News & Commentary

Autism Screening Suffers a Setback

There’s not enough evidence to merit universal screening for autism of toddlers (children ages 18 to 30 months old), according to a draft recommendation by the U.S. Preventive Services Task Force (USPSTF).

The prevalence of autism spectrum disorder (ASD) is now about 1 in 68 American children compared with 1 in 150 children 15 years ago. The reasons for autism becoming more common are unclear, although some research suggests that the rise may have more to do with the way the condition is being defined and diagnosed than a true increase.

In explaining its decision, the USPSTF cited the lack of randomized controlled trials directly addressing the question of whether screening reduces autism on a population basis. The prevention experts also mentioned the lack of evidence for early intensive treatment benefiting a screened population.

USPSTF’s recommendation not to screen is at odds with what many physician groups say should be done. The American Academy of Pediatrics recommends universal screening for ASD in all children at ages 18 and 24 months.

The American Academy of Neurology wants developmental surveillance at all well-child visits from infancy through school age. And the American Academy of Child and Adolescent Psychiatry recommends that questions about ASD be included in routine developmental assessment of young children and the psychiatric assessment of all children.

The USPSTF points to some potential harm from screening that include “the time, effort, and anxiety associated with further testing after a positive screening result, particularly if confirmatory testing is delayed because of resource limitations. Behavioral treatments are generally thought to not be associated with significant harms but can place a large time and financial burden on the family.”

The American Academy of Pediatrics (AAP) worries that the task force’s statement will be interpreted as saying that there’s no benefit to screening. The AAP stresses that early detection is crucial to early implementation and effectiveness of intervention therapies for children with ASD.

“Parents who have concerns about their child’s development, especially about the way their child plays, learns, speaks, acts or moves, should talk with their child’s doctor,” Sandra Hassink, MD, the AAP’s president, said in a press release. “A child who has developmental delays can begin therapy before a formal diagnosis has been made.”

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