Despite recommendations from an independent panel that universal autism screening has little benefit, experts in autism remain steadfast in their belief that early screening and intervention improves outcomes.
Susan E. Levy, MD, MPH, FAAP, attending physician in Developmental and Behavioral Pediatrics and chair of the Quality Improvement Committee for Developmental and Behavioral Pediatrics, and professor of Pediatrics at the Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, helped craft the American Academy of Pediatrics (AAP) guidelines on autism screening and led the session titled “Screening for autism in young children and next steps when you find it” at the AAP 2017 National Conference and Exhibition on September 18.
“The US Preventive Services Task Force (USPSTF) has stated that the evidence is insufficient to support universal screening for autism spectrum disorder (ASD). However, ASD can be diagnosed reliably between 2 and 3 years of age, and earlier intervention improves outcomes in many domains,” Levy says.
The USPSTF found there was insufficient evidence to recommend for or against screening in early 2016, stating that there was little evidence about the benefits or harms of universal autism screening to endorse the practice.
The AAP agreed with the task force’s recommendation on the need for continued research into universal screening for autism, but issued a statement after the affirmation urging pediatricians to continue screening all children at the previously recommended intervals—18 and 24 months in addition to regular developmental surveillance.
“The Academy recommends screening for ASD at 18 and 24 or 30 months, with ongoing surveillance at other visits,” Levy says. “This session summarized the current data related to screening for ASD in primary care, reviewed available instruments, and discussed how the instruments can be implemented in office flow. Faculty also reviewed the comorbid medical problems that may be present in children identified by ASD screening, action plans for referral to community services, and online resources.”
Levy was part of a team that released screening data from a national survey earlier this year. The study also found that in 2016, 81% of pediatricians reported always or almost always using one or more formal screening tools to assess for ASD—74% used the Modified Checklist for Autism in Toddlers (M-CHAT); 45% used a formal screening instrument/checklist; and 34% used informal developmental milestone checklists filled out by parents. When general development surveillance indicated a cause for concern, 43% of pediatricians employed the use of a formal screening tool as well. In terms of intervals, the study noted that 88% of pediatricians reported screening for ASD at 18 months, and 74% at 24 months.
Levy says there is no biological marker to screen for ASD, so identification depends on observation of key behavioral features. When identified early, children suspected to have ASD can be referred for a confirmation of diagnosis and put on the path to early, specific interventions and community resources.
In her presentation, Levy recommended developing systems to ensure accurate and early identification, cost-effective and timely diagnosis, and prompt implementation of evidence-based guidelines. Families should be educated about the evidence behind recommended interventions and referred to support organizations.
An informed pediatrician is also critical to the process, and Levy suggests that all children with ASD be cared for within a medical home that offers accessible, collaborative, culturally sensitive, knowledgeable, and cost-effective care.
“To best serve patients and families affected by ASD, the pediatrician should be familiar with evidence-based treatments and be comfortable in planning together with families for coordinated care across systems and across health and life transitions,” Levy says.