According to a CDC report published last year, about one in every 68 children in the United States in 2010 had autism spectrum disorder (ASD), a jump of 23 percent since 2008 that still isn't fully understood.
This spike in diagnosed cases continues an upward trend the CDC and other groups have been tracking for a number of years. In recognition of the rising prevalence of ASD, the U.S. Preventive Services Task Force (USPSTF) has released a draft recommendation statement(www.uspreventiveservicestaskforce.org) that said current evidence is insufficient to assess the balance of benefits and harms of screening for autism in children ages 18-30 months who don't have signs or symptoms of autism.
One member of the task force hastened to put that statement into perspective.
"It is important to note that the task force is not recommending against screening for autism, but is calling for more research on screening children who do not have signs or symptoms of autism," said pediatrician and USPSTF member Alex Kemper, M.D., M.P.H., M.S., in an Aug. 4 news release.(www.uspreventiveservicestaskforce.org) "As the science on autism continues to evolve, parents who have any concerns about their child's development should tell their child's doctor."
- The U.S. Preventive Services Task Force (USPSTF) released a draft recommendation statement on Aug. 4 that found current evidence is insufficient to assess the balance of benefits and harms of screening for autism in asymptomatic children ages 18-30 months.
- The USPSTF did find adequate evidence that currently available screening tests can detect autism spectrum disorders in children these ages.
- Pediatrician and USPSTF Vice Chair David Grossman, M.D., M.P.H., said in a news release that more and better evidence is needed before the task force can recommend for or against screening all children.
Dearth of Evidence
The USPSTF commissioned a systematic review to evaluate available evidence on the accuracy, benefits and potential harms of brief, formal screening instruments for ASD administered during routine primary care visits. The group also reviewed the benefits and potential harms of early behavioral treatment for children identified as having ASD through screening.
The draft evidence review(www.uspreventiveservicestaskforce.org) focused on studies that involved nonselective screening of young children (i.e., less than 36 months of age) who were not identified as having risk factors for or parental concerns about ASD. Studies included examined screening test accuracy and early treatment effectiveness for ASD in young children, focusing on both benefits and harms of potentially implementing screening in the primary care setting.
As noted, the USPSTF found adequate evidence that currently available screening tests can detect ASD in these children. Still, evidence regarding the benefits of screening asymptomatic children in this age range was lacking. Similarly, there was inadequate evidence on the efficacy of treating ASD detected through screening. Studies generally were very small with few randomized trials included.
Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that the studies on ASD treatment that were available included children who already had the diagnosis (not diagnosed through screening), were older than the suggested screening age and, generally, had significant impairment.
Moreover, she said, the studies documented intermediate clinical outcomes such as higher IQ scores, not patient-centered outcomes such as improved quality of life or function.
"So, although screening can accurately detect ASD, we still do not know if this translates into improved outcomes for these children," Frost said.
Pediatrician and USPSTF Vice Chair David Grossman, M.D., M.P.H., said in the news release that more conclusive evidence is needed before the task force can recommend for or against screening all children for ASD.
"The task force calls on researchers, advocates and the medical community to join us in pushing the research agenda forward to learn more about autism and the role of screening," he said in the release.
Frost agreed, saying, "We need studies that show the outcomes of treatment for children diagnosed through screening. Although challenging, we also need studies that involve more meaningful and long-term outcomes."
Screening in Practice
Robert Baldor, M.D., professor and senior vice chair for the Department of Family Medicine and Community Health at the University of Massachusetts Medical School in Worcester, is a family physician who specializes in developmental and intellectual disabilities and currently is focused on the increasing incidence of autism diagnosis and the benefits of early recognition and intervention.
Baldor told AAFP News that the public's awareness of the growing number of children diagnosed with ASD requires family physicians now more than ever to focus on screening, particularly as evidence mounts on the benefits of early intervention.
"Early detection and intervention are the best methods (although not fully supported by the evidence) that we currently have to make an impact to improve the lives of children, and their families, with an autism diagnosis," he said. "I certainly recommend screening for autism and other developmental delays as part of the routine well-child check and whenever a parent raises a concern."
The USPSTF will accept comments on the draft recommendation(www.uspreventiveservicestaskforce.org) and its accompanying draft evidence review(www.uspreventiveservicestaskforce.org) through Aug. 31.
The AAFP is reviewing the USPSTF's draft recommendation and will develop its own recommendation after the task force publishes its final recommendation statement.
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