Does your child respond to his name? Does he point at an airplane or a bird as it flies by? Does he make eye contact? Does he play with or show interest in other children?
These may seem like small questions, but they’re not. They’re part of a critical autism screening process that puts children as young as 18 months on a path to getting the care they need. That road is a complicated, very bumpy one, no matter where a child is on the autism spectrum.
Why make it more complicated? Why make it more difficult?
And yet, that’s what the U.S. Preventive Services Task Force has done by saying there’s insufficient evidence that screening children as young as 18 months helps. The pronouncement by the task force — a panel of experts convened by an agency of the Department of Health and Human Services — is potentially harmful for physicians, parents and, most important, children. It could mean that parents and doctors won’t know early on that a child is potentially autistic. It could mean delays in care.
And time, parents and doctors say, is all those children have. When a child is autistic, and it’s discovered early, the response is critical. A child as young as 18 months can benefit from physical, occupational, speech and behavioral therapies. Early intervention is a critical tool for children to learn basic skills and ways of handling the world, lessons that would be far more difficult to learn later on. Parents can learn strategies, what works and what doesn’t, and ultimately be better prepared for what lies ahead.
Also, early screening can lead to further testing or referrals to specialists, when necessary.
The panel’s conclusion contradicts the American Academy of Pediatrics’ recommendations — which remain in place. It’s up to families and physicians to disregard the panel’s findings, and continue to screen young children. After all, families and physicians still think there’s a benefit — even if it’s not as “measurable” as the panel wishes it were.
Ultimately, what’s the harm?
Therapies on children that young are done through play. The cost involved is minimal compared with the long-term cost of not having a proper diagnosis. And a “false positive” means little — because if neurologists later determine a child does not have autism, and no longer needs therapies, then the therapies stop. No harm done.
But the harm in stopping such screenings — or in even recommending that such screenings aren’t necessary — can be exponential. Despite the American Academy of Pediatrics’ recommendation, many pediatricians don’t do the autism screening, known as M-CHAT (short for modified checklist for autism in toddlers), when a child is 18 and 24 months old. Some who do don’t include the important, newer follow-up questions. Now, with the weight of an influential panel behind them, even more may choose not to bother, especially those in low-income or minority communities who may be overbooked, or unable to spend quality time with parents and children during well visits. The panel’s decision is troubling, too, for parents who may start to think such screenings are unimportant.
Being a parent is hard enough. Moms and dads constantly face conflicting information and sometimes, it’s hard to trust gut instincts. Being a new parent of a child who’s exhibiting potential signs of autism is particularly difficult; often you know something’s wrong — but you don’t know what.
Autism screening is a critical piece of the parenting puzzle because it is a road map for parents and physicians. It’s critical that the panel’s findings don’t become the basis for pediatricians to stop screening or for parents to stop paying attention. Our children’s future is at stake.
Randi F. Marshall is a member of Newsday’s editorial board.