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## Complete Summary

#### GUIDELINE TITLE

Assessment, diagnosis and clinical interventions for children and young
people with autism spectrum disorders. A national clinical guideline.

#### BIBLIOGRAPHIC SOURCE(S)

Scottish Intercollegiate Guidelines Network (SIGN). Assessment,
diagnosis and clinical interventions for children and young people with
autism spectrum disorders. A national clinical guideline. Edinburgh
(Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2007
Jul. 65 p. (SIGN publication; no. 98). \[232 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline was issued in 2007 and will be considered for review in
three years. Any amendments to the guideline in the interim period will
be noted on [Scottish Intercollegiate Guidelines Network (SIGN) Web
site](http://www.sign.ac.uk/new.html).

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Autism spectrum disorders (ASDs) including autism, atypical autism and
Asperger\'s syndrome

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation\
Management\
Treatment

#### CLINICAL SPECIALTY

Family Practice\
Ophthalmology\
Pediatrics\
Psychiatry\
Psychology

#### INTENDED USERS

Allied Health Personnel\
Dietitians\
Health Care Providers\
Nurses\
Occupational Therapists\
Physicians\
Psychologists/Non-physician Behavioral Health Clinicians\
Public Health Departments\
Social Workers\
Speech-Language Pathologists

#### GUIDELINE OBJECTIVE(S)

To provide evidence-based recommendations on the assessment, diagnosis
and clinical interventions for children and young people with autism
spectrum disorders (ASD)

#### TARGET POPULATION

Children and young people with autism spectrum disorders (ASD)

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Diagnosis/Evaluation**

1.  Clinical assessment according to diagnostic criteria from the
    International Classification of Diseases of the World Health
    Organisation, 10th edition (ICD-10) and the Diagnostic and
    Statistical Manual, 4th edition (DSM-IV)

2.  Surveillance

3.  Identification of children of high risk (use of structured
    instrument)

4.  Timing of diagnosis

5.  Autism spectrum disorder-specific diagnostic history from
    parent/carer

6.  Direct observation and assessment of social, and communication
    skills and behaviour

7.  Evaluation of speech, language and communication skills

8.  Assessment of intellectual, neuropsychological and adaptive
    functioning

9.  Biomedical investigations

    -   Examination of physical status, with particular attention to
        neurological and dysmorphic features

    -   Karyotyping and Fragile X DNA analysis

    -   Examination of audiological status

    -   Other investigations to rule out recognised aetiologies of
        autism spectrum disorders (ASD) (e.g., tuberous sclerosis)

10. Assessment of comorbid conditions

**Management/Treatment**

1.  Support for early communication skills

2.  Interventions for social communication and interaction

3.  Intensive behavioural programmes

4.  Behavioural interventions

5.  Pharmacologic therapy

    -   Risperidone

    -   Methylphenidate

    -   Melatonin

6.  Service provision

    -   Training of healthcare personnel

    -   Provision of information for parents/carers

    -   Education and skills interventions for parents of pre-school
        children with ASD

#### MAJOR OUTCOMES CONSIDERED

-   Accuracy of diagnostic tests

-   Communication and social functioning

-   Symptom relief

-   Quality of life

-   Adverse effects of treatment

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

A systematic review of the literature was carried out using a search
strategy devised by a Scottish Intercollegiate Guidelines Network (SIGN)
Information Officer. Databases searched include Medline, Embase, Cinahl,
PsychINFO, and the Cochrane Library. For most searches, the year range
covered was 1996-2006. Internet searches were carried out on various
websites including the New Zealand Guidelines Programme, NeLH Guidelines
Finder, and the US National Guidelines Clearinghouse. The Medline
version of the main search strategies can be found on the SIGN website,
in the section covering supplementary guideline material. The main
searches were supplemented by material identified by individual members
of the development group.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Levels of Evidence**

**1++**: High quality meta-analyses, systematic reviews of randomised
controlled trials (RCTs), or RCTs with a very low risk of bias

**1+**: Well-conducted meta-analyses, systematic reviews of RCTs, or
RCTs with a low risk of bias

**1-**: Meta-analyses, systematic reviews of RCTs, or RCTs with a high
risk of bias

**2++**: 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
causal

**2+**: Well-conducted case control or cohort studies with a low risk of
confounding or bias and a moderate probability that the relationship is
causal

**2-**: Case control or cohort studies with a high risk of confounding
or bias and a significant risk that the relationship is not causal

**3**: Non-analytic studies (e.g. case reports, case series)

**4**: Expert opinion

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Once papers have been selected as potential sources of evidence, the
methodology used in each study is assessed to ensure its validity. The
result of this assessment will affect the level of evidence allocated to
the paper, which will in turn influence the grade of recommendation that
it supports.

