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 Even though many pediatricians already do routine autism screenings
of children between 18 and 30 months old, the U.S. Preventive
Services Task Force (USPSTF), a government-backed panel of
independent physicians, concluded it’s impossible to know if this
helps or hurts.
“Our recommendation is not a recommendation against screening, but a
call for more research,” said Dr. David Grossman, vice chair of the
USPSTF.
“So far, research has appropriately focused on treatments for
children who have symptoms, especially those who are severely
affected,” Grossman added by email.
“More research on the impact of screening and treatment in very
young children whose parents or doctor have not noticed symptoms is
an important next step to helping all children.”
Approximately one in 68 children in the U.S. have autism spectrum
disorders (ASD), which can affect behavior as well as social and
communication skills.
Early symptoms can vary, but may include repetitive behaviors like
hand flapping or body rocking, extreme resistance to changes in
routine, and sometimes aggression or self-injury. Behavioral,
educational, speech and language therapy may help reduce the
severity of autism symptoms in some children.
While there’s little evidence screening or treatment harms children,
follow-up tests and interventions may place unnecessary burden on
some families in terms of costs and time, according to the USPSTF
recommendations published today in the Journal of the American
Medical Association.
But the recommendations, which are often used by government and
private insurance providers to make coverage decisions, could
eliminate funding for pediatricians to screen toddlers and
preschoolers, Dr. Jeremy Veenstra-VanderWeele of Columbia University
argued in an editorial in JAMA Psychiatry.
The American Academy of Pediatrics recommends screening all children
for autism at 18 and 24 months, he wrote.
“This is what pediatricians are supposed to be doing, and should
continue to do,” he added by email.
Screening kids even when parents and doctors don’t see symptoms may
be of benefit to children who might otherwise fall through the
cracks, Geraldine Dawson of Duke University argued in an editorial
in JAMA Pediatrics.
That’s because typical symptoms are much more likely to be noticed
in white children than in black or Hispanic kids.
“Universal autism screening helps reduce the disparities in access
to services for children from different racial and economic
backgrounds,” Dawson said by email.
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Symptoms in toddlers and preschoolers may be subtler, and harder to
spot, than some of the hallmarks like repetitive behavior that occur
more often in severe cases and with older kids, Dr. Michael
Silverstein of Boston University said by email.
For younger children, typical flags for autism may include a speech
delay, a tendency to play differently from peers or fail to make eye
contact when interacting with others, added Silverstein, author of
another accompanying editorial in JAMA.
“At this age, it is often difficult to tell the difference between
ASD and other behavioral disorders, and doing so tends to require
pediatric sub-specialist consultation,” Silverstein said. “It does
get easier to diagnose ASD as children get older.”
In other words, reserving screening for kids with easily detected
symptoms might leave out a lot of children who might benefit from
help.
Therapy at this point varies, depending on how much emphasis parents
and doctors place on goals such as improved communication or social
skills, reduced repetitive behaviors and intellectual development,
Dr. Craig Powell of the University of Texas Southwestern Medical
Center in Dallas wrote in an editorial in JAMA Neurology.
Children are unlikely to get unnecessary treatment for autism as a
result of screening, and it’s possible they might be diagnosed with
another developmental disorder as part of this process that warrants
close monitoring or intervention, Powell added by email.
The “main danger” with the recommendations is they might be taken as
advice not to screen children at all, Powell said.
“This will lead to some children going undiagnosed who might have
benefited from starting treatment sooner,” Powell concluded.
SOURCE: http://bit.ly/1c9i5E4 JAMA, online February 16, 2016.
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