Expert panel finds early identification is essential to ensure appropriate access to specialized evidence-based interventions aimed at optimizing long-term outcomes
A new report from a multidisciplinary panel of clinical practitioners and researchers on autism spectrum disorders (ASD) underscores the importance of continuing to conduct universal early childhood autism screening at well-child visits despite a controversial draft proposal issued by the U.S. Preventative Services Task Force (USPTF) last summer that recommends skipping it for most children.
Early Identification of Autism Spectrum Disorder: Recommendations for Practice and Research appears in the October 2015 online supplement to Pediatrics describing the work of a team of expert panelists who completed a systematic review of the medical literature and developed consensus statements focused on the early identification of ASD, early screening, and early interventions and outcomes – including how cultural beliefs and practices may create barriers to early detection, diagnosis, and effective treatment.
The panelists’ findings lend credence to objections raised last summer by representatives of the American Academy of Pediatrics and Children’s Hospital of Philadelphia as well as other autism advocacy and research organizations in response to the UPSTF’s draft recommendation.
The article’s authors offer an updated review, including evidence that interventions initiated in children diagnosed with ASD before age three can yield significant improvement in targeted skills including social communication, imitation, and cognitive function while also leading to normalized patterns of brain activity. Co-lead author Lonnie Zwaigenbaum, M.D., a co-director of the Autism Research Centre at Edmonton’s Glenrose Rehabilitation Hospital, points to the findings as evidence of the need for continued vigilance. “Recent studies of at-risk infants – younger siblings of children with ASD – emphasize that many behavioral features of ASD are apparent as the child approaches their first birthday. However there is considerable diversity in expression, and early detection efforts need to be an ongoing process – rather than being limited to a single age point – if children across the spectrum are to be detected."
According to the Centers for Disease Control, in 2015, approximately 1 in 68 children in the U.S. will have an Autism Spectrum Disorder. Currently, the AAP recommends that all children be universally screened on two separate occasions at well-child visits between 18- and 24-months. The Modified Checklist for Autism in Toddlers (M-CHAT) – a scientifically validated tool for detecting ASD in children ages 16- to 30-months endorsed by the AAP – is believed to be the most commonly used universal screening tool at routine visits; the screening test probes language, motor, and social delays and takes approximately 10-15 minutes to complete. Other screening tools described in the report also show promise for detecting symptoms as early as the first year of life. In addition to better outcomes, the authors point out the potential for shortening the “stressful ‘diagnostic odyssey’ that many families experience before diagnosis."
“Although all screening tools for autism have some limitations, the evidence nevertheless supports the usefulness of ASD-specific screening at 18- and 24-months, notwithstandng the need for further research regarding the best screening methods for this family of conditions. Screening facilitates early identification and that, in turn, can have multiple benefits – for the child and for the family,” said Marvin Natowicz, M.D., Ph.D. – a clinical geneticist and pathologist at the Cleveland Clinic who participated in the panels and writing of the reports.
Zwaigenbaum adds, “With the availability of screening tools that accurately identify toddlers at highest risk of ASD, and accumulating evidence that interventions targeted to this age range lead to better outcomes, we would argue that children with ASD stand to benefit from incorporation of screening into standard practice.”
The panel was sponsored by the Autism Forum under the guidance of the Northwest Autism Foundation and with the support of the Autism Research Institute.
The full article is available for free at: http://pediatrics.aappublications.org/content/136/Supplement_1.toc
Expert Panel Participants included:
Lonnie Zwaigenbaum, Margaret L. Bauman, Roula Choueiri, Deborah Fein, Connie Kasari, Karen Pierce, Wendy L. Stone, Nurit Yirmiya, Annette Estes, Robin L. Hansen, James C. McPartland, Marvin R. Natowicz, Timothy Buie, Alice Carter, Patricia A. Davis, Doreen Granpeesheh, Zoe Mailloux, Craig Newschaffer, Diana Robins, Susanne Smith Roley, Sheldon Wagner, and Amy Wetherby