Excerpt

Autism is a lifelong condition with particular issues for adults, which are addressed by this NICE guideline. While some people are diagnosed in childhood, a large proportion of adults with autism find obtaining a diagnosis in adulthood difficult or impossible. Under-recognition of autism in adults can lead to inadequate care, masking of coexisting mental and physical health problems, and to social and economic exclusion. This guideline aims to address these widespread problems and increase the uptake of interventions by adults with autism to enable them to live more independent lives.

This guideline reviews the evidence for support and interventions for adults with autism across the care pathway, from identification, assessment and diagnosis, to organisation, delivery and settings for care, through to psychosocial and biomedical interventions for autism, challenging behaviour and coexisting mental health problems. The guideline also contains a chapter on the experience of care for adults with autism, and their families and carers, which provides a context for the evidence reviews that follow.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERS
• ACKNOWLEDGEMENTS
• 1. PREFACE
  • 1.1. NATIONAL CLINICAL GUIDELINES
  • 1.2. THE NATIONAL AUTISM GUIDELINE
• 2. INTRODUCTION TO AUTISM IN ADULTS
  • 2.1. THE AUTISM SPECTRUM
  • 2.2. INCIDENCE AND PREVALENCE
  • 2.3. DIFFERENTIAL DIAGNOSIS
  • 2.4. AETIOLOGY
  • 2.5. IDENTIFICATION AND ASSESSMENT
  • 2.6. CURRENT CARE IN ENGLAND AND WALES
  • 2.7. ECONOMIC COST
• 3. METHODS USED TO DEVELOP THIS GUIDELINE
  • 3.1. OVERVIEW
  • 3.2. THE SCOPE
  • 3.3. THE GUIDELINE DEVELOPMENT GROUP
  • 3.4. REVIEW QUESTIONS
  • 3.5. SYSTEMATIC CLINICAL LITERATURE REVIEW
  • 3.6. HEALTH ECONOMICS METHODS
  • 3.7. FROM EVIDENCE TO RECOMMENDATIONS
  • 3.8. STAKEHOLDER CONTRIBUTIONS
  • 3.9. VALIDATION OF THE GUIDELINE
• 4. EXPERIENCE OF CARE
  • 4.1. INTRODUCTION
  • 4.2. REVIEW OF THE QUALITATIVE LITERATURE
  • 4.3. THEMATIC ANALYSIS OF THE QUALITATIVE LITERATURE
• 5. CASE IDENTIFICATION, ASSESSMENT AND DIAGNOSIS
  • 5.1. INTRODUCTION
  • 5.2. SIGNS AND SYMPTOMS THAT SHOULD PROMPT ASSESSMENT OF AUTISM IN ADULTS
  • 5.3. CASE IDENTIFICATION INSTRUMENTS
  • 5.4. ASSESSMENT AND DIAGNOSIS OF AUTISM IN ADULTS
• 6. PRINCIPLES AND PRACTICE FOR THE EFFECTIVE ORGANISATION AND DELIVERY OF CARE
  • 6.1. INTRODUCTION
  • 6.2. REVIEW OF EVIDENCE FOR THE ORGANISATION AND DELIVERY OF CARE
  • 6.3. PRINCIPLES UNDERPINNING EFFECTIVE ORGANISATION AND DELIVERY OF CARE FOR ADULTS WITH AUTISM
  • 6.4. CLINICAL CARE PATHWAYS
  • 6.5. SETTINGS FOR CARE
• 7. PSYCHOSOCIAL INTERVENTIONS
  • 7.1. INTRODUCTION
  • 7.2. CLINICAL EVIDENCE REVIEW OF PSYCHOSOCIAL INTERVENTIONS
  • 7.3. BEHAVIOURAL THERAPIES AIMED AT COMMUNICATION
  • 7.4. FACILITATED COMMUNICATION
  • 7.5. BEHAVIOURAL THERAPIES AIMED AT BEHAVIOUR MANAGEMENT
  • 7.6. COGNITIVE BEHAVIOURAL THERAPIES
  • 7.7. LEISURE PROGRAMMES
  • 7.8. SOCIAL LEARNING INTERVENTIONS
