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Key priorities for implementation

  • The following recommendations have been identified as priorities for implementation

Access to health and social care services

  • Ensure that all children and young people with autism have full access to health and social care services, including mental health services, regardless of their intellectual ability or any coexisting diagnosis

Knowledge and competence of health and social care professionals

  • Health and social care professionals working with children and young people with autism in any setting should receive training in autism awareness and skills in managing autism, which should include:
    • the nature and course of autism
    • the nature and course of behaviour that challenges in children and young people with autism
    • recognition of common coexisting conditions, including:
      • mental health problems such as anxiety and depression
      • physical health problems such as epilepsy
      • sleep problems
      • other neurodevelopmental conditions such as attention deficit hyperactivity disorder (ADHD)
    • the importance of key transition points, such as changing schools, or health or social care services
    • the child or young person's experience of autism and its impact on them
    • the impact of autism on the family (including siblings) or carers
    • the impact of the social and physical environment on the child or young person
    • how to assess risk (including self-harm, harm to others, self-neglect, breakdown of family or residential support, exploitation or abuse by others) and develop a risk management plan
    • the changing needs that arise with puberty (including the child or young person's understanding of intimate relationships and related problems that may occur, for example, misunderstanding the behaviour of others)
    • how to provide individualised care and support and ensure a consistent approach is used across all settings
    • skills for communicating with a child or young person with autism

Making adjustments to the social and physical environment and processes of care

  • Take into account the physical environment in which children and young people with autism are supported and cared for. Minimise any negative impact by:
    • providing visual supports, for example, words, pictures or symbols that are meaningful for the child or young person
    • making reasonable adjustments or adaptations to the amount of personal space given
    • considering individual sensory sensitivities to lighting, noise levels and the colour of walls and furnishings
  • Make adjustments or adaptations to the processes of health or social care, for example, arranging appointments at the beginning or end of the day to minimise waiting time, or providing single rooms for children and young people who may need a general anaesthetic in hospital (for example, for dental treatment)

Psychosocial interventions

  • Consider a specific social-communication intervention for the core features of autism in children and young people that includes play-based strategies with parents, carers and teachers to increase joint attention, engagement and reciprocal communication in the child or young person. Strategies should:
    • be adjusted to the child or young person's developmental level
    • aim to increase the parents', carers', teachers', or peers' understanding of, and sensitivity and responsiveness to, the child or young person's patterns of communication and interaction
    • include techniques of therapist modelling and video-interaction feedback
    • include techniques to expand the child or young person's communication, interactive play, and social routines

The intervention should be delivered by a trained professional. For pre-school children consider parent, carer, or teacher mediation. For school-aged children consider peer mediation

Anticipating and preventing behaviour that challenges

  • Assess factors that may increase the risk of behaviour that challenges in routine assessment and care planning in children and young people with autism, including:
    • impairments in communication that may result in difficulty understanding situations, or in expressing needs and wishes
    • coexisting physical disorders, such as pain or gastrointestinal disorders
    • coexisting mental health problems such as anxiety or depression and other neurodevelopmental conditions such as ADHD
    • the physical environment, such as lighting and noise levels
    • the social environment, including home, school and leisure activities
    • changes to routines or personal circumstances
    • developmental change, including puberty
    • exploitation or abuse by others
    • inadvertent reinforcement of behaviour that challenges
    • the absence of predictability and structure

Psychosocial interventions for behaviour that challenges

  • If no coexisting mental health or behavioural problem, physical disorder, or environmental problem has been identified as triggering or maintaining the behaviour that challenges, offer the child or young person a psychosocial intervention (informed by a functional assessment of behaviour) as a first-line treatment

Pharmacological interventions for behaviour that challenges

  • Consider antipsychotic medication* for managing behaviour that challenges in children and young people with autism when psychosocial or other interventions are insufficient, or could not be delivered because of the severity of the behaviour. Antipsychotic medication should be initially prescribed and monitored by a paediatrician or psychiatrist who should:
    • identify the target behaviour
    • decide on an appropriate measure to monitor effectiveness, including frequency and severity of the behaviour and a measure of global impact
    • review the effectiveness and any side effects of the medication after 3–4 weeks
    • stop treatment if there is no indication of a clinically important response at 6 weeks

Families and carers

  • Offer families (including siblings) and carers an assessment of their own needs, including whether they have:
    • personal, social and emotional support
    • practical support in their caring role, including short breaks and emergency plans
    • a plan for future care for the child or young person, including transition to adult services

Transition to adult services

  • For young people aged 16 or older whose needs are complex or severe, use the care programme approach (CPA) in England, or care and treatment plans in Wales, as an aid to transfer between services
  • Involve the young person in the planning and, where appropriate, their parents or carers
  • Provide information about adult services to the young person, and their parents or carers, including their right to a social care assessment at age 18

* At the time of publication (August 2013), no antipsychotic medication had a UK marketing authorisation for use in children for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Good practice in prescribing and managing medicines and devices for further information.

© NICE 2013. Autism in under 19s: support and management. Available from: www.nice.org.uk/guidance/CG170. All rights reserved. Subject to Notice of rights.

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication. 

First included: September 2013.