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Summary of Clinical Practice Guideline

Ministries of Health and Education (New Zealand)

New Zealand Autism Spectrum Disorder Guideline
Ministries of Health and Education. (2008).
Ministry of Health and Education (New Zealand), 312 pages.

AGREE Rating: Highly Recommended

Description:
This guideline provides recommendations for identification, diagnosis, ongoing assessment, and access to interventions and services for children, adolescents and adults with autism spectrum disorders (ASD) in New Zealand. The target audience of this guideline is primary care practitioners, education professionals, policy makers, funders, parents, carers, specialists and any others who make provisions for individuals with ASD.

  • Level A recommendations are supported by good evidence.

  • Level B recommendations are supported by fair evidence.

  • Level C recommendations are supported by expert opinion.

  • Level I indicates that there was insufficient evidence to make a recommendation.

  • Good practice point recommendations are made by the guideline developers in the absence of evidence.

Recommendations:

Autism Spectrum Disorders

  • Assessment/Diagnosis/Screening

    • Assessment Areas

      • Cognition/Language

        • “The assessment and development of communication and social goals should complement each other. Teaching of the two areas should be carried out in parallel” (Level C Evidence) (p. 95).

        • “The communicative demands of the environment should be assessed” (Level C Evidence) (p. 95).

        • “Assessments should include the pragmatic aspects of communication” (Level C Evidence) (p. 95). 

        • “Aspects which need to be assessed include eye gaze, facial expression, the child’s range of communicative functions and use of gestures” (p. 98).

        • “Play is an important social activity for children; therefore, play skills also need to be assessed” (p. 103).

      • Hearing

        • “All children suspected of having ASD or another developmental problem should have an audiology assessment” (Good Practice Point) (p. 19).

    • Assessment Instruments

      • Cognition/Language

        • “Formal assessments should always be supplemented by informal assessments which include observations across a variety of settings and activities and interviews with significant adults” (Level C Evidence) (p. 95).

        • “Developmental scales may also be useful for assessing general social development. However children with ASD often do not demonstrate typical patterns of development” (p. 103).

  • Treatment

    • Cognition/Language

      • General Findings

        • “Spontaneous communication, socialization and play goals should be a priority” (Level A Evidence) (p. 22).

        • “Treatment plans should be comprehensive, and include behavioral needs, educational interventions, psychosocial treatments, communication, environmental and systems issues and the suitability (or not) of medication” (Level B Evidence) (p. 24).

        • “Communication should be seen as a high-priority learning area, and communication goals should be included in individual plans for all children and young people with ASD” (Level A Evidence) (p. 95).

        • “The assessment and development of communication and social goals should complement each other. Teaching of the two areas should be carried out in parallel” (Level C Evidence) (p. 95).

        • “Encouraging initiations and spontaneous communication should be a key focus of intervention” (Level C Evidence) (p. 95).

        • “There is strong support for functional communication training- where the communicative function of a behavior is identified and an appropriate communication form (including signs, visual symbols or language) is taught as an alternative to the challenging behavior. This intervention has the advantage of teaching the individual to communicate, as well as reducing undesirable behaviours” (p. 97).

        •  “Interventions which emphasise the capacity to understand the purpose of communication rather than simply focusing on the form of the message (eg, learning to say words) are most important” (p. 98).

        • “When evaluating the success of interventions, consideration should be given to increases in: the initiation of spontaneous communication… greater participation in functional activities… generalization of communication skills across environments and partners… and conventional communicative means which are underscored by a wider range of partners” (p. 99).

        • “Early goals for interacting with adults need to include joint attention, turn taking, imitation, responding to gaze, initiating social interactions and engagement with toys” (p. 104).

      • Alternative and Augmentative Communication (AAC)

        • General Findings

          • “Research suggests that aided symbol use (such as photographs, line drawings, symbols, or written words) may enhance the development of speech in individuals with ASD. There appears to be no evidence that the use of augmentative communication strategies, in conjunction with language instruction, delays the acquisition of speech” (p. 99).

