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Clinical Guidelines NATIONAL CLINICAL GUIDELINES THE DIAGNOSIS & MANAGEMENT OF AUTISM SPECTRUM DISORDER Ministry of Public Health P.O. Box 42, Doha, Qatar Phone: (+974)4 407 0969 Email: [email protected] Valid From: 21st October 2019 Date of Next Revision: 21st October 2021 Version History Version Status Date Editor Description 1.0 Final 21st October 2019 Guidelines Team Final version for publication. Citation Suggested citation style: Ministry of Public Health Qatar. National Clinical Guideline: The Diagnosis and Management of Autism Spectrum Disorder (2019). Abbreviations The abbreviations used in this guideline are as follows: AAA The Adult Asperger Assessment ABA Applied Behavioural Analysis aCGH Array Comparative Genomic Hybridization ADHD Attention-Deficit Hyperactivity Disorder ADI-R The Autism Diagnostic Interview-Revised ADOS-G The Autism Diagnostic Observation Schedule-Generic AQ-10 Autism-Spectrum Quotient – 10 items CAST Childhood Autism Spectrum Test CBT Cognitive Behavioural Therapy DIR Developmental, Individual Differences, Relationship-Based Approach DISCO The Diagnostic Interview for Social and Communication Disorders EEG Electroencephalography ESDM Early Start Denver Model ESI Early Social Interaction GI Gastrointestinal ID Intellectual (learning) Disability M-CHAT Modified-Checklist for Autism in Toddlers M-CHAT-R/F Modified Checklist for Autism in Toddlers, Revised, with Follow-Up MDT Multidisciplinary Team OCD Obsessive-Compulsive Disorder Diagnosis and Management of Autism Spectrum Disorder (Date of next revision: 21st October 2021) 2 OT Occupational Therapy PDD-NOS Pervasive Developmental Disorder Not Otherwise Specified PECS Picture Exchange Communication System RPMT Responsive Education and Prelinguistic Milieu Teaching SCD Social (pragmatic) Communication Disorder SCQ Social Communication Questionnaire SLP Speech and Language Pathology SSRI Selective Serotonin Reuptake Inhibitor Treatment and Education of Autistic and Communication Related Handicapped TEACCH Children Diagnosis and Management of Autism Spectrum Disorder (Date of next revision: 21st October 2021) 3 Table of Contents 1 Information About This Guideline .......................................................................................................... 6 1.1 Objective and Purpose of the Guideline ....................................................................................... 6 1.2 Scope of the Guideline .................................................................................................................. 6 1.3 Editorial Approach......................................................................................................................... 6 1.4 Sources of Evidence ...................................................................................................................... 6 1.5 Evidence Grading and Recommendations .................................................................................... 7 1.6 Guideline Development Group Members ..................................................................................... 8 1.7 National Clinical Guidelines & Pathways Committee Members ................................................... 9 1.8 Responsibilities of Healthcare Professionals ............................................................................... 10 2 Autism Spectrum Disorder Diagnosis & Management Pathway .......................................................... 11 3 Key Recommendations of the Guideline .............................................................................................. 13 4 Background Information....................................................................................................................... 17 4.1 Definition ..................................................................................................................................... 17 4.2 Prevalence ................................................................................................................................... 17 4.3 Prognosis ..................................................................................................................................... 17 4.4 Risk Factors for Development of Autism ..................................................................................... 17 4.5 Classification ............................................................................................................................... 18 4.5.1 DSM-V ................................................................................................................................ 18 4.6 Associated Conditions ................................................................................................................. 18 4.6.1 Mental Health Conditions .................................................................................................. 18 4.6.2 Neurodevelopmental Disorders ......................................................................................... 19 4.6.3 Sensory Processing Difficulties .......................................................................................... 19 4.6.4 Epilepsy and Seizures ......................................................................................................... 19 4.6.5 Challenging Behaviours ...................................................................................................... 19 4.6.6 Sleep Disorders .................................................................................................................. 20 4.6.7 Feeding and Eating Problems............................................................................................. 20 5 Clinical Presentation ............................................................................................................................. 21 5.1 Age Variation at Presentation ..................................................................................................... 21 5.2 Symptoms and Signs of ASD ........................................................................................................ 21 5.2.1 Preschool Age Children (<5 years old) ............................................................................... 21 5.2.2 Primary School Age Children (5-11 years old) ................................................................... 23 5.2.3 Secondary School Age Children (11-18 years old) ............................................................. 25 5.2.4 Adults ................................................................................................................................. 26 6 Screening for ASD ................................................................................................................................. 28 7 Referral for Specialist Assessment ....................................................................................................... 29 8 Specialist Assessment & Diagnosis ....................................................................................................... 29 8.1 Multidisciplinary Team ................................................................................................................ 29 Diagnosis and Management of Autism Spectrum Disorder (Date of next revision: 21st October 2021) 4 8.2 History ......................................................................................................................................... 29 8.3 Examination ................................................................................................................................ 30 8.3.1 Tools to Support Diagnosis ................................................................................................ 31 8.4 Investigations .............................................................................................................................. 31 9 Diagnosis ............................................................................................................................................... 33 9.1 Diagnosing ASD ........................................................................................................................... 33 9.2 Severity Classification.................................................................................................................. 34 9.3 Diagnostic Challenges ................................................................................................................. 35 9.4 Differential Diagnosis .................................................................................................................. 35 9.5 Communicating the Diagnosis ..................................................................................................... 36 10 Management of ASD............................................................................................................................. 37 10.1 General Principles of Management............................................................................................. 37 10.1.1 Early intervention............................................................................................................... 37 10.1.2 Continuing support ............................................................................................................ 37 10.1.3 Collaboration with education and social care.................................................................... 37 10.1.4 Care Settings .....................................................................................................................
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