Early Screening of Autism Spectrum Disorder: Recommendations for Practice and Research.

Zwaigenbaum L, Bauman ML, Fein D, Pierce K, Buie T, Davis PA, Newschaffer C, Robins DL, Wetherby A, Choueiri R, Kasari C, Stone WL, Yirmiya N, Estes A, Hansen RL, McPartland JC, Natowicz MR, Carter A, Granpeesheh D, Mailloux Z, Smith Roley S, Wagner S.

Pediatrics. 2015 Oct;136 Suppl 1:S41-59. doi: 10.1542/peds.2014-3667D.

Abstract:

This article reviews current evidence for autism spectrum disorder (ASD) screening based on peer-reviewed articles published to December 2013. Screening provides a standardized process to ensure that children are systematically monitored for early signs of ASD to promote earlier diagnosis. The current review indicates that screening in children aged 18 to 24 months can assist in early detection, consistent with current American Academy of Pediatrics' recommendations. We identify ASD-specific and broadband screening tools that have been evaluated in large community samples which show particular promise in terms  of accurate classification and clinical utility. We also suggest strategies to help overcome challenges to implementing ASD screening in community practice, as  well as priorities for future research.

Approaches to enhancing the early detection of autism spectrum disorders: a systematic review of the literature.

J Am Acad Child Adolesc Psychiatry. 2014Feb;53(2):141-52. doi: 10.1016/j.jaac.2013.11.002. Epub 2013 Nov 19.

Daniels AM(1), Halladay AK(2), Shih A(3), Elder LM(4), Dawson G(5).

Comment in

J AmAcad Child Adolesc Psychiatry. 2014 Feb;53(2):133-4. 

[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.