New Zealand Autism Spectrum Disorder Guideline - Ministry of Health

Appendices
Consultation
The detailed development of the guideline
was undertaken by small working groups
within each workstream. The workstreams also
established advisory development groups to
assist in the development and provide wider
consultation.
Methodology
Each workstream used a separate methodology
for the development of the guideline.
Workstream 1
The section on diagnosis and assessment of
young children in Part 1 of the guideline is
based on the National Autism Plan for Children
2003 (NAPC), which was developed by the
United Kingdom National Autistic Society for
the National Initiative for Autism: Screening
and Assessment in conjunction with the Royal
College of Psychiatrists, the Royal College
of Paediatrics and Child Health and the All
Party Parliamentary Group on Autism 11 . The
document is available from: www.nas.org.
uk/nas/jsp/polopoly.jsp?d=368&a=2178.
This is the full version on which this part of
guideline is based and to which the reader
should refer for the evidence base and rationale
for recommendations. Further reference was
made to the Autistic Spectrum Disorders Best
Practice Guidelines for Screening, Diagnosis
and Assessment developed by the California
Department of Developmental Services 2002 33 ,
www.ddhealthinfo.org/asd.asp. Individual
members of the Paediatric Society developed
appendices 5 and 6 and the evidence-based
process that they followed is described there.
The New Zealand Guideline Development
Group in Workstream 1 applied the AGREE
tool 424 to assess the NAPC Guideline. It was
assessed as being an appropriate document to
be adapted for the New Zealand environment.
Some areas identified by the AGREE assessment
required adaptation to reflect the New Zealand
context. Adaptation of the NAPC Guideline was
undertaken during face-to-face meetings, audio
conferencing and email consultation of drafts.
A literature search by NZHTA up until June
2004 was performed to identify evidence on
the benefits and harms of pharmacological and
biomedical interventions suitable for children
with ASD to inform Part 4 of the guideline.
The search was aimed at finding literature
relevant to children aged 0 to 12 years. A list
of abstracts was generated from about 900
papers. A list of relevant papers was generated
from these abstracts and evidence tables were
compiled. Selection criteria were:
• autism-specific studies – study subjects
included individuals diagnosed with ASD
• double-blind randomised controlled trials
• systematic reviews
• case reports of adverse effects (with
particular reference to drugs in current use in
New Zealand)
• papers of general interest on the topic.
Review of the list of abstracts generated by the
NZHTA literature search noted that 70 different
medications or biologically active agents have
been described as being used therapeutically
in ASD and related disorders. In addition,
two dietary approaches have been described.
Eight classes of medications were reviewed
by different authors in Workstream 1 for their
applicability to children. Many medications
were described in only one or two papers, often
single case reports. A number of the papers
reviewed included an age range in the study
subjects outside the 0 to 12 years criteria and
thus recommendations may have a relevance to
older children.
Early in the guideline development process,
the Ministry of Health commissioned a
New Zealand Health Technology Assessment
review, undertaken by Broadstock and
Doughty, on the evidence relating to the use
of psychotropic medication in adults with
ASD. However, no adult psychiatrist was
identified to evaluate this review and produce
recommendations for pharmacotherapy
in adults. It is intended that this work be
undertaken at a later date.
Workstream 2
Major sections of Parts 2 and all of Part 3 of the
guideline were developed by a small working
group consisting of five people with expertise in
special education and ASD. Communication was
by face-to-face meetings and teleconferences.
Additional expertise was incorporated through
feedback from a consultancy group. The group
developed practice questions which were sent
Appendices
New Zealand Autism Spectrum Disorder Guideline 267