In 2014 the United States government body, the CDC reported that approximately 1 in every 68 children is born with Autism Spectrum Disorder (ASD). ASD is something of an umbrella term that encompasses many types of autism disorders which can cause varying degrees of disability and also excellence. These disorders are generally characterised by difficulties in social interaction and verbal and non-verbal communication and by the presence of repetitive behaviours.
Significant research has demonstrated that early intervention in ASD is crucial in order to buffer the negative effects that the disorder can have on a child’s development. Some research has even demonstrated that early intervention can in some cases eradicate the diagnostic symptoms of the condition entirely. As well as this, screening procedures for ASD have been shown to be easily implemented and extremely effective for diagnosing children with the disorder. Given these facts and the relatively high prevalence of ASD, experts in the area have begun to call for compulsory autism screening for all young children under 30 months. This argument has been supported by many leading healthcare groups including the American Academy of Paediatrics. However a recent report published by the US Preventative Services Task Force (USPSTF) has cast shade on this argument.
The report published late last year argued that there is simply not enough evidence to support the implementation of wide-scale compulsory autism screening. The USPSTF claims that existing research supporting the diagnostic accuracy of screening measures for ASD as well as the effectiveness of followed on treatment methods is not generalizable and does not qualify enough evidence to suggest that early diagnosis and intervention lead to better outcomes. Instead the taskforce suggest that more research is needed before any recommendations concerning compulsory screening can be made.
Though there is reason in their argument in that more research into the effectiveness of early diagnosis and treatment is needed, the USPSTF’s report neglects to consider the unavoidable disconnects between research and practice in the area of ASD. The taskforce argues that current research which has demonstrated positive treatment effects for children who have been diagnosed and treated early, is not generalizable as these children are often younger and less affected than those who are screened and treated in general practice. The research reflects an optimum treatment process. In reality, a child who is screened early will have to wait for several months to access a full assessment and even longer to access suitable treatment and thus may miss the critical period when early intervention is most effective. This argument is entirely illogical and only further points to immediate need for early screening and treatment. The problem therein lies not in whether compulsory screening is needed, but how it could feasibly introduced.
The optimum treatment process demonstrated in research practice should in fact be reflected in everyday clinical practice and moving towards early compulsory screening for ASD would represent a positive step in the right direction towards this. However there are obvious concerns that plight this movement. For instance, an increase in screening would undoubtedly lead to a significant increase in diagnosis. While this is ultimately the goal, it would place considerable pressure on treatment services meaning that even with a diagnosis, young children with ASD might still need to wait long periods before accessing early intervention services. The responsibility therefore lies in national health care systems to evaluate how a wide-scale screening and treatment process for ASD can be implemented effectively.
Ms. Niamh Allen, M.A. B.Sc.