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Evidence to make recommendation regarding screening for autism insufficient

Evidence to make recommendation regarding screening for autism insufficient

The U.S. Preventive Services Task Force (USPSTF) has concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for autism spectrum disorder (ASD) in children 18 to 30 months of age for whom no concerns of ASD have been raised by their parents or a clinician.

The report appears in the February 16 issue of JAMA.

In 2010, the prevalence of ASD in the United States was estimated at 14.7 cases per 1,000 children, or 1 in 68 children, with substantial variability in estimates by region, sex, and race/ethnicity.

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This is a pervasive developmental disorder. First described by Hans Asperger in 1944, Asperger's syndrome (AS) lies within the autistic spectrum.

A draft recommendation statement from the US Preventive Services Task Force states that the current evidence is insufficient to assess the balance of benefits and harms of screening for autism spectrum disorder (ASD) in children for whom no concerns of ASD have been raised by their parents of clinical provider. Clinicians discuss the statement and its potential implications for practice.

The USPSTF reviewed the evidence on the accuracy, benefits, and potential harms of brief, formal screening instruments for ASD administered during routine primary care visits and the benefits and potential harms of early behavioral treatment for young children identified with ASD through screening.

The USPSTF found adequate evidence that currently available screening tests can detect ASD among children age 18 to 30 months, but found inadequate direct evidence on the benefits of screening for ASD in toddlers and preschool-age children for whom no concerns of ASD have been raised by family members, other caregivers, or health care professionals.

There are no studies that focus on the clinical outcomes of children identified with ASD through screening. Although there are studies suggesting treatment benefit in older children identified through family, clinician, or teacher concerns, the USPSTF found inadequate evidence on the efficacy of treatment of cases of ASD detected through screening or among very young children.

The USPSTF found that the harms of screening for ASD and subsequent interventions are likely to be small based on evidence about the prevalence, accuracy of screening, and likelihood of minimal harms from behavioral interventions.

Although a number of potential risk factors for ASD have been identified, there is insufficient evidence to determine if certain risk factors modify the performance characteristics of ASD screening tests, such as the age at which screening is performed or other characteristics of the child or family.

Treatments for ASD include behavioral, medical, educational, speech/language, and occupational therapy and complementary and alternative medicine approaches. Treatments for young children are primarily behavioral interventions, particularly early intensive behavioral and developmental interventions.

In rendering its determination of insufficient evidence for ASD screening, the USPSTF demonstrated its understanding of the real-world complexities of primary care and its commitment to be a rigorous, transparent arbiter of best available evidence, write Michael Silverstein, M.D., M.P.H., of the Boston University School of Medicine, Boston Medical Center, Boston, and Jenny Radesky, M.D., of the University of Michigan School of Medicine, Ann Arbor, in an accompanying editorial.

Evidence to make recommendation regarding screening for autism insufficient

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