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Keeping the “Grade A” in universal early screening for autism

Pediatricians and advocates join to redouble the call for autism screening at 18 and 24 months despite equivocation by the U.S. Preventive Services Task Force

By developmental pediatrician Paul Wang, Autism Speaks senior vice president for medical research

Autism starts very early in brain development – probably before birth – and its symptoms can be detected by age 2.  We have a broad consensus, based on research, that early intervention for autism results in better outcomes. Experts also widely agree that the earlier treatment starts, the better.

The US Preventive Services Task Force – a government-appointed advisory group that yields great influence over medical practices and insurance reimbursement nationwide – supports this consensus on the effectiveness of early intervention.

Yet to our great disappointment – and against expert counsel – the Task Force has refused to recommend universal screening for all children in America.

The Task Force’s statement on universal autism screening – finalized and published today – assigned the practice an “I” grade for insufficient evidence. To their credit, the authors of the task force report have tried to underscore that their finding is not a recommendation against screening, but a call for more research.

Unfortunately, the “I” rating seems sure to mislead families – and health insurers – that autism screening is of “questionable” benefit.

Nothing could be farther from the truth. As the Task Force itself affirms, universal, early screening for is highly effective in identifying children who have autism – particularly when physicians use standardized screening methods. The best studied autism screening tool is a free questionnaire that a parent can complete in five minutes in the waiting room. It’s very easy for a pediatrician or other primary care doctor to review the answers during a well-child checkup – and decide whether the child would benefit from a full evaluation by an autism specialist.

Powerful public and expert comment
The Task Force’s final statement is especially disappointing in that it followed a public comment period filled by clear and forceful arguments for the benefits of early autism screening. This feedback came from expert clinicians and researchers and highly respected professional groups such as the American Academy of Pediatrics and the American Speech-Language-Hearing Association.

In their report, the Task Force acknowledges that evidence supporting universal early screening for autism is fast accumulating. Even in the time between the Task Force’s evidence review and draft statement, more research has been published to demonstrate the benefits of early intervention for autism – intervention not possible without early screening and diagnosis.

As a developmental-behavioral pediatrician and an autism advocate, I embrace the Task Force’s call for more research – including long-term studies following children from screening through diagnosis and treatment. 

But I and my many colleagues completely disagree that there’s any question about the risk-benefit ratio of early screening.

As the Task Force notes, early intervention is associated with improvements in many areas of function, including language, social communication and cognitive abilities.  Research also suggests that early intervention reduces autism’s lifetime economic costs.

Universal screening also may be helpful in reducing the disparities in recognizing and treating autism that we see across socio-economic and minority groups. ‘

Given the Task Force’s agreement on all these points, and the non-existent risks of screening, it’s clear that the risk to benefit ratio strongly favors universal screening for autism.

Potentially damaging consequences of “I” statement
While autism screening carries no harm, the same can’t be said of the Task Force’s statement. Their statement essentially amounts to “we don’t know whether screening helps,” and many media outlets have already echoed this misconception in their headlines.

Compounding the risk that fewer American children will undergo screening is the risk that medical insurance companies may discontinue reimbursement to physicians for screening work. While the Affordable Care Act mandates screening with no co-payments (thanks to the recommendations of the Bright Futures Project), many older plans fall outside this rule. 

And so Autism Speaks joins with the American Academy of Pediatrics and other research-based advocates for our nation’s children in redoubling the call for universal early screening for autism, and for prompt and effective delivery of early intervention services for all children found to need them.

The benefits of intervention must be made available to all American children, regardless of race, ethnicity or social status, and these benefits must be made available at the earliest possible age, when it is most effective. 

To conclude, I and my colleagues continue to wholly endorse the Bright Futures guidelines from the American Academy of Pediatrics - for continuous developmental surveillance and for specific autism screening at 18 months, 24 months, and whenever a parent or provider expresses concern.

See Autism Speaks official response to the USPSTF statement here.

Also see “Screen Your Child” for an interactive online version of the M-CHAT™ autism screening tool for toddlers, available to use free of charge on the Autism Speaks website.

 

The Autism Speaks blog features opinions from people throughout the autism community. Each blog represents the point of view of the author and does not necessarily reflect Autism Speaks' beliefs or point of view.