Posts Tagged ‘ early screening ’

The New Autism Diagnostic Criteria: What Will Be The Impact?

Thursday, October 4th, 2012

The impact of the newly proposed diagnostic criteria for autism have been debated this year and the conversation continues with a new study published online in the American Journal of Psychiatry (you can read it here). The key issue has been the extent to which the new criteria will lead to fewer diagnoses of autism. Here’s a summary of where things stand right now. 

1) The new criteria lumps all disorders along the autism spectrum together under one diagnosis. This means, for example, that separate criteria for Asperger’s Syndrome would no longer be in place. Whenever diagnostic lumping takes place, the criteria become less specific, in order to take in a large range of symptoms. A result of this is that clinicians making diagnoses have to use even more professional insight and discretion to determine if a diagnosis is warranted because the criteria are more general than before.

2) To account for the wide range of symptom expression that can be observed within this broad autism spectrum, there will be a severity scale, ranging from mild to severe.

3) A key concern has been that the new diagnostic criteria will result in fewer diagnoses of autism in the future. Some have claimed that this effect will be profound. The study cited above suggests that less than 10% of current cases would no longer meet diagnostic criteria for autism.

Now this is where the fuzziness in the debate comes into play. Whenever a child is not diagnosed with a condition, then the availability of services gets reduced. Do these 10% of kids still need services? Will they get a diagnosis that will permit access to services? This is really the crux of the question. Furthermore, there are suggestions that this study was a “best-case scenario” because it focused on more clear-cut cases and used expert clinicians with lots of experience (see, for example, the New York Times report on this). The implication is that once the new diagnostic criteria are used out in the real world, with a range of clinicians in terms of experience, the number of cases that will not be diagnosed may be higher than the 10% reported in the study.

Earlier this year, I asked an experienced clinician – Dr. Gil Tippy – to offer his take on the matter. He suggested that the rates of autism will not be severely affected if experienced clinicians are doing the assessments. His greatest concern was that the use of the new severity criteria would substantially decrease the number of kids who could receive services for their condition. His argument was that insurance companies could deny coverage to those who were given a “lower” severity rating of mild impairment – even though that “mild impairment” requires intervention. You can read the entire blog post here if you are interested in the details.

So I think there are 2 take-home messages right now:

1) The rate of diagnosis will go down – but it’s not clear to what degree.

2) The impact of the severity criteria on the ability of families to secure coverage needs to be considered in more detail, as this could result in impediments to secure treatment.

If you read Dr. Tippy’s suggestions noted above, he offers advice on how to advocate to ensure that kids are not denied services in the future. This is especially important as early screening and early intervention continue to be the most effective strategies for accelerating the development of youth diagnosed with autism. To that end, it’s important that all parents know the early signs of autism that would indicate the need for early screening – if you haven’t seen it before, here is a prior blog post that lists 7 key early signs that should never be ignored.

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Early Screening For Autism: Moving Forward, Not Backward

Wednesday, June 22nd, 2011

autism speaks logo.jpegLast week a review paper published in Pediatrics suggested that there is insufficient evidence to support routine screening for autism in toddlers. While this paper — which is a conceptual piece based on literature review and not a scientific study per se — points out a number of legitimate challenges in screening for autism, the conclusion goes against the current tide of thinking which emphasizes the importance of early identification, particularly in toddlerhood. As such, my impression is that the conclusion of this paper moves our thinking backward, rather than forward.

One of the biggest changes in parenting advice in recent years has been shifting from the “wait and see” approach to “learn the signs and act early.” The idea is to help parents learn about the most important developmental milestones and to be aware of potential signals of problem areas — so that they can work with their pediatrician to track development and determine if and when intervention would be productive. Why? Simply put, early intervention is more likely to have the most pronounced long-term effects on development.

One of the most exciting areas of research on autism focuses on testing new methods for early identification and intervention. The organization Autism Speaks — which supports all kinds of cutting-edge science — nicely summarizes the idea that we should be promoting more screening and improvements in that process rather than less screening, especially as recent studies demonstrate the potential for early intervention to have meaningful effects on development.

As a scientist, I understand that we need to bring a critical eye to our current knowledge base and practices. That said, I also appreciate that we have a public service to not only maintain momentum in research and practice, but to accelerate it when we are talking about developmental disorders such as autism. Discouraging screening for autism runs contrary to the mission of keeping parents as informed as possible about their children’s development, and also could inhibit the critical partnership between parents and pediatricians.

It is certainly true that the current screening for autism is far from an exact science. And I agree that any efforts to improve this process should be a priority for research and clinical practice. But the reality is that we need to serve parents today as we continue to improve our future efforts. Let’s keep moving forward.

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