SIGN Guideline 98: Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders

4 Principles of intervention

Following a diagnosis of ASD, children and young people, parents and carers, and professionals want effective interventions to be available and need information to help make decisions about what form these could take.

There are many different interventions and treatments for ASD in everyday use, some of which are not evidence based.¹¹²

In 2001, the Medical Research Council (MRC) review of autism research stressed the need for scientifically robust evaluations of interventions and treatments (see annex 3), with a particularly urgent need to evaluate biomedical interventions.³

If interventions and treatments are not supported by systematic reviews or RCTs (level 1 evidence) they may not appear in the guideline. The interventions that were included in the literature searches completed for this guideline are listed in annex 3.

Following a baseline assessment, the potential balance of risks and benefits from any treatment or intervention needs to be considered for each individual child, and discussed as appropriate with them and their parents/carers, so that they can make an informed decision. Children and young people, their parents/carers and clinicians, should, as far as possible, plan how they intend to evaluate the benefits from any intervention. This will help them to make a decision about whether or not to continue after any trial period.

All children and young people are entitled to benefit from their education and have positive wider life experiences. ASD symptoms can constitute a significant barrier and psychoeducational interventions for ASD are employed in this context. Parents, educationalists, health professionals, social workers and the voluntary sector may employ pragmatic, eclectic, individualised interventions to optimise a child’s functioning, by promoting development of skills, or adapting the environment to compensate when skills are not present.¹¹³ Many of these approaches are based on theoretical principles germane to ASD. Some are derived from generic considerations such as visual support to communication, or behavioural approaches to reduce challenging behaviour. Others are derived from more autism specific considerations such as the difficulty in ‘mentalising’ experienced in ASD, whereby the individual experiences difficulties understanding the motivations and perspectives of others.¹⁰⁰ Where appropriate, the guideline comments on these interventions as good practice points, recognising that many are in use in everyday practice in the UK and have widespread practitioner support.

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