New Zealand Autism Spectrum Disorder ... - Ministry of Health

Overview
Overview
Part 4: Treatment and management of ASD
Part 4 covers the management of behavioural, emotional and mental health difficulties that can be
experienced by children, young people and adults with ASD. Although some of these difficulties can
be prevented or minimised by interventions with a totally educational approach, other interventions
with a different focus may also be needed.
People with ASD are at risk of developing behavioural and emotional difficulties from childhood.
Once problem behaviours have become established, they are not likely to decrease without
intervention and are more likely to worsen than improve. Minimising or avoiding the development
of problem behaviours early in life is essential. Long-term difficulties may arise if the communicative,
social and ritualistic/obsessive aspects of ASD are not addressed.
The first step in the treatment of behavioural, emotional and mental health problems is a
comprehensive assessment which takes into account the family, social and cultural context.
Comprehensive treatment plans include components that address behavioural needs, educational
interventions, psychosocial treatments, communication and the suitability (or not) of medication.
The mainstays of treatment are supportive, educational and behavioural approaches. No medication
has been identified as a cure for ASD and the use of behavioural and environmental strategies for
managing challenging behaviour should always be considered before using pharmacotherapy.
However, a number of medications may be helpful in significantly improving various target
symptoms and associated conditions. There is very limited information on long-term safety,
particularly of some of the newer medications and there are added challenges when the person
with ASD has a co-morbidity. When prescribing medications, clinicians should consult other
appropriate references for comprehensive information on adverse effects and interactions.
Even after the use of well-implemented behavioural strategies or medications, a small number of
people with ASD will develop serious or dangerous behaviours. Strategies for these situations are
discussed. The role of clinical services is also outlined.
Key Recommendations for Treatment and Management of ASD
1. Treatment should encourage functional development, skills for independent living
to minimise stress on the person with ASD and their family and whänau.
2. Pre-treatment assessments should gather detailed information on behavioural,
emotional and mental health difficulties, address differential diagnosis, screen for
medical conditions and address environmental issues.
3. Treatment plans should be comprehensive, and include behavioural needs,
educational interventions, psychosocial treatments, communication, environmental
and systems issues and the suitability (or not) of medication.
4. Professionals, people with ASD, family, whänau and carers should work together
to evaluate treatment approaches before and during implementation.
Grade
B
B
B
C
16
New Zealand Autism Spectrum Disorder Guideline Summary