Understanding Parents' Opinions about Clinical Genetic Testing in ASD

Background: The American College of Medical Genetics recently suggested microarray testing should be a first tier investigation for children with ASD. However, genetic testing in ASD is contentious; some people believe testing is helpful, whilst others have major concerns about the potential clinical implications and applications. Little is known about whether parents would want testing for themselves and their children if it were available.

Objectives: To understand parents’ opinions about clinical genetic testing for themselves and their children with ASD 

Methods: In North East England, approximately 65% of children with ASD and their families are included on the Daslⁿe regional research database (http://daslne.org/). In February 2011, parents were sent a survey that focussed on knowledge about ASD and genetics, and opinions about clinical genetic testing; the survey was designed by experienced ASD clinical academics (members of the AGP), a clinical geneticist, experts in social policy and ethics, and a parent of a child with ASD, who also runs the regional branch of the National Autistic Society. Paper surveys were sent by post to both parents in each family, with mechanisms for separate completion and return. An online survey link was included on the paper version. Reminders were sent to non respondents.

Results: Responses were received from 377 parents (264 mothers and 113 fathers, from 293 families). The ASD characteristics of the children of responders and non responders were very similar.

Most parents overestimated their chance of having another child with an ASD; 43% of parents reported that having a child with ASD had affected their decision to have more children. If it were available, 77% said they would like their child with ASD to be tested for ‘genes that caused ASD’. Parents were asked if their child was found to have a gene that caused ASD, whether they would like testing themselves – 78% said yes. Parents were asked hypothetical questions about prenatal testing, and testing during pregnancy. If it was available, 54% of parents would like to be tested for ‘ASD genes’ before having another child. 40% of parents thought that if it was possible to test a baby during pregnancy, to see what their chances of having ASD were, this should be available; 24% would not want this, and 36% were unsure. Parents of children with less well developed language skills were more likely to want testing. Parents written responses to survey questions revealed a very broad range of opinions about testing.

Conclusions: This is the largest survey of its kind to date, and many parents were positive about genetic testing; however, opinions varied considerably. Genetic testing of ASD families will increase over the next few years; opinions about whether clinical genetic testing should be available will influence its impact.