        • Visual Supports/Activity Schedules

          • “Visual supports and technology should be available to support expressive and receptive communication and organization according to the child or young person’s individual needs” (Level B Evidence) (p. 95).

          • "Printed cues in work scheudles to stimulate social initiations to other peers with ASD" (i.e., visual cueing) have been shown to be useful for improving social skills (p. 107).

        • Sign Language

          • “Manual signs… are difficult for children to use because of motor planning and motor imitation difficulties” and therefore are less often successful. “However, manual signs used by others may be useful for some children to supplement their understanding” (p. 100).

      • Auditory/Sensory Integration Training

        • “There is insufficient evidence to make any recommendation with respect to the use of… auditory integration therapy… holding therapy… options therapy… sensory integration therapies” (Level I Evidence) (p. 153).

      • Computer-Based Intervention

        • “While there is little research on specific computer programmes for individuals with ASD, there is some evidence that computer technology may enhance motivation, increase attention, and reduce challenging behavior in individuals across the ability range” (p. 100).

      • Facilitated Communication

        • “There is no scientific validation of Facilitated Communication and it is not recommended” (Level B Evidence) (p. 154).

      • Positive Behavior Support

        • “Educational interventions should incorporate principles of positive behaviour support, particularly a focus on understanding the function of the child or young person’s behavior” (Level A Evidence) (p. 23).

      • Parent-Mediated/Implemented

        • “Support and training should be provided to families (including siblings) to develop social skills interventions in the home” (Level C Evidence) (p. 102).

      • Peer-Mediated/Implemented

        • “Interventions using carefully trained and supported typically developing peers should be encouraged” (Level A Evidence) (p. 102).

      • Pragmatic/Social Skills

        • “Goals should be functional and consider family preferences” (Level C Evidence) (p. 102).

        • “All social intervention plans should include generalisation and maintenance strategies” (Level A Evidence) (p. 102).

        • “Socialisation goals should be included in all individual education plans” (Good Practice Point) (p. 102).

        • “Goals for school-aged children may include communication, participating in classroom routines, responding to adult directions and expressing needs” (p. 104).

        • “Goals for peer interactions might include what are sometimes called ‘play organizers’ – suggesting play ideas, sharing affection, assisting others and responding to initiations from peers” (p. 104).

        • Techniques that have been shown to be useful for improving social skills include: social games, self-esteem building (i.e., "placing the child in the role of tutor or helper"), social autopsies, and cartooning (i.e., "the use of cartoon drawings to understand social situations" (p. 107).

      • Literacy Interventions

        • “Literacy instruction should be provided using multiple instructional strategies and building on the child’s special interests” (Level B Evidence) (p. 95).

      • Social Skills Groups

        • “Studies [on social skills groups] have shown good participant and parent satisfaction, but only modest improvement in target social skills. However, there is some evidence to suggest that they may, in fact, improve the participant’s mood and self-image” (p. 105).

      • Social Stories™

        • Social stories interventions have anecdotal support (p. 107).

      • Son-Rise/Options

        • “There is insufficient evidence to make any recommendation with respect to the use of… auditory integration therapy… holding therapy… options therapy… sensory integration therapies” (Level I Evidence) (p. 153).

      • Video Modeling

        • Other techniques that have been shown to be useful for improving social skills include: visual cueing, social games, video modeling, acting lessons, self-esteem building, social autopsies, and cartooning (p. 107).

    • Speech

      • Augmentative and Alternative Communication (AAC)

        • General Findings

          • “Research suggests that aided symbol use (such as photographs, line drawings, symbols, or written words) may enhance the development of speech in individuals with ASD. There appears to be no evidence that the use of augmentative communication strategies, in conjunction with language instruction, delays the acquisition of speech” (p. 99).

