This week I read a really interesting article in the New York Times by Aaron E. Carroll who is a professor of pediatrics at Indiana University School of Medicine. The article asked the question; ‘should every child should be screened for autism?‘ It did so by asking the following questions:
1 Is the condition prevalent and severe enough to warrant screening?
2 Do we have a cost-effective means to screen the general population?
3 Does early diagnosis make a difference (that is, do we have treatments available that are more successful when patients are diagnosed earlier?)
4 Will an early diagnosis motivate people to use information gained from screening?
I thought that these were insightful questions and I found myself considering the answers, but from a UK perspective.
Well the answer to question 1 is a resounding yes. Within the UK, there are an estimated 700,000 people with autism which equates to around 1 in 100 of the population. National Autistic Society. Autism will therefore have great impact upon many individuals within society and their family members. Therefore screening is most definitely warranted.
Now question 2 is where it gets tricky. Do we have cost effective means to screen the population? Screening for ASD within the UK is haphazard at the best of times, with many families facing long waiting time for diagnosis. At present many professionals can be involved in the diagnostic process including psychologists, psychiatrists, paediatrician and speech and language therapists. It is usually a multi disciplinary team (MDT) approach, plus input from the parents that leads to a final diagnosis. But the process is a lengthy one and there are a shortage of child psychologists, psychiatrists and speech and language therapists as it is. So although I believe that the means is cost effective, there needs to be an increase in the number of professionals who can help to diagnose and this seems very unlikely. The whole system would have to be restructured and re evaluated.
So to question 3, does early diagnosis make a difference? Well yes, I don’t think that anyone could argue with this point. Early diagnosis and early support services and interventions such as ABA, TEACCH, Portage, speech and language therapy, occupational therapy but to name a few are all vital for the continuing development of the child . Early diagnosis is the key to early intervention and this has been proven to help a child dramatically with their social, communication and developmental difficulties in those important early years. These interventions though, the author of the article pointed out, are very rarely pharmaceutical based, as they focus on the behaviour and development of the child. For this very reason, studies of this kind on intervention and therapy will sadly never be funded for any research purposes, even though we all know that these therapies do make a difference for these children.
This leaves us with question 4, will an early diagnosis motivate people to use information gained from screening? Again this is a most definite yes. I believe that parents and caregivers of autistic children would do anything to help improve the quality of life for their child, who wouldn’t?
So, should universal screening be undertaken? I really do think that it should, but I really can’t see our UK government ploughing money into such a widespread health screening programme for all children. The system is already struggling to diagnose those children who do have ASD, many of them waiting up to 5 years for an initial diagnosis. The system it seems is already stretched to breaking point. But in an ideal world, universal screening would help so many children and their families. Early intervention would take place, those children and families would gain help and support from an early age and resources would be made available.
The article concludes by stating that universal screening does not seem likely to be taking place any time soon, even though
“Autism is prevalent, screening works, and early intervention seems to make a difference in those found to have the condition.”
I whole heartedly agree.
Source: Arron E Carroll: The New York Times: Why There’s Disagreement Over Screening Every Child for Autism