Screening

Screening recommendations vary worldwide. In the absence of evidence concerning the longer term outcomes of screened versus nonscreened children, more evidence is needed to determine the benefits of screening at the population level.[138] In the US, the American Academy of Pediatrics and the American Academy of Neurology recommend screening for ASD in primary care at regular checkups, starting during infancy.[29] Several screening tools have been developed for children >18 months and include the Checklist for Autism in Toddlers (CHAT) and the Modified Checklist for Autism in Toddlers (M-CHAT); screening tools for ASD for both children and adults typically have good sensitivity (e.g., 0.83 for M-CHAT) but poor specificity (e.g., 0.51 for M-CHAT).[139] For all ages, a positive screening result does not mean a definite diagnosis of ASD, and a negative result does not rule out ASD. Results may vary depending on the setting used and any comorbid mental health disorders.[140] Repeating the use of screening tools to monitor signs suggestive of ASD over time is generally recommended.[141] In other countries, such as the UK, widespread screening for ASD is not currently recommended. Instead, healthcare professionals are encouraged to remain vigilant for any signs that may indicate ASD, and to take regular opportunities to discuss the child's development with the parents as part of existing health surveillance programs.

The American Academy of Neurology and Child Neurology Society have produced red flags for ASD.[142] If any of these are present, they recommend further evaluation:

  • No babbling or pointing or other gesture by 12 months

  • No single words by 16 months

  • No two-word spontaneous (not echolalic) phrases by 24 months

  • Loss of language or social skills at any age.

Use of this content is subject to our disclaimer