Universal Screening for Autism Pointless, Researchers Say

Fran Lowry

June 16, 2011

June 16, 2011 — Routine population-based screening for autism as currently recommended by the American Academy of Pediatrics, is likely to do more harm than good, researchers from McMaster University in Hamilton, Ontario, Canada, say. However, at least one expert begs to differ.

"On the basis of the available research we believe that we do not have enough sound evidence to support the implementation of a routine population-based screening program for autism," investigators led by Jan Willem Gorter, MD, and colleagues write in a study published online June 13 in Pediatrics.

"Autism confers a significant burden and has a huge impact on the lives of affected children and their families, so for that reason screening is warranted," Dr. Gorter told Medscape Medical News.

"However, the screening tests for autism have not been applied or even studied in such a public health approach, in the way that breast cancer screening, for example, has been, and even if the correct diagnoses were to be made, there are very few resources to help these children. Many face waiting lists for as long as 2 or 3 years to get treatment."

Dr. Gorter and his team conducted a literature search to assess the effectiveness of community screening programs for autism based on scientific criteria. They concluded that none of the screening tests for autism had high enough accuracy in terms of sensitivity, specificity, and high predictive value. Moreover, there was a serious lack of effective treatment available should such a diagnosis be made.

Routine Screening Harmful?

Dr. Gorter believes that at the present time, such routine screening may actually be harmful.

"Here we have parents who do not have concerns about their children. Is it ethical to diagnose that child — who was considered by the parents to be healthy — as having autism or likely to have autism, without there being any services in the community to provide the care that child needs?"

"If you really want to implement a program for mass screening, you really have to know that you are doing more good than harm," he said

Dr. Gorter said ongoing research in this field is needed.

"I would say this paper is a call to action, to get people thinking about the need for developing excellent screening tools and clinical trials, and also for creating the proper services to really help children with autism and their families,' he said. "At this time, we recommend careful surveillance and assessment of all preschoolers who present with impairments in their language development, cognitive or social functioning, but not routine screening."

Autism Speaks Begs to Differ

Geraldine Dawson, PhD, Chief Science Officer of Autism Speaks, is outraged at the suggestion that routine screening for autism be abandoned and argues that good screening tools exist and early intervention is crucial to help children with autism lead productive lives.

"Autism Speaks wholeheartedly agrees with the recommendations of the American Academy of Pediatrics that all children be screened for autism at the 18- and 24-month old checkups as part of routine pediatric care," she told Medscape Medical News.

"Reliable and feasible screening tools exist.  Research has shown that early intervention results in significant increases in IQ, language, and adaptive behavior, offering children the best change for a positive outcome," she said.

Medscape Medical News contacted the American Academy of Pediatrics for comment but requests for an interview went unanswered.

Dr. Gorter and Dr. Dawson have disclosed no relevant financial relationships.

Pediatrics. Published online June 13, 2011.


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