Task force recommends early autism screening
In 2014, the Centers for Disease Control and Prevention reported that one in 68 children born in the U.S. was diagnosed with autism spectrum disorder.
Researchers at the University of Pennsylvania and the London School of Economics and Political Science estimate that more than 3.5 million Americans have ASD. They also report that cost of care may be as high as $2 million over the course of the individual’s lifetime.
That figure is in addition to the estimated $250,000 it takes to raise a child these days. Additionally, between 2000 and 2010, rates of ASD increased 119.4 percent, according to the CDC, making it the fastest growing developmental disability. In light of these statistics, screening for ASD has taken on greater importance.
In February, the U.S. Preventive Services Task Force (USPSTF) issued recommendations for autism screening, along with early intervention for children who identify on the autism spectrum, after reviewing the evidence on the benefits and potential harms of this practice.
According to the CDC, individuals with ASD may suffer impairment in social situations, communicating and functioning ability. The findings in the USPSTF report prompted a range of reactions from healthcare professionals.
The final report from the USPSTF found adequate evidence to support current ASD screening for children age 18 to 30 months. However, the task force cited inadequate direct evidence to perform this screening in toddlers and preschoolers whose pediatricians, family and caregivers express no concerns about ASD.
Paul Wang, M.D., senior vice president for Medical Research at Autism Speaks®, noted that his organization supports universal screening for autism, particularly for younger children.
“The average age for diagnosis of autism is still close to four-years-old, even though symptoms can be reliably detected by age two. This tells us that current diagnostic efforts are too often late in detecting autism, which leads to delays providing children with treatment and other supports,” he said.
Furthermore, research consistently shows that treatment is effective and that the earlier it is started, the better the outcome, Wang added. “In the long run, providing early intervention is actually cost effective. It reduces the total cost of caring for persons with ASD,” he said. “That’s why we need to make diagnoses as early as possible and that’s what universal screening would help to accomplish.”
Both Wang and the USPSTF agree there are no harms associated with early screening in all children, regardless of whether behavioral concerns exist or not.
According to the USPSTF, their findings do not represent a definitive statement either for or against screening, but rather constitute a call for more research.
Wang agrees with that assessment. “We need to continue supporting research that refines current treatment approaches, and develops new approaches, so that we can optimize long-term outcomes for children affected by autism,” he said. “We do not need more research on the effectiveness of screening. As the USPSTF agrees, screening already has been proven effective and reliable in identifying ASD.”
The National Institute of Mental Health is currently involved in five large-scale studies that are evaluating early identification of ASD and how it is connected to services. The studies aim to address issues related to universal screening, early diagnosis and treatment.
In an editorial published in the February 2016 issue of JAMA, Michael Silverstein, M.D., MPH, Department of Pediatrics at the Boston University School of Medicine at the Boston Medical Center, noted that the USPSTF “demonstrated its understanding of the real-world complexities of primary care and its commitment to be a rigorous, transparent arbiter of best available evidence” when it rendered its recommendations regarding ASD screening.