Diagnosis and Management of Autism Spectrum Conditions in Adults : The Dutch 2012 Guideline

Background: There is wide variation in rates of identification and referral for diagnostic assessment, models of multi-professional working, assessment criteria, diagnostic practice, biomedical investigation and therapeutic interventions  for adults with features of autism spectrum conditions (ASC). These factors contribute to delays in reaching a diagnosis ,  diagnostic overshadowing and subsequent access to appropriate services and support. There is an increasing emphasis on “best practice” by clinicians, consumers and health managers. As a consequence, guidelines serve as systematically developed statements designed to help practitioners and patients make decisions about appropriate health care for specific circumstances. The  recent increase of available data on ASC has allowed for the development of symptom-based algorithms for the psychopharmacological management of specific target symptoms associated with ASC. Current treatment and management for autism spectrum conditions is often focused on children and adolescence, for which Dutch guidelines have already been developed and inplemented.

Objectives: To produce a clinical guideline on the management of autistic spectrum disorders in adults, as instructed by the Dutch society of Psychiatry (NVvP) and the Dutch National Institute of Psychology (NIP), in collaboration with the the Trimbos Institute, and the British National Collaborative Centre for Mental Health (NCCMH).

Methods: Both the scope and review questions were set out by the NCCMH. The Dutch taskgroup and topic groups pursued a 3 tier approach, deciding whether to evaluate, adapt or adopt the resulting scientific evidence. The scope of the guideline included case identification, diagnosis and assessment,biomedical interventions,and psychosocial interventions.

Results: We present the biomedical considerations and recommendations with regard to antipsychotics, antidepressants, anxiolytics, cognitive enhancers and stimulants, anticonvulsants, hormones, and complementary-alternative medicine, for the treatment of core symptoms and associated features for individuals with ASC. The quality of evidence and strenght of recommendations are expressed in GRADE (Grading of Recommendations Assessment,Development and Evaluation) terminology.

Conclusions: The authors show how the guideline assists decision making in clinical practice with a comprehensive summary of evidence based and practice based pharmacological interventions for ASC and related comorbid conditions in adults.