Routine screening for autism not needed: researchers

June 13, 2011, McMaster University

Proposals recommending routine screening of all children for autism gets a thumbs down from researchers at McMaster University.

In a study in the online edition of the journal Pediatrics, the researchers say there is "not enough sound evidence to support the implementation of a routine population-based screening program for ."

Not only are there no good screening tools or effective treatments but there is no evidence yet that does more good than harm, said Dr. Jan Willem Gorter, a researcher in McMaster's CanChild Centre for Childhood Disability Research and associate professor of pediatrics.

Contrary to the McMaster researchers' findings, the American Academy of Pediatrics recently recommended that screening for autism be incorporated into routine practice, such as a child's regular physician check-up, regardless of whether a concern has been raised by the parents.

Autism, or the (ASDs), is a group of serious with major, life-altering implications. Its symptoms include differences and disabilities in many areas, including social, communication skills, fine and gross motor skills, and sometimes intellectual skills.

During the past three decades, the prevalence of autism has risen dramatically to 11 cases per 1,000 school-aged children from 0.8 cases per 1,000. Reasons for this increase vary: improved detection, changes in diagnosing the disorder or an actual increase. The disorder is more common in males with a 4:1 male-to-female ratio.

For the study, McMaster researchers conducted a literature search to assess the effectiveness of community screening programs for autism.

"None of the autism screening tests currently available has been shown to be able to fulfill the properties of accuracy, namely high sensitivity, high specificity, and high predictive value (proportion of patients with positive test results who are diagnosed correctly) in a population-wide screening program," researchers said.

Gorter said that unlike breast cancer screening, no autism screening programs have been studied in randomized controlled trials. "There is no solid evidence on which to base the recommendations of the American Academy of Pediatrics."

"None of the autism screening tests for the general population that we have today have proven accuracy," said Gorter. "That is, they aren't good enough to accurately detect children who have autism or to accurately detect those who don't."

Gorter said the study is a "call for action."

At this time, the researchers called community screening of all preschoolers premature. Alternatively, they recommend careful surveillance and assessment of all preschoolers who show signs of language, social and cognitive problems.

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3 / 5 (2) Jun 13, 2011
As the mom of a child with Autism, I take exception to this conclusion. All preschoolers should indeed be screened. Those who have language and social delays would be assessed, and then identified on time. It's a crying shame that still, today, so many kids are rediagnosed in the pre-teen years, and with diagnoses that probably do not reflect their developmental trajectory. The lack of proper assessment of language and socio-emotional functioning by the age of four, makes it hard for an 8 year old who was diagnosed with ADHD to be properly rediagnosed with one of the ASD's. Often times, they are given PDD-NOS or Asperger's due to the lack of proper documentation of the early years. So, toddlers should not only be screened for Autism, but also Epilepsy, since about a third of the Autistic population has Epilepsy. The latest research shows that the mortality rate of Epileptics who have Autism is much higher than those who have Epilepsy alone. This is very disappointing work.
not rated yet Jun 13, 2011
I say that if a child has mild Autism, or Asperger's and can function properly within their normal range, then that child shouldn't necessarily be singled out through some discriminating screening program, and separated from the rest of their peers. Being given the diagnosis of Asperger's can be isolating enough, but having everybody else know that you have autistic traits? I think that there should be significant functional/language problems present and noticeable enough for a child to be diagnosed with Autism.
5 / 5 (3) Jun 13, 2011
Rima, you missed the point. What was being said is that BETTER screening techniques are needed before a hamfisted program that was designed as a reaction to public displeasure like your own gets forced onto GPs who barely know what they're doing anyway.

Your frustration is understandable, and you seem to legitimately know what you're talking about, but Oh Lordy I do wish people would read articles properly before 'taking exception'.
not rated yet Jun 13, 2011
I didn't miss the point. The lack of better Autism-specific diagnostic tools are no reason not to screen anyway. We already know that language, social communications, and socio-emotional development are key parts of making or ruling out a diagnosis. We also know that documenting any anomalies in the early development of a child is crucial to making a correct diagnosis once the child is past the toddler years.

As for unnecessarily labeling a child, well, if an entire team deems it necessary to either flag the child for follow-up or recommend services so that he or she has a better chance of not getting a full diagnosis, then living with a label of some sort (developmental delay comes to mind here), it is much better than finding, at the age of ten or twelve, that the child should have been given early childhood intervention services.
not rated yet Jun 13, 2011
As for accurate assessment tools, instead of highly subjective tools and the training of psychologists and developmental specialists, we may never have them. The saying, when you've met a child with Autism you've met one child with Autism, is accurate. It may well be that it will continue to be a diagnosis that requires a multi-disciplinary approach to diagnose, in the absence of any better way to do it. In the meantime, since we know that early intervention is very successful, we must redouble our efforts to find the children who need it.

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