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More Screening, Not Less

A new report was released yesterday in the journal Pediatrics that questions the value of uniform early screening for autism spectrum disorders.  The premise behind the report titled, “Early Autism Detection: Are We Ready for Routine Screening?” was a desire to evaluate the usefulness of universal screening for infants at 18 to 24 months of age given what is known about the quality of  screening tools, the availability of effective treatments, and other considerations.

The authors argue that there have not been enough quality studies comparing screening tools. The availability of effective treatments for those who screened positive is also far from wide or uniform causing the authors to question the value of screening overall.

Autism Speaks remains in support of American Academy of Pediatrics recommendation that all infants be screened for autism spectrum disorders.

The sense of urgency of our mission to create a world in which suffering because of autism no longer exists demands identification and intervention as early as possible, where we do, in fact, have data for the effectiveness for intervention.  Dr. Geraldine Dawson, chief science officer of Autism Speaks says, “Early intervention has been shown to result in significant increases in cognitive and language abilities and adaptive behavior, allowing children the best chance for a positive outcome.

Instead of closing the door to an opportunity to guide the development of an infant who is headed toward struggles with an atypical development, we must create new opportunities for those infants to thrive. Indeed, the path to obtaining effective treatments that target the unique needs of your child is still shadowy, but it is something to which are bringing light together.  Autism Speaks supports research on effective early screening methods as well as finding best ways to deliver interventions that were shown to be effective to all those who need them today.

  1. June 15, 2011 at 5:40 pm

    I would like to suggest that the early screening should be expanded to include a screening for the nutritional adequacy of the diet in terms of meeting the nutrient needs for good brain development. The baseline needs should be based upon the actual composition of a healthy brain rather than what someone believes is needed. I believe this should be completed at 3-6 months of age and should include an evaluation of the present as well as contemplated diet through the early years. My research suggests this is the most direct route to PREVENTION of autism and also has shown the need for specific nutritional supplementation beginning around three months of age as none of the milks evaluated were totally adequate. Breast milk was in fact the best but was still lacking a number of nutrients.

  2. Bill Wills
    June 15, 2011 at 11:29 pm

    Having a son on the specturm who is now 24 years old. I always think what if Autism Speaks was around when he was one or two years old. Had we been able to have what is availble today who knows where and how much better he would be if that were true. So the earlier the intervention the better. Since Autism Speaks has been around I have seen much more improvement in youner people that get the diagnosis at an early age. They are so much better off then my son was at that age,that is not to say that my son in not doing well which he is,it has just taken longer.

  3. Sarah
    June 16, 2011 at 6:30 am

    Couldn’t agree more. Remember, this came out of Canada – where everyone is covered by medical insurance (and waiting lists for services are years and years). This reeks of been counters. Even if a baby is tagged for possibly having autism and ultimately doesn’t have autism, something may still be wrong with the child (sensory integration, hearing disorder, etc.). Early intervention for any impairment is key. I am quite sure that the association for the blind, hearing, CP, whatever would agree.

  4. Katie Wright
    June 16, 2011 at 10:05 am

    Agree. Why not screen? It is ridiculous to argue against a 2 minute test.

    However, I do agree w/ the point the authors make about – what then?
    OK, they screen and recommend services but the waiting lists are endless, specialist almost impossible to see.
    We need to think beyond screening and focus more on treatment interventions.

    • JUDY FRIDLEY
      June 26, 2011 at 11:46 pm

      WHAT IS THE TEST?

  5. June 16, 2011 at 11:51 am

    “The availability of effective treatments for those who screened positive is also far from wide or uniform causing the authors to question the value of screening overall.”

    Just as we saw in the latest news in Canada, an author is suggesting that the lack of effective resources for those screened positive for autism is an adequate reason to not make screening a requirement. The underlying suggestion is that parents should find out the hard way that their child has autism – when the child’s behavior is possibly unbearable and the symptoms are prevalent. After two years of parental uncertainty and questioning whether their child is “normal” (because in many cases children develop normally and then regress), two years of lost language, eye contact, sensory deprivation among other social and neurological regressions for the child, that’s when these authors believe screening should take place.

    Wouldn’t the smarter thing to do is cry out for more resources, research, effective treatments across the board seeing as how more and more children are being born autistic – with no end or cure or reason behind the causes in sight? Just my thoughts on the matter.

  6. Sarah
    June 20, 2011 at 9:41 am

    Any screening for early intervention should be on a dual track with medical screening for early warning signs of an immune system dysregulation.

    We need medical screening for immune system over reactivity. Inflammation is a huge problem and can interfere with brain function. Early identification of an immune system problem is key. We also need new treatments to help quell inflammation in the gut and the brain so that our kids can function better.

    My son did not show any signs of autism until after age 2. At fisrt signs were very subtle and the symptoms worsened after age 3. So medical screening early on for a family history of auto immune, neurological or neuro-pschyatric issues should be standard practice especially prior to vaccinating.

  7. Jay
    June 20, 2011 at 11:35 am

    i think its very imp to do this early . i have two sons that have signs of this disorder. i took my son to the dr at 2 years old the dr told me that i worried to much he would talk when he was ready . i wish i would have got more help. i worry day in and out about not only having one child but two , its very hard but with God on my side im still fighting

  8. csedlacek@wiautism.com
    June 22, 2011 at 11:19 pm

    I agree that early detection is the key. The lack of available services is not a valid reason to delay evaluating children for something that can have such a dramatic impact on their lives. Instead of focusing our efforts on eliminating these screenings, our focus should be on solving the real problem: the needs of children with autism are not being met. We should advocate for available, quality services for all children with special needs. We should also push for professionals who work with our children, including the pediatricians who administer the screenings, to receive thorough training on autism spectrum disorders. We should work on efforts to coordinate care for children, youth, and adults on the autism spectrum so that whenever they receive a diagnosis, they can access the care and treatment needed to live a happy and successful life.

    As a professional working with children on the autism spectrum, I would also like to add that I have seen the incredible resilience and strength that parents of children with autism have. Although they may not always have formal resources available (or they are forced to wait for funding for services), many of the parents I have worked with have dedicated significant time and energy to learn all they can in order to help their children. It is an oversight to assume that early detection cannot be helpful without the availability of formal services. It ignores the power that parents and family members have to truly make a difference. Their work to improve the lives of their children should be recognized and applauded.

  9. June 27, 2011 at 2:06 pm

    I agree with all the comments above. We need more research and treatment, but we can’t throw out the screening because we think another area is more important.

    It was so refreshing to read your comments Dr. Rongey. I seldom hear anyone address the importance of diet and how that effects brain development. I am an OT but specialize in feeding difficulties in pediatrics. I believe and have seen that when children eat a balanced diet, it effects their regulation, progress in therapy, and overall development.

    Ditto the above comments about parents being dedicated and resilient with helping their children when they may not get the resources they need. They are the real hero’s and should be empowered with the information they need to help their children. Appropriate screening and educating our doctors is essential. We need an army to accomplish all these tasks. Sitting around while we watch the statistics continue to rise, unacceptable. Time for many to get their heads out of the sand.

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