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SIGN 145 • Assessment, diagnosis and …

SIGN 145 assessment , diagnosis and interventions for autism spectrum disordersA national clinical guideline June 2016 EvidenceKEY TO EVIDENCE STATEMENTS AND RECOMMENDATIONSLEVELS OF EVIDENCE1++High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias1+Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias1 -Meta-analyses, systematic reviews, or RCTs with a high risk of bias2++ High-quality systematic reviews of case-control or cohort studies High-quality case-control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal2+Well-conducted case-control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal2 - Case-control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal3 Non-analytic studies, eg case reports, case series4 Expert opinionRECOMMENDATIONSSome recommendations can be made with more certainty than others.

SIGN 145 • Assessment, diagnosis and interventions for autism spectrum disorders A national clinical guideline June 2016

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1 SIGN 145 assessment , diagnosis and interventions for autism spectrum disordersA national clinical guideline June 2016 EvidenceKEY TO EVIDENCE STATEMENTS AND RECOMMENDATIONSLEVELS OF EVIDENCE1++High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias1+Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias1 -Meta-analyses, systematic reviews, or RCTs with a high risk of bias2++ High-quality systematic reviews of case-control or cohort studies High-quality case-control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal2+Well-conducted case-control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal2 - Case-control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal3 Non-analytic studies, eg case reports, case series4 Expert opinionRECOMMENDATIONSSome recommendations can be made with more certainty than others.

2 The wording used in the recommendations in this guideline denotes the certainty with which the recommendation is made (the strength of the recommendation).The strength of a recommendation takes into account the quality (level) of the evidence. Although higher-quality evidence is more likely to be associated with strong recommendations than lower-quality evidence, a particular level of quality does not automatically lead to a particular strength of factors that are taken into account when forming recommendations include: relevance to the NHS in Scotland; applicability of published evidence to the target population; consistency of the body of evidence, and the balance of benefits and harms of the strong recommendations on interventions that should be used, the guideline development group is confident that, for the vast majority of people, the intervention (or interventions ) will do more good than harm.

3 For strong recommendations on interventions that should not be used, the guideline development group is confident that, for the vast majority of people, the intervention (or interventions ) will do more harm than conditional recommendations on interventions that should be considered , the guideline development group is confident that the intervention will do more good than harm for most patients. The choice of intervention is therefore more likely to vary depending on a person s values and preferences, and so the healthcare professional should spend more time discussing the options with the POINTS Recommended best practice based on the clinical experience of the guideline development has accredited the process used by Scottish Intercollegiate Guidelines Network to produce clinical guidelines. The accreditation term is valid until 31 March 2020 and is applicable to guidance produced using the processes described in SIGN 50: a guideline developer s handbook, 2015 edition ( ).

4 More information on accreditation can be viewed at Improvement Scotland (HIS) is committed to equality and diversity and assesses all its publications for likely impact on the six equality groups defined by age, disability, gender, race, religion/belief and sexual guidelines are produced using a standard methodology that has been equality impact assessed to ensure that these equality aims are addressed in every guideline. This methodology is set out in the current version of SIGN 50, our guideline manual, which can be found at The EQIA assessment of the manual can be seen at The full report in paper form and/or alternative format is available on request from the Healthcare Improvement Scotland Equality and Diversity care is taken to ensure that this publication is correct in every detail at the time of publication. However, in the event of errors or omissions corrections will be published in the web version of this document, which is the definitive version at all times.

5 This version can be found on our web site This document is produced from elemental chlorine-free material and is sourced from sustainable Intercollegiate Guidelines NetworkAssessment, diagnosis and interventions for autism spectrum disordersA national clinical guidelineJune 2016 assessment , diagnosis and interventions for autism spectrum disordersScottish Intercollegiate Guidelines Network Gyle Square, 1 South Gyle Crescent Edinburgh EH12 published June 2016 ISBN 978 1 909103 46 7 Citation textScottish Intercollegiate Guidelines Network (SIGN). assessment , diagnosis and interventions for autism spectrum disorders. Edinburgh: SIGN; 2016. (SIGN publication no. 145). [June 2016]. Available from URL: consents to the photocopying of this guideline for the purpose of implementation in , diagnosis and interventions for autism spectrum disordersContentsContents1 Introduction.

