Aotearoa New Zealand Autism Guideline: He Waka Huia Takiwātanga Rau
Whaikaha – Ministry of Disabled People and Ministry of Education. (2022).
Wellington (New Zealand): Ministry of Health, (3rd Edition), Retrieved September 14, 2023 from https://www.whaikaha.govt.nz/about-us/policy-strategies-and-action-plans/nz-autism-guideline.
This update of a previous guideline provides recommendations for the identification, diagnosis, and treatment of individuals on the autism spectrum across the lifespan. This guideline and its supplemental papers are living documents that will be regularly updated to be more responsive to the guideline's audience. See the Notes on this Article section below for the link to access the supplemental papers.
Whaikaha – Ministry of Disabled People in partnership with the Ministry of Education (New Zealand)
This article is a living guideline, so supplemental papers on topics related to the guideline are published periodically. The full listing of documents can be found at the<a href="https://www.health.govt.nz/our-work/disability-services/disability-projects/autism-spectrum-disorder-guideline/living-guideline-group-keeping-asd-guideline-date#papers" title="https://www.health.govt.nz/" class="ApplyClass"> Ministry of Health's</a> webpage.
Interpreters and translators should be available when assessing individuals whose first language is not English. "Supports should be culturally responsive for the child or young person" (Good practice point; p. 115).
"All children suspected of being on the autism spectrum or having other developmental challenges should have an audiology assessment" (Good Practice Point; p. 22).
"Spontaneous communication, socialisation, and play goals should be a priority" (Grade A Evidence; p. 26).
"The assessment and development of communication and social goals should complement each other. Teaching of the two areas should be carried out in parallel" (Grade C Evidence; p. 115).
"Early identification of children on the autism spectrum is essential. Early identification enables early intervention and is likely to lead to a better quality of life" (Grade B Evidence; p. 22).
"Standardised [autism spectrum disorder] ASD assessment interviews and schedules should be used. The intellectual, adaptive, and cognitive skills associated with autism/takiwātanga should be seriously considered and, where possible and appropriate, formally assessed" (Grade B Evidence; p. 22).
"Approaches should emphasise pivotal skills such as spontaneity, initiation, motivation, and self-management" (Grade C Evidence; p. 104).
All children on the autism spectrum "should have an assessment and support suggestions by a speech-language therapist with expertise in the autism spectrum at a minimum of once a year, more often in early childhood" (Good Practice Point; p. 115).
"Early intensive behavioural intervention (EIBI) should be considered as an approach of value for young [children on the autism spectrum] ... to improve outcomes such as cognitive ability, language skills, and adaptive behaviour" (Grade B Evidence; p. 165).
"Timely access to visual supports and technology should be available to support expressive and receptive communication and organisation according to the child or young person’s individual needs" (Grade B Evidence; p. 115).
"Services should be available to ensure a young child is appropriately engaged across a variety of home, educational and community settings in goal-directed activities for at least 15 to 25 hours per week" (Grade B Evidence; p. 26).
"Decisions about the type of support and the degree of intensity should be informed by a skilled team and reflect the child’s developmental stage, characteristics, teaching goals, and family preferences" (Grade C Evidence; p. 104).
"There is no evidence that any single model is effective for teaching every goal to all children [on the autism spectrum] .... Models should be chosen to fit the characteristics of the child and the learning situation" (Grade B Evidence; p. 26).
"Assessments should include the pragmatic aspects of communication" (Grade C Evidence; p. 115).
"Communication should be seen as a high-priority learning area, and communication goals should be included in individual plans for all ... children and young people" on the autism spectrum (Grade A Evidence; p. 115).
"Supports should take place in natural settings, using natural routines and natural consequences" (Grade A Evidence; p. 115).
"Social assessment should be carried out in a variety of natural settings with both adults and peers as social partners" (Grade C Evidence; p. 122).
Interventions targeting social development should:
<div>
<ul>
<li>take place in natural settings and incorporate natural activities;</li>
<li>incorporate strategies for generalization and maintenance of skills; and,</li>
<li>encourage the integration of carefully trained and supported peers who are not on the autism spectrum (Grade A Evidence).</li>
</ul>
</div>
"Literacy instruction should be provided using multiple instructional strategies and building on the child’s focused interests" (Grade B Evidence; p. 115).
"Generalisation and maintenance need to be carefully planned. The learning of new skills should take place in the child or young person’s usual environment, i.e., with their usual carers and teachers and with access to peers" who are not on the autism spectrum (Grade B Evidence; p. 26).
"Support programmes should be monitored and evaluated on an ongoing basis. Where there is lack of progress over a three-month period, changes should be made to the curriculum or support goals, the time set aside for instruction, the intensity of the instruction (such as lower teacher–child ratios), or increasing consultation and support for staff" (Grade A Evidence; p. 104).
"Decisions about participating in social skills groups should be guided by whether [a person on the autism spectrum] ... values it, and whether they are expected to benefit from it" (Good Practice Point; p. 162).
"Supports and strategies based on the principles of applied behaviour analysis should be considered for" children on the autism spectrum (Grade A Evidence; p. 165).
"All behavioural approaches should be of good quality and incorporate the following principles: person-centered planning, functional assessment, positive strategies, multifaceted, focus on the environment, meaningful outcomes, focus on ecological validity and systems-level intervention" (Grade C Evidence; p. 28).
"Facilitated and structured social skills groups should be considered for children and young people on the autism spectrum with less obvious support needs" (Grade B Evidence; p. 28).
"Formal assessments should always be supplemented by informal assessments which include observations across a variety of settings and activities and interviews with significant adults" (Grade C Evidence; p. 115). Communication aspects (e.g., eye gaze, facial expression, gestures, range of communicative function) should be included in the assessment.
"A formal whole population screening programme for the identification of autism is not recommended" (Grade B Evidence; p. 50).
"Encouraging initiations and spontaneous communication should be a key focus of supports" (Grade C Evidence; p. 115).
"Services should not wait for the diagnostic process to be completed but should be available as soon as a significant developmental need is identified" (Grade C Evidence; p. 104).
"Children will benefit from communication goals that are carefully planned and implemented by teachers and carers throughout the curriculum and throughout the day, ... [therefore] speech-language therapists will need skills in scaffolding teachers' and carers' learning to support such an approach" (Grade C Evidence; p. 118).
"Structured educational/daily living programmes and interventions with an emphasis on visually based cues should be implemented. They should focus on skill enhancement and establishment of communication strategies. Family-centered treatment approaches should be provided" (Grade C Evidence; p. 137).
Autism-specific screening instruments with sufficient sensitivity and specificity include the Checklist for Autism in Toddlers (CHAT) and the Autism Screening Questionnaire (ASQ; Grade B Evidence).
