Clinical questions

 Action Recommendations

 Evidence Quality

 Strength of recommendation

 Study Type

 References

 Case history

1-Relevant case history, includes family’s concerns about the child’s speech and language; birth, medical, and developmental history; history of middle ear infections; family history of late language emergence or other language difficulties; language history and proficiency for children who are dual-language learners.

6, high

7, high

Strong recommendation

6, systematic review and meta-analysis

7, systematic review and meta-analysis

6, 7

 Referrals based on case history report

2-If motor/ neurological problems are re- ported by parents or observed during the initial interview or screening, a referral for neurological examination will be needed.

High

Strong recommendation

Systematic review & meta-analysis

8

3-If syndrome features are suspected, a referral for genetic testing should be     considered and discussed with parents.

High

Strong

recommendation

Meta-analysis

9

4-Psychometric and neurodevelopment    assessments must be considered*.

 High

Strong  

recommendation

  Systematic review & meta-analysis

 8

5-If feeding and/or swallowing problem is suspected (including drooling, choking             attacks, feeding difficulties, repeated attacks of chest infections), etc.; a referral for         necessary instrumental assessment techniques and relevant therapeutic methods must be considered.

High

Strong

recommendation

Systematic review

10

6-Audiological assessment is crucial in the assessment process of any child presenting with language delay and/or disorder (including Autism Spectrum Disorder) in order to rule out the existence of any hearing   impairment*.

  11, high

12, high

 Strong

recommendation

11-Systematic review

12- Systematic review & meta-analysis

 11, 12

7-Electroencephalography can be recommended in certain cases particularly for children with history of absence ( pyknolepsy) and/or convulsions.

High

Strong recommendation

Systematic review

13

8-Brain imaging can be considered in children with history of serious head trauma; followed by loss of consciousness and/or vomiting.

Moderate

Strong recommendation

Systematic review with limitations

14

Clinical questions

Action Recommendations

 Evidence quality

 Strength of recommendation

 Study Type

 References

 Medical/ health referrals whenever indicated

9- A child with a severe speech/language delay should receive a comprehensive health assessment to identify or rule out medical conditions that might be related to the delay.

Moderate

Conditional recommendation

Cross sectional controlled study

15

 Screening

10-It is important that the phoniatrician uses screening and assessment tools that provide the most representative sample of the child’s behaviors across a range of people and activities within the child’s natural environments.

Moderate

Conditional recommendation

Literature

review

16

 Pre- assessment Planning

 11-Pre-assessment planning involves one or more professionals who meet with the child and family to gather information and plan the upcoming assessment. Common goals for planning include identifying what the family needs and wants from the assessment process, the roles that family members (and caregivers) would prefer to take in the assessment, and the child’s areas of strength and need.

Moderate

Conditional recommendation

Literature

review

17, 18

 Assessment Measures

 12-Assessment is accomplished using a       variety of measures and activities, including both standardized and non-standardized measures, as well as formal and informal assessment tools.  Phoniatricians     have the obligation to ensure that standardized measures used in assessment show robust psychometric properties that provide strong evidence of their quality.

Moderate

Conditional recommendation

Literature

review

19

 Assessment components

 13-For each individual, assessment must take into account the body functions and structures, activity (e.g., communication skills), participation (e.g., functional use of language) and contextual factors (environ- mental and personal factors).

Low

Strong recommendation

Qualitative study

20

 Oral mechanism examination & speech sounds        assessment

 1-Assessment includes oral mechanism ex- amination (structure, power   function and programming) and speech sound assessment

 Moderate

  Strong recommendation

 Single comparative controlled study

 21

 Clinical questions

 Action Recommendations

 Evidence quality

 Strength of recommendation

 Study Type

 References

 Differential 

Diagnosis

15-Following   initial   assessment, a differential diagnosis should be formed, taking into account all the available information in order to exclude the existence of any associated hearing impairment, autism spectrum disorder or social communication disorder, dyspraxia (verbal, oral ± motor), co-morbid attention deficit hyperactivity disorder, cognitive delay, global developmental delay or central auditory processing difficulties and learning disabilities.

Very low

Strong recommendation

  Professional consensus

4

 Interpretation of results

16-Screening and assessment results are interpreted within the context of a child’s overall development and in collaboration with family members and with other professionals as appropriate.

Very low

Strong recommendation

        Clinical expertise

3

Sharing results

 17-A clear explanation of the               behavior/disorder will be offered to the individual and their family, with written information to reinforce this.

