Recommendations regarding the routine use of formal screening tools for Autism Spectrum Disorder (ASD) in primary care (PC) and similar settings are varied. This article delves into the existing evidence concerning universal screening of children for ASD within primary care environments.
Our research involved a systematic review of prominent databases such as Medline, PsychInfo, Educational Resources Informational Clearinghouse, and Cumulative Index of Nursing and Allied Health Literature. We focused on studies that provided psychometric properties of ASD screening tools applied to general populations within primary care and comparable settings.
The study selection process prioritized research where investigators reported on the effectiveness of screening instruments in unselected groups within primary care and PC-like environments. Data extraction was meticulously performed by at least two reviewers per study, ensuring accuracy and consistent quality ratings based on predetermined criteria.
Our analysis revealed substantial evidence indicating moderate to high positive predictive values for primary care screening tools in identifying children aged 16 to 40 months, and in one study, for children 48 months and older in primary care and similar contexts. However, we noted a scarcity of evidence assessing the sensitivity, specificity, and negative predictive value of these instruments. Notably, no studies directly examined the impact of screening on treatment outcomes or potential harm.
It is important to acknowledge potential limitations such as publication bias, selective reporting within studies, and the constraints of our search strategy.
In conclusion, the current body of evidence suggests that ASD screening tools represent a valuable asset for accurately determining the proportion of young children in general populations who may have ASD within primary care and related settings. However, the complexities inherent in establishing a clear pathway from screening to intervention indicate that clinical and policy experts will likely continue to play a crucial role in shaping screening practices. Given that ASD is a prevalent neurodevelopmental condition with considerable long-term implications and costs, and with increasing support for early intensive intervention to improve outcomes, widespread early identification remains a critical public health imperative.
