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 autism."
Not only are there no good screening tools or effective treatments but there is no evidence yet that routine screening 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 autism spectrum disorders (ASDs), is a group of serious neurodevelopmental disorder 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.
- Mona Al-Qabandi, Jan Willem Gorter, Peter Rosenbaum. Early Autism Detection: Are We Ready for Routine Screening? Pediatrics, 2011; DOI: 10.1542/peds.2010-1881
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