Early Autism Detection: Are We Ready for Routine Screening?

Developmental Pediatrics, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait.
PEDIATRICS (Impact Factor: 5.47). 06/2011; 128(1):e211-7. DOI: 10.1542/peds.2010-1881
Source: PubMed


BACKGROUND. Autism is a serious neurodevelopmental disorder that has a reportedly rising prevalence rate. The American Academy of Pediatrics recommends that screening for autism be incorporated into routine practice. It is important to consider the pros and cons of conducting autism screening as part of routine practice and its implications on the community. We have explored this question in the context of screening from a scientific point of view.
A literature search was conducted to assess the effectiveness of community screening programs for autism.
Judged against critical questions about autism, screening programs failed to fulfill most criteria. Good screening tools and efficacious treatment are lacking, and there is no evidence yet that such a program would do more good than harm.
On the basis of the available research, we believe that we do not have enough sound evidence to support the implementation of a routine population-based screening program for autism. Ongoing research in this field is certainly needed, including the development of excellent screening instruments and demonstrating with clinical trials that such programs work and do more good than harm.

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Available from: Peter L Rosenbaum, Dec 02, 2014
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    • "Age may affect the discriminative sensitivity when used to screen children with DLD, thus resulting in low sensitivity for the CCDI. A previous study has indicated that the diagnostic validity in screening children with ASD may vary depending on the age of the child and severity of symptoms [18]. In future studies, larger samples are needed to determine if age affects the diagnostic discrimination of sensitivity and specificity. "
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    ABSTRACT: Objectives The Chinese Child Developmental Inventory (CCDI) is one of the most commonly used developmental screening tools. However, limited data are available regarding the diagnostic validity (sensitivity and specificity) of the CCDI in identifying children with developmental language disorders. The aim of this study was to determine how well the CCDI functions within a hospital-based setting when administered by clinicians. Materials and Methods A hospital-based sample of 235 children (aged 15–78 months) with suspected developmental language delay was included for a validity test. The subscales of the CCDI examined in this study were expressive language (EL), comprehension conceptual (CC), situation comprehension (SC), self-help, personal–social (PS), and general development (GD). Results Acceptable high specificities (77.9–95.1%) were found for most of the subscales, except for the PS (57.6%). The EL subscale was the most suitable for the screening of children with language delay, but the sensitivity was only at the acceptable (66%) level. The EL and PS subscales were good predictors of autistic spectrum disorders with specificities of 70% and 76.2%, respectively. Rather high sensitivities were observed for the EL, CC, and SC subscales (71–80%) for children with developmental delay. Conclusion The CCDI completed by parents is a valid screening tool for identifying children with risks of developmental language delay.
    Tzu Chi Medical Journal 08/2013; 25(4). DOI:10.1016/j.tcmj.2013.07.004
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    • "In population settings, none of the autism screening tests has been shown to be able to fulfill the properties of accuracy [36]. The difficulty in the implementation of a routine population-based screening program for autism can be explained from our perspective. "
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    ABSTRACT: In the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), autistic characteristics in social interaction and communication are described as qualitative impairments. However, the difference between autistics and nonautistics in the draft of the 5th edition (DSM-5 draft) is quantitative rather than qualitative. The word "qualitative" is deleted in the draft text, and it is specified that the relation between social demands and individual limited capacities is critical for symptom manifestation (criterion C). Because the proposed levels of support requirement in the draft are mere observable outcomes of social vulnerability, the boundary between level 1 and nonautistic condition is determined by the relation between social demands and individual capacities. In addition to the introduction of the single category (autism spectrum disorder (ASD)) to cover the entire case spectrum, the DSM-5 draft is clearly based on a conviction that ASD is indistinguishable from the normal behavioral range. This concise review provides an explanation for this implicit paradigm shift from qualitative to quantitative. Importantly, the conditional role of social demands for symptom manifestation in the draft can be plausibly interpreted using a unique liability-probability model.
    05/2013; 2013(9):201719. DOI:10.1155/2013/201719
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    • "Several methodologies have helped to study early detection and examine early development in ASD. Screening instruments for early signs of ASD, such as the CHecklist for Autism in Toddlers (CHAT), Early Screening for Autistic Traits (ESAT), the Modified-CHAT, and the Infant Toddler Checklist (ITC) have demonstrated the possibility to prospectively identify ASD at 18 months or even earlier (for reviews see [1, 4]) in low-risk and high-risk populations. Common early signs are primarily delays and deficits in response to name and joint attention and limited or perseverative early play. "
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    ABSTRACT: Currently, autism cannot be reliably diagnosed before the age of 2 years, which is why longitudinal studies of high-risk populations provide the potential to generate unique knowledge about the development of autism during infancy and toddlerhood prior to symptom onset. Early autism research is an evolving field in child psychiatric science. Key objectives are fine mapping of neurodevelopmental trajectories and identifying biomarkers to improve risk assessment, diagnosis and treatment. ESSEA (Enhancing the Scientific Study of Early Autism) is a COST (European Cooperation in Science and Technology) Action striving to create a European collaboration to enhance the progress of the discovery and treatment of the earliest signs of autism, and to establish European practice guidelines on early identification and intervention by bringing together European expertise from cognitive neuroscience and clinical sciences. The objective of this article is to clarify the state of current European research on at-risk autism research, and to support the understanding of different contexts in which the research is being conducted. We present ESSEA survey data on ongoing European high-risk ASD studies, as well as perceived challenges and opportunities in this field of research. We conclude that although high-risk autism research in Europe faces several challenges, the existence of several key factors (e.g., new and/or large-scale autism grants, availability of new technologies, and involvement of experienced research groups) lead us to expect substantial scientific and clinical developments in Europe in this field during the next few years.
    European Child & Adolescent Psychiatry 01/2013; 22(6). DOI:10.1007/s00787-012-0368-4 · 3.34 Impact Factor
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