Daniels AM(1), Halladay AK(2), Shih A(3), Elder
LM(4), Dawson G(5).
Comment in
[Are We There Yet? The State of Early Prediction and Intervention in Autism Spectrum Disorder]
BACKGROUND: A reliable diagnosis of autism can
be made as early as 24 months, yet in many children diagnoses are made much
later. A delay in diagnosis translates into a missed opportunity to provide
early intervention services and to improve outcomes. The aim of the current
study was to review the literature on early detection approaches in primary
care and other community settings in the United States.
METHODS: A search was conducted of the
peer-reviewed and gray literature to identify studies published from January
1990 through January 2013 testing approaches to enhance the early detection of
autism in community settings in the United States.
RESULTS: The search identified 40 studies
describing 35 approaches, which were grouped into the following categories:
awareness (n = 4), routine screening (n = 21), and practice improvement to
enhance screening (n = 10). Awareness approaches were associated with positive
changes in knowledge of autism-related topics. Routine screening yielded high
or increased rates of screening and referrals; however, few studies assessed
the effect of screening on age at diagnosis or services enrollment. Practice
improvement approaches resulted in increased screening and referral rates and
highlighted the importance of adopting a multipronged approach to enhance early
detection.
CONCLUSIONS: Although studies that tested
screening approaches in community settings found positive results, the
effectiveness of such efforts on reducing time to diagnosis and services
enrollment remains largely untested. The fact that few studies reported
outcomes beyond rates of referral indicates the need for enhanced
methodological rigor, particularly with respect to length of follow-up and
quality of measures used.