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Screening for Autism Spectrum Disorder

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JAMA

The US Preventive Services Task Force (USPSTF) has published new recommendations on screening for autism spectrum disorder (ASD).

February 16, 2016

WHAT IS AUTISM SPECTRUM DISORDER?

Autism spectrum disorder is a disorder of brain development in children. It affects a child’s behavior and his or her ability to interact with others. Children with ASD have trouble communicating with and relating to others and may have different interests than children without ASD. Some signs and symptoms of ASD include avoiding eye contact, not playing with other children, repetitive behaviors, language difficulties, and showing an intense focus on certain objects while having no interest in other things. Autism spectrum disorder can range from mild to severe. Symptoms of ASD are usually first seen in the second year of life but can start earlier or later. The February 16, 2016, issue of JAMA contains the new USPSTF recommendations on screening for ASD.

Jill Jin, MD, MPH

WHAT TESTS ARE USED TO SCREEN FOR ASD?

Several tests can be used to screen for ASD in children younger than 30 months. A commonly used tool is the Modified Checklist for Autism in Toddlers—Revised With Follow up (M-CHAT-R/F), which is a questionnaire filled out by parents, with a follow-up questionnaire given by a health care professional if needed. If the results of these screening tests are positive, further diagnostic testing is required.

WHAT IS THE PATIENT POPULATION UNDER CONSIDERATION FOR SCREENING FOR ASD?

The USPSTF recommendation applies to children aged 18 to 30 months who do not have a prior diagnosis of ASD or developmental delay and for whom no concerns about ASD have been raised by parents, other caregivers, or health care professionals.

WHAT ARE THE POTENTIAL BENEFITS AND HARMS OF SCREENING FOR ASD?

The potential benefit of screening for ASD is that diagnosing ASD at an earlier age may lead to earlier intervention and treatment, which typically includes behavioral, educational, and speech/language therapy. There is evidence that earlier intervention and treatment may lead to better outcomes in children with autism detected because of symptoms. The harms of screening and subsequent interventions for ASD are likely to be small but may include anxiety and financial costs associated with misdiagnosis, further testing, and potential interventions.

HOW STRONG IS THE RECOMMENDATION TO SCREEN FOR ASD?

Although there is evidence supporting the benefit of early treatment for ASD, there are currently no studies that focus on outcomes in young children identified with ASD through screening alone in whom no concerns for ASD have been raised by family members, caregivers, or health care professionals.

BOTTOM LINE: CURRENT RECOMMENDATION FOR SCREENING FOR ASD

The USPSTF concludes that the current evidence is insufficient (called an “I” recommendation) to assess the balance of benefits and harms of screening for ASD.

 read more at JAMA

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