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Monday, June 13, 2011

An Argument Against Screening

The Hamilton Spectator (Ontario) reports:

An autistic diagnosis changes the course of child’s life, and their parents’.

What if it isn’t true?

That is something McMaster researchers are trying to avoid, asking for a call to action from the research community against a recent proposal recommending routine autism screening for all children.

“You could miss-label a child,” said McMaster researcher Dr. Jan Willem Gorter. “We know that a child can be over diagnosed based on symptoms. For example, if a young child doesn’t respond to its name it could well be an early sign of autism.

“But it could also be something as simple as a hearing difficulty.”

Gorter is a researcher for McMaster’s CanChild Centre for Childhood Disability Research and associate professor of pediatrics. His findings in a literary review suggest that there are no good screening tools and no evidence that routine screening will do more good than harm, contrary to a recent recommendation by the American Academy of Pediatrics (AAP) incorporate autism screening into routine practice.

Gorter was quick to caution that there is a big difference between routine screening -- which means surveying everyone, including apparently healthy people -- and clinical surveillance, which means surveying those who present with impairments that indicate a possible problem.

"We as a group think that if parents have concerns, they should go for surveillance," Gorter said. "But routine screening doesn't necessarily address that and at this point, it may be premature."

The AAP, which currently has 60,000 pediatrician members, currently recommends all children be screened at specific intervals, regardless of whether a concern has been raised, saying that pediatricians play a key role in early recognition of disorders.

Other groups have also thrown their support behind that recommendation.

In an email, Dr. Geraldine Dawson, chief science officer of Autism Speaks, the nation's largest autism science and advocacy organization, said the group supported the AAP's recommendation that children be screened at their 18 and 24-month checkups.

"Early intervention has been shown to result in significant increases in cognitive and language abilities and adaptive behavior," she said, "allowing children the best chance for a positive outcome."

The abstract:

Early Autism Detection: Are We Ready for Routine Screening?

Mona Al-Qabandi, MD, MRCPCHa, Jan Willem Gorter, MD, PhD, FRCP(C)b,c, Peter Rosenbaum, MD, FRCP(C)b,c

Background. Autism is a serious neurodevelopmental disorder that has a reportedly rising prevalence rate. The American Academy of Pediatrics recommends that screening for autism be incorporated into routine practice. It is important to consider the pros and cons of conducting autism screening as part of routine practice and its implications on the community. We have explored this question in the context of screening from a scientific point of view.

Method: A literature search was conducted to assess the effectiveness of community screening programs for autism.

Results: Judged against critical questions about autism, screening programs failed to fulfill most criteria. Good screening tools and efficacious treatment are lacking, and there is no evidence yet that such a program would do more good than harm.

Conclusions: On the basis of the available research, we believe that we do not have enough sound evidence to support the implementation of a routine population-based screening program for autism. Ongoing research in this field is certainly needed, including the development of excellent screening instruments and demonstrating with clinical trials that such programs work and do more good than harm.