The methodological assessment is based on a number of key questions that
focus on those aspects of the study design that research has shown to
have a significant influence on the validity of the results reported and
conclusions drawn. These key questions differ between study types, and a
range of checklists is used to bring a degree of consistency to the
assessment process. Scottish Intercollegiate Guidelines Network (SIGN)
has based its assessments on the MERGE (Method for Evaluating Research
and Guideline Evidence) checklists developed by the New South Wales
Department of Health, which have been subjected to wide consultation and
evaluation. These checklists were subjected to detailed evaluation and
adaptation to meet SIGN\'s requirements for a balance between
methodological rigor and practicality of use.

The assessment process inevitably involves a degree of subjective
judgment. The extent to which a study meets a particular criterion
(e.g., an acceptable level of loss to follow up) and, more importantly,
the likely impact of this on the reported results from the study will
depend on the clinical context. To minimize any potential bias resulting
from this, each study must be evaluated independently by at least two
group members. Any differences in assessment should then be discussed by
the full group. Where differences cannot be resolved, an independent
reviewer or an experienced member of SIGN Executive staff will arbitrate
to reach an agreed quality assessment

**Evidence Tables**

Evidence tables are compiled by SIGN executive staff based on the
quality assessments of individual studies provided by guideline
development group members. The tables summarise all the validated
studies identified from the systematic literature review relating to
each key question. They are presented in a standard format to make it
easier to compare results across studies, and will present separately
the evidence for each outcome measure used in the published studies.
These evidence tables form an essential part of the guideline
development record and ensure that the basis of the guideline
development group\'s recommendations is transparent.

**Criteria for Assessing the Reporting of the Diagnosis of Autism
Spectrum Disorder (ASD) in the Literature**

When reviewing the literature the guideline development group found that
the definitions of ASD used for diagnosis varied considerably when
reported and were often not reported at all. To allow for consistency
within the guideline the group agreed that three elements -- assessment
process, classification system and diagnostic instrument - were
important in the accurate diagnosis of ASD. If a paper did not record
diagnosis in this way it was downgraded.

+------------------+---------------------------------------------------+
| A.  **Components |                                                   |
|     of           |                                                   |
|     diagnostic   |                                                   |
|     assessment** |                                                   |
+------------------+---------------------------------------------------+
| 1.  *A           |                                                   |
|     recognised   |                                                   |
|     **process**  |                                                   |
|     of obtaining |                                                   |
|     information  |                                                   |
|     in necessary |                                                   |
|     domains,     |                                                   |
|     usually by   |                                                   |
|     m            |                                                   |
| ultidisciplinary |                                                   |
|     or           |                                                   |
|     multiagency  |                                                   |
|     personnel*   |                                                   |
|                  |                                                   |
| 2.  *Mapping of  |                                                   |
|     the          |                                                   |
|     resulting    |                                                   |
|     information  |                                                   |
|     into a       |                                                   |
|     recognised   |                                                   |
|                  |                                                   |
| **classification |                                                   |
|     system**     |                                                   |
|     such as      |                                                   |
|     DSM--IV or   |                                                   |
|     ICD--10 (see |                                                   |
|     section      |                                                   |
|     2.2)*        |                                                   |
|                  |                                                   |
| 3.  *Assessment  |                                                   |
|     using a      |                                                   |
|     recognised   |                                                   |
|     and          |                                                   |
|     published    |                                                   |
|     **diagnostic |                                                   |
|                  |                                                   |
|    instrument*** |                                                   |
+------------------+---------------------------------------------------+
| B.  **Components |                                                   |
|     of a         |                                                   |
|     reliable     |                                                   |
|     diagnosis**  |                                                   |
+------------------+---------------------------------------------------+
| Increasing       | Use of a process, ***and*** a diagnostic          |
| accuracy and     | classification system, ***and*** an instrument    |
| reliability      | (i.e. 1, 2, ***and*** 3, from A)                  |
+------------------+---------------------------------------------------+
|                  | 1.  Use of a process ***and*** a diagnostic       |
|                  |     classification system                         |
|                  |                                                   |
|                  | > OR                                              |
|                  |                                                   |
|                  | 2.  Use of an instrument ***and*** a diagnostic   |
|                  |     classification system                         |
+------------------+---------------------------------------------------+
|                  | The use of a process, a diagnostic classification |
|                  | system ***or*** an instrument, used ***singly***  |
+------------------+---------------------------------------------------+
|                  | Diagnosis simply stated                           |
+------------------+---------------------------------------------------+
| *Note: Each      |                                                   |
| component of the |                                                   |
| assessment       |                                                   |
| should be        |                                                   |
| explicitly       |                                                   |
| stated in the    |                                                   |
| study/report     |                                                   |
| under            |                                                   |
| consideration*   |                                                   |
+------------------+---------------------------------------------------+

