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Screening Tools for Autism Spectrum Disorder in Primary Care: A Systematic Evidence Review
Susan E Levy1, Audrey Wolfe2, Daniel Coury3,4
1Center for Autism Research, Department of Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Autism spectrum disorder (ASD) screening tools effectively identify young children in primary care. Evidence supports their use, though more research is needed on sensitivity and specificity for early diagnosis.
Area of Science:
- Pediatrics
- Developmental Neuroscience
- Public Health
Background:
- Autism spectrum disorder (ASD) is a neurodevelopmental disorder with significant lifelong costs.
- Early intervention improves outcomes for young children with ASD.
- Population-level early identification of ASD is a critical public health goal.
Purpose of the Study:
- To systematically review the evidence for universal screening of autism spectrum disorder (ASD) in primary care settings.
- To evaluate the psychometric properties of formal screening instruments used for ASD in primary care.
Main Methods:
- Systematic review of studies reporting psychometric properties of ASD screening tools in unselected populations.
- Searched multiple databases including Medline, PsychInfo, ERIC, and CINAHL.
- Data extraction and quality assessment performed by at least two authors.
Main Results:
- Evidence indicates moderate to high positive predictive values for ASD screening tools in children aged 16-40 months and older in primary care settings.
- Limited evidence was found for sensitivity, specificity, and negative predictive value of these instruments.
- No studies directly assessed the impact of screening on treatment or harm.
Conclusions:
- ASD screening tools can accurately identify percentages of young children with ASD in primary care.
- Challenges in linking screening to outcomes mean clinical and policy groups will continue to guide screening practices.
- Early identification of ASD remains a pressing public health objective.
Context:
Recommendations conflict regarding universal application of formal screening instruments in primary care (PC) and PC-like settings for autism spectrum disorder (ASD).
Objectives:
We systematically reviewed evidence for universal screening of children for ASD in PC.
Data Sources:
We searched Medline, PsychInfo, Educational Resources Informational Clearinghouse, and Cumulative Index of Nursing and Allied Health Literature.
Study Selection:
We included studies in which researchers report psychometric properties of screening tools in unselected populations across PC and PC-like settings.
Data Extraction:
At least 2 authors reviewed each study, extracted data, checked accuracy, and assigned quality ratings using predefined criteria.
Results:
We found evidence for moderate to high positive predictive values for ASD screening tools to identify children aged 16 to 40 months and 1 study for ≥48 months in PC and PC-like settings. Limited evidence evaluating sensitivity, specificity, and negative predictive value of instruments was available. No studies directly evaluated the impact of screening on treatment or harm.
Limitations:
Potential limitations include publication bias, selective reporting within studies, and a constrained search.
Conclusions:
ASD screening tools can be used to accurately identify percentages of unselected populations of young children for ASD in PC and PC-like settings. The scope of challenges associated with establishing direct linkage suggests that clinical and policy groups will likely continue to guide screening practices. ASD is a common neurodevelopmental disorder associated with significant life span costs.1,2 Growing evidence supports functional gains and improved outcomes for young children receiving intensive intervention, so early identification on a population level is a pressing public health challenge.3,4.
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