New Zealand Autism Spectrum Disorder Guideline - Ministry of Health

Part 4: Treatment and management of ASD
• avoid treatment approaches that do not
provide information on how to assess
whether the person with ASD is suitable
for that treatment
• use appropriate methods to determine
whether the treatment was effective (eg,
appropriate behavioural data; trialling the
treatment for a sufficient length of time,
completion of appropriate questionnaires
about the targeted behaviours/skills before
and after treatment, telling no one when a
treatment has started, and monitoring of the
behaviour of the person with ASD by making
written notes) 278-281 (Recommendation 4.3.3).
4.3.a Behavioural interventions
Behavioural interventions, based on careful
and thorough assessment, are often the most
appropriate means of addressing behavioural
34 248 258 262 269 270
problems for people with ASD
249 282
and those with an intellectual disability
(Recommendation 4.3.4). However, assessment
must be comprehensive and consider all
potential causes of behavioural problems (eg,
pain, undiagnosed medical issues, sensory
problems, abuse, etc).
Although differences of opinion exist regarding
how behavioural interventions are described
(eg, applied behaviour analysis, positive
behaviour support, behaviour modification,
behavioural programming, etc) 248 283 , and
various methods of behavioural assessment and
interventions development have been published,
all behavioural interventions are based on
the science of applied behaviour analysis.
It is beyond the scope of the New Zealand
ASD Guideline to provide details on how a
practitioner should conduct a behavioural
assessment, and how behavioural interventions
are developed and implemented. A large
literature on this exists, and includes many
lengthy texts. Features common to behavioural
interventions of good quality are:
• person-centred planning: through which the
person with ASD remains the focus of the
assessment and treatment, and the individual
characteristics are taken into account
• functional assessment: a comprehensive
assessment, through which all the factors that
reliably precede, predict and maintain the
problem behaviour (including setting, specific
triggers, reinforcers) are identified, through
means of thorough interview, observation,
recording and/or formal testing
• positive intervention strategies: a preference
for interventions which use positive
reinforcement, as opposed to punishment
• multifaceted interventions: packages of
treatment which include more than one
intervention, such as specific intervention
procedures combined with staff and carer
education
• focus on environment: designing or altering
the environment of the person with ASD to
effect behaviour change
• meaningful outcomes: measures of successful
intervention which are significant to the
person with ASD and/or the people with
whom they associate
• focus on ecological validity: interventions
which are settings-specific and are
implemented in the places that people live,
study, work, socialise or otherwise spend
their time, so that they can be transferred or
generalised to other settings
• systems-level intervention: interventions that
take into account the systems-level issues
and overall context (eg, agency policy, staff
professional learning and development,
financial constraints, team values etc) and,
when required, seek to alter matters at the
systems level 283 (Recommendation 4.3.5).
Within New Zealand, a range of professionals
develop and implement behavioural
interventions. However, there are significant
variations in educational level, professional
affiliation or accreditation, expertise and
supervision arrangements, all of which can
impact on intervention quality. Consumers are
Part 4
New Zealand Autism Spectrum Disorder Guideline 141