6 The need for a guideline .. Remit of the guideline .. Statement of intent ..32 Key recommendations .. Diagnostic criteria .. Recognition, assessment and diagnosis .. Non-pharmacological interventions for children .. Non-pharmacological interventions for adults ..63 Definitions and concepts .. Definitions .. Diagnostic criteria ..74 Recognition, assessment and diagnosis .. Recognition in primary care .. Methods of assessment .. Individual profiling .. Conditions associated with ASD .. Biomedical investigations .. Prognostic indicators in childhood ..195 Principles of intervention ..206 Non-pharmacological interventions for children and young people .. Parent-mediated Communication interventions .. Behavioural/psychological interventions .. Nutritional interventions .. Other interventions ..287 Non-pharmacological interventions for adults .. Communication interventions .

7 Facilitated communication .. Social skills interventions .. Behavioural interventions .. Cognitive behavioural therapies ..308 Pharmacological interventions for children and young people .. General principles .. Second-generation antipsychotics .. Methylphenidate .. Noradrenergic reuptake inhibitors .. Antidepressants .. Naltrexone .. Hormonal interventions .. Melatonin ..35 assessment , diagnosis and interventions for autism spectrum disordersAssessment, diagnosis and interventions for autism spectrum disorders9 Pharmacological interventions for adults .. General principles .. Antipsychotics .. Pharmacotherapy to improve cognition .. Methylphenidate .. Noradrenergic reuptake inhibitors .. Antidepressants .. Anxiolytics .. Anticonvulsants .. Naltrexone .. Hormonal interventions .

8 Melatonin ..3910 Service Training .. interventions and meeting support needs .. Information provision and support for parents/carers .. Support during transition ..4111 Provision of Providing information and support .. Checklist for provision of information .. Sources of further information ..4612 Implementing the guideline .. Implementation strategy .. Resource implications of key recommendations .. Auditing current practice .. Health technology assessment advice for NHSS cotland ..4913 The evidence base .. Systematic literature review .. Recommendations for Review and updating ..5214 Development of the guideline .. Introduction .. The guideline development group .. Consultation and peer review ..54 Abbreviations ..56 Annexes .. | 1 assessment , diagnosis and interventions for autism spectrum disordersAssessment, diagnosis and interventions for autism spectrum disorders1 THE NEED FOR A GUIDELINES ince SIGN 98.

9 assessment , diagnosis and clinical interventions for children and young people with autism spectrum disorders was published in July 2007, there have been significant developments in interagency working attributable to the Getting it Right for Every Child (GIRFEC) approach now enshrined in the Children and Young People (Scotland) Act ,2 The Scottish Strategy for Autism (2011) has provided a ten-year framework to progress implementation, planning and outcomes for adult and children and young people s services with a view to developing effective joint pathways for service This guideline updates SIGN 98 to reflect new evidence for managing children and young people and to incorporate evidence which applies to adults and older people. The inclusion of adults is in response to the increasing understanding that autism spectrum disorder (ASD) is a lifelong condition in which the core features of ASD persist whilst manifesting differently according to different age stages.

10 Depending on the severity of autistic difficulties, ASD may not be evident as a presentation throughout preschool, primary, or secondary school years or in adulthood. It may not be recognised because of associated coexisting conditions. Variable environmental factors, for example relatively smaller class size in primary school years, or family scaffolding of social impairment in childhood or adolescence or, in adults, unmasking of symptoms and signs of ASD due to loss of informal carers, will also influence this Alternatively the signs and symptoms of ASD may not always have been recognised by parents, carers, the individual themselves or other professionals,5 so may not present until adulthood, or perhaps even older adulthood. There is therefore a need for a guideline which reflects the whole age is a highly prevalent condition. A community survey in England in 2007 estimated around 1% of adults have Prevalence in children is also around 1%.


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