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Routine Screening For Autism: Is It Really Necessary?

Routine Screening For Autism: Is It Really Necessary?

A just-published study in the journal Pediatrics questions the need for early autism screening of all children — screening that many autism experts have said should be routine based on research showing that early diagnosis and early intervention provide the best outcomes for autistic children. Indeed, the American Academy of Pediatrics, which publishes Pediatrics, recommends that doctors screen children for autism at regular checkups at the ages of 18 and 24 months. Says Geraldine Dawson, chief science officer for Autism Speaks in CNN:

“By screening for autism at an early age, children are able to begin intervention as soon as possible. Studies have shown that early intervention results in significant increases in cognitive and language abilities, and adaptive behavior, and gives children the best chance for a positive outcome.”

As the Toronto Sun points out, some other studies (including one previously published in Pediatrics from the Children’s Hospital of Philadelphia ) provide evidence for the advantages of autism screening for all younger children.

The authors of the new study are experts in cerebral palsy at McMaster University in Canada and I’m suspecting their not being “autism experts” specifically will be pointed out to question their findings. Conversely, the researchers being from “outside” the field of autism research could be as much an advantage, as it may enable them to evaluate the screening tools and therapeutic interventions for autism with a more balanced perspective.

A closer look at the Pediatrics study shows that one of the researchers’ concerns is that the current screening tools — tests like the CHAT, M-CHAT and SCQ which rely very much on parental responses — are useful but are not sufficiently reliable as far as correctly identifying those children who are autistic and those who are not. Further, while I’m the first to speak up for the benefits of some early intervention therapies like Applied Behavior Analysis (ABA), a teaching methodology based on Skinnerian behavior therapy, clinical reviews of studies about the outcomes of intensive ABA as is (certainly here in New Jersey) routinely recommended for young children diagnosed with autism have yet fully to validate such. Say the McMaster University researchers:

Systematic reviews of clinical trials of the effectiveness of applied behavior intervention programs on cognitive, adaptive behavior, and language development in preschool-aged children with autism revealed that compared with standard care, applied behavior intervention did not significantly improve the cognitive outcomes of children. Results of a recent systematic review suggest that cognitive behavior therapy is an effective treatment for anxiety in people with Asperger syndrome but not for those with other ASD subtypes.Thus, more clinical trials are needed, but at present, claims regarding the efficacy of applied behavior analysis have not been substantiated.

As the authors say, ”at the present time, neither proven therapies nor preventive measures exist for the universal treatment of children and youth with autism, and further intervention research is needed.” 

Further, the authors potentially activate a lighting rod of protests in saying that there is  ”little support for the effectiveness for speech and language therapy for people with autism.” My own son has received speech therapy since he was 2 years old. He can speak in one to six word phrases, in articulation that is not always clear and sometimes he’s frustrated and enraged when he can’t figure out how to get us to understand his meaning; he certainly has (and has always had) a great desire to communicate. From our experience, speech and language therapy has helped Charlie but a parent’s thoroughly unscientific observations are not the most reliable measures of the efficacy of a therapy.

Lead author Dr. Jan Willem Gorter emphasizes that

…he and his co-authors were not specifically referring to “the surveillance that is happening in doctors’ offices” at 18 and 24 months.

They were recommending against a population-wide screening program that would require screening every child at a certain age level for autism, he said. Nobody is conducting such a study at this time in the United States.

Such a study was carried out in South Korea by researchers from Yale University and George Washington University and produced another finding that has rattled some commonly-accepted notions about autism. The study in the American Journal of Psychiatry found a prevalence rate of autism in 1 in 38 children, which is far far higher than the current figure of 1 in 110 children, and even of the 1 in 94 rate in New Jersey that’s currently the highest in the US.

The value of the new Pediatrics study, and of the South Korea study, is that they point out that we should not be complacent and assume we have already found the best instruments to diagnose and evaluate autism, or are using the best possible teaching methods. The South Korea study suggests that we could be seriously underdiagnosing autism, which would suggest that the current instruments used in the US are not identifying many cases. Again, while ABA has benefited my own son tremendously, we have had to “unteach” some things he learned from his years of ABA, and not because the ABA therapists weren’t doing ABA “correctly.” Behavior-based teaching is not the only method for teaching autistic children and may not be the best — and should not be the sole — method for teaching older children and autistic teenagers and adults

The one thing I’ve learned from the past decade-plus of raising my now 14-year-old son is that, much as we’d like to say “we’ve found the perfect teaching method for everything” – or “we can spot autism in anyone, we should know” – we have to be flexible and constantly reexamine our own premises and practices: Charlie is no robot, and, the more he grows and learns and changes, the more our teaching methods and much else with him must grow, learn and change, too. 

 

Related Care2 Coverage

New Genetic Studies Suggest Why Autism Is More Common In Boys Than Girls

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30 comments

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9:34AM PDT on Jun 18, 2012

There are multiple studies and psychiatrists themselves who say 'autism' is OVERDIAGNOSED. Also that it is a crock that it is a 'mental disorder' or 'mental illness' which is what the DSM of Psychiatry states it is. I suppose if people want labels and are desperately in confusion as to what is going on with a person they will grasp at any straws.

6:51AM PST on Feb 4, 2012

Interesting. Thanks.

10:05PM PST on Jan 31, 2012

thank you...

4:15PM PST on Nov 18, 2011

thanks

12:55AM PDT on Jun 20, 2011

Hopefully, they wouldn't only screen for autism- it seems like a good idea to evaluate a child's mental, emotional and physical growth by a professional, as there are plenty of parents out there who have no idea if their child is "age appropriate" or not for all those parameters...

6:35AM PDT on Jun 19, 2011

Hasn't anyone out there thought about what has coincided with the exploding numbers of neurological disorders in children?More and more accumulative neurotoxic vaccines injected into babies and young children!!!Why is Dr Andrew Wakefield still being character-assassinated over his findings of vaccine-strain measles virus growing in the bowels of autistic children,when his findings have been replicated in two other studies????The reason in my opinion is that autism is now another "cash cow"for the pharmaceutical and also the psychology "industries"!Has anyone read "Selling Sickness",an amazing expose on how drug companies concoct a drug and then fabricate a disease or condition so that they can make billions of dollars!(largely funded by taxpayers!)From what I understand,there has never been a case of autism in unvaccinated or conscientious objector groups or communities;seems pretty clear where terrible childhood affliction has come from!?

11:55AM PDT on Jun 18, 2011

Routine screening MIGHT be fine - as long as it is 100% accurate, without false negatives or false positives.

12:32PM PDT on Jun 16, 2011

Stanley Greenspan's Floortime Model is also being researched, and has many strengths, especially for early childhood. It is a relationship-based model, with the primary goal being to support parents in developing ways to connect with their child at their child's level, and use those connections to expand development in all areas. It has strong anecdotal support, and the research has been started to develop the academic support too.

11:48PM PDT on Jun 15, 2011

I agree with Eug F screen for chemicals that cause these problems. Arm parents with proof from this. Then where does the screening and labeling stop with human beings. Once a label is given people react accordingly and that label convinces one they are defective and react as such Stop labeling humans

7:14PM PDT on Jun 15, 2011

Why not have routine screening? The earlier the problem is diagnosed the earlier treatment can begin.

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