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Autism Spectrum Disorders in Pre-School Children

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Autism Spectrum Disorders in Pre-School Children Academy of Medicine, Singapore Autism Spectrum Disorders in Pre-School Children AMS-MOH Clinical Practice Guidelines 1/2010 College of Family Physicians, College of Paediatrics and Child Health, Singapore Singapore Mar 2010 Levels of evidence and grades of recommendation Levels of evidence Level Type of Evidence 1+ + High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias. 1+ Well conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias. - 1 Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias 2+ + High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2+ Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal - 2 Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3 Non-analytic studies, e.g. case reports, case series 4 Expert opinion Grades of recommendation Grade Recommendation A At least one meta-analysis, systematic review of RCTs, or RCT + + rated as 1 and directly applicable to the target population; or A body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results B A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or Extrapolated evidence from studies rated as 1+ + or 1+ C A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or Extrapolated evidence from studies rated as 2+ + D Evidence level 3 or 4; or Extrapolated evidence from studies rated as 2+ GPP R ecommended best practice based on the clinical experience of (good practice the guideline development group. points) 5?@A@5"?!1B"5C@5D!:E@-D?@AD( ! "#$%&'!()*+$,#'!-%&.,/*,&!%0! 1,*2(+3..4!53%4/,*0! ! ! "6(2678!54%0%+94!1,9+$%+*!:#%/*4%0*&!;<=>;> ! Published by Ministry of Health, Singapore 16 College Road, College of Medicine Building Singapore 169854 Printed by Chung Printing Copyright 2010 by Ministry of Health, Singapore ISBN 978-981-08-5448-5 Available on the MOH website: http://www.Moh.gov.sg/cpg Statement of Intent These guidelines are not intended to serve as a standard of Medical care. Standards of Medical care are deterMined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge advances and patterns of care evolve. The contents of this publication are guidelines to clinical practice, based on the best available evidence at the tiMe of developMent. Adherence to these guidelines May not ensure a successful outcoMe in every case. These guidelines should neither be construed as including all proper Methods of care, nor exclude other acceptable Methods of care. Each physician is ultiMately responsible for the ManageMent of his/her unique patient, in the light of the clinical data presented by the patient and the diagnostic and treatMent options available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oreword Autism spectrum disorders (ASD) are a group of developmental disorders characterised by impaired communication and social interaction, restricted interests and repetitive behaviours, with onset before 3 years of age. Examples of ASD include Autism and Asperger syndrome. Although the degree of severity and impairment in ASD is highly variable, ASD have a profound impact on the affected children and their families. Current estimates of global prevalence of ASD range between 50 to 60 per 10,000 school-aged children, making ASD a serious public health concern.i Locally, the Singapore Burden of Disease Study 2004 found ASD to be the leading cause of disease burden in children aged between 0-14 years, causing a loss of more than 5110 disability-adjusted life years (DALYs) in 2004 (20.7% of total DALYs lost in this age group).ii There is significant variance in the assessment practices and diagnostic criteria used by healthcare professionals who work with children with ASD. Furthermore, an increasing number of parents and caregivers of children with ASD are turning to complementary and alternative therapies publicised in the media; these therapies might not have a strong scientific basis and might be ineffective or even harmful to the children. It is therefore timely to develop this first national guideline that incorporates the best available evidence from the scientific literature to assist all children with ASD and the healthcare professionals who work with them. PROFESSOR K SATKU DIRECTOR OF MEDICAL SERVICES i Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE et al. The epidemiology of autism spectrum disorders. Annu Rev Public Health. 2007;28:235-58. ii Ministry of Health, Singapore. Singapore burden of disease study 2004. [Online]. 2009 Mar 1 [cited 2010 Mar 2]. 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