Should all young children be screened for autism spectrum disorder?

Mandell, David S.; Mandy, William

doi:10.1177/1362361315608323

Cited by 33 publications

(26 citation statements)

References 4 publications

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“…For example, the US Preventative Services Task Force (USPSTF) concluded that there was “insufficient evidence to recommend screening for ASD in children aged 18 months to 30 months for whom no concerns of ASD have been raised,” defining critically needed evidence as “large, high-quality cluster randomized clinical trials of treatment that enroll young children with ASD identified through screening.”135 However, screening (for example, using M-CHAT) has been shown to have predictive validity (as acknowledged by the USPSTF135), identifies ASD symptoms earlier and more consistently than general inquiry about parent concerns110117 (an alternative strategy recommended by the USPSTP135), may reduce disparities in access to diagnostic services,136 and accelerates the pathway to accessing specialized interventions that improve outcomes 135137. Thus, some have argued that screening is warranted on the basis of the balance between potential risks and benefits, even in the absence of evidence from randomized controlled trials (RCTs) 138139140. Ultimately, estimates of sensitivity and specificity as well as changes in age of diagnosis and access to intervention are needed to fully evaluate the systems impact of ASD screening.…”

Section: Screening and Surveillancementioning

confidence: 99%

Autism spectrum disorder: advances in diagnosis and evaluation

Zwaigenbaum

Penner

2018

BMJ

182

137

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Autism spectrum disorder (ASD) has a variety of causes, and its clinical expression is generally associated with substantial disability throughout the lifespan. Recent advances have led to earlier diagnosis, and deep phenotyping efforts focused on high risk infants have helped advance the characterization of early behavioral trajectories. Moreover, biomarkers that measure early structural and functional connectivity, visual orienting, and other biological processes have shown promise in detecting the risk of autism spectrum disorder even before the emergence of overt behavioral symptoms. Despite these advances, the mean age of diagnosis is still 4-5 years. Because of the broad consistency in published guidelines, parameters for high quality comprehensive assessments are available; however, such models are resource intensive and high demand can result in greatly increased waiting times. This review describes advances in detecting early behavioral and biological markers, current options and controversies in screening for the disorder, and best practice in its diagnostic evaluation including emerging data on innovative service models.

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Section: Screening and Surveillancementioning

confidence: 99%

Autism spectrum disorder: advances in diagnosis and evaluation

Zwaigenbaum

Penner

2018

BMJ

182

137

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“…It is known that receiving a diagnosis of ASD greatly affects the child and his/her parents: indeed, the diagnosis can yield some beneficial effects [ 8 , 9 ], but it can also be associated with risks, disadvantages, and contraindications [ 10 , 11 , 12 ]. Concerning the consequences of an ASD diagnosis, both parents and clinicians expect an effective intervention once a diagnosis is given [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Implications of an Autism Spectrum Disorder Diagnosis: An Interview Study of How Physicians Experience the Diagnosis in a Young Child

Jacobs

Steyaert

Dierickx

et al. 2018

JCM

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Clinicians are significant translators and interpreters towards parents of the abundant literature on autism spectrum disorder (ASD). However, how clinicians experience and view ASD and an ASD diagnosis is not well known. Sixteen physicians working with young children with a (presumed) diagnosis of ASD participated in a semi-structured interview. They described their professional view on ASD and an ASD diagnosis, and how they experienced its use in their clinical practice. Interpretative phenomenological analysis of the data revealed two main topics about physicians’ experiences: how they view ASD and an ASD diagnosis, and how they experience the implications of an ASD diagnosis. The latter topic comprised three themes: (1) the ASD diagnosis leads to a particular treatment trajectory and services; (2) ambivalence about how the ASD diagnosis impacts parents and child; and (3) psycho-relational functions of the ASD diagnosis. Physicians feel that some doubts and questions are inevitable when dealing clinically with ASD and an ASD diagnosis. They also perceive that there are certain risks associated with assigning the categorical ASD diagnosis to a young child. Altogether however, ASD is perceived by physicians as a useful and valuable diagnosis both because of treatment related consequences and of several psycho-relational implications.

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“…[ 1 ] However, the actual estimates are substantially higher as there is no surveillance mechanism to ensure universal reporting of each of these cases, especially in low- and middle-income nations. [ 4 ] Further, the epidemiological studies performed in the last couple of decades have shown confirmatory evidence to suggest a rise in the prevalence of ASDs across the world. [ 4 5 ] Different reasons such as an increase in the level of awareness, expansion of the diagnostic criteria, improvement in the diagnostic tools and reporting, have been identified for the eventual rise in the prevalence of ASDs.…”

mentioning

confidence: 98%

“…[ 1 5 ] In addition, measures such as counseling family members about the different aspects of the disease, its prognosis, and types of services available; offering behavior therapy to negate the concerns of difficulty in communication and impairment of the social behavior; ensuring accessibility and availability of comprehensive package of services, including health promotion, rehabilitation and care services; formulating policies to enable coordination between different sectors to safeguard education or employment options of the affected persons; and supporting the above measures with broader measures to make the country's infrastructure more accessible, inclusive, and supportive. [ 1 4 5 6 7 ]…”

mentioning

confidence: 99%