Additional information can be found in the companion document titled
\"SIGN 50: A Guideline Developers\' Handbook.\" (Edinburgh \[UK\]:
Scottish Intercollegiate Guidelines Network. \[SIGN publication; no.
50\]), available from the [SIGN Web
site](http://www.sign.ac.uk/methodology/index.html).

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

**Synthesizing the Evidence**

Guideline recommendations are graded to differentiate between those
based on strong evidence and those based on weak evidence. This judgment
is made on the basis of an (objective) assessment of the design and
quality of each study and a (perhaps more subjective) judgment on the
consistency, clinical relevance and external validity of the whole body
of evidence. The aim is to produce a recommendation that is
evidence-based, but which is relevant to the way in which health care is
delivered in Scotland and is therefore implementable.

It is important to emphasize that the grading does not relate to the
importance of the recommendation, but to the strength of the supporting
evidence and, in particular, to the predictive power of the study
designs from which that data was obtained. Thus, the grading assigned to
a recommendation indicates to users the likelihood that, if that
recommendation is implemented, the predicted outcome will be achieved.

**Considered Judgment**

It is rare for the evidence to show clearly and unambiguously what
course of action should be recommended for any given question.
Consequently, it is not always clear to those who were not involved in
the decision making process how guideline developers were able to arrive
at their recommendations, given the evidence they had to base them on.
In order to address this problem, SIGN has introduced the concept of
considered judgment.

Under the heading of considered judgment, guideline development groups
summarize their view of the total body of evidence covered by each
evidence table. This summary view is expected to cover the following
aspects:

-   Quantity, quality, and consistency of evidence

-   Generalisability of study findings

-   Directness of application to the target population for the guideline

-   Clinical impact (i.e., the extent of the impact on the target
    patient population, and the resources needed to treat them.)

-   Implementability (i.e., how practical it would be for the NHS in
    Scotland to implement the recommendation.)

Guideline development groups are provided with a pro forma in which to
record the main points from their considered judgment. Once they have
considered these issues, the group is asked to summarize their view of
the evidence and assign a level of evidence to it, before going on to
derive a graded recommendation.

Additional detail about SIGN\'s process for formulating guideline
recommendations is provided in Section 6 of the companion document
titled \"SIGN 50: A Guideline Developers\' Handbook.\" (Edinburgh
\[UK\]: Scottish Intercollegiate Guidelines Network. \[SIGN publication;
no. 50\], available from the [SIGN Web
site](http://www.sign.ac.uk/methodology/index.html).

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**Grades of Recommendation**

Note: The grade of recommendation relates to the strength of the
evidence on which the recommendation is based. It does not reflect the
clinical importance of the recommendation.

