Search This Blog

Thursday, August 20, 2015

For Screening

In The Politics of AutismI discuss screening and diagnosis. At The Huffington Post, Dr. Lisa Shulman takes issue with  the U.S. Preventive Services Task Force, which says there is insufficient evidence to support universal autism screening.
The task force's review of the literature found evidence supporting the ability of screening instruments to pick up behavioral signs of autism in young toddlers. The review also found data supporting the benefit of early intervention in terms of improved outcome. However, it determined that there were insufficient data to support a recommendation for screening. This decision seemed to hinge on the lack of outcome data on young children who were "asymptomatic" and whose symptoms were picked up only by screening. But these children don't exist. Children who fail screening tests are symptomatic and demonstrating signs and symptoms of autism--but these signs are not being recognized or voiced until the screenings are carried out.
Waiting until the signs and symptoms are evident to parents and pediatricians takes us back to where we were a couple of decades ago. It will delay diagnosis, delay treatment and impact outcomes. These delays will also likely lead to more-significant disparities of care, since the literature has shown that minority populations are less likely to bring their concerns to their doctors and doctors may be less likely to pursue an autism diagnosis in such populations. Universal screening levels the identification playing field.
We live in an era in which 1 in 68 children is diagnosed with ASD. A timely diagnosis--during the critical window of the toddler years--is required in order to obtain the early intensive behavioral intervention that has been shown to result in the best outcomes. Discouraging universal, early screening is an indefensible course of action.
In the "balance of benefits and harms" that the task force's draft statement speaks of, a well-documented benefit should carry more weight and be given extra consideration over "harms" of inconvenience. That is where common sense comes in.