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Clinical practice guidelines for diagnosis of autism spectrum disorder in adults and children in the UK: a narrative review.

ABSTRACT: BACKGROUND:Research suggests that diagnostic procedures for Autism Spectrum Disorder are not consistent across practice and that diagnostic rates can be affected by contextual and social drivers. The purpose of this review was to consider how the content of clinical practice guidelines shapes diagnoses of Autism Spectrum Disorder in the UK; and investigate where, within those guidelines, social factors and influences are considered. METHODS:We electronically searched multiple databases (NICE Evidence Base; TRIP; Social Policy and Practice; US National Guidelines Clearinghouse; HMIC; The Cochrane Library; Embase; Global health; Ovid; PsychARTICLES; PsychINFO) and relevant web sources (government, professional and regional NHS websites) for clinical practice guidelines. We extracted details of key diagnostic elements such as assessment process and diagnostic tools. A qualitative narrative analysis was conducted to identify social factors and influences. RESULTS:Twenty-one documents were found and analysed. Guidelines varied in recommendations for use of diagnostic tools and assessment procedures. Although multidisciplinary assessment was identified as the 'ideal' assessment, some guidelines suggested in practice one experienced healthcare professional was sufficient. Social factors in operational, interactional and contextual areas added complexity to guidelines but there were few concrete recommendations as to how these factors should be operationalized for best diagnostic outcomes. CONCLUSION:Although individual guidelines appeared to present a coherent and systematic assessment process, they varied enough in their recommendations to make the choices available to healthcare professionals particularly complex and confusing. We recommend a more explicit acknowledgement of social factors in clinical practice guidelines with advice about how they should be managed and operationalised to enable more consistency of practice and transparency for those coming for diagnosis.

SUBMITTER: Hayes J

PROVIDER: S-EPMC6044100 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Clinical practice guidelines for diagnosis of autism spectrum disorder in adults and children in the UK: a narrative review.

Hayes Jennie J Ford Tamsin T Rafeeque Hateem H Russell Ginny G

BMC psychiatry 20180713 1

<h4>Background</h4>Research suggests that diagnostic procedures for Autism Spectrum Disorder are not consistent across practice and that diagnostic rates can be affected by contextual and social drivers. The purpose of this review was to consider how the content of clinical practice guidelines shapes diagnoses of Autism Spectrum Disorder in the UK; and investigate where, within those guidelines, social factors and influences are considered.<h4>Methods</h4>We electronically searched multiple data ...[more]

PMID: 30005612

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Project description:Introduction: Clinicians working with children with autism spectrum disorder (ASD) occupy an important position between parents and the wide-ranging research findings. However, it is not widely known how clinicians view and experience ASD in children, even though their perspective has been shown to significantly influence their work. Material and methods: Sixteen physicians working with preschool children without a diagnosis of (intellectual or other) disability with a (presumed) diagnosis of ASD participated in a semistructured interview. They described their professional views on ASD, and how they experienced its use in their clinical practice. The data were analyzed by applying the qualitative research method of interpretative phenomenological analysis of the data through Nvivo 11. Results: The main topic of the interviewed physicians' views and experiences of ASD in a young child comprised three inductively established themes: 1) physicians' views on ASD are multifaceted but fit within their personal clinical styles; 2) the ASD diagnosis is a "descriptive" part of a clinical trajectory; and 3) ASD treatment is a mix of "standard" approaches and a personalized search. These physicians' perspectives on ASD are composed of multiple and sometimes ambiguous facets. However, their views are embedded in their personal clinical styles in general (i.e., beyond ASD) and are experienced as clinically "workable." With the aim of finding an adequate approach to the problems parents bring to their office, many interviewed physicians say that-complementary to or rather than a classificatory diagnosis-they prefer using a personalized "profile" of a child in a therapeutic "process." Conclusions: The interviewed physicians consider doubts and concerns to be an inherent part of their clinical work with ASD in young children, but do not experience this ambiguity as an obstacle to clinical care. These physicians deal with the multiplicity of their views on ASD by basing their eclectic views on their generally adopted clinical styles, and by selecting what works for them, and for the parents and child, from what they regard as the 'textbook knowledge' on ASD. We discuss the implications of these findings for translating research results to the clinic.

Dataset Information

Clinical practice guidelines for diagnosis of autism spectrum disorder in adults and children in the UK: a narrative review.

Publications

Clinical practice guidelines for diagnosis of autism spectrum disorder in adults and children in the UK: a narrative review.

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