Dear Editor,
We would like to thank you for your article, “Expert Panel Withholds Support for Early Autism Screening” (The New York Times, August 3, 2015), and commend your balanced reporting of the U.S. Preventive Services Task Force proposal for screening young children with autism spectrum disorder (ASD). As you stated, experts have urged early screening for ASD in infants and toddlers for many years, in order to begin treatment as early as possible. There is consensus amongst experts in the field that early screening increases early detection, that early detection can lead to access to early intervention, and that this early intervention is life-changing for many children with ASD. Moreover, early intervention can lead to tremendous cost savings to society over the course of the individual’s lifespan. Early identification may also benefit society by increasing the ability to engage in etiologic investigation and counseling regarding recurrence risk (Johnson, Myers & The Council on Children with Disabilities, 2007).
We are pleased to read in your report that the task force “determined that screening tools do identify children with autism at young ages” and “agreed that studies show early intensive intervention leads to significant improvements in cognitive and language outcomes in some [though not all] children.” While the task force concludes that it is premature to recommend universal, early screening due to gaps in the research, we concur with the concerns of researchers (who indeed acknowledge these gaps), that the task force proposal still may “give short shrift to the progress that children can make if they get access to early intervention during a critical ‘window of opportunity’.” Though diagnosis may not be required to receive early intervention treatment services (Centers for Disease Control and Prevention, 2015), screening can uncover delays that may be addressed through evidence-based treatments such as applied behavior analysis, which can lead to effective outcomes for individuals with ASD (AHRQ, 2014). Because these specialized interventions are often skill-based, learning to learn skills can also lay the ground work for greater success once a child enters the school system.
In his balanced analysis of the task force’s recommendation, Dr. Daniel Coury (2015) concludes:
We do have evidence that we are already missing children with developmental and ASD concerns with our current screening processes; we should not be making this worse by stopping screening in asymptomatic children. We have evidence of effective screening strategies, evidence of effective interventions, and evidence that early identification and intervention lead to best outcomes. While we await further evidence to assess the benefits of screening asymptomatic children, it is prudent to err on the side of caution and continue to screen all children in accordance with existing guidelines (p. 3).
We agree with Dr. Coury on this matter, and appreciate you bringing to light this vital viewpoint via experts in the field of ASD such as Dr. Fred Volkmar, Dr. Diana Robins and Dr. Paul Wang, all of whom are in favor of early autism screening, and who engage in professional endeavors that support science in autism treatment. At ASAT, it is our mission to disseminate accurate, timely, and scientifically sound information to better the lives of individuals with autism and their families, and we thank you for taking the time to report on this critical topic.
Renee Wozniak, PhD, BCBA-D and David Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment
References
Centers for Disease Control and Prevention. (2015). Autism spectrum disorder (ASD):Early intervention services. Retrieved from http://www.cdc.gov/ncbddd/autism/treatment.html
Coury, D. L. (2015). Babies, bathwater, and screening for autism spectrum disorder: Comments on the USPSTF recommendations for autism spectrum screening. Journal of Developmental and Behavioral Pediatrics, 0(0), 1 – 3.
Johnson, C. P., Myers, S. M. & The Council on Children with Disabilities. (2007).Identification and evaluation of children with autism spectrum disorder. Pediatrics, 120(5), 1883 – 1215.
Weitlauf, A. S., McPheeters, M. L., Peters, B., Sathe, N., Travis, R., Aiello, R.,…Warren, Z. (August, 2014). Therapies for children with autism spectrum disorder: Behavioral interventions update. Comparative Effectiveness Review No. 137. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2012-00009-I.) AHRQ Publication No. 14-EHC036-EF. Rockville, MD: Agency for Healthcare Research and Quality.
