Center for Autism Research, Department of Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Spaulding Rehabilitation Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts.
Pediatrics. 2020 Apr;145(Suppl 1):S47-S59. doi: 10.1542/peds.2019-1895H.
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. 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..
关于在初级保健（PC）和类似 PC 的环境中普遍应用正式筛查工具对自闭症谱系障碍（ASD）进行筛查，相关建议存在冲突。
我们系统地回顾了在 PC 中对 ASD 进行儿童普遍筛查的证据。
我们检索了 Medline、PsychInfo、教育资源信息交换所和 Cumulative Index of Nursing and Allied Health Literature。
我们纳入了研究者在 PC 和类似 PC 的环境中对未选择的人群报告筛查工具的心理测量学特性的研究。
至少有 2 位作者对每项研究进行了审查、提取数据、检查准确性，并使用预定标准分配质量评级。
我们发现，在 PC 和类似 PC 的环境中，针对 16 至 40 个月和 1 项研究中≥48 个月的儿童，ASD 筛查工具具有中度至高度的阳性预测值。目前可获得的关于仪器敏感性、特异性和阴性预测值的证据有限。没有研究直接评估筛查对治疗或危害的影响。
潜在的局限性包括发表偏倚、研究内的选择性报告以及受限的搜索。
ASD 筛查工具可用于准确识别 PC 和类似 PC 的环境中未选择的幼儿群体中 ASD 的比例。与建立直接联系相关的挑战范围表明，临床和政策小组可能会继续指导筛查实践。ASD 是一种常见的神经发育障碍，与整个生命周期的成本显著相关。越来越多的证据支持接受密集干预的幼儿在功能上的获益和改善的结局，因此在人群层面上进行早期识别是一个紧迫的公共卫生挑战。