  • Service Delivery

    • Setting

      • “Social assessment should be carried out in a variety of natural settings with both adults and peers as social partners” (Level C Evidence) (p. 102).

      • “Interventions are most effective if they take place in natural settings and within regular routines and activities and involve opportunities for interactions with typically developing peers” (p. 106).

Social Communication Disorders

  • Assessment/Diagnosis/Screening

    • Assessment Areas

      • Cognition/Language

        • "The assessment and development of communication and social goals should complement each other.  Teaching of the two areas should be carried out in parallel" (Grade A Evidence) (p. 95).

        • "Assessments should include the pragmatic aspects of communication" (Grade C Evidence) (p. 95).

  • Treatment

    • Cognition/Language

      • General Findings

        • "Spontaneous communication, socialisation and play goals should be a priority" (Grade A Evidence) (p. 87).

        • "The assessment and development of communication and social goals should complement each other.  Teaching of the two areas should be carried out in parallel" (Grade A Evidence) (p. 95).

        • "[Social development] goals should be functional and consider family preferences" (Grade C Evidence) (p. 102).

        • "Socialisation goals should be included in all individual education plans" (Good Practice Point) (p. 102).

        • "When making a choice about educational placement, teams should consider whether [...] factors, [such as opportunities for contact with typically developing peers,] are provided or can be created" (Grade C Evidence) (p. 127).

        • "Treatment plans should be comprehensive, and include behavioural needs, educational interventions, psychosocial treatments, communication, environmental and systems issues and the suitability (or not) of medication" (Grade B Evidence) (p. 135).

        • "All children and adults with ASD should have access to leisure facilities and meaningful activity tailored to their needs and interests and designed to promote social inclusion" (Grade B Evidence) (p. 173).

        •  "Services should provide ongoing support where required to help someone with ASD build up and maintain social contacts, using strategies to promote social inclusion" (Grade C Evidence) (p. 173).

      • Parent-Mediated/Implemented

        • "Support and training should be provided to families (including siblings) to develop social skills interventions in the home" (Grade C Evidence) (p. 102).

      • Peer-Mediated/Implemented

        • "[Social] interventions using carefully trained and supported typically developing peers should be encouraged" (Grade A Evidence) (p. 102).

        • "Peers should be provided with information about ASD and given support and encouragement to foster relationships" (Grade C Evidence) (p. 127).

        • "Support and training should be provided to education professionals to develop peer-mediated strategies for social development" (Good Practice Point) (p. 189).

      • Pragmatic/Social Skills Treatment

        • General Findings

          • "Social interventions should take place in natural settings and within natural activities as much as possible" (Grade A Evidence) (p. 102).

          • "[Social] interventions using carefully trained and supported typically developing peers should be encouraged" (Grade A Evidence) (p. 102).

          • "All social intervention plans should include generalisation and maintenance strategies" (Grade A Evidence) (p. 102).

          • "Support and training should be provided to families (including siblings) to develop social skills interventions in the home" (Grade C Evidence) (p. 102).

          • "People with ASD should be taught social skills, and be educated in community safety, strategies to keep safe when out at night, and what to do if they are abused"(Grade C Evidence) (p. 179).

        • Social Skills Groups

          • "The development of social skills and community groups for young people and adults should be undertaken to minimise and avoid problems" (Grade C Evidence) (p. 137).

  • Service Delivery

    • Provider

      • "School staff should receive professional learning and development in modifying the learning, physical and social environments to support the child" (Grade C Evidence) (p. 187).

      • "Support and training should be provided to education professionals to develop peer-mediated strategies for social development" (Good Practice Point) (p. 189).

    • Setting

      • "Social assessment should be carried out in a variety of natural settings with both adults and peers as social partners" (Grade C Evidence) (p. 102).

      • "Social interventions should take place in natural settings and within natural activities as much as possible" (Grade A Evidence) (p. 102).

Keywords:
Autism Spectrum Disorders

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