KCE Report 233
Autism in children and young people
For subjects over 4years old, the HAS recommendations are entirely expert based. In children with severe symptoms and low developmental level it is recommended to continue a personalised project including a global intervention and various other support measures (educational, specific therapeutic, environmental...) as needed by the patient and the parents. Children with a satisfactory developmental level should be supported to attend regular school. Specific personalised support measures (global intervention program, educational...) should be organised. In case of heterogeneous development, interventions should be tailored to the situation. Based on the lack of scientific evidence and the absence of expert consensus no recommendations could be made regarding psychoanalysis and institutional psychotherapy. Specifically, HAS and ANESM recommend that even in non-verbal children every personalized programme includes communication. Collaboration should be established between the professional caretakers and the parents. The development of oral communication skills necessitates (see also section 4.4.2 on Speech and language problems)
a personal relationship between the (caring) adult and the child
the use of specific techniques to establish interpersonal contact and augment communication
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diagnosis is made. Interventions aimed at play, imitation and social behaviour should be proposed early on and the parents should be trained. The child should be assisted in every aspect of daily life: school, shopping etc. These interventions can be part of a more comprehensive approach. Specific recommended interventions are:
educational, behavioural and developmental interventions being part of a comprehensive early approach (see global approach)
expert consensus recommends individual or personal sessions, at any age, to stimulate interpersonal exchange. The type of intervention should be adapted to the level of functioning. For children with a high developmental level (Asperger syndrome), HAS and ANESM recommend that clear goals should be set regarding emotional functioning. Specific recommended interventions are:
CBT (grade B)
Role play (grade C)
Conversation groups (expert consensus)
Individual psychotherapy (expert consensus)
4.2.4.2 Recommendations regarding pharmacological, biomedical and dietary interventions
that the caretakers and the parents integrate the acquired skills into daily life Specific recommended interventions are:
NICE recommends not using the following interventions for the management of core features of autism in children and young people:
antipsychotics
antidepressants
anticonvulsants
speech therapy (based on expert consensus) to promote the emergence of spoken language or any other means of communication (sign, picture, symbol, writing, etc..) (see also section 4.4.2 Speech and language problems).
personalised educational, behavioural and developmental interventions as described for improving social interactions. The development of social interactions necessitates a personal programme in close collaboration with the parents and with clear goals. There is low quality evidence to advice that a programme should be implemented as soon as communication appears problematic and even before a firm
exclusion diets (such as gluten- or casein-free diets). HAS recommends to limit the use of drugs to the following indications:
pain
associated epilepsy
associated somatic disease