  • 7.9. SUPPORTED EMPLOYMENT PROGRAMMES
  • 7.10. SUPPORT FOR FAMILIES, PARTNERS AND CARERS
• 8. BIOMEDICAL INTERVENTIONS
  • 8.1. INTRODUCTION
  • 8.2. ANTIPSYCHOTICS FOR BEHAVIOUR MANAGEMENT
  • 8.3. ANTICONVULSANTS FOR BEHAVIOUR MANAGEMENT
  • 8.4. DRUGS AFFECTING COGNITION FOR BEHAVIOUR MANAGEMENT
  • 8.5. HORMONAL INTERVENTIONS: ADRENOCORTICOTROPHIC HORMONE FOR BEHAVIOUR MANAGEMENT
  • 8.6. HORMONAL INTERVENTIONS: SECRETIN FOR AUTISTIC BEHAVIOURS
  • 8.7. HORMONAL INTERVENTIONS: OXYTOCIN FOR CORE SYMPTOMS OF AUTISM
  • 8.8. HORMONAL INTERVENTIONS: MELATONIN FOR COEXISTING CONDITIONS
  • 8.9. STIMULANTS FOR COEXISTING CONDITIONS
  • 8.10. ANXIOLYTICS FOR COEXISTING CONDITIONS
  • 8.11. ANTIDEPRESSANTS FOR AUTISTIC BEHAVIOURS
  • 8.12. EXCLUSION DIETS, VITAMINS, MINERALS AND SUPPLEMENTS FOR AUTISTIC BEHAVIOURS
  • 8.13. CHELATION FOR AUTISTIC BEHAVIOURS
  • 8.14. TESTOSTERONE REGULATION FOR AUTISTIC BEHAVIOURS
  • 8.15. HYPERBARIC OXYGEN THERAPY FOR AUTISTIC BEHAVIOURS
• 9. SUMMARY OF RECOMMENDATIONS
  • 9.1. GENERAL PRINCIPLES OF CARE
  • 9.2. IDENTIFICATION AND ASSESSMENT
  • 9.3. INTERVENTIONS FOR AUTISM
  • 9.4. INTERVENTIONS FOR CHALLENGING BEHAVIOUR
  • 9.5. INTERVENTIONS FOR COEXISTING MENTAL DISORDERS
  • 9.6. ASSESSMENT AND INTERVENTIONS FOR FAMILIES, PARTNERS AND CARERS
  • 9.7. ORGANISATION AND DELIVERY OF CARE
  • 9.8. RESIDENTIAL CARE
  • 9.9. RESEARCH RECOMMENDATIONS
• APPENDICES
  • APPENDIX 1. SCOPE FOR THE DEVELOPMENT OF THE CLINICAL GUIDELINE
  • APPENDIX 2. DECLARATIONS OF INTERESTS BY GUIDELINE DEVELOPMENT GROUP MEMBERS
  • APPENDIX 3. SPECIAL ADVISORS TO THE GUIDELINE DEVELOPMENT GROUP
  • APPENDIX 4. STAKEHOLDERS WHO RESPONDED TO EARLY REQUESTS FOR EVIDENCE
  • APPENDIX 5. STAKEHOLDERS AND EXPERTS WHO SUBMITTED COMMENTS IN RESPONSE TO THE CONSULTATION DRAFT OF THE GUIDELINE
  • APPENDIX 6. RESEARCHERS CONTACTED TO REQUEST INFORMATION ABOUT UNPUBLISHED OR SOON-TO-BE PUBLISHED STUDIES
  • APPENDIX 7. ANALYTIC FRAMEWORK AND REVIEW QUESTIONS
  • APPENDIX 8. REVIEW PROTOCOLS
  • APPENDIX 9. SEARCH STRATEGIES FOR THE IDENTIFICATION OF CLINICAL STUDIES
  • APPENDIX 10. QUALITY CHECKLIST TEMPLATES FOR CLINICAL STUDIES AND REVIEWS
  • APPENDIX 11. SEARCH STRATEGIES FOR THE IDENTIFICATION OF HEALTH ECONOMIC EVIDENCE
  • APPENDIX 12. METHODOLOGY CHECKLIST TEMPLATE FOR ECONOMIC STUDIES
  • APPENDIX 13. RESEARCH RECOMMENDATIONS
  • Appendix 14. Clinical evidence – study characteristics tables
  • APPENDIX 15. CLINICAL EVIDENCE – FOREST PLOTS
  • APPENDIX 16. COMPLETED METHODOLOGY CHECKLISTS
  • APPENDIX 17. HEALTH ECONOMIC EVIDENCE – COMPLETED METHODOLOGY CHECKLISTS
  • APPENDIX 18. HEALTH ECONOMIC EVIDENCE – EVIDENCE TABLES OF PUBLISHED STUDIES
  • APPENDIX 19. GRADE EVIDENCE PROFILES
• REFERENCES
• ABBREVIATIONS

The views presented in this book do not necessarily reflect those of the British Psychological Society, and the publishers are not responsible for any error of omission or fact. The British Psychological Society is a registered charity (no. 229642).