Systematic Review: Recommendations for Rehabilitation in ASD and ID From Clinical Practice Guidelines

Abstract

Objective To identify and summarize clinical practice guidelines for autism spectrum disorder (ASD) and intellectual disability (ID) for the Package of Interventions for Rehabilitation for the World Health Organization (WHO). Data Sources Academic databases, Google Scholar, guideline databases, and professional society websites were searched using the general criteria “ASD/ID” AND “rehabilitation” AND “guideline,” restricted to English-only guidelines. Study Selection Work group members independently screened titles and abstracts (1952 ASD; 1027 ID) and excluded articles if not (1) a guideline; (2) about rehabilitation; (3) published since 2008; or (4) about ASD/ID. Full-text screening (29 ASD; 5 ID) involved 3 additional exclusion criteria: (1) contained conflict of interest; (2) lacked information on strength of recommendation; or (3) failed the Appraisal of Guidelines for Research and Evaluation II instrument. Six guidelines (4 ASD: 2 on youth, 1 on adults, 1 on all ages; 2 ID: 1 on challenging behaviors, 1 on mental health) resulted. Data Extraction Work group members extracted 524 recommendations (386 ASD; 138 ID) from the guidelines including the level of evidence, diagnostic and age group, recommendation type (assessment, intervention, service), target, and valence. Data Synthesis Of the 270 intervention recommendations (212 ASD; 58 ID), only 36 for ASD and 47 for ID were empirically based. Most comprised biomedical (23%), pharmacologic (29%), and psychosocial (21%) interventions for ASD and behavioral (14%), pharmacologic (29%), and psychological (14%) interventions for ID. Intervention recommendations primarily targeted coexisting conditions (56% ASD; 93% ID), whereas core symptoms received much less attention (26% ASD). Conclusions Clinical practice guidelines reviewed for ASD and ID primarily contained recommendations based on expert opinion, with the plurality of recommendations relating to pharmacologic treatment. Vital next steps include identifying relevant interventions for inclusion in the WHO Package and continuing to conduct rigorous intervention research, particularly on core symptoms of these conditions, to extend recommendations for high-quality guidelines.

Prevalence and Developmental Profiles of Autism Spectrum Disorders in Children With Global Developmental Delay

“…Some scholars believe that the increase in the prevalence of ASD in recent years may be related to the lack of understanding of ASD in the past and misdiagnosis of ASD as GDD/ID; or in case of GDD/ID combined with ASD, only GDD/ID is diagnosed, but ASD is not diagnosed ( 3 ). The treatment of ASD and GDD/ID are not all the same, current evidence supports that ASD should be primarily targeted at social communication skills complemented by management of abnormal behavior, but children with GDD may obtain greater benefit from structured daily routines, cognitive behavioral therapy and so on ( 11 , 12 ). Early diagnosis and targeted treatment are of great significance to improve the prognosis ( 13 – 15 ).…”

AGREEing on Clinical Practice Guidelines for Autism Spectrum Disorders in Children: A Systematic Review and Quality Assessment

“…Despite the publication of several reviews of ASD CPGs [ 25 , 39 , 40 ], there are no evidence-based CPGs for ASD in Saudi Arabia; therefore, doctors are forced to make the best decisions for ASD patients based only on their clinical knowledge and experience. This review adds to the knowledge base using the AGREE II instrument to systematically assess the quality of recently published CPGs of ASD in children as part of a national CPG adaptation initiative in Saudi Arabia.…”

“…Two similar SRs of ASD CPGs were published during the undertaking of our research for the CPG project [ 39 , 40 ].…”

“…The authors did not report the two overall assessments. Moreover, they mapped the biomedical, pharmacologic, and psychosocial interventions within the assessed CPGs [ 39 ]. Similarly, Pattison et al assessed 17 ASD CPGs published up to April 2020.…”

Subgrouping School-Aged Children on the Autism Spectrum Based on Co-Occurring Psychiatric Symptoms

“…For example, based on our study's subgroups, when seeing an autistic child with a combination of internalizing and externalizing symptoms, a psychologist may want to collaborate with a physician to monitor for atypical sleep duration, gastrointestinal conditions, and/or neurological conditions. Psychiatric symptom-based subgroups also affect responses to intervention and should be carefully considered in the development of intervention guidelines, which are currently broad (i.e., non-specific to subpopulations), and in future studies on how different subpopulations of autistic children respond to interventions (Antshel et al, 2011;McBride et al, 2020;Dekker et al, 2021;Wickstrom et al, 2021). For example, light therapy could be beneficial to children belonging to a High Psychiatric Symptoms subgroup, who are at elevated risk for depression and atypical sleep duration (Fritzsche et al, 2001).…”