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Research Review: Outcomes of 24- to 36-month-old children with autism spectrum disorder vary by ascertainment strategy: a systematic review and meta-analysis.
Journal of Child Psychology and Psychiatry ( IF 7.6 ) Pub Date : 2019-04-29 , DOI: 10.1111/jcpp.13057
Megan Micheletti 1, 2, 3 , Courtney McCracken 2, 3 , John N Constantino 4 , David Mandell 5 , Warren Jones 1, 2, 3, 6 , Ami Klin 1, 2, 3, 6
Affiliation  

BACKGROUND Despite widespread recommendations for early surveillance of risk for autism spectrum disorder (ASD), no research to date has shown that early surveillance leads to better clinical outcomes. Preliminary research has suggested that children with ASD ascertained via prospective follow-up have better outcomes than those ascertained via community referral. Because prospective studies include early surveillance, by comparing outcomes of children with ASD across ascertainment strategies, we may gain insight into the effects of early surveillance relative to its absence. METHODS A systematic review was conducted to identify studies reporting outcomes of 24- to 36-month-olds with ASD ascertained via prospective follow-up, community referral, or universal screening. A meta-analysis using a random effects model was used to calculate overall effect size estimates for developmental level and symptom severity across ascertainment cohorts. RESULTS Eleven prospective, ten community referral, and eight universal screening studies were identified, reporting on 1,658 toddlers with ASD. We found no differences in outcomes between community referral and universal screening studies. Relative to both, prospective studies reported significantly higher developmental levels and lower symptom severities. CONCLUSIONS Outcomes of young children with ASD ascertained via prospective follow-up are better than those of children with ASD recruited via community referral or universal screening. Although we discuss why sampling bias is not likely the driving force behind these findings, we cannot rule out the possibility that sampling bias contributes to the observed differences; future studies should probe the effects of sociodemographic variables on clinical outcomes as a function of ascertainment strategy. This limitation notwithstanding, our results raise the possibility that prospective follow-up may confer a 'surveillance effect' that contributes to improved developmental and diagnostic outcomes in children with ASD. Future research should test this hypothesis and determine the specific mechanism by which surveillance may improve outcomes.

中文翻译:

研究回顾:24至36个月大的自闭症谱系障碍儿童的结局因确定策略而异:系统评价和荟萃分析。

背景技术尽管广泛建议对自闭症谱系障碍(ASD)的风险进行早期监测,但迄今为止,尚无研究表明早期监测可带来更好的临床结果。初步研究表明,通过前瞻性随访确定的ASD儿童比通过社区转诊确定的儿童具有更好的结局。因为前瞻性研究包括早期监测,所以通过比较确定性策略对患有ASD的儿童的结局,我们可能会了解缺乏早期监测的影响。方法进行了系统的审查,以鉴定通过前瞻性随访,社区转诊或全民筛查确定的报告24至36个月大的ASD结果的研究。使用随机效应模型的荟萃分析用于计算确定人群中发育水平和症状严重程度的总体效应量估计值。结果确定了11项前瞻性研究,10项社区推荐和8项普查结果,报告了1658名ASD幼儿。我们发现社区转诊和普遍筛查研究的结果没有差异。相对于前两者,前瞻性研究报道了显着较高的发育水平和较低的症状严重程度。结论通过前瞻性随访确定的ASD儿童的结局要优于通过社区转诊或普遍筛查招募的ASD儿童的结局。尽管我们讨论了为什么抽样偏差不太可能成为这些发现背后的驱动力,我们不能排除抽样偏差导致观察到的差异的可能性;未来的研究应根据确定策略来探讨社会人口统计学变量对临床结局的影响。尽管存在这种局限性,我们的结果增加了前瞻性随访可能产生“监视作用”的可能性,该监视作用有助于改善ASD儿童的发育和诊断结果。未来的研究应检验这一假设,并确定监视可改善结果的具体机制。我们的结果增加了前瞻性随访可能赋予“监视作用”的可能性,该监视作用有助于改善ASD儿童的发育和诊断结果。未来的研究应检验这一假设,并确定监视可改善结果的具体机制。我们的结果增加了前瞻性随访可能赋予“监视作用”的可能性,该监视作用有助于改善ASD儿童的发育和诊断结果。未来的研究应检验这一假设,并确定监视可改善结果的具体机制。
更新日期:2019-04-29
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