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April 2016

Autism Screening or Smoke Screen and Mirrors?

Author Affiliations
  • 1Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas
  • 2Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
JAMA Neurol. 2016;73(4):386-387. doi:10.1001/jamaneurol.2016.0126

Parents are constantly “screening” their children from birth, anxiously making sick-visit appointments with their pediatrician for issues as simple as transient neonatal acne, “stork bite” nevus complex, or an occasional viral illness. Parents excitedly watch for developmental milestones—eg, eye contact, cooing, social smile, babbling, sitting, crawling. In every state of the union, early childhood intervention programs are mandated to formally evaluate and in many cases treat every child whose parents have a developmental concern prior to age 3 years. Developmental assessments are performed by a clinical care professional at each pediatrician visit. If parents raise a developmental concern, they are reassured and the child is further tested or referred to specialists or early childhood intervention. In addition, the American Academy of Pediatrics recommends universal screening for autism spectrum disorder (ASD) at ages 18 and 24 months, while the American Academy of Neurology and the Child Neurology Society recommend developmental surveillance at all well-child visits at least through school age. The US Preventive Services Task Force (USPSTF) has commissioned an evidence-based review of screening for ASD in young children. This detailed, thorough monograph is now published in JAMA.1 The report concludes, deceptively simply but accurately, that more research is needed to determine the benefits and harms of screening the general population. A USPSTF draft recommendation statement available online summarizes: “There is not enough evidence available now on the potential benefits and harms of ASD screening in young children to recommend for or against this screening.”2 As scientists and physicians, it is important for us to recognize that this is not a recommendation at all but rather a “call to arms” in the struggle to help patients and families affected by ASD find their way to optimal outcomes.

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