**A**: At least one meta-analysis, systematic review of randomized
controlled trials (RCTs), or RCT rated as 1++ and directly applicable to
the target population; *or*

A body of evidence consisting principally of studies rated as 1+,
directly applicable to the target population, and demonstrating overall
consistency of results

**B**: A body of evidence including studies rated as 2++, directly
applicable to the target population, and demonstrating overall
consistency of results; *or*

Extrapolated evidence from studies rated as 1++ or 1+

**C**: A body of evidence including studies rated as 2+, directly
applicable to the target population and demonstrating overall
consistency of results; *or*

Extrapolated evidence from studies rated as 2++

**D**: Evidence level 3 or 4; *or*

Extrapolated evidence from studies rated as 2+

**Good Practice Points**: Recommended best practice based on the
clinical experience of the guideline development group

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review\
Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

The national open meeting is the main consultative phase of Scottish
Intercollegiate Guidelines Network (SIGN) guideline development.

**Peer Review**

All SIGN guidelines are reviewed in draft form by independent expert
referees, who are asked to comment primarily on the comprehensiveness
and accuracy of interpretation of the evidence base supporting the
recommendations in the guideline. A number of general practitioners
(GPs) and other primary care practitioners also provide comments on the
guideline from the primary care perspective, concentrating particularly
on the clarity of the recommendations and their assessment of the
usefulness of the guideline as a working tool for the primary care team.
The draft is also sent to a lay reviewer in order to obtain comments
from the patient\'s perspective. The comments received from peer
reviewers and others are carefully tabulated and discussed with the
chairman and with the guideline development group. Each point must be
addressed and any changes to the guideline as a result noted or, if no
change is made, the reasons for this recorded.

As a final quality control check prior to publication, the guideline and
the summary of peer reviewers\' comments are reviewed by the SIGN
Editorial Group for that guideline to ensure that each point has been
addressed adequately and that any risk of bias in the guideline
development process as a whole has been minimised. Each member of the
guideline development group is then asked formally to approve the final
guideline for publication.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

***Note from the Scottish Intercollegiate Guidelines Network (SIGN) and
National Guideline Clearinghouse (NGC)**: In addition to these
evidence-based recommendations, the guideline development group also
identifies points of best clinical practice in the full-text guideline
document.*

The grades of recommendations (A--D) and levels of evidence (1++, 1+,
1-, 2++, 2+, 2-, 3, 4) are defined at the end of the \"Major
Recommendations\" field.

**[Diagnostic Criteria]{.underline}**

**C**- All professionals involved in diagnosing Autism Spectrum
Disorders (ASD) in children and young people should consider using
either International Classification of Diseases (ICD)-10 or Diagnostic
and Statistical Manual of Mental Disorders (DSM)-IV.

**[Recognition, Assessment, and Diagnosis]{.underline}**

**Recognition in Primary Care**

*Screening*

**C** - Population screening for ASD is not recommended.

*Surveillance*

**D** - As part of the core program of child health surveillance,
healthcare professionals can contribute to the early identification of
children requiring further assessment for ASD, and other developmental
disorders:

-   Clinical assessment should incorporate a high level of vigilance for
    features suggestive of ASD, in the domains of social interaction and
    play, speech and language development and behavior

-   The Checklist for Autism in Toddlers (CHAT) or modified CHAT
    (M-CHAT) can be used in young children to identify clinical features
    indicative of an increased risk of ASD but should not be used to
    rule out ASD

*Screening of High Risk Groups*

**C** - The use of an appropriate structured instrument may be a useful
supplement to the clinical process to identify children and young people
at high risk of ASD.

*Timing of Diagnosis*

**D** - ASD should be part of the differential diagnosis for very young
(preschool) children displaying absence of normal developmental
features, as typical ASD behaviors may not be obvious in this age group.

**Methods of Assessment**

*Components of Specialist Assessment*

[History Taking (Parent/Carer Interview)]{.underline}

**D** - Healthcare professionals involved in specialist assessment
should take an ASD specific diagnostic history

**C** - ASD specific history taking instruments may be considered as a
means of improving the reliability of ASD diagnosis

[Clinical Observation/Assessment (Child/Young Person
Assessment/Interview)]{.underline}

**D** - Healthcare professionals should directly observe and assess the
child or young person\'s social and communication skills and behavior.

**C** - Healthcare professionals should consider using ASD-specific
observational instruments, as a means of improving the reliability of
ASD diagnosis.

**Individual Profiling**

**D** - All children and young people with ASD should have a
comprehensive evaluation of their speech and language and communication
skills, which should inform intervention.

