EBP Compendium: Summary of Clinical Practice Guideline

Scottish Intercollegiate Guidelines Network; NHS Quality Improvement Scotland (United Kingdom)
Assessment, Diagnosis and Clinical Interventions for Children and Young People with Autism Spectrum Disorders: A National Clinical Guideline
Scottish Intercollegiate Guidelines Network. (2007).
Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN), SIGN publication No. 98, 65 pages.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations for assessment and intervention for children with autism spectrum disorders (ASD). The target audience includes a wide range of professionals involved in the management and care of children with ASD. Recommendations are graded A, B, C, D, or "Good Practice Point" based on the strength of supporting evidence. Grade A recommendations are based on evidence from systematic reviews and meta-analyses of randomized controlled trials that are directly relevant to the population. Grade B recommendations include high quality case control or cohort studies or high quality systematic reviews of those studies that are directly applicable to the population, or recommendations extrapolated from Grade A evidence. Grade C recommendations include well conducted case control or cohort studies or recommendations extrapolated from Grade B evidence. Grade D recommendations are based on evidence from non-analytic studies or expert opinion or recommendations extrapolated from Grade C evidence. Good Practice Points are recommendations based on the clinical experience of the guideline development group.

Recommendations:

• Assessment/Diagnosis
  • Assessment Areas
    • Cognition/Language
      • Interventions, such as the use of visual augmentation, should be trained to support communication (Grade D Evidence) and should be informed by effective assessment (Good Practice Point) (p. 16).
      • “Clinical assessment should incorporate a high level of vigilance for features suggestive of ASD, in the domains of social interaction and play, speech and language development and behavior” (Grade D Evidence) (p. 6).
      • “Healthcare professionals should directly observe and assess the child or young person’s social and communication skills and behavior” (Grade D Evidence) (p. 12). 
      • A comprehensive speech and language evaluation is recommended for all children and young people with ASD. The results should guide intervention planning (Grade D Evidence) (p. 12).
    • Hearing
      • Examination of audiological status should be established, as clinically relevant, for all children and young people with ASD (Grade D Evidence) (p. 13).
  • Assessment Instruments
    • Diagnosis
      • “Healthcare professionals should consider using ASD-specific observational instruments, as a means of improving the reliability of ASD diagnosis” (Grade C Evidence) (p. 12).
      • “All professionals involved in diagnosing ASD in children and young people should consider using either ICD-10 or DSM-IV” (Grade C Evidence) (p. 4).
    • Screening
      • “CHAT or M-CHAT can be used in young children to identify clinical features indicative of an increased risk of ASD but should not be used to rule out ASD” (Grade D Evidence) (p. 6).
• Treatment
• Cognition
• General Findings
  • Interventions, such as the use of visual augmentation, should be trained to support communication (Grade D Evidence) and should be informed by effective assessment (Good Practice Point) (p. 16).
  • Individuals with ASD may benefit from the adaptation of the communicative, social, and physical environment (e.g., provision of visual prompts, reduction of requirements in social interactions, use of routine, time tables, and prompts, and reduction of sensory irritation) (Good Practice Point) (p. 17).
• Applied Behavioral Analysis/Discrete Trial Training
  • “The Lovaas programme should not be presented as an intervention that will lead to normal functioning” (Grade A Evidence) (p. 18). However, behavioral interventions should be considered to address specific behaviours in children and young people with ASD, “both to reduce symptom frequency and severity and to increase the development of adaptive skills” (Grade B Evidence) (p. 18).
• Auditory/Sensory Integration Training
  • “Auditory integration training is not recommended” (Grade A Evidence) (p. 18).
• Cognitive Behavioral Therapy
  • No conclusions could be drawn regarding the effectiveness or potential harm of cognitive behavioral therapy in children with ASD with a verbal IQ of at least 69 (Conclusion based on a high quality meta-analysis or systematic review with low risk of bias) (p. 20).
• Facilitated Communication
  • “Facilitated communication should not be used as a means to communicate with children and young people with ASD” (Grade A Evidence) (p. 19).
• Pragmatics/Social Skills
• “Interventions to support social communication should be considered for children and young people with ASD, with the most appropriate intervention being assessed on an individual basis” (Grade D Evidence) (p. 17).

Keywords: Autism Spectrum Disorders

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Added to Compendium: October 2011