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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    • "This happened on different registers, from the social and emotional support they received through participating in the study, to their understanding that should developmental delays be detected the MIND Institute would Lappé provide information about services and other studies children could participate in. While pediatricians have been tasked with monitoring children for developmental delays and early signs of autism during routine well-baby checkups (Johnson and Myers, 2007; Al-Qabandi et al, 2011; Dawson et al, 2011), many mothers I interviewed described either not recognizing the signs of autism in their affected child or having their pediatrician not take their concerns seriously. On the basis of these experiences, they perceived the study as providing a more reliable resource for monitoring their younger children's development. "
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    ABSTRACT: Research on autism has increased significantly over the past several decades. This upsurge parallels the steep rise in autism diagnoses. Together, these conditions have increased the number of people occupying the social role of research participants, including investigators, analysts and subjects. Simultaneously, addressing scientific questions about autism now involves new research efforts including prospective enriched-risk cohort studies exploring the environmental and genetic causes of autism during pregnancy and early child development. Rather than one-time donations, these studies require extended commitments on the part of all those involved in the research. This article draws on ethnographic observations of research practices and interviews with investigators, study staff and participants to examine the emergent relationships between research and care in this area of autism science. I introduce the notion of ‘taking care’ to describe the forms of anticipatory labor and mutual extraction involved in longitudinal research. Through tracing three modes of taking care across practices of study design, data collection and participation, I argue that research and care become intimately intertwined and mutually constructed during the research process. These findings reflect how processes of taking and giving are constitutive of research participation for all those engaged in the research enterprise. This article considers the relationships between these practices and new forms of community and sociality related to biomedical science.
    Full-text · Article · Sep 2014 · BioSocieties
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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.
    Full-text · Article · Aug 2013 · Tzu Chi Medical Journal
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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.
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