on the extreme diversity of human neurological development. I prefer to treat diagnostic categories as useful if they lead to improvements in the development, life functions, or personal understanding of the individual in question.

That being said, I think that hyperlexia, if it is defined specifically as fluent decoding without commensurate comprehension, may or may not overlap with giftedness, and may or may not overlap with ASD, but probably is less likely to overlap with giftedness, and more likely to overlap with some form of savantism, whether on the spectrum or otherwise. If it is defined as fluent decoding with or without commensurate comprehension, then, in the case of with comprehension, I think it is more likely to overlap with giftedness, with or without some other neurological/neuropsychological condition (such as a communication/language disorder, or ASD), and less likely to be solely a manifestation of ASD.

But that's just my opinion.

As always - I very much appreciate the time you take to answer my questions.

From reading and talking to people at CSLD in Chicago about it I understand that reading comprehension ability is the key differentiation in hyperlexia types.

If a young child decodes well, but has lower IQ (70) and comprehends what he decodes only at the level of his IQ, it is considered true hyperlexia, as in a disability and is much more likely to occur in ASD cases or other developmental disorders. If a young child decodes well and comprehends at his IQ level of 140, then there is no doubt that this is just precious gifted reading. These two outlying cases are pretty clear.

The real question is with the kids who decode well above their chronological age but comprehend at their IQ level, when their IQ level is more typical - 85-125 (like it is probably in my son's case, based on Cogat). Is that still a part of some disability or just a specific advanced ability unrelated to IQ, like music or art skill or sports?

Are advanced math abilities common in hyperlexic kids? There is zip about it in the hyperlexia studies. Nothing at all - everyone just focuses on single word reading. There is one study ("Reading and arithmetic in adolescents with autism spectrum disorders: Peaks and dips in attainment.") that says groups with arithmetic ability peaks and reading ability peaks are mutually exclusive. So is having a 99%ile math ability on top of above-level word decoding differentiates from the hyperlexia as a disability?

Are advanced spelling skills common in hyperlexia? Does spelling require comprehension? Some say yes, some say no.

This is so confusing....

I have a child who was an early reader and I suppose her decoding skills were above her comprehension. By her third birthday, she was able to decode anything put in front of her but she couldn't possibly have understood something like War and Peace. These days, with guidance, she might but not when she was 3.

She also has precocious abilities in music and math. I think this means she is very good at recognizing and learning patterns.

She is not on spectrum but she had interesting processing issues up to age 4 and she is still fearful of loud roaring sounds. She did lining up objects things too when she was two and loved toys that had wheels. So, yes, she had ASDish traits but has now grown out of them.

Her development has been uneven if not unpredictable but she is who she is and I never thought her early reading was a sign of disability. She read with expressions, she giggled and laughted at funny weird parts, she asked questions, and shared what she read with us. If she was reading with a flat voice and never uttered a comment while reading, I think I would have worried.

I suppose DD fits Hyperlexia 3. She is not the easiest child to raise but I wouldn't want her any other way.

Our DD16 is very, very similar to Mana's description of her DD. And I agree, I think she sees patterens much more easily than others, and the is part of what explains her areas of relative strength- very early reading, math, foreign language and music. She finds music theory comes very easily, and seems to find things like composing and arranging music cone naturally, seeing patterns and relationships. Like Mana's daughter, we never had concerns about comprehension, spelling was easy and basically automatic. And she also had traits which could be considered ASD-ish, but which are completely absent now (mainly sensory, loud-noise aversion and anxiety, emotionally hypersensitive.)

How old is your daughter now? Is she in school?

Our PDD-NOS symptoms were largely sensory avoidances of all types (oral, tactile etc), repetitive play and language delays. A little bit of everything but none was serious. Maybe because he was a boy or maybe because his language delay was still substantial at 2.5y, the psychologist gave us an ASD dx. The symptoms have disappeared or disappearing, so it is similar to what you are describing.

My son does well in music classes (piano), but he doesn't love it. He has no problems reading the notes, but his fine motor skills aren't advanced (they are age-appropriate, specially for a male child) so I have to incentivize every time it is time to practice.

We had concerns about reading comprehension because we were told we would have those issues by our psychologist who noted his hyperlexia. So far, based on scores it doesn't appear to be the case, but from reading ASD boards, it seems like the real struggle for diagnosed kids comes in the later elementary grades and he just finished the 1st (7.5yo) - way too early to tell, despite very high 90s in the reading comprehension, spelling, vocabulary and math. Did your DD have Cogat testing in school? Did she have verbal/nonverbal gap that is typical in hyperlexic kids?

