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 The proposed guideline, from the U.S. Preventive Services Task
Force, an independent, government-backed panel that recommends
whether to adopt screening tests for various conditions, applies to
children aged 18 to 30 months who show no signs of an autism
spectrum disorder (ASD).
It represents the first time the task force has looked at autism
screening, and comes as ASD diagnoses rise in the United States.
About one in 68 U.S. children has an autism spectrum disorder, which
can create difficulties with social interaction, communication and
other aspects of everyday life, according to the Centers for Disease
Control and Prevention.
Other organizations promote some level of ASD screening during early
childhood, including the American Academy of Pediatrics (AAP), which
recommends ongoing surveillance and screening at 18 and 24 months
regardless of whether a child show signs of the disorder.
"We want to make sure this recommendation is not misunderstood," Dr.
David Grossman, vice chairman of the task force, said in an
interview. "Children who are exhibiting signs and symptoms should be
referred and tested."
The task force review, which began in 2013, found significant
research gaps regarding the benefits and harms of screening all
children for ASD, said Grossman, who is also a pediatrician in
Seattle.
“We need more evidence and we think that evidence is achievable,"
Grossman said.
The task force said, for example, it needs more research on the
outcomes of children who are diagnosed through screening even though
they do not have signs or symptoms of ASD.
The task force did find evidence to support the accuracy of the
tools used to screen children, notably the Modified Checklist for
Autism in Toddlers (M-CHAT).
Parents answer a series of questions about their children such as
communication skills, attention and movements in the M-CHAT. Based
on those results, a closer examination may be required to diagnose
ASD.
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Under the AAP recommendation, healthcare providers would regularly
watch for signs of ASD, and screen a child with a tool such as
M-CHAT at ages 18 and 24 months.
“That combination approach has been shown to be effective at
identifying kids early,” said Dr. Susan Levy, chair of the AAP's
autism subcommittee. Levy was not involved in crafting the proposed
guideline.
Levy, who is a developmental and behavioral pediatrician at the
Children’s Hospitals of Philadelphia, said her concern is that the
task force’s statement will lead people to question the benefit of
screening.
Early identification allows for early intervention, which is known
to result in better outcomes for children, she said.
Parents of toddlers should tell their pediatricians about poor eye
contact, problems with social connections, responsiveness and
interest in peers.
“Just having the family say 'I’m concerned about my child’s
development' is enough,” she said.
The public can comment on the task force's proposal until Aug. 31 on
its website: http://bit.ly/1N4Ea5j
(Reporting by Andrew M. Seaman; Editing by Michele Gershberg and
Steve Orlofsky)
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