AGREEing on Clinical Practice Guidelines for Autism Spectrum Disorders in Children: A Systematic Review and Quality Assessment

Yasser S Amer; Shuliweeh Alenezi; Fahad A Bashiri; Amel Hussain Alawami; Ayman Shawqi Alhazmi; Somayyah A Aladamawi; Faisal Alnemary; Yasser Alqahtani; Maysaa W Buraik; Saleh S AlSuwailem; Shahad M Akhalifah; Marcela Augusta de Souza Pinhel; Melanie Penner; Ahmed M Elmalky

doi:10.3390/children9071050

AGREEing on Clinical Practice Guidelines for Autism Spectrum Disorders in Children: A Systematic Review and Quality Assessment

Children (Basel). 2022 Jul 14;9(7):1050. doi: 10.3390/children9071050.

Authors

Yasser S Amer^{1

2

3

4

5}, Shuliweeh Alenezi⁶, Fahad A Bashiri⁷, Amel Hussain Alawami⁸, Ayman Shawqi Alhazmi⁹, Somayyah A Aladamawi^{10

11}, Faisal Alnemary¹², Yasser Alqahtani¹³, Maysaa W Buraik⁸, Saleh S AlSuwailem¹², Shahad M Akhalifah¹², Marcela Augusta de Souza Pinhel^{14

15}, Melanie Penner^{16

17}, Ahmed M Elmalky^{18

19}

Affiliations

¹ Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh 11451, Saudi Arabia.
² Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh 11451, Saudi Arabia.
³ Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh 11451, Saudi Arabia.
⁴ Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria 5424041, Egypt.
⁵ Guidelines International Network, Perth PH16 5BU, Scotland, UK.
⁶ Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia.
⁷ Pediatric Neurology Division, Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia.
⁸ Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia.
⁹ Developmental Pediatric Department, Children's Hospital, King Saud Medical City, Ministry of Health, Riyadh 12746, Saudi Arabia.
¹⁰ King Abdullah bin Abdulaziz University Hospital, Riyadh 11564, Saudi Arabia.
¹¹ College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia.
¹² Autism Center of Excellence, Riyadh 11564, Saudi Arabia.
¹³ King Fahad Armed Forces Hospital, Jeddah 23311, Saudi Arabia.
¹⁴ Department of Health Science, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, Brazil.
¹⁵ Department of Molecular Biology, São José do Rio Preto Medical School, São José do Rio Preto 15090-000, Brazil.
¹⁶ Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada.
¹⁷ Department of Pediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada.
¹⁸ Morbidity and Mortality Unit, King Saud University Medical City, King Saud University, Riyadh 11451, Saudi Arabia.
¹⁹ Public Health and Community Medicine Department, Theodor Bilharz Research Institute (TBRI), Academy of Scientific Research, Cairo 3863130, Egypt.

Abstract

Background: Autism spectrum disorder (ASD) is a multifaceted neurodevelopmental disorder requiring multimodal intervention and an army of multidisciplinary teams for a proper rehabilitation plan. Accordingly, multiple practice guidelines have been published for different disciplines. However, systematic evidence to detect and intervene must be updated regularly. Our main objective is to compare and summarize the recommendations made in the clinical practice guidelines (CPGs) for ASD in children released from November 2015 to March 2022.

Methods: CPGs were subjected to a systematic review. We developed the inclusion and exclusion criteria and health-related questions, then searched and screened for CPGs utilizing bibliographic and CPG databases. Each of the CPGs used in the study were critically evaluated using the Appraisal of Guidelines for REsearch and Evaluation II (AGREE II) instrument. In a realistic comparison table, we summarized the recommendations.

Results: Four eligible CPGs were appraised: Australian Autism CRC (ACRC); Ministry of Health New Zealand (NZ); National Institute for Health and Care Excellence (NICE); and Scottish Intercollegiate Guidelines Network, Healthcare Improvement Scotland (SIGN-HIS). The overall assessments of all four CPGs scored greater than 80%; these findings were consistent with the high scores in the six domains of AGREE II, including: (1) scope and purpose, (2) stakeholder involvement, (3) rigor of development, (4) clarity of presentation, (5) applicability, and (6) editorial independence domains. Domain (3) scored 84%, 93%, 86%, and 85%; domain (5) 92%, 89%, 54%, and 85%; and domain (6) 92%, 96%, 88%, and 92% for ACRC, NICE, NZ, and SIGN-HIS, respectively. Overall, there were no serious conflicts between the clinical recommendations of the four CPGs, but some were more comprehensive and elaborative than others.

Conclusions: All four assessed evidence-based CPGs demonstrated high methodological quality and relevance for use in practice.

Keywords: AGREE II instrument; autism spectrum disorder; clinical practice guidelines; pediatrics; psychiatry; quality assessment; systematic review.

Publication types

Review

Grants and funding

The National Center for Developmental and Behavioral Disorders, Saudi Health Council, Riyadh, Saudi Arabia, covered Article Processing Charges but did not influence the research proceedings, writing up, or the findings of this research project.