Pediatric Annals

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CME Article 

Universal Screening for Autism Spectrum Disorders: A Snapshot within the Big Picture

John C. Duby, MD, FAAP

Abstract

Two Screens by Two Years was the mantra initiated by the media on October 29, 2007, when the American Academy of Pediatrics (AAP) unveiled guidelines and an accompanying toolkit developed for the identification and management of children with autism spectrum disorders (ASD). However, the mantra should have sounded: “Five Screens by Two and a Half Years” since screening for ASD is just one piece of the much bigger picture of developmental screening. Moreover, screening tests are simply instantaneous “snapshots” spliced into an ongoing “developmental surveillance video.” Periodic screening and continuous surveillance are important; all children should have both as part of a health maintenance protocol. Although primary care physicians long have been advised to monitor children’s growth, development, and behavior at health supervision visits, the recommendation to screen all children formally with standardized tools at specific ages is new. The recommendation for universal general developmental screening was launched by an AAP policy statement published in July 2006. Included in it was a recommendation to screen all children for ASD at the 18-month visit. The 2007 ASD guidelines reinforced the 2006 statement, expanded the process, and recommended an additional ASD-specific screen at the 24-month visit to detect the small subset of children with ASD who regress after 18 months of age. These recommendations were made in recognition of the mounting evidence that early diagnosis and intervention optimize outcomes in children with ASD and that ASD symptoms can be observed in very young children.

ABOUT THE AUTHORS

John C. Duby, MD, FAAP, is Co-director, The NeuroDevelopmental Center, Akron Children’s Hospital, Akron, Ohio; Professor of Pediatrics, Northeastern Ohio Universities College of Medicine, Rootstown; and is a member of the Executive Committee, American Academy of Pediatrics (AAP) Council on Children with Disabilities. Chris Plauché Johnson, MEd, MD, FAAP, is Clinical Professor of Pediatrics, University of Texas Health Science Center at San Antonio; Medical Director, Autism Diagnostic Team at the Village of Hope, San Antonio; and was Co-chair, Autism Expert Panel of the AAP Council on Children with Disabilities.

Dr. Duby and Dr. Johnson have disclosed no relevant financial relationships.

Address correspondence to: John C. Duby, MD, FAAP, via e-mail at jduby@chmca.org; or Chris Plauché Johnson, MEd, MD, FAAP, via e-mail at drchris@flash.net.

EDUCATIONAL OBJECTIVES

  1. Objectively define developmental screening and developmental surveillance and how these are deployed in the office setting.
  2. Describe an inclusive strategy to monitor for signs of autism spectrum disorders (ASD) within the context of general developmental surveillance.
  3. Discuss the logistics of universal screening for ASD in the office setting with special attention to feasibility and benefits when balanced against other time/cost pressures in the office setting.

Abstract

Two Screens by Two Years was the mantra initiated by the media on October 29, 2007, when the American Academy of Pediatrics (AAP) unveiled guidelines and an accompanying toolkit developed for the identification and management of children with autism spectrum disorders (ASD). However, the mantra should have sounded: “Five Screens by Two and a Half Years” since screening for ASD is just one piece of the much bigger picture of developmental screening. Moreover, screening tests are simply instantaneous “snapshots” spliced into an ongoing “developmental surveillance video.” Periodic screening and continuous surveillance are important; all children should have both as part of a health maintenance protocol. Although primary care physicians long have been advised to monitor children’s growth, development, and behavior at health supervision visits, the recommendation to screen all children formally with standardized tools at specific ages is new. The recommendation for universal general developmental screening was launched by an AAP policy statement published in July 2006. Included in it was a recommendation to screen all children for ASD at the 18-month visit. The 2007 ASD guidelines reinforced the 2006 statement, expanded the process, and recommended an additional ASD-specific screen at the 24-month visit to detect the small subset of children with ASD who regress after 18 months of age. These recommendations were made in recognition of the mounting evidence that early diagnosis and intervention optimize outcomes in children with ASD and that ASD symptoms can be observed in very young children.