**D** - Children and young people with ASD should be considered for
assessment of intellectual, neuropsychological and adaptive functioning.

**Biomedical Investigations**

**D** - Where clinically relevant, the need for the following should be
reviewed for all children and young people with ASD:

-   Examination of physical status, with particular attention to
    neurological and dysmorphic features

-   Karyotyping and Fragile X DNA analysis

-   Examination of audiological status

-   Investigations to rule out recognised aetiologies of ASD (e.g.,
    tuberous sclerosis, see Annex 3 in the original guideline document)

**Conditions Associated with ASD**

**C** - Healthcare professionals should be aware of the need to
routinely check for comorbid problems in children and young people with
ASD. Where necessary, detailed assessment should be carried out to
accurately identify and manage comorbid problems.

**[Non-Pharmacological Interventions]{.underline}**

**Communication Interventions**

*Support for Early Communication Skills*

**D** - Interventions to support communication in ASD are indicated,
such as the use of visual augmentation (e.g., in the form of pictures of
objects).

*Interventions for Social Communication and Interaction*

**D** - Interventions to support social communication should be
considered for children and young people with ASD, with the most
appropriate intervention being assessed on an individual basis.

*Behavior/Psychological Interventions*

[Intensive Behavioral Programmes]{.underline}

**A** - The Lovaas programme should not be presented as an intervention
that will lead to normal functioning.

*Interventions for Specific Behaviors*

**B** - Behavioral interventions should be considered to address a wide
range of specific behaviors in children and young people with ASD, both
to reduce symptom frequency and severity and to increase the development
of adaptive skills.

*Auditory Integration Training*

**A** - Auditory integration training is not recommended.

*Facilitated Communication*

**A** - Facilitated communication should not be used as a means to
communicate with children and young people with ASD.

**[Pharmacological Interventions]{.underline}**

**Risperidone**

**B** - Risperidone is useful for short term treatment of significant
aggression, tantrums or self injury in children with autism

**B** - Weight should be monitored regularly in children and young
people who are taking risperidone.

**Methylphenidate**

**B** - Methylphenidate may be considered for treatment of attention
difficulties/hyperactivity in children or young people with ASD.

**Secretin**

**A** - Secretin is not recommended for use in children and young people
with ASD.

**Melatonin**

**D** - Melatonin may be considered for treatment of sleep problems
which have persisted despite behavioral interventions.

**[Service Provision]{.underline}**

**ASD Training**

**D** - All professions and service providers working in the ASD field
should review their training arrangements to ensure staff has up-to-date
knowledge and adequate skill levels.

**Training and Support for Parents**

*Information Provision*

**D** - Professionals should offer parents good quality written
information and an opportunity to ask questions when disclosing
information about their child with ASD

**D** - Parents should be provided with information in an accessible and
absorbable form.

*Meeting Support Needs*

**B** - Education and skills interventions for parents of pre-school
children with ASD should be offered.

**[Definitions]{.underline}**:

**Grades of Recommendation**

*Note: The grade of recommendation relates to the strength of the
evidence on which the recommendation is based. It does not reflect the
clinical importance of the recommendation.*

**A**: At least one meta-analysis, systematic review of randomized
controlled trials (RCTs), or RCT rated as 1++ and directly applicable to
the target population; *or*

A body of evidence consisting principally of studies rated as 1+,
directly applicable to the target population, and demonstrating overall
consistency of results

**B**: A body of evidence including studies rated as 2++, directly
applicable to the target population, and demonstrating overall
consistency of results; *or*

Extrapolated evidence from studies rated as 1++ or 1+

**C**: A body of evidence including studies rated as 2+, directly
applicable to the target population and demonstrating overall
consistency of results; *or*

Extrapolated evidence from studies rated as 2++

**D**: Evidence level 3 or 4; *or*

Extrapolated evidence from studies rated as 2+

**Good Practice Points**: Recommended best practice based on the
clinical experience of the guideline development group

**Levels of Evidence**

**1++**: High quality meta-analyses, systematic reviews of randomized
controlled trials (RCTs), or RCTs with a very low risk of bias

**1+**: Well-conducted meta-analyses, systematic reviews of RCTs, or
RCTs with a low risk of bias

**1-**: Meta-analyses, systematic reviews of RCTs, or RCTs with a high
risk of bias

**2++**: 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 causal

**2+**: Well-conducted case control or cohort studies with a low risk of
confounding or bias and a moderate probability that the relationship is
causal

**2-**: Case control or cohort studies with a high risk of confounding
or bias and a significant risk that the relationship is not causal

**3**: Non-analytic studies (e.g. case reports, case series)

**4**: Expert opinion

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is identified and graded for each
recommendation (see \"Major Recommendations\").

