To Screen or Not to Screen? The Debate on Autism Diagnosis

Could a proposal by an expert panel undermine years of progress made in the identification and intervention of autism?

Could years of monumental effort to build awareness of autism be reversed? That’s the concern among many health care professionals and parents following the release of a draft proposal that concluded there isn’t sufficient evidence to recommend universal autism screening of young children.

The proposal, drafted by the U.S. Preventive Services Task Force, is in direct contrast to current guidelines issued by the American Academy of Pediatrics (AAP), which urge universal screening of all children using standardized screening tools at ages 18 and 24 months.

Formed by a panel of independent experts in prevention and primary care, the proposal could have repercussions across health care, from the treatment a patient receives to insurance coverage.

Although the panel was quick to clarify that its conclusions were directed towards asymptomatic children, autism experts fear that a lack of support from the panel will undermine years of effort — both in the lab and through public awareness campaigns — that have shown that early intervention in autism may lead to greater developmental improvement.

“We know that autism is common and that the growing numbers are largely due to appropriately classifying cases that were missed in the past,” Melissa Nishawala, MD, assistant professor and Medical Director of the Autism Spectrum Disorder Clinical & Research Program at NYU Langone, told Neurology Advisor. “Many of these missed cases were either milder or easily misunderstood as some other disorder. Only universal screening is likely to pick up these cases.”

The AAP quickly came to its own defense after the proposal was published. In a statement, Sandra G. Hassink, MD, president of the AAP, said:

Autism Spectrum Disorder (ASD) has a tremendous impact on families, affecting an estimated 1 in 68 children in the U.S. Because early identification and referral for appropriate intervention are critical to ensuring that  children with autism have access to effective therapies, the American Academy of Pediatrics (AAP) recommends all children be screened for ASD at ages 18 and 24 months, along with regular developmental surveillance.

The draft recommendation statement on autism screening released Aug. 3 by the U.S. Preventive Services Task Force runs counter to AAP guidelines. The AAP remains committed to its recommendation for the timely screening and identification of children who would benefit from early intervention and treatment.