American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

National Initiative for Autism: Screening and Assessment; National Autistic Society; Royal College of Psychiatrists; Royal College of Paediatrics and Child Health; All Party Parliamentary Group on Autism (United Kingdom)
National Autism Plan for Children (NAPC): Plan for the Identification, Assessment, Diagnosis and Access to Early Interventions for Pre-School to Primary School Aged Children with Autism Spectrum Disorders (ASD)

Le Couteur, A., Baird, G., et al. (2003).
London (United Kingdom): The National Autistic Society, 57 pages.

AGREE Rating: Highly Recommended

Description:

This guideline provides good practice recommendations for the identification, assessment, diagnosis and intervention for preschool and elementary school-aged children with autism spectrum disorder (ASD). The target audience of this guideline includes speech-language pathologists and other professionals providing services to this population.  

Recommendations:

  • Assessment/Diagnosis
    • Assessment Areas
      • Cognition/Language
        • “A systematic approach to direct observation is recommended to examine communication, social interaction, and play skills” (p. 35).
        • “An initial framework of assessment (Aarons and Gittens, 1992) should include communication strategies, social interaction and joint attention; learning
          potential and preferred learning style; readiness to engage, listen and attend, and play skills, as well as receptive and expressive competencies. It should be undertaken by a speech and language therapist with ASD training or another professional with explicit training in this field” (p. 36).
    • Assessment Instruments
      • Diagnosis - “Standard semi-structured assessment tools such as the Autism Diagnostic Observation Schedule (Lord et al, 2000) are available, although training is required and currently limited in availability” (p. 35).
      • Screening
        • There is insufficient evidence to recommend any one autism specific screening tool over another. Screening tools such as the Social Communication Questionnaire (SCQ) (Rutter et al, 2002), the Pervasive Developmental Disorders Screening Test (PDDST) (Siegel, 1998), and the Childhood Asperger’s Syndrome Test (CAST) (Scott, 2002) may be useful in determining if there is a need for further assessment (p. 32).
        • Given the limited sensitivity and specificity of screening tests for developmental problems, parental questionnaires, such as the Parent Evaluation of Developmental Status, may be used as an adjunct to help identify problems or delays (p. 26).
      • Cognition/Language - The choice of language assessment should be determined by the individual characteristics of the child and should be used in conjunction with “more informal but semi-structured techniques” to obtain a comprehensive understanding of the child’s communication and social understanding of language (p. 36).
  • Treatment
    • Cognition/Language
      • General Findings
        • The most effective educational programmes are those that
          • take account of “characteristic behavioural patterns” (p. 44).
          • “employ a structured approach to teaching” (p. 44).
          • focus on increasing a specific developmental skill and social understanding.
          • “foster integration with peers” (p. 44).
        • The child’s Individual Education Plan should include strategies to develop communication skills; enhance social interaction; and directly teach communication, social understanding, play skills, and other activities of daily living (p. 45).
        • “There is a range of therapies promoted for individuals with ASD. However most of these lack experimental evidence of effectiveness (Smith 1999; Howlin and Charman, in press; Diggle, McConachie and Randle, 2002)” (p. 46).
      • Auditory/Sensory Integration Training & Facilitated Communication - "There is… emerging evidence that some therapies previously advocated by professionals and parents, such as auditory integration therapy are no more effective than placebo (Mudford et al, 2000; Dawson and Watling 2000), whilst others (such as Facilitated Communication) are now discouraged because of adverse side effects or other risks to the child (Bebko, Perry and Byson, 1996; Dunn-Gier et al, 2000; Campbell et al, 1990; Pfeiffer et al, 1995)” (p. 47).
      • Augmentative and Alternative Communication - Children with co-morbid specific developmental disorders may require speech and language therapy for the development and training of an augmented communication program (p. 47).

Keywords: Autism Spectrum Disorders

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Added to Compendium: November 2010

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