Assessment, Diagnosis and Interventions for Autism Spectrum Disorders
Scottish Intercollegiate Guidelines Network. (2016).
Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network, (145), 1-76.
This guideline provides recommendations for surveillance, screening, assessment, and intervention of individuals across the lifespan on the autism spectrum.
Scottish Intercollegiate Guidelines Network
"Population screening for [autism spectrum disorder] ASD is not recommended" (Strong Recommendation; p. 8).
Although it is a strong recommendation for preschool-aged children, based on clinical expertise, parents of children and young people of any age on the autism spectrum should be offered education and skills interventions (Good Practice Point).
"All professionals involved in diagnosing [autism spectrum disorder] ASD in children, young people or adults should consider using the current version of either [International Classification of Diseases] ICD or [Diagnostic and Statistical Manual of Mental Disorders] DSM. The classification system used for diagnosis should be recorded in the patient’s notes" (Conditional Recommendation; p. 7).
An assessment by a specialist should include a case history, clinical observation, and functional skills assessment. "An assessment of mental health needs, well being and risk should be considered for all individuals [on the autism spectrum]" (Good Practice Point; p. 13).
"Choice of interventions to support communication in children and young people [on the autism spectrum] should be informed by effective assessment" (Good Practice Point; p. 22).
"Access to support from staff trained in applied behaviour analysis-based technologies (e.g., Picture Exchange Communication System, discrete trial training, task analysis, prompting, fading or shaping) to build independence in adaptive, communication and social skills should be considered for children [on the autism spectrum]" (Conditional Recommendation; p. 24).
"[Screening] instruments may be used for information gathering, but they should not be used to make or rule out a referral for an assessment for [autism spectrum disorder] ASD" (Strong Recommendation; p. 9)
"Interventions to support communicative understanding and expression in individuals [on the autism spectrum], such as the Picture Exchange Communication System and the use of environmental visual supports (eg in the form of pictures or objects), should be considered" (Conditional Recommendation; p. 22).
"Healthcare professionals should note that an individual’s level of comprehension may be at a lower developmental level than that suggested by their expressive language skills" (Good Practice Point; p. 16)
Facilitated communication should not be used to communicate with children, young people, or adults on the autism spectrum (Strong Recommendation).
"Assessment of speech, language and communication may be indicated for adults [on the autism spectrum] particularly in the presence of intellectual disability" (Good Practice Point; p. 16).
"Adapting the communicative, social and physical environments of children and young people [on the autism spectrum] may be of benefit (options include providing visual prompts, reducing requirements for complex social interactions, using routine, timetabling and prompting and minimising sensory irritations)" (Good Practice Point; p. 22).
"A diagnostic assessment, alongside a profile of the individual’s strengths and weaknesses, carried out by a multidisciplinary team which has the skills and experience to undertake the assessments, should be considered as the optimum approach for individuals suspected of having [autism spectrum disorder] ASD" (Conditional Recommendation; p. 13).
"As part of the core programme of child health surveillance, healthcare professionals can aid early identification of children requiring further assessment for [autism spectrum disorder] ASD and other developmental disorders. Clinical assessment should incorporate a high level of vigilance for features suggestive of ASD, in the domains of social interaction and play, speech, language and communication difficulties and behaviour" (Strong Recommendation; p. 9).
"All children and young people [on the autism spectrum] should have a comprehensive evaluation of their speech and language and communication skills, which should inform intervention" (Strong Recommendation; p. 16)
"Healthcare professionals involved in specialist assessment should take an [autism spectrum disorder] ASD-specific developmental history and should directly observe and assess the individual’s social and communication skills and behaviour" (Strong Recommendation; p. 15).
"Interventions to support social communication should be considered for children and young people [on the autism spectrum], with the most appropriate intervention being assessed on an individual basis" (Conditional Recommendation; p. 22).
When clinically relevant, the need for an audiological examination should be reviewed for all individuals on the autism spectrum (Strong Recommendation).
"Consider the use of a structured instrument to assist information gathering in the assessment of an individual with possible [autism spectrum disorder] ASD" (Conditional Recommendation; p. 15).
"[Autism spectrum disorder] ASD should be part of the differential diagnosis for preschool children displaying absence of age-appropriate developmental features, as typical ASD behaviours may not be obvious in this age group" (Strong Recommendation; p. 10).
"Professionals should offer individuals, parents and carers good-quality written information and an opportunity to ask questions when sharing information about the individual [on the autism spectrum]. Information should be provided in an accessible and understandable form" (Strong Recommendation; p. 43).
"Children under three years of age who have regression in language or social skills should be referred for assessment for [autism spectrum disorder] ASD" (Strong Recommendation; p. 9).
"Parent-mediated intervention programmes should be considered for children and young people of all ages who are affected by [autism spectrum disorder] ASD, as they may help families interact with their child, promote development and increase parental satisfaction, empowerment and mental health" (Good Practice Point; p. 21).
"Education and skills interventions for parents of preschool children [on the autism spectrum] should be offered" (Strong Recommendation; p. 41).
"For adults, [autism spectrum disorder] ASD should be considered as part of an assessment if they have developmental delay, failure to meet adult milestones (work, development of intimate relationships or independence from parents), emotional and behavioural problems, intellectual disability or genetic syndromes" (Good Practice point; p. 10).
"The use of the Autism Spectrum Quotient-10 instrument may be considered to help identify adults with possible [autism spectrum disorder] ASD capable of self completing the instrument, who should be referred for assessment" (Conditional Recommendation; p. 11).
