Autism screening for all preschoolers "premature," study finds

There isn't enough sound, scientific evidence to justify physicians routinely screening young children for autism, a study published online June 13 in Pediatrics concludes.

After evaluating literature on the topic, researchers determined that autism screening programs have not been studied in randomized, controlled trials in a way that other communitywide screening programs, such as breast cancer screening, have been examined (link).

Autism screening often involves questionnaires. For example, in the commonly used Social Communication Questionnaire, parents answer yes/no questions that help physicians evaluate whether a child may have autism. Study authors said autism screening tests such as these are not accurate enough to justify a populationwide screening program.

"That is, they aren't good enough to accurately detect children who have autism or to accurately detect those who don't," said Jan Willem Gorter, MD, PhD, a study author and an associate professor of pediatrics at McMaster University's CanChild Centre for Childhood Disability Research in Hamilton, Ontario.

In addition, study authors determined that none of the many therapies available after an autism diagnosis has a curative outcome or a "well-established efficacy to change the course of the condition."

"At this time, we recommend careful surveillance and assessment of all preschoolers who present with impairments in their development of language, social function or cognitive skills that result in activity limitations," study authors wrote. "But we believe that community screening of all preschoolers is premature."

That is contrary to the routine screening for toddlers that the American Academy of Pediatrics recommends. AAP leaders say the study doesn't mean physicians should forgo their screening practices.

Susan L. Hyman, MD, chair of the AAP's autism subcommittee, said study authors are thoughtful and "spot on" that the tools used to evaluate children need to improve.

"But that does not in any way mean we should not be identifying difficulties in young children," said Dr. Hyman, an associate professor of pediatrics at the Strong Center for Developmental Disabilities at the University of Rochester School of Medicine and Dentistry in New York and chief of neurodevelopmental and behavioral pediatrics at the Golisano Children's Hospital at Strong.

She said while new tools are being developed, physicians need to do the best they can with what is available. Current tests identify differences, and though children who test positive may not have autism, it is a red flag for something, Dr. Hyman said.

"Screen with your eyes open. Recognize the screening tests aren't perfect. But it is your obligation to ... support the families you serve," she said.

Although there is no cure for autism, there are therapies that improve life for patients and their families, Dr. Hyman said. She noted that many treatments for medical conditions aren't based on a cure, but on qualitative improvements.

Dr. Hyman said the study is a good call to action. She said the best outcome would be for "funding sources to say, 'Yes. We need more research.' "

Study authors agree. Dr. Gorter also said the study is a "call for action" and authors wrote that "ongoing research in this field is certainly needed," including developing "excellent screening instruments and demonstrating with clinical trials that such programs work and do more good than harm."