Draft Research Plan
Screening for Autism Spectrum Disorder in Young Children
February 25, 2021
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.
Abbreviation: ASD=autism spectrum disorder.
- Does universal screening for autism spectrum disorder (ASD) in children ages 12 to 36 months improve:
- Access and timing of ASD evaluation, diagnosis, and ASD-specific intervention?
- Developmental, functional, and quality of life outcomes?
- What is the accuracy of screening instruments to detect ASD in children ages 12 to 36 months?
- What are the harms of screening for ASD in children ages 12 to 36 months and their families?
- Do interventions targeting young children with ASD improve developmental, functional, and quality of life outcomes?
- To what extent is the timing of intervention initiation (by age and in relation to the establishment of an ASD diagnosis) associated with ASD-related outcomes?
- What are the harms of interventions for ASD in young children?
Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.
- What are the disparities related to identifying and treating young children with ASD?
- What interventions help facilitate earlier access to ASD-related services (evaluation or intervention) for children who have screened positive for or have otherwise been identified at risk for ASD?
- What is the relationship between access and timing of evaluation, diagnosis, and ASD-specific intervention and health outcomes (i.e., developmental, functional, and quality of life outcomes)?
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).
|Condition||Clinical diagnosis of ASD|
|Populations||KQs 1–3: Children ages 12 to 36 months not previously known to have ASD
KQs 4, 5: Children younger than age 6 years (<72 months) with clinically diagnosed ASD
|KQs 1–3: Studies limited to:
KQs 4, 5: Studies limited to:
|Setting||KQs 1–3: Primary care settings and primary care–referable settings, childcare and other education settings
KQs 4, 5: Clinical, educational, early intervention, or home settings
KQs 1, 3: Universal screening (i.e., screening the entire population)
|KQs 1, 3: Screening of preselected (including prospectively followed) or referred populations
KQ 2: Genetic or biomarker screening or imaging
|Interventions||ASD-specific behavioral and communication interventions, including developmental approaches, naturalistic developmental behavioral interventions, augmentative and alternative communication therapy, parent training, and social skills training, with or without other interventions.
Example interventions include: the Early Start Denver Model (ESDM), applied behavioral analysis (ABA)/Discrete Trial Training and Teaching, Pivotal Response Training (PRT), milieu teaching, and incidental teaching
|Interventions limited to:
|Comparators||KQs 1, 3: No screening or usual care
KQ 2: Reference standard (clinical assessment with explicit diagnostic criteria)
KQs 4, 5: No intervention/waitlist, usual care, minimal ASD intervention, or non-ASD–specific intervention (e.g., low-intensity speech therapy)
|KQs 4, 5: Active ASD intervention (i.e., a study comparing two or more active ASD interventions without a true control group)|
|Outcomes||KQ 1a: Timing of referral/evaluation, diagnosis, and access to intervention
KQ 1b: Developmental and functional outcomes, including autism symptom severity; adaptive behavior; cognitive ability and intelligence; communication and language skills; social competence; daily living skills; problem behavior; academic placement/achievement; child quality of life; parent stress, well-being, and quality of life
KQ 2: Raw cell values (true positive, true negative, false positive, false negative), sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratio values, and area under the curve
KQ 3: Harms of ASD screening (e.g., stigma, family distress, false reassurance, and opportunity cost)
KQ 4: Developmental and functional outcomes, including autism symptom severity; adaptive behavior; cognitive ability and intelligence; communication and language skills; social competence; daily living skills; problem behavior; academic placement/achievement; child quality of life; parent stress, well-being, and quality of life
KQ 5: Harms of intervention (e.g., deterioration or worsening in adaptive behavior or autism symptom severity, parental distress, and quality of life)Outcomes will be grouped into the following time points: immediately post-intervention, 1 to 5 months post-intervention, 6 to 11 months post-intervention, 12 to 23 months post-intervention, 24 to 35 months post-intervention, and so on (i.e., every 6 months for the first year and yearly thereafter).
|Study design||KQs 1, 3–5: Randomized clinical trials; nonrandomized and quasi-experimental designs; retrospective and prospective cohort designs
KQ 2: Diagnostic accuracy studies
|KQs 1, 3–5: Case-control studies; single case reports or single case design
KQ 2: Case-control studies, single case design
|Study geography||Studies that primarily take place in countries categorized as “Very High” on the 2019 Human Development Index (as defined by the United Nations Development Programme)||Studies that primarily take place in countries not categorized as “Very High” on the 2019 Human Development Index|
|Publication language||English||Any language other than English|
|Publication date||2000 to present|
|Publication type||Peer-reviewed article or report||Dissertation, thesis, or editorial/commentary|
|Quality rating||Fair- or good-quality studies||Poor-quality studies|
Abbreviations: ASD=autism spectrum disorder; KQ=key question.