At a time when 1 in 68 children is diagnosed with autism, early identification, diagnosis and treatment is crucial to give children the best opportunity to reach their full potential. The ambiguity of the statement offered by the US Preventative Services Task Force (USPSTF) on autism screening is troubling and unfortunately, may be easily misinterpreted. While the task force does not explicitly recommend against screening for autism, they state there is insufficient evidence to support autism-specific screening in clinical settings. Instead, they have called for more research in this area.
As a result, the task force has failed to fully endorse screening despite an abundance of research that demonstrates it is effective in a variety of settings1-3, leads to earlier identification of autism4, and that this earlier identification provides opportunities for early intervention which improves the lives of children with autism5. Research has demonstrated that formal screening is more effective than relying on clinician judgement alone1,6. This is especially important in reducing racial and ethnic disparities in access to care7,8 Moreover, screening is quick, affordable and has no substantial risk. We intend to review the USPSTF report and its methodology to understand why it differs from other evidence-based recommendations from the American Academy of Pediatrics and from experts in the field of autism spectrum disorders. Every child deserves an early, accurate diagnosis and we are hopeful that after the review period the USPSTF reconsider their conclusions. You can read more about the recommendations and response here.
There are a number of world renowned autism researchers who agree with this position. They include:
The High Risk Baby Siblings Research Consortium (https://www.autismspeaks.org/science/science-news/bsrc-response-uspstf-call-more-research-universal-autism-screening)
Jill Harris, Children’s Specialized Hospital of NJ
Bryan King, Seattle Childrens Hospital
Ami Klin, Emory University
David Mandell, University of Pennsylvania
James McPartland, Yale University
Diana Robins, Drexel University
Celine Saulnier, Emory University
Amy Wetherby, Florida State University
- Robins DL. Screening for autism spectrum disorders in primary care settings. Autism : the international journal of research and practice. 2008;12(5):537-556.
- Miller JS, Gabrielsen T, Villalobos M, et al. The each child study: systematic screening for autism spectrum disorders in a pediatric setting. Pediatrics. 2011;127(5):866-871.
- Robins DL, Casagrande K, Barton M, Chen CM, Dumont-Mathieu T, Fein D. Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics. 2014;133(1):37-45.
- Herlihy LE, Brooks B, Dumont-Mathieu T, et al. Standardized screening facilitates timely diagnosis of autism spectrum disorders in a diverse sample of low-risk toddlers. Journal of developmental and behavioral pediatrics : JDBP. 2014;35(2):85-92.
- Pierce K, Carter C, Weinfeld M, et al. Detecting, studying, and treating autism early: the one-year well-baby check-up approach. The Journal of pediatrics. 2011;159(3):458-465 e451-456.
- Wetherby AM, Brosnan-Maddox S, Peace V, Newton L. Validation of the Infant-Toddler Checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age. Autism : the international journal of research and practice. 2008;12(5):487-511.
- Khowaja MK, Hazzard AP, Robins DL. Sociodemographic Barriers to Early Detection of Autism: Screening and Evaluation Using the M-CHAT, M-CHAT-R, and Follow-Up. Journal of autism and developmental disorders. 2015;45(6):1797-1808.
- Daniels AM, Halladay AK, Shih A, Elder LM, Dawson G. Approaches to enhancing the early detection of autism spectrum disorders: a systematic review of the literature. Journal of the American Academy of Child and Adolescent Psychiatry. 2014;53(2):141-152.