Year: 2016
Type: editorial
Abstract: In this issue of JAMA, the US Preventive Services Task Force (USPSTF) presents final recommendations for screening children aged 18 to 30 months for autism spectrum disorder (ASD). 1 Autism spectrum disorder can be responsible for significant, long-term impairment in social interaction, communication, and functional capacity.Emerging evidence suggests that early intensive behavioral therapy has the potential to improve outcomes.2 The prevalence of ASD has increased in recent years and is estimated to be as high as 1 in 68 children, 3 suggesting that improving long-term outcomes could have substantial societal impact.The USPSTF reviews topics that focus only on asymptomatic populations and services provided in (or referable from) primary care and makes its recommendations by following a transparent set of methodologic processes.4 The USPSTF concluded that, "the current evidence is insufficient to assess the balance of benefits and harms of screening for ASD in young children for whom no concerns of ASD have been raised by their parents or a clinician" 1 and has given the recommendation an I grade.The I grade stems from the small size and variable quality of intervention studies and from a lack of direct evidence that screening leads to clinical improvement.1 Although this recommendation may be disappointing to many people, the USPSTF has appropriately applied its methodology to the question of ASD screening and has fulfilled its charge of applying rigorous analysis to the best available evidence.Asking the USPSTF to consider downstream policy or practice ramifications of its decision, or others' interpretations of it, would be to devalue its critical role as an impartial evaluator of evidence.Professional societies, constituent groups, families, and individual clinicians will need to contextualize the USPSTF's evaluation within a broader discussion on policy and patient care and assess, based on this broader context, whether universal ASD screening is warranted.In considering the USPSTF's recommendation, the issue of "direct evidence" is critical.Although validation studies might prove a screening test to be good at identifying a certain condition, and separate interventional studies might show improvement in those treated for that condition, this piecemeal analytic framework demonstrates only the strength of individual links in a complicated process chain that includes screening, diagnostic evaluation, engagement with treatment, and improved health outcomes.Conversely, higher-
Source: JAMA
Authors: Michael Silverstein, Jenny Radesky
Language: Italian
Subfield: Cognitive Neuroscience
Field: Neuroscience
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W2276515162