Guideline for Autism Spectrum Disorder

Evidence-based Guideline for Autism Spectrum Disorder

The New Zealand Autism Spectrum Disorder Guideline was launched in Parliament on 2 April 2008, the United Nation's first World Autism Awareness Day. The Guideline is a single, credible source of NZ and overseas evidence, experience and practice, brought together by teams from across education, health, disability, and community services. Information about the development of the guideline and some frequently asked questions and responses are also available on the Ministry of Health website.

Print copies of the summary Guideline are available now; print copies of the Māori translation and the full Guideline will be available in about a month.

Know what's in the Guideline, use it, promote it and quote it!

Background

For the first time in New Zealand, an Autism Spectrum Disorder (ASD) Guideline has been developed. The Guideline is intended to provide evidence-based information that will guide provision of support and services for both children and adults with ASD, their families and whānau. There have been many requests from people with ASD and their families, together with services who support them, for guidance about interventions that are effective.

The process of developing the NZ ASD Guideline is a ground breaking example of health, education and disability service leaders working together for the benefit of people with ASD. The development has been jointly sponsored and funded by the Ministries of Education and Health, and we understand that this is the only ASD Guideline in the world that takes a whole-of-life and cross-sector approach. This collaboration was in response to repeated pleas from people with ASD, their families and whānau, who routinely have to deal with many services and professionals.

If properly developed, communicated and implemented, research has shown that evidence-based guidelines can improve outcomes. The NZ ASD Guideline is an evidence-based summary that covers the identification, diagnosis, ongoing assessment, interventions and services for people with ASD. It seeks to provide the best evidence currently available to help with decision-making that will improve health, educational and social outcomes. The NZ ASD Guideline is intended for use by primary care practitioners, specialists, education professionals, policy makers, funders, parents, carers, and any others who make provision for individuals with ASD.

Public consultation on the draft ASD Guideline occurred from December 2006 to March 2007. The responses have been analysed, and, together with national and international peer review reports, have been incorporated into the final ASD Guideline.

The Ministries of Education and Health are committed to ensuring that the NZ ASD Guideline will lead to improved services and so commissioned an impact analysis, which assessed the likely impact of implementing the key recommendations in the Guideline.

For more information about the NZ ASD Guideline visit the Ministry of Health's website.

back to top

What does the evidence say?

The Ministry of Education, Special Education is already drawing on the evidence from the draft NZ ASD Guideline as we lead and manage a suite of research, evaluation, and professional learning and development programmes aimed at improving the quality of education and support for children and young people with ASD.

From the comprehensive review of the up-to-date evidence around effective interventions that was carried out in developing the NZ ASD Guideline, currently the indications are that no one approach is best for all individuals, as shown in the following quotations:

`As a group, these studies show that intensive early intervention for children with autistic spectrum disorders makes clinically significant differences for many children. However, each of the studies has methodological weaknesses, and more of the reports were descriptive rather than evaluations with controlled experimental research designs.

There are virtually no data on the relative merit of one model over another, either overall or as related to individual differences in children. It appears that a majority of children participating in comprehensive behavioural interventions made significant progress in at least some developmental domains, although methodological limitations preclude definitive attributions of the progress to specific intervention procedures' [pg 171, Educating Children with Autism, National Academy Press 2001].

Evidence does indicate that there are a number of key characteristics of quality intervention programmes. Although pertaining to early childhood, the following have been adapted for school settings (Autism Spectrum Disorder Guideline, Ministries of Health and Education 2008):

• Making the earliest possible start to intervention;
• Individualising services for children and families and whānau;
• Providing systematic `planful' teaching;
• Providing a curriculum that meets the need of the child with ASD;
• Intensity of engagement of the child;
• Sustainable family involvement;
• Structured environments;
• Developmentally appropriate practices;
• Intervention in natural environments and with access to typically developing children.

Education, through early childhood education services and schools, plays a central part in the life of any child or young person. Because of the difficulties experienced by people with ASD, careful planning and support is important to ensure the young person has meaningful learning opportunities and is fully included in the life of the school or early childhood education service. Children and young people with ASD can and do learn social and communication skills, and manage their stress and behaviour with effective teaching and an appropriately structured environment.

Addressing the needs of a young person with ASD at school or in early childhood education services requires a team approach. Those who spend the most time with the young person (especially their families and whānau) will understand their abilities and difficulties, special interests and fears. Families and whānau are likely to have developed many strategies that, when shared, will help everyone to tune into the young person's unique needs. Moreover, the evidence indicates that young people with ASD develop most effectively when strategies are used consistently across the home and education settings.