Routine screening for autism not needed: McMaster researchers

Proposals recommending routine screening of all children for autism
get 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.