Draft Research Plan

Autism Spectrum Disorder in Young Children: Screening

June 15, 2013

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Expand All

 

Select Text Description below for details

//Slide down text description when text description is clicked $(document).ready(function(){ $('.cd-collapse').hide(); $('.trigger').click(function(){ $(this).parent().next('.cd-collapse').slideToggle(1200); }); });

[D] Select for Text Description.

The analytic framework illustrates the process through which children ages 12 to 36 months may receive screening for autism spectrum disorder (ASD). Screening tests are associated with varied performance characteristics (sensitivity, specificity, negative and positive predictive value) (KQ 2), and their performance may be modified by a child's risk factors (KQ 2a), age (KQ 2b), and other characteristics of the child or family. Children at risk for ASD may progress to a diagnostic evaluation, and those identified as having ASD may receive interventions. Screening for ASD and interventions may lead to outcomes such as changes in core ASD symptoms, cognitive/intellectual functioning, language and communication skill development, challenging behavior, adaptive behavior, educational placement/achievement, and quality of life for the child and family (KQs 1 and 4) or harms (KQs 3 and 5). Outcomes of interventions may be modified by timing or ASD severity (KQs 4a and 4b). Numbers in circles within the diagram indicate the placement of key questions in relation to the process.

Abbreviations: ASD=autism spectrum disorder.

  1. Is screening for autism spectrum disorder (ASD) in children ages 12 to 36 months associated with improved short- and long-term outcomes?
  2. What are the performance characteristics (e.g., sensitivity, specificity, positive and negative predictive values) of ASD screening tests in children ages 12 to 36 months?
    1. Do certain risk actors (e.g., prematurity or having a sibling diagnosed with ASD) modify the performance characteristics of ASD screening tests?
    2. Does the age at which ASD screening is performed modify the performance characteristics of ASD screening tests?
  3. What are the harms (e.g., distress, potential misclassification) of ASD screening for the child and family?
  4. What is the effect of interventions targeting young children (i.e., of preschool and elementary school age) on the following outcomes: core ASD symptoms, cognitive and intellectual functioning, language development, challenging behavior, adaptive behavior, educational placement/achievement, and quality of life for the child and family?
    1. What is the effect of intervention timing (by age and in relation to the establishment of a definitive diagnosis) on treatment outcomes?
    2. What is the effect of severity of ASD on treatment outcomes?
  5. What are the harms of treatment for ASD in young children?

Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.

  1. Are there adequate screening resources (e.g., training for health care providers, reimbursement for tools and time, referral systems for positive results) to support routine screening in primary care or affiliated care systems?
  2. Are there adequate diagnostic and treatment resources to provide services to children who screen positive for ASD?
  3. To what degree does evidence indicate that children can be accurately diagnosed with ASD using the Autism Diagnostic Observation Schedule and/or expert clinical opinion? What does the current scientific literature demonstrate about the persistence of an ASD diagnosis?
  4. To what extent does overdiagnosis (false-positive results) exist in children who are referred to diagnostic evaluation after screening?
  5. To what extent does underdiagnosis exist in children who are referred to diagnostic evaluation after screening?
  6. Do the outcomes of screening for ASD and the efficacy and harms of interventions for ASD in young children differ by subgroups, such as racial/ethnic minority, low-income, and uninsured children?

The Proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Report. Criteria are overarching as well as specific to each of the key questions (KQs).

Category Inclusion
Population Young children ages 12 to 36 months undergoing screening for ASD
Setting Settings and populations of children applicable to U.S. primary care practice, early intervention and educational settings

Studies conducted in countries rated as “very high human development” on the Human Development Index: Andorra, Argentina, Australia, Austria, Bahrain, Barbados, Belgium, Brunei Darussalam, Canada, Chile, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hong Kong (China), Hungary, Iceland, Ireland, Israel, Italy, Japan, Republic of Korea, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, New Zealand, Norway, Poland, Portugal, Qatar, Singapore, Slovakia, Slovenia, Spain, Sweden, Switzerland, United Arab Emirates, United Kingdom, United States
Screening (KQs 1–3) ASD screening tools or measures capable of use in primary care setting
Treatment or Management Interventions (KQs 4–5) Early, intensive developmental and behavioral interventions appropriate for treating symptoms of ASD in young children
Comparisons KQ 1: No specific ASD screening 
KQs 2, 2b: No specific ASD screening
KQ 2a: Screening in the population with no noted risk factors
KQ 4: No early intervention
Outcomes Core ASD symptoms, cognitive and intellectual functioning, language development, challenging behavior, adaptive behavior, educational placement/achievement, quality of life for child and family assessed in preschool and elementary school age groups
Harms KQ 3: Distress, potential misclassification
KQ 5: Negative behavioral changes, child distress, family distress
Study Designs KQs 1–3: Any study design 
KQs 4–5: Any study design (except single case reports) targeting young children with ASD, including at least 10 children with ASD, and published since the EPC's prior review of therapies for ASD in children
Language English only
Data Sources MEDLINE via PubMed, PsycInfo, Educational Resources Information Clearinghouse (ERIC), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Health Technology Assessment, and Database of Abstracts of Reviews of Effects; secondary referencing
Search Dates KQs 1–3: MEDLINE, PsycInfo, ERIC, Cochrane databases: 2000 up to 2013 
KQs 4–5: MEDLINE, PsycInfo, ERIC, CINAHL: 2010–2013 (literature published since last search update of the EPC’s prior review of treatments for children with autism)