ESCAP practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment

Overview

This practice guidance from the European Society of Child and Adolescent Psychiatry (ESCAP), published in European Child & Adolescent Psychiatry in 2021, summarizes current knowledge on autism spectrum disorder for clinicians and educators across Europe, especially in underserved areas. It draws on a narrative review, international guidelines and expert opinion, and it offers general principles rather than endorsing specific programmes.

Classification and detection

DSM-5 and ICD-11 both place autism among the neurodevelopmental disorders as a single spectrum defined by difficulties in social communication and restricted, repetitive behaviours, with specifiers for intellectual and language ability. Autism is common and persists throughout life. Diagnosis is often late, although parents usually notice concerns in toddlerhood. Early signs include delays in speech, pointing and responding to name. Screening tools can flag children for assessment but cannot confirm the diagnosis, and clinicians should respond promptly to concerns raised by parents and teachers.

Diagnosis

Assessment should be multiprofessional and include a detailed history, direct observation, developmental and language assessment, physical, sensory and neurological examination, genetic evaluation where indicated, and screening for co-occurring emotional and behavioural problems and social circumstances. Standardised instruments support but do not replace clinical judgement. Adults, and women and girls who may mask their difficulties, need particular care. Families should receive the diagnosis with empathy, a chance to ask questions and a written report.

Intervention and support

Ten general principles guide care, including individualised assessment, building on strengths, functional analysis of behaviour, making environments more autism-friendly, professionals acting as coaches for families and teachers, a coordinating keyworker, inclusion and respect for individual rights. The strongest evidence supports parent-mediated social communication therapies for young children, while naturalistic developmental behavioural approaches, parent training and social skills programmes have some support. Positive behaviour support is recommended for behaviours that challenge. Support should continue through school, the transition to adulthood and adult life, including supported employment and mental health care.

Medication and unproven treatments

No medication treats the core features of autism. Drugs may be used for co-occurring conditions such as irritability, ADHD or insomnia, cautiously, on an individual basis and within a broader plan. Unproven tests and alternative treatments should not be used, and there is no link between autism and the MMR vaccine.