    Low

Strong recommendation

Non-experimental study

22

 Special considerations in bilingualism

 18- For bilingual children, appropriate assessment in all languages is necessary to differentiate between a linguistic difference and a true communication disorder.

Low

Strong recommendation

Non-controlled study

      23

 Clinical questions

 Action Recommendations

 Evidence quality

 Strength of recommendation

 Study Type

 References

Special considerations in bilingualism

19- In most bilingual cases, the use of standardized tests alone is not sufficient and cannot be used to decisively determine the presence or absence of a communication disorder.

Moderate

Conditional recommendation

Meta analysis with limitations

       24

Identification of severe speech/ language delay

20- A severe speech/language delay can be indicated by no words at 18 months; fewer than 30 words at 24 months; or no word combinations at 36 months. However, it should be noted that at 18 months, the  condition  mentioned  above can be considered as language delay but not necessarily severe as some children catch up, to some extent with their peers, provided that they are given the family is given the appropriate counselling

Will be changed into modified

 Moderate

 Conditional recommendation

Clinical Practice Guidelines, Report of recommendations

 Clinical questions

 Action Recommendations

 Evidence Quality

 Strength of Recommendation

Study Type

References

 Identification of Specific Language Impairment

21- Children who continue to have poor language abilities below chronological age expectations (by late preschool or school age) that cannot be explained by other factors (e.g., low nonverbal intelligence, sensory impairments, or autism spectrum disorder) may be identified at that point as having Specific Language Impairment.

 26, high

27, moderate

 Conditional recommendation

 26, controlled study

27, review with limitations

   26, 27

 Hypothesis formation

22-Management will be planned, based on the results of information gathering/assessment and consequent hypothesis formation and understanding of the theoretical frameworks relevant to the behavior/disorder and knowledge of the different approaches to intervention/ management.

Very low

Strong recommendation

Professional consensus

4

Management Planning & Goal Setting

 23-A management plan, with provisional timescales, will be drawn up in consultation with the individual. It will be shared with their caregiver and other professionals and will de- tail the aims, objectives and expectations of identified relating to the individual’s activity, participation and well-being.

Moderate

Strong

recommendation

Literature review

28

 Initiation of therapy

24-For children between 18 and 36 months with a speech/language delay and no other apparent developmental issues, speech-language treatment should be initiated; whether direct / indirect methods.

High

Strong recommendation

Systematic review

29

 Indirect intervention

25-When no other developmental delays or disabilities have been identified or are suspected, the typical course for a late talker, less than 2   years, is regular monitoring or monitoring combined with indirect language stimulation.

Moderate

Strong recommendation

Review with limitations

30

 Intervention for young children

26- Because young children (less than 2 years) learn through familiar, natural activities, it is important for the phoniatrician to provide information that promotes the parents’ and/or other caregivers’ abilities to implement communication-enhancing strategies during those everyday routines, creating increased learning opportunities and participation for the child.

Very low

Strong recommendation

Guidelines committee

31

 Clinical questions

 Action Recommendations

 Evidence Quality

 Strength of Recommendation

 Study Type

 References

 Direct     intervention

 27- When language delays persist over time, or are present with other identified or suspected delays or disabilities (e.g., intellectual disabilities, autism spectrum disorder, hearing impairment), direct speech and language services are     indicated; the phoniatrician coordinates services with other professionals working with the child. Family participation is very important.

Moderate

Strong recommendation

Literature review

32

Intervention to promote various inefficient language skills

 28-Speech and language intervention can include working on phonology, semantics, morphology and syntax, pragmatics (including narration), and literacy (+ other intervention methods used in written language disorders/learning disabilities*)

33, Moderate

34, moderate

35, low

Strong recommendation

33, controlled study

34, single subject design

35, expert opinion

33, 34,35

 Clinical questions

 Action Recommendations

 Level of Evidence

 Strength of Recommendation

 Study Type

 References

Management of phonology & articulation problems

 29-Within an appropriate context & when- ever indicated, consideration needs to be given to the development of the child’s:

·  Phonological system

·  Phonological processes

·  Intelligibility

·  Phonetic system

·   Phonetic errors

·   Self-monitoring

·  Pre-literacy skills

·  Literacy skills

·  Prosody & resonance

Very low

Strong recommendation

Professional consensus

4

 Management of Processing problems

30-The phoniatrician should consider the child’s ability to process speech as a critical skill for speech and language development.

