Federal Panel Proposal Does Not Endorse Routine ASD Screening

A draft proposal from the U.S. Preventative Services Task Force (UPSTF) does not recommend universal screening for autism spectrum disorder (ASD).

ASHA provided comments on the draft report and took exception with the conclusion that “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” in children who have no signs or symptoms of ASD or developmental delay and for whom no concerns of ASD have been raised by parents or doctors.

The proposal runs counter to American Academy of Pediatrics guidelines, which recommend screening for all children at ages 18 and 24 months in addition to developmental surveillance and monitoring.

The 16-member task force, comprising mostly health care epidemiologists and clinical scientists, was assembled by the Agency for Healthcare Research and Quality, a division of the U.S. Department of Health and Human Services. The task force recommendations—which will be finalized after review of public comments—can have widespread implications in driving practices and determining reimbursement policies.

Because some screening tests in the protocol—especially those that include parent interviews—had better precision than others, ASHA also recommends the addition of two statements:

• “The USPSTF found adequate evidence that currently available tests can detect ASD in children between the ages of 18 to 30 months.”

• “It is critical that children be identified as early as possible and receive necessary early intervention services.”

ASHA also suggests that the consumer fact sheet accompanying the recommendation include speech-language pathologists in the list of health care professionals who can help parents with their concerns; a list of early ASD warning signs; and a statement that ASHA recommends screening at 18 and 24 months per the American Academy of Pediatrics.

“Although we agree that more research is needed in this area,” ASHA’s comments state, “the possibility that some may interpret the statement as a call to limit screening—which may result in missed opportunities for early diagnosis of ASD during a critical developmental window for children who can benefit from early intervention—is a significant concern.”