Original Title: Trastornos del Espectro Autista: evidencia científica sobre la detección, el diagnóstico y el tratamiento

Authors' objectives: Overall objective To prepare a synthesis of the scientific literature identifying, assessing and summarising the best available evidence regarding ASD in terms of its prevalence, detection, diagnosis and treatment. Specific objectives —To assess the prevalence of ASD. —To describe the available evidence on the current instruments and strategies for the detection of ASD. —To describe the available evidence on the current instruments and strategies for the diagnosis of ASD. —To describe the available evidence on the benefits and risks of the different treatment options for the management of ASD. Based on the information obtained, a report should be drafted to support decision making in the context of the Spanish National Health System.

Authors' results and conclusions: Results This report is based on 5 CPGs, 1 HTA report and 17 SR with or without MA. Of the CPGs, 3 provided information about the detection and diagnosis of ASD in children, while 4 concerned treatments for ASD in children and/or adults. The HTA reported evaluated the efficacy, effectiveness and safety of medical interventions in children. Lastly, the 17 SRs included focused on different types of treatment for people with ASD. All the CPGs and the HTA report were deemed to be of high quality. In the case of the SRs, 5 were rated as high quality and the others as moderate quality.

Authors' recommendations: We do not recommend any specific instrument for identifying children and young people who should be referred for a diagnostic assessment of autism. Further, we do not recommend population screening for the identification of ASD in primary care. To help in the diagnosis of cases of suspected ASD, we recommend the use of the diagnostic criteria of the DSM-5 manual and International Classification of Diseases (ICD) 10 or 11. Pharmacological treatment should never be used alone, but always as part of a broader multidisciplinary treatment plan. In addition, treatment should be considered on a case-by-case basis and should take into account patient needs in terms behaviour, education, psychosocial intervention, communication and pharmacological treatment, as required, as well as any comorbidities. The scientific evidence is weak in terms of efficacy, effectiveness and safety of the various non-pharmacological interventions, and we are not able to recommend their widespread used as a treatment for ASD. More high-quality research is needed to identify the specific characteristics of the interventions that are most effective and the characteristics of patients who may benefit from them.

Authors' methods: A systematic review was conducted of clinical practice guidelines (CPG), health technology assessment reports and systematic reviews (SR) with or without meta-analysis (MA) published after the release of a technical report by the Agency for Health Quality and Assessment of Catalonia (AQuAS) on the detection, diagnosis and treatment of ASD, which served as the starting point. A comprehensive literature search was carried out for CPGs and HTA reports in public repositories and SRs/MAs in relevant literature databases (Medline [PubMed], Embase [Ovid], Cochrane Library [Wiley InterScience], CINAHL [EBSCOhost] and PsycINFO [Ovid]). The methodological quality of the documents retrieved was evaluated using the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II), in the case of CPGs, critical reading tools (FLC 3.0) in the case of SRs (with or without MA) and the instrument of the group for the development and validation of the quality assessment instruments produced by the health technology assessment agencies/units (GEVIEC) for the evaluation of the quality of the HTA reports.

Project Status: Completed

Year Published: 2022

URL for published report: https://www.euskadi.eus/contenidos/informacion/osteba_publicacion/eu_def/adjuntos/OSTEBA-115-2021-Trastorno-autista.pdf

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>