Universal Autism Screening Lacks Evidence of Benefit, Medical Panel Finds
The U.S. Preventative Services Task Force—an influential and independent group of experts in prevention and primary care—has said that there's insufficient evidence to show that screening all young children for autism is beneficial.
The task force's decision, released Tuesday, is not a recommendation against screening, it said. Rather, the panel said, it doesn't have enough information to weigh whether the potential benefits of early intervention balance out potential harms, such as anxiety from a false positive or money and resources wasted on unneeded treatment.
The panel's decision runs counter to recommended practice from the American Academy of Pediatrics. That group says that all children should be screened for autism spectrum disorder at 18 months and at 24 months, or whenever a parent or health care provider sees issues of concern. In the view of the pediatrics group, universal screening allows more children to benefit from early intervention.
Toddler autism screening usually involves asking caregivers a set of questions, such as whether the child makes unusual finger movements near his or her eyes, or whether the child smiles back at adults. Children deemed at risk of autism based on the questionnaire are then supposed to receive a more extensive evaluation.
Autism Screening Recommendation Sparks Pushback
The task force released a draft of its recommendations back in August, and many groups pushed back then against the idea that universal screening didn't have a sufficient research base. The Centers for Disease Control and Prevention estimates autism prevalence at 1 in 68 children in its most recent surveillance report, and the prevalence numbers have been on a steady upward climb.
The panel said that its recommendation is a call for more research.
"Good-quality studies are needed to better understand the intermediate and long-term health outcomes of screening for [autism spectrum disorder] among children without obvious signs and symptoms," the panel said, and whether that earlier identification is associated with health benefits. It's particularly important to do such work in minority populations and among populations who lack ready access to health care, it noted.
Representatives from Autism Speaks, a well-known autism advocacy group, says that it was disappointed by the panel's decision. The recommendation may lead health insurers to conclude that early autism screening has little value, and thus should not be covered, wrote Paul Wang, Autism Speaks' senior vice president for medical research.
"While autism screening carries no harm, the same can't be said of the Task Force's statement. Their statement essentially amounts to 'we don't know whether screening helps,' and many media outlets have already echoed this misconception in their headlines," Wang wrote.
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