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No need to screen children under 2 1/2 for autism, experts say

There is “insufficient evidence” to support universal screening of children under age 2 1/2 for signs and symptoms of autism, an influential panel of medical experts concluded Tuesday.

The U.S. Preventive Services Task Force, a government-funded panel of medical experts that makes recommendations about preventive medical services, drew that conclusion after analyzing reams of studies on screening for autism. It’s a decision that is not sitting well with advocates and doctors.

Panelists have ignited controversy in the past with their recommendations on mammograms. Women need fewer of them, the task force concluded — and starting later in life.

Now they’re stoking ire in the autism community, which backs the American Academy of Pediatrics’ recommendation of screening all children between ages 18 months and 30 months.

The hope is to identify the condition early in life and to begin early intervention therapies. Some studies have overwhelmingly demonstrated that children with autism fare better when behavioral and other therapies are begun early in life.

Panelists, led by Dr. David C. Grossman, a Seattle-based pediatrician, concluded Tuesday there is not enough scientific grounding to determine “the long-term benefits or harms” of screening children who don’t have obvious symptoms.

Grossman and his colleagues are calling for more research.

Until those studies are available, panelists suggested Tuesday that doctors should use their clinical judgment to decide if screening children without overt signs and symptoms is appropriate.

“How could the panel make this decision with everything that is going on with autism in this country,” asked Evelyn Ain of Oyster Bay, a national advocate and co-founder of Autism United. “Autism is one of the biggest epidemics that this world has ever seen.”

The Centers for Disease Control and Prevention estimated in 2014 that 1 in 68 children is autistic.

Ain said autism is a spectrum of disorders — that range from mild to severe — affecting speech and language, social behavior and learning capacity.

Some children with an autism spectrum disorder never speak. Other children exhibit repetitive behaviors, such as rocking back and forth for extended periods. Still others may become obsessed with objects of a certain color or lining up toys in a specific order.

Ain, whose son, 16, has autism, said advocates strongly believe “the earlier, the better,” when it comes to diagnosis and intervention.

Panelists marked their decision with a letter grade of “I” for insufficient evidence and underscored that it is not a recommendation against screening, even though it is not endorsement. Grossman and his team of panelists Tuesday said the recommendation would not affect insurance coverage.

“We need more research to help us understand the benefits and harms of screening young children whose parents, caregivers, or doctor have not noticed any symptoms,” Grossman said.

Dr. Andrew Adesman, chief of developmental pediatrics at Cohen Children’s Medical Center in New Hyde Park, said he stands behind recommendations from the American Academy of Pediatrics.

“Screening is often a wonderful thing,” Adesman said. “But it does carry a small cost in terms of time and effort. The hope is that it identifies children who otherwise would be missed.”

He said screening involves a questionnaire that parents must answer. “There are some children whose development is so unflaggingly normal that it may be superfluous to screen them,” Adesman said.

But screening is important, he added, because it helps identify subtleties that some parents may miss in their day-to-day lives with the child.

Alycia Halladay, chief science officer of the Autism Science Foundation, an advocacy organization that supports research into autism spectrum disorders, voiced concern Tuesday with the panel’s recommendations.

“We are very disappointed in the final recommendation,” she said. “Together with the scientific and public health communities, we have raised concerns about the rating and have not agreed with the conclusions based on the data that exists,”

She said the recommendations may harm children whose symptoms are not immediately obvious to parents or clinicians.


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