Screening Tools for Autism Spectrum Disorder in Primary Care: A Systematic Evidence Review.

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TitleScreening Tools for Autism Spectrum Disorder in Primary Care: A Systematic Evidence Review.
Publication TypeJournal Article
Year of Publication2020
AuthorsLevy, SE, Wolfe, A, Coury, D, Duby, J, Farmer, J, Schor, E, Van Cleave, J, Warren, Z
JournalPediatrics
Volume145
IssueSuppl 1
PaginationS47-S59
Date Published2020 04
ISSN1098-4275
KeywordsAutism Spectrum Disorder, Child, Preschool, Humans, Infant, Mass Screening, Primary Health Care
Abstract

CONTEXT: Recommendations conflict regarding universal application of formal screening instruments in primary care (PC) and PC-like settings for autism spectrum disorder (ASD).

OBJECTIVES: We systematically reviewed evidence for universal screening of children for ASD in PC.

DATA SOURCES: We searched Medline, PsychInfo, Educational Resources Informational Clearinghouse, and Cumulative Index of Nursing and Allied Health Literature.

STUDY SELECTION: We included studies in which researchers report psychometric properties of screening tools in unselected populations across PC and PC-like settings.

DATA EXTRACTION: At least 2 authors reviewed each study, extracted data, checked accuracy, and assigned quality ratings using predefined criteria.

RESULTS: We found evidence for moderate to high positive predictive values for ASD screening tools to identify children aged 16 to 40 months and 1 study for ≥48 months in PC and PC-like settings. Limited evidence evaluating sensitivity, specificity, and negative predictive value of instruments was available. No studies directly evaluated the impact of screening on treatment or harm.

LIMITATIONS: Potential limitations include publication bias, selective reporting within studies, and a constrained search.

CONCLUSIONS: ASD screening tools can be used to accurately identify percentages of unselected populations of young children for ASD in PC and PC-like settings. The scope of challenges associated with establishing direct linkage suggests that clinical and policy groups will likely continue to guide screening practices. ASD is a common neurodevelopmental disorder associated with significant life span costs. Growing evidence supports functional gains and improved outcomes for young children receiving intensive intervention, so early identification on a population level is a pressing public health challenge..

DOI10.1542/peds.2019-1895H
Alternate JournalPediatrics
PubMed ID32238531