Federal Panel Rejects Universal Autism Screening
In a move that could have broad implications, an influential government task force says that evidence is insufficient to recommend that all children be screened for autism.
The U.S. Preventive Services Task Force on Tuesday affirmed its position that too little is known about the benefits and harms of universal autism screening to endorse the practice at this time.
The statement comes six months after the panel issued a draft expressing similar views.
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“The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for autism spectrum disorder (ASD) in young children for whom no concerns of ASD have been raised by their parents or a clinician,” the task force statement published in the Journal of the American Medical Association said.
Comprised of 16 physicians, the panel is authorized by Congress and overseen by a division of the U.S. Department of Health and Human Services. The task force’s recommendations can have significant impact within the medical community.
In issuing what’s known as an “I statement,” the task force emphasized the need for more research and opted to leave significant discretion to doctors.
“It is important to note that an I statement is not a recommendation for or against screening,” the panel said. “In the absence of evidence about the balance of benefits and harms, clinicians should use their clinical judgment to decide if screening in children without overt signs and symptoms is appropriate for the population in their care.”
Autism advocates are none too pleased by the panel’s move. In a statement, Autism Speaks said the task force’s recommendation “risks misleading families – and health insurers – on the value of autism screening.”
“We have a broad consensus, based on research, that early intervention for autism results in better outcomes. Yet to our great disappointment – and against expert counsel – the USPSTF has refused to recommend universal screening for all children,” the group said.
The task force’s position is at odds with the American Academy of Pediatrics, which recommends that kids undergo developmental screening at each well-child visit and all children be screened for autism at 18 and 24 months.
Susan Levy, a professor of pediatrics at The Children’s Hospital of Philadelphia and the University of Pennsylvania who chairs the pediatrics group’s autism subcommittee, said that without regular screenings some children – especially those with more subtle developmental issues – may be overlooked.
“What the research has shown is that some parents may not be aware of the signs and symptoms,” Levy said. “The well-child visit is brief. If you’re depending on signs you see during the visit or parents bringing up issues, you’re going to miss some kids.”
Beyond worries about when children with autism are flagged, the task force recommendations could also affect whether insurance providers cover the cost of autism screening.
“Although the USPSTF has said it shouldn’t influence insurance coverage … it doesn’t take a lot for an insurance company to change their policies,” Levy said.
The American Academy of Pediatrics is sticking by its screening recommendations, Levy indicated, and she expects that there will be no significant changes to the academy’s guidance when the group issues updates to its screening recommendations this October.