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Saturday, January 30, 2016

An Argument for Universal Screening

In The Politics of AutismI discuss screening and diagnosis.

At The Journal of Autism and Developmental Disorders, a letter disagrees with the United States Preventive Services Task Force (USPSTF) on universal autism screening.  Signers are: Diana L. Robins, Lauren B. Adamson, Marianne Barton, James E. ConnellJr., Thyde Dumont-Mathieu, Paul H. Dworkin, Deborah Fein, Mark A. Greenstein, Ho-Wen Hsu, Connor Kerns, Craig Newschaffer, Jennifer Plumb, Paul Shattuck, Renee Turchi, and Giacomo Vivanti.

An excerpt:
In conclusion, we are in full agreement that ASD screening is effective in detecting toddlers at risk for ASD. In fact, the task force’s evidence report highlights that in primary care screening studies, 50–60 % of ASD cases detected through ASD screening were found before parents or physicians had any concerns (AHRQ2015, page 53); although the screening tools cannot have perfect sensitivity and specificity, children detected through screening are likely to be younger than children detected through other strategies (e.g., see Guevara et al. 2013). We also agree that additional research, including larger, well-controlled trials of children identified through screening is needed to fully evaluate the effects of early detection and treatment of ASD and to boost the support for population-based ASD screening. However, we believe strongly that the evidence that ASD can be effectively detected by primary care screening—in many cases before concerns have been identified—coupled with an imperfect but growing and compelling body of evidence demonstrating positive effects of ASD-specific early intervention, is more than sufficient to recommend this practice. Access to early intervention services will be delayed if early screening efforts are decreased as a result of the task force’s recommendation. Should there be a reduction in primary-care based screening as a result of the task force report, thousands of children with ASD will experience delays in the diagnosis and initiation of early intervention services that may impose lifelong limitations to their quality of life.