Autism Spectrum Disorder in Adults: Diagnosis and Management
National Collaborating Centre for Mental Health. (2012).
London (United Kingdom): British Psychological Society; Royal College of Psychiatrists, (Clinical Guideline 142), 472.
This guideline provides recommendations for assessment and treatment of adults on the autism spectrum. The target audience of this guideline is "primary, community, secondary, tertiary and other healthcare professionals who have direct contact with, and make decisions concerning the care of, adults with autism" (p. 13). Select recommendations that are relevant toward speech-language pathology are provided below; for the complete set of recommendations, review the full guideline.
National Collaborating Centre for Mental Health (United Kingdom); National Institute for Health & Clinical Excellence (United Kingdom)
<p>This document was reviewed with the following:</p><ul><li>National Institute for Health and Care Excellence. (2014). <i>Autism in Adults: Evidence Update May 2014</i>(Evidence Update 59). Retrieved from <a href="http://www.nice.org.uk/guidance/cg142/evidence/cg142-autism-in-adults-evidence-update2" title="http://www.nice.org.uk/guidance/cg142/evidence/cg142-autism-in-adults-evidence-update2">www.nice.org</a></li></ul>
<p>"Social learning programmes to improve social interaction should typically include:</p>
<ul>
<li>modelling;</li>
<li>peer feedback (for group-based programmes) or individual feedback (for individually delivered programmes);</li>
<li>discussion and decision-making;</li>
<li>explicit rules; [and]</li>
<li>suggested strategies for dealing with socially difficult situations" (p. 231).</li>
</ul>
"During a comprehensive assessment, take into account and assess for possible differential diagnoses and coexisting disorders or conditions" (p. 137).
<p>"A comprehensive assessment should:</p>
<ul>
<li>be undertaken by professionals who are trained and competent;</li>
<li>be team-based and draw on a range of professions and skills; [and]</li>
<li>where possible involve a family member, partner, carer or other informant or use documentary evidence (such as school reports) of current and past behaviour, and early development" (p. 136).</li>
</ul>
"Do not provide facilitated communication for adults [on the autism spectrum]" (p. 200).
<p>"All health and social care professionals providing care and support for adults [on the autism spectrum] should have a broad understanding of the:</p>
<ul>
<li>nature, development, and course of autism;</li>
<li>impact on personal, social, educational, and occupational functioning;</li>
<li>impact of and interaction with the social and physical environment;</li>
<li>impact on and interaction with other coexisting mental and physical disorders and their management; [and]</li>
<li>potential discrepancy between intellectual functioning as measured by IQ and adaptive functioning as reflected, for example, by difficulties in planning and performing activities of daily living including education or employment" (p. 72).</li>
</ul>
<p>"For adults [on the autism spectrum] without a learning disability or with a mild to moderate learning disability, who have identified problems with social interaction, consider:</p>
<ul>
<li>a group-based social learning programme focused on improving social interaction; [and]</li>
<li>an individually delivered social learning programme for people who find group-based activities difficult" (p. 231).</li>
</ul>
"In each area a specialist community-based multidisciplinary team for adults [on the autism spectrum] (the specialist autism team) should be established. The membership should include speech and language therapists" (p. 163).
"To organise and structure the process of a more complex assessment, consider using a formal assessment tool, such as the Diagnostic Interview for Social and Communication Disorders (DISCO), the [Autism Diagnostic Observation Schedule – Generic] ADOS-G, or the [Autism Diagnostic Interview – Revised] ADI-R" (p. 350).
<p>In order "to aid more complex diagnosis and assessment for adults, consider using a formal assessment tool" (p. 137).</p>
<ul>
<li>Consider "the following tools for people who do not have a learning disability:
<ul>
<li>the Adult Asperger Assessment (AAA; includes the Autism-Spectrum Quotient [AQ] and the Empathy Quotient [EQ]);</li>
<li>the Autism Diagnostic Interview – Revised (ADI-R);</li>
<li>the Autism Diagnostic Observation Schedule – Generic (ADOS-G);</li>
<li>the Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI); [and]</li>
<li>the Ritvo Autism Asperger Diagnostic Scale – Revised (RAADS-R)" (p. 137).</li>
</ul>
</li>
</ul>
<ul>
<li>Consider "the following tools in particular for people with a learning disability:
<ul>
<li>the ADOS-G; [and]</li>
<li>the ADI-R" (p. 137).</li>
</ul>
</li>
</ul>
<p>"All health and social care professionals providing care and support for adults [on the autism spectrum] should:</p>
<ul>
<li>aim to foster the person's autonomy, promote active participation in decisions about care and support self-management;</li>
<li>maintain continuity of individual relationships wherever possible;</li>
<li>ensure that comprehensive information about the nature of, and interventions and services for, their difficulties is available in an appropriate language or format (including various visual, verbal and aural, easy-read, and different colour and font formats); [and]</li>
<li>consider whether the person may benefit from access to a trained advocate" (p. 72).</li>
</ul>
<p>"When discussing and deciding on interventions with adults [on the autism spectrum], consider:</p>
<ul>
<li>their experience of, and response to previous interventions;</li>
<li>the nature and severity of their autism;</li>
<li>the extent of any associated functional impairment arising from the autism, a learning disability or a mental or physical disorder;</li>
<li>the presence of any social or personal factors that may have a role in the development or maintenance of any identified problem(s);</li>
<li>the presence, nature, severity and duration of any coexisting disorders; [and]</li>
<li>the identification of predisposing and possible precipitating factors that could lead to crises if not addressed" (p. 139).</li>
</ul>
"Based on the limited and very low-quality evidence for behavioural therapies ... [the guideline group] concluded that there was insufficient evidence to make a recommendation about the use of behavioural therapies for the core autistic symptom of social-communication impairment in adults [on the autism spectrum]" (p. 197).
