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Screening for Autism Spectrum Disorder in Young Children

A Systematic Evidence Review for the U.S. Preventive Services Task Force

Evidence Syntheses, No. 129

Investigators: , PhD, MPH, , PhD, , MS, , PhD, , MA, MLIS, , MBBS, MPH, , PhD, and , PhD.

Author Information
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 13-05185-EF-1

Structured Abstract

Context:

The Centers for Disease Control and Prevention estimates that 1 in 68 children has an autism spectrum disorder (ASD) and the majority of children are not diagnosed until after 4 years of age. Current approaches rely on developmental surveillance, general developmental screening, and/or parental concerns. Systematic screening has been advocated for identifying ASD at earlier ages.

Objective:

We systematically reviewed the evidence about benefits and harms of routine screening for ASD in primary care settings.

Methods:

We explicitly focused on studies of screening instruments for use in young (≤36 months of age), unselected populations (e.g., universal screening approaches).

Results:

We identified 17 unique screening studies reported in 22 papers. The most commonly studied tool was the Modified Checklist for Autism in Toddlers (M-CHAT), including the most recently available variant (M-CHAT-Revised with Followup [M-CHAT-R/F]), which has a positive predictive value of 48 percent in diverse populations of children ages 16 to 30 months. Forty-two studies of good and fair quality addressed interventions for young children. Among these, 17 involved direct provision of intervention to children. Fifteen of these 17 studies assessed cognitive outcomes, and outcomes were significantly more improved in the treatment versus comparison arm in 10 studies. Sixteen of these 17 studies assessed language outcomes, and outcomes were significantly improved in the treatment versus comparison group in 10 studies. Thirteen studies involved parent training. Five of these 13 studies addressed cognitive outcomes, and outcomes were significantly improved in the treatment versus comparison group in one study. Twelve of the 13 studies addressed language outcomes, and outcomes were significantly improved in the treatment versus comparison group in three studies. Thus, 20 studies overall measured cognitive outcomes and 11 reported greater benefit for the intervention group compared to the control group, and language outcomes were significantly improved in treatment versus comparison arms in 13 of 28 studies assessing language. Twelve studies focused on play and interaction and typically measured joint attention as the outcome. Nine out of 10 studies evaluating joint attention outcomes reported greater benefit in the treatment arm compared to the control arm. None of the studies focused on screen-detected children.

Conclusions:

Both the M-CHAT and the M-CHAT-R/F, when including the followup interview procedure, have a positive predictive value of around 50 percent in community practices for children between 16 and 30 months of age. Screening tools are widely available. Multiple treatments are available to young children with ASD. Early intensive interventions demonstrate statistically significant improvements in cognitive and language outcomes in children compared to eclectic treatments obtained in the community or other comparison groups, although the studies are generally small, and, within the studies, some children benefit while others do not. We found no studies that directly compared long-term outcomes of screened versus nonscreened children. More research is needed to determine the benefits and harms of screening the general population.

Contents

Acknowledgements: The authors gratefully acknowledge the following individuals for their contributions to this project: Dr. Evelyn Whitlock, Ms. Tracy Biel, Dr. Mary Louise Lindegren, Ms. Sanura Latham, Ms. Rebecca Jerome, and Ms. Jessica Kimber. We also thank AHRQ Officers Elizabeth Kato, MD, MRP, Karen Lee, MD, MPH, Tess Miller, DrPH, and Tracy Wolff, MD, MPH, and current and former members of the USPSTF who contributed to topic deliberations.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1. Contract No. 290-2012-00015-I. Prepared by: Vanderbilt Evidence-based Practice Center2

Suggested citation:

McPheeters ML, Weitlauf AS, Vehorn A, Taylor C, Sathe NA, Krishnaswami S, Fonnesbeck C, Warren ZE . Screening for Autism Spectrum Disorder in Young Children: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 129. AHRQ Publication No. 13-05185-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2016.

This report is based on research conducted by the Vanderbilt Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00015-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

1

5600 Fishers Lane, Rockville, MD 20857; www‚Äč.ahrq.gov

2

Vanderbilt University Medical Center, Nashville, TN

Bookshelf ID: NBK349703PMID: 26985520

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