Screening Tools for Autism Spectrum Disorder in Primary Care: A Systematic Evidence Review.

Abstract

Recommendations conflict regarding universal application of formal screening instruments in primary care (PC) and PC-like settings for autism spectrum disorder (ASD). We systematically reviewed evidence for universal screening of children for ASD in PC. We searched Medline, PsychInfo, Educational Resources Informational Clearinghouse, and Cumulative Index of Nursing and Allied Health Literature. We included studies in which researchers report psychometric properties of screening tools in unselected populations across PC and PC-like settings. At least 2 authors reviewed each study, extracted data, checked accuracy, and assigned quality ratings using predefined criteria. We found evidence for moderate to high positive predictive values for ASD screening tools to identify children aged 16 to 40 months and 1 study for ≥48 months in PC and PC-like settings. Limited evidence evaluating sensitivity, specificity, and negative predictive value of instruments was available. No studies directly evaluated the impact of screening on treatment or harm. Potential limitations include publication bias, selective reporting within studies, and a constrained search. ASD screening tools can be used to accurately identify percentages of unselected populations of young children for ASD in PC and PC-like settings. The scope of challenges associated with establishing direct linkage suggests that clinical and policy groups will likely continue to guide screening practices. ASD is a common neurodevelopmental disorder associated with significant life span costs.^1,2 Growing evidence supports functional gains and improved outcomes for young children receiving intensive intervention, so early identification on a population level is a pressing public health challenge.^3,4.