  Moderate

 Conditional recommendation

 Controlled study

  36

Multidisciplinary team

31-The multidisciplinary team may include an audiologist, early childhood general and special education teachers and interpreter (if needed), neurodevelopmental pediatrician, occupational therapist, physical therapist and school psychologist, phoniatrician, qualified speech & language therapist ± childcare providers, educational diagnosticians, educational therapists, reading specialists, social workers, child and developmental psychologists, pediatric neurologists, and child psychiatrists.

Moderate

Strong recommendation

Review with limitations

37

 Clinical questions

 Action Recommendations

 Evidence Quality

 Strength of Recommendation

 Study Type

 References

 Multidisci- plinary team

32-It is essential that all the professionals involved in the multidisciplinary team have the capacity to collaborate effectively and collectively.

  38, moderate

39, moderate

 Strong recommendation

 38, literature review

39, literature review

 38, 39

 Multidisci- plinary team

33-It is essential that all the professionals involved in the multidisciplinary team possess knowledge of typical and atypical patterns of development in the domains of cognition; communication; emergent literacy; and motor, sensory, and   social-emotional functioning.

Very low

Strong recommendation

Expert opinion & reasoning from first principles

40

 Augmentative & Alternative Communication

34-Augmentative or alternative communication methods may be considered as a temporary means of communication for late talkers, particularly in severe cases. Research shows that use of AAC may aid in the development of natural speech and language

  41, high

42, low

43, low

 Strong recommendation

 41, randomized controlled trial 

42, case report

43, clinical trial

  41, 42, 43

 Augmented input

35-Augmented input is based on the concept that language input provides a model for language development. This approach can lead to increased symbol comprehension in young AAC* users and in users with severe cognitive or intellectual disabilities, as well as increased symbol comprehension and production. Augmented input—also called “natural aided language” or “aided language modeling”—is a receptive language training approach in which the communication   partner provides spoken words along with AAC* symbols during communication tasks (e.g., partner points to the AAC* symbols while simultaneously talking).

 44, high

45, high

46, moderate

47, moderate

Strong recommendation

44, multiple-baseline design

45, multiple-probe design

46, literature review

47, literature review

 44,45,46,47

Clinical questions

 Action Recommendations

 Evidence Quality

 Strength of Recommendation

 Study Type

 References

Reflective Practice

 36-Management aims and objectives must be reviewed regularly and frequently. If anticipated progress is not achieved the therapeutic intervention should be re viewed.

Very low

Strong recommendation

Professional consensus

4

Evaluation of outcome

37-Outcomes of therapy should be routinely measured, reflecting the range of interventions delivered and the aims agreed for therapy (every 3-6 months; provided that the child regularly & consistently attends his/her previously scheduled sessions).

Very low

Strong recommendation

Professional consensus

4

 Clinical questions

 Action Recommendations

 Evidence Quality

 Strength of Recommendation

 Study Type

 References

Referral

1-If the child exhibits warning signs of autism spectrum disorder, the child, regardless of age, should receive a referral for “a communication and language assessment by a phoniatrician possibly specifying with rehabilitation if necessary”.

Moderate

Strong recommendation

literature review

48

Diagnostic Statistical Manual-V (DSM-5)

 2-According to the DSM-5, individuals who meet the specified criteria are given the diagnosis of Autism Spectrum Disorder (ASD) with one of three levels of severity.

N.B. DSM-5 reflects a number of changes from those in the DSM-IV.

49, high

50, moderate

2, review & clinical expertise

 Strong recommendation

  49, meta-analysis

50, comparative study

49, 50, 2

Diagnosis

 3-Current findings suggest that ADOS [Autism Diagnostic Observation Scale] is best for not missing children who have ASD and is similar to CARS [Childhood Autism Rating Scale] and ADI-R[Autism Diagnostic Interview - Revised] in not falsely diagnosing ASD in a child who does not have ASD. ADOS has acceptable accuracy in populations with a high prevalence of ASD. However, overdiagnosis is likely if the tool is used in populations with a low- er prevalence of ASD. This finding supports current recommended practice for ASD diagnostic tools to be used as part of a multi-disciplinary assessment, rather than as stand- alone diagnostic instruments.

High

Strong recommendation

Systematic review

51

 Clinical questions

 Action Recommendations

 Evidence Quality

 Strength of Recommendation

 Study Type

 References

 Joint attentio evaluation

 4-An evaluation of the individual’s ability to direct and maintain shared attention with another individual should be completed.

