While the American Academy of Pediatrics recommends routine screenings for autism, an article recently published in Pediatrics by Mona Al-Qabandi and colleagues questions the wisdom of that recommendation. After searching through scientific studies, the authors evaluated the effectiveness of screening programs and concluded there isn’t enough evidence to support the academy’s position. They called for further development of screening methods backed up by clinical trials that show these screenings work.
However, their concern over the degree of accuracy of current tools and their bold statement that “screening is pointless,” shows misunderstanding. Screening tools do not diagnose autism. They alert the pediatrician to developmental delays and possibilities he might otherwise miss.
What is a Screening for Autism?
According to the Centers for Disease Control and Prevention, diagnosing an autism spectrum disorder takes two steps. The first step is a developmental screening. A screening “is a short test to tell if children are learning basic skills when they should, or if they might have delays,” the CDC writes. A delay in any of the areas covered by the short quiz alerts the physician to a potential problem.
With most pediatricians not trained to recognize the signs and symptoms of autism, screenings such as the Checklist for Autism in Toddlers (CHAT) can help a doctor know when to refer the child for further evaluation. A screening covers a few of the basic characteristics of autism like:
- lack of eye contact
- no interest in where you are pointing
- an inability to point to things themselves
- a lack of imaginative play
- or a problem with hand-and-eye coordination
Since there are no diagnostic tests for autism, diagnosis eventually comes by a thorough professional observation of the child’s communication abilities, behavior, and developmental level. A screening is a tool that helps physicians learn about, and understand when to refer a child for a comprehensive diagnostic evaluation by specialists. It is only after an extensive process of:
- behavior evaluation
- parent interviews
- hearing screening
- vision screening
- genetic testing
- neurological testing
and other medical tests that autism is finally diagnosed.
Potential Benefits of Autism Screenings
Autism screenings work to flag children with developmental issues such as autism, but they also help detect a wide range of other difficulties like:
- language disorders and problems
- developmental disability
- mental retardation
- severe anxiety
- attention and hyperactivity issues
Early detection for all of these problems can help children receive the intervention they need. In fact, in a study undertaken in 2006 and published in the Archives of General Psychiatry, Catherine Lord and colleagues found that the “diagnosis of autism in 2-year-olds was quite stable up through 9 years of age.” The changes seen in that study were mostly due to kids moving from a Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS) to a more classic type of autism. That means signs and symptoms increased as they grew older. Only one child out of eighty-four first diagnosed with classic autism had no signs by age nine.
However, more than 10% of the kids first diagnosed with PDD-NOS later on received a non-spectrum diagnosis. That’s what Al-Qabandi and colleagues are concerned about. Yet despite their misgivings that up to 25% of those initially screened don’t actually have autistic disorder, early screenings do catch anywhere from 75% to 90% of children who would not receive further evaluation should screenings stop. For those who screen negative, anxious parents can relax and allow their children to develop at their own pace.
Dangers of Diagnosis Delay
In the CNN article, “Canadian Researchers Question Autism Screening,” author Miriam Falco brings up a couple of excellent points about what might happen if doctors take the Pediatrics article seriously. With few physicians trained to spot potential autism, their tendency is to take a wait-and-see attitude regarding developmental delay. Falco fears that the researcher’s perspective may cause doctors to further ignore parental concerns. A scary thought, since that could seriously hinder, or even obliterate, current advocacy efforts towards early intervention.
But even more frightening is the possibility that Falco raises about insurance companies. Things are hard enough for parents trying to secure funds to pay for alternative therapies like chelation and special diets, but should the “screenings are pointless” idea take hold, parents could suddenly find themselves without any insurance coverage for autism at all. If insurance companies decide to stop paying for further evaluations or standard treatment options, due to a screening’s inadequacy, the financial burden parents carry today will skyrocket.
Screening Benefits Outweigh the Dangers of Being Wrong
The purpose of a screening isn’t to diagnose, but to determine if a child has enough characteristics to justify to their HMO or PPO that a more intensive, expensive evaluation is essential. Autism screenings by design over-estimate the number of children with autism, so no one gets missed. The idea is to look for unique characteristics specific to the autism spectrum, not issues typical of children in general. On one hand, a negative result can relieve a parent’s concern when a child is not exhibiting autism characteristics. On the other, it can keep a physician from ignoring legitimate developmental issues that need further investigation. In that way, children with autism or learning disabilities and attention deficits or hyperactivity can receive the early intervention they need to reach their full potential.
Sources
- Ahead with Autism, “Checklist for Autism in Toddlers (CHAT), (accessed June 14, 2011).
- Archives of General Psychiatry, Catherine Lord, Ph.D., et al, “Autism from 2 to 9 years of age,” 63(6):694-701, June 2006.
- Centers for Disease Control and Prevention, Autism Spectrum Disorders (ASDs), “Screening and Diagnosis,” (accessed July 14, 2011).
- CNN, Falco, Miriam, “Canadian researchers question autism screening,”June 13, 2011.
- Fox News/Reuters, “Study Recommends Against Autism Screening,” June 13, 2011.
- Siegal, Bryna, Getting the Best for Your Child with Autism: An Expert’s Guide to Treatment, The Guilford Press, January 2008.
- Pediatrics, Mona Al-Qabandi, MD, MRCPCH, Jan William Gorter, MD, PhD, FRCP(C), Peter Rosenbaum, MD, FRCP(C), "Early Autism Detection: Are We Ready for Routine Screening?" 128(1):e211-e217, July 1, 2011; doi:10.1542/peds.2010-1881.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her child’s health should contact a doctor for advice.
Vickie Ewell - Vickie has worked with autistic individuals for 9 years. She has celiac disease and specializes in gfcf living.
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