目的:确定并总结世界卫生组织(WHO)康复干预措施包的自闭症谱系障碍(ASD)和智力障碍(ID)的临床实践指南。
方法:学术数据库,谷歌学者,指南数据库,和专业协会网站使用一般标准“ASD/ID”和“康复”和“指南”进行搜索,\"仅限于英语指南。
方法:工作组成员独立筛选标题和摘要(1952年ASD;1027ID),如果不是(1)指南;(2)关于康复;(3)自2008年以来发表;或(4)关于ASD/ID,则排除文章。全文筛选(29ASD;5ID)涉及3个额外的排除标准:(1)包含利益冲突;(2)缺乏有关建议强度的信息;或(3)未通过《研究和评估指南II》工具的评估。六个准则(4个ASD:2个关于青年,1成人,所有年龄段的1个;2个ID:1个挑战行为,1关于心理健康)。
方法:工作组成员从指南中提取了524条建议(386ASD;138ID),包括证据水平,诊断和年龄组,推荐类型(评估,干预,service),目标,和价。
结果:在270项干预建议(212ASD;58ID)中,只有36例ASD和47例ID是基于经验的。大多数包括生物医学(23%),药理学(29%),以及对ASD和行为(14%)的社会心理(21%)干预,药理学(29%),和心理干预(14%)。干预建议主要针对共存条件(56%ASD;93%ID),而核心症状受到的关注要少得多(26%ASD).
结论:针对ASD和ID审查的临床实践指南主要包含基于专家意见的建议,与药物治疗有关的多个建议。接下来的重要步骤包括确定纳入世卫组织一揽子计划的相关干预措施,并继续进行严格的干预研究,特别是这些疾病的核心症状,扩展高质量指南的建议。
OBJECTIVE: To identify and summarize clinical practice
guidelines for autism spectrum disorder (ASD) and intellectual disability (ID) for the Package of Interventions for Rehabilitation for the World Health Organization (WHO).
METHODS: Academic databases, Google Scholar,
guideline databases, and professional society websites were searched using the general criteria \"ASD/ID\" AND \"rehabilitation\" AND \"
guideline,\" restricted to English-only
guidelines.
METHODS: Work group members independently screened titles and abstracts (1952 ASD; 1027 ID) and excluded articles if not (1) a
guideline; (2) about rehabilitation; (3) published since 2008; or (4) about ASD/ID. Full-text screening (29 ASD; 5 ID) involved 3 additional exclusion criteria: (1) contained conflict of interest; (2) lacked information on strength of recommendation; or (3) failed the Appraisal of Guidelines for Research and Evaluation II instrument. Six guidelines (4 ASD: 2 on youth, 1 on adults, 1 on all ages; 2 ID: 1 on challenging behaviors, 1 on mental health) resulted.
METHODS: Work group members extracted 524 recommendations (386 ASD; 138 ID) from the guidelines including the level of evidence, diagnostic and age group, recommendation type (assessment, intervention, service), target, and valence.
RESULTS: Of the 270 intervention recommendations (212 ASD; 58 ID), only 36 for ASD and 47 for ID were empirically based. Most comprised biomedical (23%), pharmacologic (29%), and psychosocial (21%) interventions for ASD and behavioral (14%), pharmacologic (29%), and psychological (14%) interventions for ID. Intervention recommendations primarily targeted coexisting conditions (56% ASD; 93% ID), whereas core symptoms received much less attention (26% ASD).
CONCLUSIONS: Clinical practice guidelines reviewed for ASD and ID primarily contained recommendations based on expert opinion, with the plurality of recommendations relating to pharmacologic treatment. Vital next steps include identifying relevant interventions for inclusion in the WHO Package and continuing to conduct rigorous intervention research, particularly on core symptoms of these conditions, to extend recommendations for high-quality guidelines.