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate early diagnosis and management of children and young people
with autism spectrum disorders may help a child to maximize his or her
potential.

#### POTENTIAL HARMS

-   Adverse effects associated with risperidone include
    tiredness/sedation early in treatment and increased appetite and
    weight gain

-   Methylphenidate adverse effects may include difficulty falling
    asleep, appetite decrease, irritability and emotional outbursts.

-   Melatonin is not a licensed medication, which limits the information
    that is available about effectiveness and safety

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

This guideline is not intended to be construed or to serve as a standard
of care. Standards of care are determined on the basis of all clinical
data available for an individual case and are subject to change as
scientific knowledge and technology advance and patterns of care evolve.
Adherence to guideline recommendations will not ensure a successful
outcome in every case, nor should they be construed as including all
proper methods of care or excluding other acceptable methods of care
aimed at the same results. The ultimate judgement must be made by the
appropriate healthcare professional(s) responsible for clinical
decisions regarding a particular clinical procedure or treatment plan.
This judgement should only be arrived at following discussion of the
options with the patient, covering the diagnostic and treatment choices
available. It is, however, advised that significant departures from the
national guideline or any local guidelines derived from it should be
fully documented in the patient\'s case notes at the time the relevant
decision is taken.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

Implementation of national clinical guidelines is the responsibility of
each National Health Service (NHS) Board and is an essential part of
clinical governance. It is acknowledged that every Board cannot
implement every guideline immediately on publication, but mechanisms
should be in place to ensure that the care provided is reviewed against
the guideline recommendations and the reasons for any differences
assessed and, where appropriate, addressed. These discussions should
involve both clinical staff and management. Local arrangements may then
be made to implement the national guideline in individual hospitals,
units and practices, and to monitor compliance. This may be done by a
variety of means including patient-specific reminders, continuing
education and training, and clinical audit.

Key points for audit are identified in the original guideline document.

#### IMPLEMENTATION TOOLS

Audit Criteria/Indicators\
Chart Documentation/Checklists/Forms\
Quick Reference Guides/Physician Guides

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Scottish Intercollegiate Guidelines Network (SIGN). Assessment,
diagnosis and clinical interventions for children and young people with
autism spectrum disorders. A national clinical guideline. Edinburgh
(Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2007
Jul. 65 p. (SIGN publication; no. 98). \[232 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2007 Jul

#### GUIDELINE DEVELOPER(S)

Scottish Intercollegiate Guidelines Network - National Government Agency
\[Non-U.S.\]