I don't know if I believe in hyperlexia3 anymore. Statistically speaking, PDD-NOS dx is only 35% stable within the first three years for children diagnosed before 36 months, so a lot of kids recover from this mild form of ASD, and I assume some have hyperlexia too, but a lot don't. I don't think it is a specific hyperlexia type. I think it is a specific ASD presentation that isn't stable over time, and it is the children's typical IQs instead of hyperlexia that seems to improve the chances of recovery significantly.

Hi Chicagomom. Yes, our DD took the CoGat in third grade. She scored 99% composite; the difference between verbal and nonverbal was small, I don't remember which was higher but they were pretty close.

Her music skills were not as evident when she was as young as your DS, except for generally being a fast learner. At this point she transposes and reads/writes in several clefs, has extremely good relative pitch and a weirdly accurate aural memory. All could be related at least in part to seeing and reproducing/playing with patterns, kind of like learning a foreign language, also something that comes easily to her.

As far as school goes, academics are far too easy, even now with AP and dual enrollment, but she has always been self-motivated to find and create challenge herself, either in or outside of class. Socially there have been bumpy times, particularly in early middle school, but I'm not sure it's anything that unusual.

Hope that helps in some way.

DD10 could spell individual words very early, and probably read them, though she only read them aloud right around when she turned 3. In Kindergarten she read chapters books well and was give 5th grade reading comprehension materials by her teacher; by the end of K her reading level appeared to be around grade 8, though it was always a bit hard to tell because lack of background knowledge was an issue. (I remember her Kindergarten teacher giving her a 5th grade passage about the fall of the Berlin Wall, for example--try asking a Kindergartner what they now about the Cold War, lol!) Anyway, I suppose she might fit Hyperlexia III except she had very good comprehension.

She also has dx of ADHD and high functioning autism, but still reads at a very high level. High school? College? I dunno. But she's also great with patterns and working several years ahead in mathematics. The reading was not a transient or isolated skill.

IME it is worth watching as the kids make leaps in social development through elementary-- there are a few moments where all of a sudden a light bulb turns on and the kids get new awareness of themselves, each other, and their social powers. Keep an eye on whether your child develops alongside peers in this regard. PDD-NOS (ASD) looks really different in elementary than it does in preschool, especially in a gifted kid.


The thing to watch for a kid like this (again IME) is comprehension of perspectives in reading, and making inferences. As they move from understanding basic content to understanding things like the motivation of a character, or the angle from which a text is written, that is where comprehension issues can crop up in a strong reader with PDD-NOS / ASD.

I just wanted to point out with all of this ASD/PDD-NOS talk that PDD-NOS is no longer a diagnosis given due to the aforementioned discrepant outcomes. The previous diagnoses of PDD-NOS, Asperger's, and Autistic Disorder were all wrapped up into Autism Spectrum Disorder--there are no subtypes (whether that be PDD-NOS, Asperger's, "high functioning," or "low functioning"). If you have a clinician considering diagnosing your child with PDD-NOS or Asperger's, seek a different one.
Children diagnosed with an ASD through the use of an ADOS-2 by a research reliable examiner and with a full assessment (autism-specific interview and developmental/cognitive/language/etc testing) have an incredibly low rate of ever "growing out of" their symptoms.
(I work in autism assessment at an internationally renowned center for autism.)

Priiak,

I have a question. What happens to those who are at the higher/est functioning end of things? Are they less likely to be diagnosed now under the new system?

ds's neuropsych w/ a large university believes a lot of kids are being misdiagnosed with autism. The autism rate keeps going up, not down.

There are many reasons for the autism rate going up, but that's a conversation for another time.
My point stands: if a diagnosis is made with an appropriate assessment (autism specific interview, ADOS-2 with a research reliable examiner, additional cognitive/language/etc testing, additional reports from school/outside sources other than the parent, etc), the likelihood of that diagnosis changing is slim. Of course, there are always outliers, but they're just that: outliers.
The issue is really in the lack of appropriate diagnostic techniques, e.g. therapists diagnosing on the basis of an hour with the child every other week, quick diagnoses at intake during a psych hold, etc. I've seen plenty of those, and they're an issue. But, that's not just specific to ASD. I also see bipolar, schizophrenia, and other weighty diagnoses are also handed out like candy. I once saw a three year old who had been previously diagnosed with bipolar. Bipolar!
On the other hand, many children of color and girls are heavily underdiagnosed with ASD. All too often, children of color are instead diagnosed with conduct disorder, intellectual disability, schizophrenia, personality disorders, etc, before finally receiving ASD.

