ESCAP Practice Guidance for Autism: A Summary of Evidence-Based Recommendations for Diagnosis and Treatment
European Child & Adolescent Psychiatry
Fuentes, J., Hervás, A., et al. (2021).
European Child & Adolescent Psychiatry, 30(6), 961-984.
This guideline from the European Society of Child and Adolescent Psychiatry (ESCAP) provides good practice recommendations on the assessment and treatment of autistic people of all ages.
European Society of Child and Adolescent Psychiatry
When assessing for autism, "the diagnostic team should be multi-professional" (p. 965) involving medical, psychological, speech-language pathology, neurology, education, occupational therapy, physiotherapy, and any other appropriate professions with input from the individual's carers. Assessment should include a clinical history as well as developmental assessments of expressive and receptive language, social communication, and functional abilities. Assessment results should be provided to families using clear, precise language accessible for the family's social and educational background and should be available in a comprehensive, written report. Families should be given time to process diagnostic information and ask questions, preferably at a follow-up appointment.
<div>Services for autism should be individualized to the person's strengths, needs, and family and social context. Interventions and supports should be adapted as the individual's circumstances change over time. The individual's strengths should be identified, fostered, and when possible, used to circumvent areas of relative weakness. Functional analysis of an individual's ability should be conducted to identify underlying causes of difficulties, to develop skills for improving quality of life, and to identify any limiting environmental factors (e.g., social, sensory, cognitive, physical) in order to provide opportunities for progress and minimize difficulties.</div>
For autistic individuals, no specific communication interventions can be recommended for all individuals due to a limited evidence base and variability in the outcomes for individuals; however, a number of general approaches may be helpful for children and their families such as:
<ul>
<li>developmentally-based, social communication therapies [e.g., Joint Attention Symbolic Play Engagement and Regulation (JASPER), Preschool Autism Communication Trial (PACT), developmental individual-difference relationship-based model (DIR), Floortime, Hanen More than Words];</li>
<li>interventions based on applied behavior analysis (ABA) [e.g., early intensive behavior intervention (EIBI), ABA approaches with more natural, child-initiated, developmentally appropriate strategies and tasks];</li>
<li>naturalistic developmental behavioral interventions [e.g., Early Start Denver Model (ESDM), enhanced milieu teaching (EMT), incidental teaching (IT), pivotal response treatment (PRT), reciprocal imitation training (RIT), social communications/emotional regulation/transactional support (SCERTS)];</li>
<li>parent-focused behavioral management programs (e.g., Stepping Stones Triple P);</li>
<li>social skill programs [e.g., Secret Agent Society (SAS)]; and</li>
<li>speech-language therapies focused on increasing comprehension and spontaneous communication [e.g., Picture Exchange Communication System (PECS), Treatment and Education of Autistic and related Communication Handicapped Children (TEACCH), Social Stories].</li>
</ul>
Clinicians and therapists working with autistic individuals should "serve as a coach for the key people directly involved in the individual’s life - i.e., parents, teachers, other family members, support workers, employers, etc." (p. 971). Broad strategies for making the physical and social environment more accessible, inclusive, and supportive should be implemented across all appropriate contexts for the individual (e.g., family home, educational, work settings, community facilities, cultural or religious groups).