52, Moderate

53, moderate

54, moderate

Strong recommendation

52, comparative study

53, longitudinal study

54, review 

 52, 53, 54

 Evaluating the child’s readiness to focus and shift attention

5-An evaluation of the individual’s readiness and ability to focus and shift attention will be made. This is the baseline for determining which type of intervention and management would be appropriate.

55, high

56, moderate

Strong recommendation

55, controlled study

56, comparative study

55, 56

Assessment considerations

6-It is recommended that all members of    the assessment team consider the individual’s behavioral presentation and needs in comparison to other individuals of the same gender, and be aware of how [autism spectrum disorder] ASD may manifest differently in males and females”

57, moderate

Conditional recommendation

Cross sectional study

57

Assessment of the child’s social Interactions

7-It is essential to make a qualitative assessment of the individual’s social interaction skills in a variety of social settings such as a school, nursery or day center.

 58, moderate 

59, low

60, low

61, low

62, low

63, very low

Conditional recommendation

 58, comparative study

59, expert opinion

60, expert opinion

61, qualitative study

62, observational interviews

63, expert opinion

 58, 59, 60, 61

 Assessment considerations

8-It is recommended that all members of the assessment Team consider racial, ethnic, and/or socioeconomic background of the individual and how cultural factors may    influence the assessment of autism               spectrum disorder (ASD) concerns.

Moderate

Conditional recommendation

Literature review

64

 Clinical questions

 Action Recommendations

 Evidence Quality

 Strength of Recommendation

 Study Type

 References

 Comprehensive assessment

 9-Depending on the individual’s age and abilities, the phoniatrician typically assesses:

·  Receptive language

·   Expressive language

·  Literacy skills

·  Social communication

·  Conversational skills

·  Speech prosody

65, high

66, low

Conditional recommendation

 65, systematic review

66, study but with    no control

65, 66

Comprehensive assessment

 10-Comprehensive assessment for ASD* typically includes structured, reliable and valid tests (until standardized assessment tools for the Egyptian culture is available) that should be culturally and linguistically appropriate, and if the norming sample is not representative of the individual assessed, the standard scores should be viewed with caution; depending on the differences in the Arabic accents and dialects across different regions in Egypt).

  High

Strong recommendation

Systematic review

67

 Checklists

 11-When possible, parent checklists should be provided in their native language to obtain the most accurate information.

Very low

Strong recommendation

   Expert opinion

68

Clinical questions

 Action Recommendations

 Evidence Quality

Strength of Recommendation

 Study Type

 References

 Naturalistic observation

12-Observation of the individual in everyday social settings with others. Criterion-referenced assessments may be used during naturalistic observations to document an individual’s functional use of language across social situations.

Very low

Strong recommendation

Expert opinion

68

 Dynamic assessment

 13-Dynamic Assessment seeks to identify an individual’s skills as well as his or her learning potential. Dynamic assessment is highly interactive and emphasizes the learning process over time. It can be used in conjunction with standardized assessments.

69, high

70, high

Conditional

recommendation

69, systematic review

70, systematic review

69, 70

Evaluation of potential benefit of using AAC*

14-Assessment may also include evaluation of the potential benefit of using augmentative and alternative communication (AAC) to facilitate functional improvements

Moderate

Conditional

recommendation

Systematic review with limitations

71

Differential Diagnosis ASD** vs. SCD***

15-It is important to differentiate between Autism Spectrum Disorder and social communication disorder. Phoniatricians will be instrumental in making this   differential diagnosis.

Moderate

Conditional recommendation

2, literature review

2

 Statement

Topic

 Action Recommendations

   Evidence Quality

 Strength of Recommendation

Study Type

 References

 Ongoing assessment

16-As part of the ongoing assessment process, dynamic assessment procedures can be used to identify the skills that an individual has achieved, those that may be emerging, and the contextual supports that enhance communication skills (e.g., AAC* or modeling).

High

Conditional recommendation

Systematic review

72

 Audiological assessment      in ASD**

17-The similarities in communication and socialization             symptoms between hearing impairment and ASD** populations, along with the possibility of dual diagnosis, can present challenges for differential diagnosis. An audiologic assessment is conducted when hearing loss and/or ASD** are suspected.

Suggestions for assessing hearing in individuals with these and other challenging behaviors include, for example, minimizing distractions in using the individual’s primary/preferred language form, increasing the individual’s familiarity with assessment procedures prior to testing, allowing the individual to touch and explore earphones; considering the need for auditory brainstem response (ABR) testing when behavioral audiometry is not possible.