#### SOURCE(S) OF FUNDING

Scottish Executive Health Department

#### GUIDELINE COMMITTEE

Not stated

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Guideline Development Group*: Dr Iain McClure\* (*Chair*) Consultant
Child and Adolescent Psychiatrist, Murray Royal Hospital, Perth; Mrs
Jennifer Beattie, Principal Teacher in Special Needs, Kenmay Academy,
Aberdeenshire; Mrs Sheila Boyd, Occupational Therapist, Scottish Centre
for Autism, Glasgow; Ms Margo Cattanach, Community Charge Nurse -
Learning Disabilities, Larbert; Dr Sally Cheseldine, Consultant Clinical
Psychologist, Child and Adolescent Mental Health Services, Edinburgh; Mr
Paul Dickinson, Clinical Psychologist, NHS Highland, Inverness; Mrs
Penny Ellingham, Social Worker, Royal Hospital for Sick Children,
Edinburgh; Dr David Fitzpatrick, Clinical Paediatric Geneticist, MRC
Human Genetics Unit, Edinburgh; Mrs Bette Francis, Vulnerable Adults
Unit, Scottish Executive Health Department, Edinburgh; Dr Anne
Gilchrist\*,  Consultant Adolescent Psychiatrist, Royal Cornhill
Hospital, Aberdeen; Dr Rob Henderson, Specialist Registrar in Public
Health Medicine, Highland NHS Board, Inverness; Mrs Alison Leask\*,
Project Manager, NHS Education for Scotland and Chair, Autism Argyll; Dr
Tommy MacKay, Consultant Psychologist, Psychology Consultancy Services,
Dunbartonshire; Ms Marjory Macleod, Senior Dietitian, Sighthill Health
Centre, Edinburgh; Mrs Roslyn McCaughey, Senior Speech and Language
Therapist, Renton Primary (Secretary) School, Renton; Dr John March,
Research Scientist, Moredun Research Institute, Penicuik; Dr Craig
Melville\*, Senior Lecturer in Learning Disabilities Psychiatry,
University of Glasgow, Gartnavel Royal Hospital; Mrs Rona Membury, Lay
Representative, Inverness; Dr Elise Merry, Consultant Paediatrician,
Armitstead Child Development Centre, Dundee; Professor Anne O\'Hare\*,
Consultant Paediatrician, Royal Hospital for Sick Children, (Vice-chair)
Edinburgh; Dr Safia Qureshi, SIGN Programme Director; Ms Marion
Rutherford, Speech and Language Therapist, Royal Hospital for Sick
Children, Edinburgh; Ms Chris Simmonds, Health Visitor, Aberdeen; Dr
Georgina Soulby, Consultant Community Paediatrician - Children Services,
Raigmore Hospital, Inverness; Ms Janis Toy, Residential Services
Manager, Daldorch House School, East Ayrshire; Ms Diane Waugh, Lay
Representative, Sense Scotland, Glasgow; Ms Joanna Welsh, SIGN
Information Officer

*\*Member of the writing group*

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Declarations of interests were made by all members of the guideline
development group. Further details are available from the Scottish
Intercollegiate Guidelines Network (SIGN) Executive.

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline was issued in 2007 and will be considered for review in
three years. Any amendments to the guideline in the interim period will
be noted on [Scottish Intercollegiate Guidelines Network (SIGN) Web
site](http://www.sign.ac.uk/new.html).

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[Scottish Intercollegiate Guidelines Network (SIGN) Web
site](http://www.sign.ac.uk/guidelines/published/numlist.html).

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Quick reference guide: Assessment, diagnosis and clinical
    interventions for children and young people with autism spectrum
    disorders. Scottish Intercollegiate Guidelines Network, 2007 Jun.
    2 p. Available in Portable Document Format (PDF) from the [Scottish
    Intercollegiate Guidelines Network (SIGN) Web
    site](http://www.sign.ac.uk/guidelines/published/numlist.html).

-   SIGN 50: A guideline developer\'s handbook. Edinburgh (Scotland):
    Scottish Intercollegiate Guidelines Network. (SIGN publication; no.
    50). Available from the [SIGN Web
    site](http://www.sign.ac.uk/methodology/index.html).

-   Appraising the quality of clinical guidelines. The SIGN guide to the
    AGREE (Appraisal of Guidelines Research & Evaluation) guideline
    appraisal instrument. Edinburgh (Scotland): Scottish Intercollegiate
    Guidelines Network, 2001. Available from the [SIGN Web
    site](http://www.sign.ac.uk/methodology/agreeguide/index.html).

Also, chart documentation of suggested screening instruments in high
risk groups is provided in Annex 4 of the [original guideline
document](http://www.sign.ac.uk/pdf/sign98.pdf).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI Institute on August 31, 2007.

#### COPYRIGHT STATEMENT

Scottish Intercollegiate Guidelines Network (SIGN) guidelines are
subject to copyright; however, SIGN encourages the downloading and use
of its guidelines for the purposes of implementation, education, and
audit.

Users wishing to use, reproduce, or republish SIGN material for
commercial purposes must seek prior approval for reproduction in any
medium. To do this, please contact <sara.twaddle@nhs.net>.

Additional copyright information is available on the [SIGN Web
site](http://www.sign.ac.uk/guidelines/published/copyright.html).

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
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Guidelines represented on the NGC Web site are submitted by guideline
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<http://www.guideline.gov/about/inclusion.aspx> .

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Date Modified: 11/10/2008