Autism Spectrum Disorder in Under 19s: Support and Management

National Collaborating Centre for Mental Health. (2013).

London (United Kingdom): National Institute for Clinical Excellence, (Clinical Guideline 170), 1-866.

This guideline provides recommendations for the treatment of children and youth on the autism spectrum. The target audience of this guideline is clinicians and school leaders (e.g., principals, service commissioners). Recommendations relevant to speech-language pathology are provided here.

National Collaborating Centre for Mental Health (United Kingdom); National Institute for Health and Care Excellence (United Kingdom)

<p>This guideline was reviewed with the following supplemental documents:</p><ul> <li>Kendall, T., Megnin-Viggars, O., et al. (2013). Management of Autism in Children and Young People: Summary of NICE and SCIE Guidance. <em>BMJ, 347</em>, f4865. doi:10.1136/bmj.f4865</li> <li>National Institute for Health and Care Excellence. (2014). <em>Autism</em> (Quality Standard 51). Retrieved from <a href="https://www.nice.org.uk/guidance/qs51" title="https://www.nice.org.uk/guidance/qs51">www.nice.org.uk</a></li> <li>National Institute for Health and Care Excellence. (2016). <em>Surveillance Report 2016 – Autism Spectrum Disorder in Under 19s: Recognition, Referral and Diagnosis (2011) NICE Guideline CG128 and Autism Spectrum Disorder in Under 19s: Support and Management</em> (2013) NICE Guideline CG170. Retrieved from <a href="https://www.nice.org.uk/guidance/cg170/resources/surveillance-report-2016-autism-spectrum-disorder-in-under-19s-recognition-referral-and-diagnosis-2011-nice-guideline-cg128-and-autism-spectrum-disorder-in-under-19s-support-and-management-2013-nice--2660568733/chapter/Surveillance-decision?tab=evidence" title="https://www.nice.org.uk/guidance/cg170/resources/surveillance-report-2016-autism-spectrum-disorder-in-under-19s-recognition-referral-and-diagnosis-2011-nice-guideline-cg128-and-autism-spectrum-disorder-in-under-19s-support-and-management-2013-nice--2660568733/chapter/Surveillance-decision?tab=evidence">www.nice.org.uk</a></li> <li>National Institute for Health and Care Excellence. (2021). <em>2021 Exceptional Surveillance of Autism Spectrum Disorder in Under 19s: Support and Management (NICE Guideline CG170)</em>. Retrieved from <a href="https://www.nice.org.uk/guidance/cg170/evidence/2021-exceptional-surveillance-of-autism-spectrum-disorder-in-under-19s-support-and-management-nice-guideline-cg170-9140668525?tab=evidence" title="https://www.nice.org.uk/guidance/cg170/evidence/2021-exceptional-surveillance-of-autism-spectrum-disorder-in-under-19s-support-and-management-nice-guideline-cg170-9140668525?tab=evidence">www.nice.org.uk</a></li> <li>National Institute for Health and Care Excellence. (2021). <em>2021 Surveillance of Autism (NICE Guidelines CG128, CG143 and CF170)</em>. Retrieved from <a href="https://www.nice.org.uk/guidance/cg142/resources/2021-surveillance-of-autism-nice-guidelines-cg128-cg142-and-cg170-9140525965/chapter/Surveillance-decision?tab=evidence" title="https://www.nice.org.uk/guidance/cg142/resources/2021-surveillance-of-autism-nice-guidelines-cg128-cg142-and-cg170-9140525965/chapter/Surveillance-decision?tab=evidence">www.nice.org.uk</a></li></ul><blockquote style="margin: 0px 0px 0px 40px; border: none; padding: 0px;"></blockquote><blockquote style="margin: 0px 0px 0px 40px; border: none; padding: 0px;"></blockquote><blockquote style="margin: 0px 0px 0px 40px; border: none; padding: 0px;"></blockquote>

"Take into account the physical environment in which children and young people [on the autism spectrum] ... are supported and cared for. Minimise any negative impact by providing visual supports, for example, words, pictures or symbols that are meaningful for the child or young person" (NICE, 2013; p. 808).

"Do not use neurofeedback to manage speech and language problems in children and young people" on the autism spectrum (NICE, 2013; p. 817).

Individuals on the autism spectrum should "have a personalised plan that is developed and implemented in a partnership between them and their family and carers (if appropriate) and the autism team" (NICE, 2014; p. 20).

For children and young people on the autism spectrum, factors that may impact behavior, routine assessment, and care planning should be evaluated. Such factors may include communication differences that "result in difficulty understanding situations or in expressing needs and wishes" (NICE, 2013; p. 811).

Individuals on the autism spectrum should "have a documented discussion with a member of the autism team about opportunities to take part in age-appropriate psychosocial interventions" (NICE, 2014; p. 26).

<div>"Assess for any feeding, growth or nutritional problems, including restricted diets. Monitor and refer if needed" (NICE, 2021; p. 7).</div>

Although preliminary evidence was promising, it was insufficient for the guideline development group to recommend the picture exchange communication system to improve speech and language for children on the autism spectrum. Further research is recommended (NICE, 2013).

<div>Diagnostic assessment for autism in individuals should begin within 3 months of referral to an autism team (NICE, 2014).</div>

<p>"Consider a specific social-communication intervention ... that includes play-based strategies with parents, carers, and teachers to increase joint attention, engagement, and reciprocal communication in the child or young person. Strategies should:</p> <ul> <li>be adjusted to the child or young person's developmental level;</li> <li>aim to increase the parents', carers', teachers' or peers' understanding of, and sensitivity and responsiveness to, the child or young person's patterns of communication and interaction;</li> <li>include techniques of therapist modeling and video-interaction feedback; [and]</li> <li>include techniques to expand the child or young person's communication, interactive play, and social routines.</li> </ul> <p>The intervention should be delivered by a trained professional. For pre-school children consider parent, carer, or teacher mediation. For school-aged children consider peer mediation" (NICE, 2013; p. 810).</p>

"As part of the preparation for the transition to adult services, health and social care professionals should carry out a comprehensive assessment of the young person [on the autism spectrum] .... The assessment should make best use of existing documentation about personal, educational, occupational, social and communication functioning, and should include assessment of any coexisting conditions, especially depression, anxiety, [attention deficit hyperactivity disorder] ADHD, obsessive-compulsive disorder (OCD), and global delay or intellectual disability" (NICE, 2013; p. 817).

"Do not use auditory integration training to manage speech and language problems in children and young people" on the autism spectrum (NICE, 2013; p. 817).