73, moderate

74, very low

Conditional recommendation

73, review

74, case study

73, 74

 Clinical questions

 Action Recommendations

 Evidence Quality

 Strength of Recommendation

 Study Type

 References

Genetic testing

18-Diagnostic evaluation may include genetic testing, particularly if there is a family history of intellectual disability or genetic conditions associated with ASD (e.g., fragile X, tuberous sclerosis) or if the child exhibits physical features suggestive of a possible genetic syndrome.

High

Conditional recommendation

Systematic review with meta-analysis

75

Metabolic testing

19-Diagnostic evaluation may include metabolic testing, if the child exhibits symptoms such as lethargy, cyclic vomiting, pica, or seizures.

 High

 Conditional recommendation

 Systematic review with meta-analysis

 76

Conveying information to parent

20-The phoniatrician’s role includes incorporating a family perspective into the                  assessment, effectively eliciting information from families about their concerns, beliefs, skills, and knowledge in relation to the individual being assessed. It is important to convey information to families clearly and empathetically.

Moderate

Conditional recommendation

Literature review & Clinical expertise

77

 Language intervention

21-Phoniatricans will need to advocate for inclusion of language intervention for individuals diagnosed with Autism Spectrum Disorder and ensure that individuals with Autism Spectrum Disorder also receive a diagnosis of language disorder, when they meet the criteria.

Moderate

Conditional recommendation

Literature review & clinical experience

78

 Clinical questions

Action Recommendations

 Evidence Quality

 Strength of Recommendation

 Study Type

 References

Language intervention

 22-Regardless of the presence or absence of difficulties acquiring the form and con- tent of language, all individuals with Autism Spectrum Disorder are eligible for speech-language pathology services due to the pervasive nature of the social communication impairment.

High

Strong

 recommendation

Systematic review with meta-analysis

79

 Social  communication intervention

23-Social communication intervention can have moderate effectiveness in increasing early social communication outcomes (e.g., joint attention, synchronous engagement).

High

Strong recommendation

Systematic review with meta-analysis

80

 Intervention for high-functioning individuals with ASD

24-It is important to provide intervention to address the gap between cognitive potential and social adaptive functioning. As high-functioning individuals with ASD pose particular challenges both for identification and for determining eligibility for services.

81, low

82, low

83, low

 Strong recommendation

81, comparative study

82, qualitative study

83, descriptive study

81, 82, 83

Verbal based intervention &Augmentative & Alternative Communication

 25-The use of verbal-based intervention (i.e., focused play intervention) and                     augmentative and alternative communication (i.e., Picture Exchange Communication Systems [PECS]) improve spoken and non-verbal communication in minimally verbal children with autism spectrum disorder.

 84, high

85, very low

86, low

 Strong

 recommendation

 84, meta analysis study with limitations

85, case study

86, scoping review with limitations

84, 85, 86

Augmentative & Alternative Communication

26-Augmentative and alternative                      communication can be considered an evidence-based practice for supporting social-communication skills in individuals with autism spectrum disorder or intellectual disabilities and complex communication needs.

87, high

88, moderate

 Strong

 recommendation

87, meta-analysis study with limitations

85,Case study

86, scopin review with limitations

 87, 88

Important recommendation

27-It is preferable not to recommend computer-based instructions and video modeling in the Egyptian culture for fear that these might be overused / misused by parents and caregivers; thereby increasing the echolalia and deteriorating the child’s social communication skills.

89, high

90, high

Strong recommendation

89, systematic literature review

90, review of evidence

89, 90

Recommendations regarding watching television & using cell phones and iPad

28-It is important to advice the parents and caregivers to reduce, or preferably, totally eliminate whenever possible) the child’s exposure to iPad, cell phones, computers, etc. in a systematically-planned manner and to try to replace these activities with more interactive, communicatively-enriching ones.

Moderate

Strong recommendation

systematic review with meta-analysis and limitations

91

 Clinical questions

 Action Recommendations

 Evidence Quality

 Strength of

Recommendation

 Study Type

 References

 Auditory/ Sensory Integration Training

 29-Sensory integration therapies are used to treat integration dysfunction in one or more sensory systems. Treatments can include physical exercise, sensory/tactile stimulation, and auditory integration training.