ABOUT THE AUTHORS

John C. Duby, MD, FAAP, is Co-director, The NeuroDevelopmental Center, Akron Children’s Hospital, Akron, Ohio; Professor of Pediatrics, Northeastern Ohio Universities College of Medicine, Rootstown; and is a member of the Executive Committee, American Academy of Pediatrics (AAP) Council on Children with Disabilities. Chris Plauché Johnson, MEd, MD, FAAP, is Clinical Professor of Pediatrics, University of Texas Health Science Center at San Antonio; Medical Director, Autism Diagnostic Team at the Village of Hope, San Antonio; and was Co-chair, Autism Expert Panel of the AAP Council on Children with Disabilities.

Dr. Duby and Dr. Johnson have disclosed no relevant financial relationships.

Address correspondence to: John C. Duby, MD, FAAP, via e-mail at jduby@chmca.org; or Chris Plauché Johnson, MEd, MD, FAAP, via e-mail at drchris@flash.net.

EDUCATIONAL OBJECTIVES

  1. Objectively define developmental screening and developmental surveillance and how these are deployed in the office setting.
  2. Describe an inclusive strategy to monitor for signs of autism spectrum disorders (ASD) within the context of general developmental surveillance.
  3. Discuss the logistics of universal screening for ASD in the office setting with special attention to feasibility and benefits when balanced against other time/cost pressures in the office setting.

Two Screens by Two Years was the mantra initiated by the media on October 29, 2007, when the American Academy of Pediatrics (AAP) unveiled guidelines and an accompanying toolkit developed for the identification and management of children with autism spectrum disorders (ASD). However, the mantra should have sounded: “Five Screens by Two and a Half Years” since screening for ASD is just one piece of the much bigger picture of developmental screening. Moreover, screening tests are simply instantaneous “snapshots” spliced into an ongoing “developmental surveillance video.” Periodic screening and continuous surveillance are important; all children should have both as part of a health maintenance protocol. Although primary care physicians long have been advised to monitor children’s growth, development, and behavior at health supervision visits, the recommendation to screen all children formally with standardized tools at specific ages is new. The recommendation for universal general developmental screening was launched by an AAP policy statement published in July 2006. Included in it was a recommendation to screen all children for ASD at the 18-month visit. The 2007 ASD guidelines reinforced the 2006 statement, expanded the process, and recommended an additional ASD-specific screen at the 24-month visit to detect the small subset of children with ASD who regress after 18 months of age. These recommendations were made in recognition of the mounting evidence that early diagnosis and intervention optimize outcomes in children with ASD and that ASD symptoms can be observed in very young children.

ABOUT THE AUTHORS

John C. Duby, MD, FAAP, is Co-director, The NeuroDevelopmental Center, Akron Children’s Hospital, Akron, Ohio; Professor of Pediatrics, Northeastern Ohio Universities College of Medicine, Rootstown; and is a member of the Executive Committee, American Academy of Pediatrics (AAP) Council on Children with Disabilities. Chris Plauché Johnson, MEd, MD, FAAP, is Clinical Professor of Pediatrics, University of Texas Health Science Center at San Antonio; Medical Director, Autism Diagnostic Team at the Village of Hope, San Antonio; and was Co-chair, Autism Expert Panel of the AAP Council on Children with Disabilities.

Dr. Duby and Dr. Johnson have disclosed no relevant financial relationships.

Address correspondence to: John C. Duby, MD, FAAP, via e-mail at jduby@chmca.org; or Chris Plauché Johnson, MEd, MD, FAAP, via e-mail at drchris@flash.net.

EDUCATIONAL OBJECTIVES

  1. Objectively define developmental screening and developmental surveillance and how these are deployed in the office setting.
  2. Describe an inclusive strategy to monitor for signs of autism spectrum disorders (ASD) within the context of general developmental surveillance.
  3. Discuss the logistics of universal screening for ASD in the office setting with special attention to feasibility and benefits when balanced against other time/cost pressures in the office setting.

10.3928/00904481-20090101-03

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