The US Preventive Services Task Force (USPSTF), an independent, government-backed panel that recommends whether to adopt screening tests for certain conditions, has said that more evidence will be needed to support autism screening in young children who have no developmental problems. The guidelines being considered apply to children aged 18 to 30 months who do not show any signs of an autism spectrum disorder (ASD), reports Reuters.
Although autism diagnoses are increasing in the US, this is the first time the task force has analyzed autism screening. Approximately one in 68 of the nation’s children has an autism spectrum disorder, which can cause problems with social interaction, communication, and other elements of everyday living, according to the CDC. There are organizations that promote some type of autism screening during the early years, such as the American Academy of Pediatrics (AAP), which recommends surveillance and screening at 18 and 24 months, whether or not a child shows signs of the disorder.
But the task force review that began in 2013 found breaches in the research concerning the benefits and harms of this screening, according to Dr. David Grossman, vice chairman of the task force. More evidence is needed, added Grossman.
The accuracy of the instruments used to screen children was found to be evident, most notably the Modified Checklist for Autism in Toddlers (M-CHAT). For this test, parents answer questions about their children’s communication skills, attention, and movements. Dr. Susan Levy, chair of the AAP’s autism subcommittee, is concerned that the statement from the task force may lead parents to doubt the benefit of the screening.
If autism spectrum disorder is discovered early in a child’s development, says Levy, outcomes for the child are improved. Parents of toddlers should advise their pediatricians about poor eye contact, irregular social connections, responsiveness, and level and type of interest in peers.
Molly Walker of MedPageToday reiterated that the task force cited inadequate direct evidence on the benefits of screening.
“Good-quality studies are needed to better understand the intermediate and long-term health outcomes of screening for ASD in children, and whether identification through screening is associated with clinically important improvements in health outcomes,” the authors wrote. “Treatment studies that enroll younger children, especially those with screen-detected ASD, are critical to understanding the potential benefits of screening.”
Max Wiznitzer, MD, pediatric neurologist at Rainbow Babies & Children’s Hospital in Cleveland, agreed that if a child has normal development through regular surveillance of parents and pediatrician, additional screening is not necessary. But, he adds, the reality of clinical practice is that only about half of pediatricians actually perform developmental screening.
Young Shin Kim, MD, associate professor at the University of California San Francisco School of Medicine, said the findings were not a surprise to her, but that she was emphatic that pediatricians screening for ASD need to have better tools.
“Sometime, ASD symptoms can appear without apparent motor and speech delays. These symptoms include social engagement with people and non-verbal social communications such as gestures, eye contact, etc.” Kim told MedPage Today via e-mail. “Therefore, it would be desirable to include separate valid and reliable ASD screeners for pediatricians, which we do not have at the moment.
This report, in the opinion of Geraldine Dawson, PhD, professor, psychiatry and behavioral sciences at Duke University School of Medicine, shows that research is needed that will assess the importance of early universal screening for autism on outcomes for children.