March 7, 2016

National Panel Finds Insufficient Evidence to Recommend Universal Autism Screening

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.