Many toddlers aren’t receiving both AAP-recommended screenings for autism spectrum disorder (ASD), according to a new study of Utah children.
The study also found those who screened positive were diagnosed earlier than children who were not screened, giving them the opportunity to access services earlier.
The AAP recommends screening for autism at ages 18 and 24 months. To look more closely at primary care screening, researchers analyzed data on more than 36,000 children attending visits at 20 Utah clinics from 2013-’16.
About 73% were screened using the Modified Checklist for Autism in Toddlers at either the 18- or 24-month visit, and 54% were screened at both visits, according to “Primary Care Autism Screening and Later Diagnosis,” (Carbone PS, et al. Pediatrics. July 6, 2020, https://doi.org/10.1542/peds.2019-2314).
The data also showed Hispanic children were screened at the lowest rates, and family physicians were less likely to screen than pediatricians.
Children who screened positive were 17 times more likely to be diagnosed than those who screened negative and 10 times more likely compared to unscreened children, according to the study.
Children were diagnosed at an average age of 4 years regardless of whether they had been screened. However, those with a positive screen were diagnosed 12 months earlier than those who screened negative and 10 months earlier than those not screened.
“Our findings support the American Academy of Pediatrics recommendation for universal screening in that more children and younger children with ASD will have opportunities to access evidence-based therapies that improve outcomes,” authors wrote.
They attributed the lack of difference in age at diagnosis between screened and unscreened children to false negatives. About two-thirds of children diagnosed with autism had screened negative.
The researchers said, “providers should closely monitor for signs of ASD with developmental surveillance and broadband developmental screening tests and refer for concerns even after a negative ASD screen.”
Authors of a related commentary called for new ways to think about screening that would be better suited for diverse settings and reduce false negatives.
“The way forward may be examining developmental trajectories over time, much like we examine physical growth charts, or using more objective measures that can overcome some of the limitations inherent to parent-completed tools,” they wrote.
Another Pediatrics article released today also looks at autism screening. “A Statewide Tiered System for Screening and Diagnosis of Autism” is available at https://pediatrics.aappublications.org/content/early/2020/07/02/peds.2019-3876.
