Systematic Review: Recommendations for Rehabilitation in ASD and ID From Clinical Practice Guidelines

DOI

10.1016/j.arrct.2021.100140

Authors

Jordan Wickstrom, Functional and Applied Biomechanics Laboratory, Clinical Center, National Institutes of Health, Bethesda, MD.
Kristin Dell'Armo, Center for Autism Spectrum Disorders, Nationwide Children's Hospital, Columbus, OH.
Emma Salzman, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA.
Jessica L. Hooker, Autism Institute, Florida State University College of Medicine, Tallahassee, FL.
Abigail Delehanty, Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA.
Somer Bishop, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA.
Marc J. Tassé, Nisonger Center, Ohio State University, Columbus, OH.
Amy M. Wetherby, Autism Institute, Florida State University College of Medicine, Tallahassee, FL.
Antonia M. Piergies, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA.
Diane Damiano, Functional and Applied Biomechanics Laboratory, Clinical Center, National Institutes of Health, Bethesda, MD.
Alexandra Rauch, Rehabilitation Programme, World Health Organization, Geneva, Switzerland.
Audrey Thurm, Neurodevelopmental and Behavioral Phenotyping Service, National Institutes of Mental Health (NIMH), National Institutes of Health, Bethesda, MD.

Document Type

Journal Article

Publication Date

9-1-2021

Publication Title

Archives of rehabilitation research and clinical translation

Volume

3

Issue

3

First Page

100140

Keywords

AGREE-II, Appraisal of Guidelines for Research and Evaluation II, ASD, autism spectrum disorder, Autism spectrum disorder, Guideline, ID, intellectual disability, Intellectual disability, Neurobehavioral manifestations, Neurodevelopmental disorders, Rehabilitation, Therapeutics, WHO, World Health Organization

Abstract

Objective: To identify and summarize clinical practice guidelines for autism spectrum disorder (ASD) and intellectual disability (ID) for the Package of Interventions for Rehabilitation for the World Health Organization (WHO). Data Sources: Academic databases, Google Scholar, guideline databases, and professional society websites were searched using the general criteria "ASD/ID" AND "rehabilitation" AND "guideline," restricted to English-only guidelines. Study Selection: Work group members independently screened titles and abstracts (1952 ASD; 1027 ID) and excluded articles if not (1) a guideline; (2) about rehabilitation; (3) published since 2008; or (4) about ASD/ID. Full-text screening (29 ASD; 5 ID) involved 3 additional exclusion criteria: (1) contained conflict of interest; (2) lacked information on strength of recommendation; or (3) failed the Appraisal of Guidelines for Research and Evaluation II instrument. Six guidelines (4 ASD: 2 on youth, 1 on adults, 1 on all ages; 2 ID: 1 on challenging behaviors, 1 on mental health) resulted. Data Extraction: Work group members extracted 524 recommendations (386 ASD; 138 ID) from the guidelines including the level of evidence, diagnostic and age group, recommendation type (assessment, intervention, service), target, and valence. Data Synthesis: Of the 270 intervention recommendations (212 ASD; 58 ID), only 36 for ASD and 47 for ID were empirically based. Most comprised biomedical (23%), pharmacologic (29%), and psychosocial (21%) interventions for ASD and behavioral (14%), pharmacologic (29%), and psychological (14%) interventions for ID. Intervention recommendations primarily targeted coexisting conditions (56% ASD; 93% ID), whereas core symptoms received much less attention (26% ASD). Conclusions: Clinical practice guidelines reviewed for ASD and ID primarily contained recommendations based on expert opinion, with the plurality of recommendations relating to pharmacologic treatment. Vital next steps include identifying relevant interventions for inclusion in the WHO Package and continuing to conduct rigorous intervention research, particularly on core symptoms of these conditions, to extend recommendations for high-quality guidelines.

Open Access

OA

Preprint

Additional Link

Repository Citation

Wickstrom, J., Dell'Armo, K., Salzman, E., Hooker, J. L., Delehanty, A., Bishop, S., Tassé, M. J., Wetherby, A. M., Piergies, A. M., Damiano, D., Rauch, A., & Thurm, A. (2021). Systematic Review: Recommendations for Rehabilitation in ASD and ID From Clinical Practice Guidelines. Archives of rehabilitation research and clinical translation, 3 (3), 100140. https://doi.org/10.1016/j.arrct.2021.100140