As reported
on NPR,
the U.S. Preventive Services Task Force recently issued a recommendation
that there is not enough evidence to support screening for autism spectrum
disorder (ASD) in children for whom parents or others have not expressed
concerns about ASD. Created in 1984, this 16-member task force consists of
volunteer experts in prevention and evidence-based medicine appointed by the
Agency for Healthcare Research and Quality, which is part of the Department of
Health and Human Services.
The NPR article
notes that the recommendation is controversial, as child development experts
say there is evidence to support early screening and the risks of screening are
minimal.
The task
force document stated that evidence in support of universal screening “is
lacking, of poor quality, or conflicting, and the balance of benefits and harms
cannot be determined.” Among other things, the document also stated that:
Research
has focused on screening and diagnostic tools and treatment for symptomatic
children, especially those who are severely affected. Good-quality studies are
needed to better understand the intermediate and long-term health outcomes of
screening for ASD among children without obvious signs and symptoms and whether
earlier identification through universal screening is associated with
clinically important improvements in health outcomes.
The NPR
article noted that the task force recommendation does not align with the American
Academy of Pediatrics’ guidelines, which recommend screening all children for
ASD at 18 and 24 months.
The most
common screening process involves a 20-question checklist for parents or
caregivers, involving questions such as “If you point at something across the
room, does your child look at it?” and “Does your child get upset by everyday
noises?” If the responses indicate the possibility of ASD, the practitioner has
a follow-up interview with the parent or caregiver. If necessary, the next step
is a full diagnostic workup.
The NPR
article also noted that editorials in JAMA Psychiatry
and JAMA
Pediatrics criticized the new recommendation.
