Assessment and diagnosis of autism spectrum disordersBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6628 (Published 21 October 2011) Cite this as: BMJ 2011;343:d6628
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The BMJ of 29 October 2011 contains three items about autism spectrum disorders (ASD), and two of them have considerable scope for causing confusion about the case for population-based screening for ASD. First, the editorial on NICE Clinical Guideline 128 states that NICE regards screening tools as a useful adjunct to gathering information about autism related behaviours.(1,2) The NICE guidance relates to children with suspected ASD and specifically excludes consideration of applying screening tools to whole populations. Without any acknowledgment of that fact, the next sentence of the editorial refers to a debate about routine population-based screening for autism.
Second, Blenner et al discuss policies on population-based screening for ASD under the heading ‘How should non-specialists assess children with suspected autism?’ (3) This is inappropriate, because population-based screening is irrelevant to children with suspected autism. Children with suspected autism need careful consideration of possible referral and diagnosis by whoever has raised the suspicion of autism. They do not need population-based screening for ASD, which stands or falls on whether it benefits children without suspected autism.
Autism is common, and can significantly affect a child and their family. There is therefore considerable appetite to develop screening for all children to detect possible early autism so they might be treated sooner. However this is not the purpose of the NICE guidance, nor is it in their scope. Population screening for ASD is currently being considered by the UK National Screening Committee. A report for consultation is available at www.screening.nhs.uk/autism and comments can be submitted until 16 January 2012. Meanwhile, careless application to whole populations of material that deals with screening in children with suspected disease should be avoided.
1. Zwaigenbaum L. Assessment and diagnosis of autism spectrum disorders. BMJ 2011;343:d6628 (29 October).
2. National Institute for Health and Clinical Excellence. Autism: recognition, referral and diagnosis of children and young people on the autism spectrum. (Clinical guideline 128.) 2011. http://guidance.nice.org.uk/CG128.
3. Blenner S, Reddy A, Augustyn M. Diagnosis and management of autism in childhood. BMJ 2011;343:d6238 (29 October).
Competing interests: NHS Solutions for Public Health has received funding from the Department of Health via the National Screening Committee to produce an evidence-based appraisal of the viability, effectiveness and appropriateness of a screening programme for ASD in children below the age of 5 years.
Zwaigenbaum has provided a helpful summary of the key themes of the
new NICE guideline on assessment and diagnosis of autism spectrum
disorders (ASD)1. However, we would like to correct his suggestion that
the NICE guideline is the first ASD practice guideline to "emphasise the
diverse clinical presentation of this disorder across the developmental
spectrum"1. The Scottish Intercollegiate Guidelines Network (SIGN)
guideline on 'Assessment, diagnosis and clinical interventions for
children and young people with autism spectrum disorders' (SIGN 98)2
published in 2007, features three tables explaining the different
developmental presentations of ASD and this guideline is referenced by
Indeed, SIGN 98 covers very similar areas to the new NICE guideline and
makes similar recommendations, regarding assessment (whilst, in addition,
considering and making recommendations as regards the evidence for
interventions). This is a reassuring consensus. In the UK, having
evaluated and interpreted the evidence base for ASD in children and young
people over the last 5 years, we are now in a strong position to explore
the potential for service change, based on evidence.
1. Zwaigenbaum, L. Assessment and diagnosis of autism spectrum
disorders. BMJ 2011; 343:d6628
2. Scottish Intercollegiate Guidelines Network (2007) Assessment,
Diagnosis and Clinical Interventions for Children and Young People with
Autism Spectrum Disorders (The SIGN Guideline). Edinburgh: Royal College
of Physicians. [cited 4 November 2011] Available from
Competing interests: IMcC is the Chair, and AOH the Vice Chair, of SIGN guideline 98