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

Abstract

Objective: Autism spectrum disorder (ASD) and intellectual disability (ID) were selected for inclusion in the development of a Package of Interventions for Rehabilitation for the World Health Organization (WHO). Here, we describe results of a search of guidelines for these conditions. Methods: A literature search for clinical practice guidelines was performed for ASD and ID. Using the Appraisal of Guidelines for Research and Evaluation instrument and other inclusion and exclusion criteria, guidelines were identified for abstraction of recommendations, which were collated into categories based on diagnosis, patient age, type and target of service, valence, and level of evidence. Results: Six guidelines remained after screening. Four ASD guidelines focused on diagnosis, management and support, and two ID guidelines covered the prevention, assessment, and management of challenging behavior and mental health problems, with 386 and 138 recommendations resulting for each group, respectively. Out of 524 total recommendations, 212 ASD and 58 ID recommendations focused on intervention. The primary type of intervention pertained to pharmacology for each group (27% ASD, 29% ID), followed by psychosocial (21%) and biomedical (23%) for ASD and behavioral (14%) and psychological (14%) for ID. Regarding target of intervention, recommendations primarily focused on coexisting conditions for each group (56% ASD, 93% ID) and core symptoms for ASD (26%), whereas adaptive functioning received little attention (11% ASD, 7% ID). Conclusions: Although these six guidelines provided many recommendations for comorbid and specific problems in ASD and ID, very few recommendations targeted core symptoms, and many were based on expert opinion. A vital next step includes identifying relevant interventions from the guidelines or that are missing to be included in the WHO Package of Interventions for Rehabilitation.

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

“…Psychopathology-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 future studies (Antshel et al, 2011;McBride et al, 2020;Dekker et al, 2021;Wickstrom et al, 2021). Finally, the findings of this study provide additional rationale to investigate the shared mechanisms of psychiatric and medical conditions.…”

“…For example, based on our study’s subgroups, when seeing a child with ASD and a combination of sleep disturbances, gastrointestinal disorders, and/or neurological disorders, a pediatrician may want to collaborate with a mental health provider, as this child might be at particularly high risk for externalizing problems, whereas a child with a NVIQ < 70 could be suspectable to internalizing problems, and a child with a NVIQ < 70, a sleep disturbance, and/or a gastrointestinal disorder may be vulnerable to both internalizing and externalizing problems. Psychopathology-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 children with ASD respond to interventions targeting core and associated symptoms (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 Psychopathology” subgroup, who are at elevated risk for depression and sleep disturbances (Fritzsche et al, 2001).…”

“…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).…”