92, for sensory integration therapy, insufficient evidence (very low) for sensory integration effectiveness in autism spectrum disorder

93, for auditory integration therapy: The 2002 ASHA Work Group on auditory integration therapy, after reviewing empirical research in the area to date, concludes that AIT has not met scientific standards for efficacy that would justify its practice by audiologists and speech-language pathologists.

However, it was mentioned well-designed, institutionally approved, research protocols designed to assess the efficacy of Auditory Integration Therapy are encouraged. It is recommended that this position be reexamined should scientific, controlled studies. supporting AIT's effectiveness and safety become available. 

 Strong recommendation

92, systematic review

93, empirical research review

 92, 93

Applied Behavior Analysis (ABA)

30-Applied behavior analysis (ABA) programs are moderately effective in improving socialization skills in children with autism spectrum disorder.

94, moderate

95, moderate

Strong recommendation

 94, meta-analytic study with limitations

95, meta-analytic study

with limitations

94, 95

 Early Intensive Behavioral Intervention

31-Early intensive behavioral intervention (EIBI) is an effective treatment for children diagnosed with autism spectrum disorders (ASD) with suggested gains in the areas of adaptive behavior, Intelligent Quotient (IQ), communication, socialization, and daily living skills, with the largest gains made in IQ and the smallest in socialization”.

Moderate

Conditional recommendation

Meta-analysis

with limitations for behavioral intervention

95

 Clinical questions

 Action Recommendations

 Evidence Quality

 Strength of Recommendation

 Study Type

 References

Cognitive Behavioral Therapy (CBT)

 32-Cognitive Behavioral Therapy (CBT) is an intervention approach with the     underlying assumption that an individual’s behavior is mediated by maladaptive patterns of thought or understanding and that change in thinking or cognitive patterns can lead to changes in behavior.

High

Conditional recommendation

Randomized control trial - Pilot study

96

Parent-mediated or implemented intervention

 33-Parent-implemented interventions are likely to result in meaningful            improvements in communication for children with Autism Spectrum Disorder (ASD).

 97, high

98, high

99, high

Strong recommendation

97, systematic review

98, randomized controlled trial

99, randomized controlled trial

97, 98, 99

 Parent-implemented Functional Communication Training

 34-Parent-implemented [functional     communication training] FCT is suggested to produce meaningful reductions in challenging behavior and these changes tend to generalize to other situations and maintain over time.

High

Strong recommendation

Systematic review

100

 Clinical questions

 Action Recommendations

 Evidence

Quality

 Strength of Recommendation

 Study Type

 References

 Peer- implemented Treatment

35-Peer-mediated or implemented           treatment approaches incorporate peers as communication partners for children with ASD in an effort to minimize isolation, provide effective role models, and boost communication competence.

Moderate

Strong recommendation

Systematic review with limitations

101

 Generalization-promotion strategy

36-The use of generalization-promotion strategy (e.g., having a familiar person deliver intervention, teaching across various stimuli and responses) can support successful generalization.

 High

 Strong recommendation

 Systematic review

  102

Teaching staff-           mediated intervention

37-Interventions delivered by teaching staff in an inclusive preschool setting can be effective in improving outcomes for young children with ASD.

Moderate

Strong recommendation

Systematic review with limitations

103

Social communication interventions

38-Social communication treatment    approaches and frameworks are designed to increase social skills, using social group settings and other platforms.

High

Strong recommendation

Randomized controlled trial

104

 Clinical questions

 Action Recommendations

 Evidence Quality

 Strength of Recommendation

 Study Type

 References

 Group Social Skills Intervention

39-Social groups can positively affect social knowledge in youth with ASD.

 Moderate

Conditional recommendation

Systematic review with meta-analysis and limitations

 105

 Social story intervention

40-Social story interventions can have a positive impact on the social interaction of students with autism spectrum disorder.

 Moderate

 Conditional recommendation

Literature review

 106

Transition panning

41-Effective transition planning involves the student as an active, respected participant of the team as well as his/her family, who can provide valuable information

about the student’s needs.

Moderate

Conditional recommendation

Systematic with  meta-analysis but additional high quality research was recommended

107

 Functional communication training in school-age children

42-Teachers and other school personnel can successfully implement functional communication training to increase appropriate communication in school-aged children having autism spectrum disorders.

     Moderate

Strong recommendation

Literature review

108

Role of peers in social skills modeling

43-A peer mentor can serve as a role model and source of social skills information and feedback in social settings providing opportunities for social involvement and the development of friendships.

High

Conditional recommendation

Systematic review

109