Screening Tools for Autism Spectrum Disorder in Primary Care: A Systematic Evidence Review
CONTEXT: Recommendations conflict regarding universal application of formal screening abstract
instruments in primary care (PC) and PC-like settings for autism spectrum disorder (ASD).
OBJECTIVES: We systematically reviewed evidence for universal screening of children for ASD
in PC.
DATA SOURCES: We searched Medline, PsychInfo, Educational Resources Informational
Clearinghouse, and Cumulative Index of Nursing and Allied Health Literature.
STUDY SELECTION: We included studies in which researchers report psychometric properties of
screening tools in unselected populations across PC and PC-like settings.
DATA EXTRACTION: At least 2 authors reviewed each study, extracted data, checked accuracy, and
assigned quality ratings using predefined criteria.
RESULTS: 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.
LIMITATIONS: Potential limitations include publication bias, selective reporting within studies, and
a constrained search.
CONCLUSIONS: 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.