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Screening for autistic spectrum disorder in early childhood
1Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain. sophjullien@gmail.com.
Insights
Discrepancies exist in recommendations for screening young children for autistic spectrum disorder (ASD). While screening tools accurately identify ASD in toddlers, evidence on the benefits of early intervention for screen-detected cases is lacking.
Area of Science:
- Pediatrics
- Developmental Psychology
- Public Health
Background:
- Autistic spectrum disorder (ASD) is a developmental condition requiring early identification and intervention.
- Current recommendations for universal ASD screening in young children vary significantly among different institutions.
- There is a need to evaluate the evidence supporting the effectiveness of early screening and intervention for ASD.
Purpose of the Study:
- To review existing recommendations and evidence regarding the effectiveness of screening young children for ASD.
- To identify discrepancies in institutional guidelines for universal ASD screening.
- To assess the benefits and harms of early ASD screening and subsequent interventions.
Main Methods:
- Conducted a literature search up to November 8, 2019, using key terms and manual searches.
- Summarized recommendations and the strength of evidence from various institutions.
- Synthesized findings from systematic reviews, including the certainty of evidence.
Main Results:
- Significant discrepancies exist in recommendations for universal ASD screening in young children.
- ASD screening tools are effective in identifying ASD in children aged 12-36 months.
- Evidence supports the benefit of early interventions for ASD identified through developmental concerns, but not for those detected via screening.
Conclusions:
- There is inadequate evidence to confirm the benefits of interventions for ASD cases identified solely through screening.
- Further research is needed to establish the effectiveness of interventions for screen-detected ASD.
- Guidelines for universal ASD screening should consider the current evidence on screening accuracy and intervention effectiveness.
Abstract:
We looked at existing recommendations and supporting evidence on the effectiveness of screening young children for autistic spectrum disorder (ASD) for improving short- and long-term outcomes.We conducted a literature search up to the 8th of November 2019 by using key terms and manual search in selected sources. We summarized the recommendations and the strength of the recommendation when and as reported by the authors. We summarized the main findings of systematic reviews with the certainty of the evidence as reported.There are discrepancies among the recommendations given by different institutions on universal screening for ASD in children. Some recommend that all children should be screened with an ASD-specific instrument during well-child visits at ages 18 and 24 months in conjunction with ongoing developmental surveillance and broadband developmental screening; some conclude that the current evidence is insufficient to assess the balance of benefits and harms of screening for ASD in young children for whom no concerns of ASD have been raised by their parents or a clinician; and others recommend against universal screening, but for a screening among children with high risks.There is adequate evidence that ASD screening tools applied to children between 12 and 36 months accurately identify those with ASD. There is some evidence showing benefit of early interventions applied to children with ASD, from children identified with developmental concern by their family, teacher or clinicians. We found no evidence on the effectiveness of interventions applied to children with ASD detected through screening.
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