Screening for Autism Spectrum Disorder in Young Children: Still Not Enough Evidence.
Toddler autism screens can flag risk yet show no clear link to better later outcomes, so treat positive results as a cue for more assessment and early teaching, not a promise.
01Research in Context
What this study did
Grigore et al. (2024) looked at every paper that tested toddler autism screens. They asked two questions. Do the tools catch autism early? Do kids who screen positive do better after therapy?
The team only kept studies that watched children over time. They dropped papers that just checked if a tool worked in one visit.
What they found
The answer to both questions was “we still don’t know.” Some screens caught many kids, others missed them. No clear proof showed that screen-detected toddlers gain more from early help than kids found later.
In short, the tools are shaky and the payoff is unproven.
How this fits with other research
Older papers cheered screening on. Goodwin et al. (2012) told doctors to screen every toddler at 18 and 24 months. The new review says hold on—the old advice rested on weak data.
Tool studies looked brighter. Matson et al. (2004) and Wu et al. (2020) showed the STAT and T-STAT spot autism with good accuracy. Grigore’s team agrees the tools can flag risk, but warns that accuracy alone does not prove kids end up better off.
Outcome studies back the warning. Spjut Jansson et al. (2016) followed screen-positive toddlers who received ABA or eclectic therapy and saw no group advantage after two years. Tsiplova et al. (2023) tracked kids to age 11 and still found no lasting bonus from early therapy. These null results feed the new “inconclusive” verdict.
Why it matters
You may still screen, but you now have evidence to share with families: a positive result means “let’s watch and test further,” not a guarantee that early therapy will change the long run. Use the moment to start teaching simple play and communication skills while the full evaluation unfolds, and keep measuring progress child by child.
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02At a glance
03Original abstract
Early detection of autism spectrum disorder (ASD) has the potential to significantly reduce the impact of the condition, however previous reviews have found little evidence to support screening programs for ASD in young children. We conducted a review with the aim of updating evidence on 3 aspects: (a) diagnostic stability of ASD in young children; (b) accuracy of ASD screening tools in young children; and (c) the benefits of early interventions in screen-detected young children with ASD. A total of 33 studies were included in our review. Five studies looking at diagnostic stability reported estimates ranging from 71.9% to 100%, however the majority only included a follow-up of 24 months and all studies raised concerns regarding the risk of bias due particularly to lack of blinding, sample size, and patient flow. A total of 25 studies, reported in 26 articles, were identified that reported accuracy data on 11 screening tools. Most of the reports were concerned with versions of M-CHAT, reporting sensitivity estimates from 0.67 to 1.0; however, many of these were deemed to be of high risk of bias due to lack of blinding and follow-up. Four studies reported on early interventions in screen-detected children; however, the majority did not find significant improvements on the relevant outcomes. Overall, the evidence on screening for ASD in young children captured by this review is not conclusive regarding the 3 aspects of screening in this population. Future studies should attempt to ensure blinded diagnostic assessments, include longer follow-up periods and limit attrition.
Journal of Primary Care & Community Health, 2024 · doi:10.1177/21501319241263223