CDC wants earlier autism screen

In 2007, the American Academy of Pediatrics (AAP) called for screening children at 18 and 24 months or at any time parents had a concern about autism spectrum disorder (ASD).

Results of a recent survey from the National Center for Health Statistics (NCHS) show, however, that the median age at which children with special health care needs and ASD were identified was 5 years. Almost 40% of children were diagnosed at 6 years or older, and less than one-fifth were identified at 2 years or younger. These numbers come from interviews with parents or guardians of 1,420 school-aged children who were reported to have ASD.

A report from the Centers for Disease Control and Prevention (CDC), Autism and Developmental Disabilities Monitoring Network, said that although more children are being diagnosed at earlier ages, most are not diagnosed until after 4 years.

The AAP reported last year that about half of pediatricians say they don't routinely use recommended screening tools for developmental delays, and yet most children with autism would be identified in the primary care setting if screening tools were used.

There are actually 2 parts to screening: The first looks at all developmental concerns and is recommended at 9 months, 18 months, and 24 months and at well-child visits at 3 and 4 years. The other part is autism screening at 18 and 24 months.

The NCHS report shows that school-aged children identified as having ASD were diagnosed by a range of professionals, but those identified younger than 5 years (19.5%) were most often identified by generalists, including pediatricians, family physicians, and nurse practitioners. The ratios change significantly when children were identified older than 5 years, with 23.9% identified by a psychiatrist and 28.8% identified by a psychologist, including a school psychologist.

Peacock noted that generalists often do not diagnose children but rather they may be identified as being at risk by a generalist and then referred to a specialist.

The CDC has available on its Web site a self-assessment version of its Autism Case Training ( http://www.cdc.gov/ncbddd/actearly/act/class.html) so that pediatricians can get continuing education credits.