I also see far too much of this. In particular, I seem to have had a chain recently of highly-verbal girls (some 2e) misidentified with conduct or personality disorders, usually by therapists.

I agree that kids are not diagnosed properly these days, but I don't agree that ADOS can provide diagnostic stability. ADOS consists of different parts and they all sum up to make up a total score. Some of them, like communication can improve dramatically in kids over the years, changing the diagnostic outcome.

My son isn't an outlier. He had three ADOS tests, different modules, same administrator. Two years apart, starting at 2.5yo. He easily qualified for PDD-NOS five years ago, under DSM-IV, based on ADOS, because his language delay and communication part was very high. As his language improved, his ADOS scores and his diagnosability went down, with basically only socialization issues remaining, not being sufficient for a dx on its own (it might have been enough for SCD but not AS). His ADOS was borderline at 4.5 and was below threshold at 6.5.

Not surprisingly, kids whose presentation is consistent with former PDD-NOS (language delay must be present), that are diagnosed before 36 months can "beat" ASD by the age of 8-10, when their verbal issues become undetectable and their social skills improve as a result of communication improvement.

Again, PDD-NOS was discarded in the DSM-5 due to a number of factors, and thus can't be factored in when looking at current autism rates and the ability to "beat ASD." If you "beat" ASD, you never had it. That's not how ASD works.
We're going to have to agree to disagree on the ADOS-2. I'm a research reliable examiner of it and use it daily. I worked with one of its authors. Studies, along with my own personal experience, show that that measure and the ADI are the most solid measures of ASD out there. They have fantastic reliability and validity, consistently across repeated studies (including longitudinal). Of course, they should NEVER be used on their own to make a diagnosis and any decent clinician knows this. As for your comment about the ADOS-2 and language, each module accounts for language disabilities. ASD language difficulties are quite different than standard language disorders and the ADOS-2 and clinicians know this very well.
I'm glad your son was an outlier, but he's just that: an outlier, and can't be compared to the whole of the autism population.
But, I'll repeat: any parent who has a concern for autism should not accept a diagnosis without either the ADI or the ADOS-2. Full stop.

I agree with you that ADOS is the best test that exists, what I was diasagreeing with is the fact that once diagnosed by ADOS means always diagnosed.

I think ASD can be divided unevenly into groups. One would be a broad group with some deep genetic involvement - CNVs in nuclear DNA, mitochondrial issues etc, when recovery from ASD is as likely as from Down syndrome. Another group is when the ASD is a result of some epigenetic problem during prenatal or perinatal stage of development, that introduces a delay in the development rather than a permanent impairment. All environmental causes, maternal causes, immune disorders, prematurity etc would fall here.

I know for a fact what caused my son's delays. I have PCOS and very very likely had high fetal testosterone levels, that have been shown to produce some autistic traits, lateralization changes (hyperlexia?) and speech delays. Yet, the exposure to FT was limited (only nine months) and given child's brain plasticity, was reversible through intense postnatal therapies, life experiences etc. Was it not a real ASD then if it can be reversed? If a child can recover from a brain trauma, why can't we accept that a child like mine can recover from ASD?

He may not have a typical outcome, but there are hundreds of boys like him. Whether you call this hyperlexia III or PDD-NOS or something else, it is certain to me after dealing with this firsthand, that with a lot of effort, ASD presentation can change over time and no test given at the age of 2.5 can accurately predict where the child will be at age of 16. It is true for all intelligence tests and it is true for ADOS.

This is very interesting, since I also had high testosterone while pregnant and DS was also one of those hyperlexia 3 kids. His sister is genetically unrelated, but I still carried the pregnancy. The two of them are remarkably similar...for instance PRI scores in the 140's on the WISC IV. Both of them early readers. What are the odds that would occur in two genetically unrelated individuals? DD has ADHD but never had any autistic like traits. But she's also female and that probably plays a role as well.

My daughter has 144 in visual spatiaI on WISC-V (no PRI in V) and has attention issues, but she wasn't hyperlexic. Also zero autistic traits. So I'm sure girls are affected too, but in a different way. I think my mom had it as well and I'm an engineer with a very distant BAP.