Lack of evidence on autism screening

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The US Preventive Services Task Force (USPSTF) has concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for autism spectrum disorder (ASD) in children 18 to 30 months of age for whom no concerns of ASD have been raised by their parents or a clinician.

This is an I statement, indicating that evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. An I statement is not a recommendation against screening but a call for more research.

Autism spectrum disorder is a developmental disorder characterised by persistent and significant impairments in social interaction and communication and restrictive and repetitive behaviours and activities, when these symptoms cannot be accounted for by another condition. In 2010, the prevalence of ASD in the US was estimated at 14.7 cases per 1,000 children, or 1 in 68 children, with substantial variability in estimates by region, sex, and race/ethnicity.

The USPSTF reviewed the evidence on the accuracy, benefits, and potential harms of brief, formal screening instruments for ASD administered during routine primary care visits and the benefits and potential harms of early behavioural treatment for young children identified with ASD through screening.

The USPSTF is an independent, volunteer panel of experts that makes recommendations about the effectiveness of specific preventive care services such as screenings, counselling services, and preventive medications.

Detection, and Benefits of Early Detection and Intervention or Treatment
The USPSTF found adequate evidence that currently available screening tests can detect ASD among children age 18 to 30 months, but found inadequate direct evidence on the benefits of screening for ASD in toddlers and preschool-age children for whom no concerns of ASD have been raised by family members, other caregivers, or health care professionals. There are no studies that focus on the clinical outcomes of children identified with ASD through screening. Although there are studies suggesting treatment benefit in older children identified through family, clinician, or teacher concerns, the USPSTF found inadequate evidence on the efficacy of treatment of cases of ASD detected through screening or among very young children. Treatment studies were generally very small, few were randomized trials, most included children who were older than would be identified through screening, and all were in clinically referred rather than screen-detected patients.

Harms of Early Detection and Intervention or Treatment
The USPSTF found that the harms of screening for ASD and subsequent interventions are likely to be small based on evidence about the prevalence, accuracy of screening, and likelihood of minimal harms from behavioral interventions.

Risk Assessment
Although a number of potential risk factors for ASD have been identified, there is insufficient evidence to determine if certain risk factors modify the performance characteristics of ASD screening tests, such as the age at which screening is performed or other characteristics of the child or family.

Treatment and Interventions
Treatments for ASD include behavioral, medical, educational, speech/language, and occupational therapy and complementary and alternative medicine approaches. Treatments for young children are primarily behavioral interventions, particularly early intensive behavioral and developmental interventions.

USPSTF Assessment
The USPSTF concludes that there is insufficient evidence to assess the balance of benefits and harms of screening for ASD in children age 18 to 30 months for whom no concerns of ASD have been raised. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

Abstract
Description: New US Preventive Services Task Force (USPSTF) recommendation on screening for autism spectrum disorder (ASD) in young children.
Methods: The USPSTF reviewed the evidence on the accuracy, benefits, and potential harms of brief, formal screening instruments for ASD administered during routine primary care visits and the benefits and potential harms of early behavioral treatment for young children identified with ASD through screening.
Population: This recommendation applies to children aged 18 to 30 months who have not been diagnosed with ASD or developmental delay and for whom no concerns of ASD have been raised by parents, other caregivers, or health care professionals.
Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for ASD in young children for whom no concerns of ASD have been raised by their parents or a clinician. (I statement)

JAMA material
JAMA I statement
JAMA editorial
JAMA Paediatrics editorial
JAMA Neurology editorial
JAMA Psychiatry editorial
JAMA Patient Page


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