2023 clinical practice guidelines on autism spectrum disorder in children and adolescents in Singapore.

Introduction: Autism is a neurodevelopmental condition that is increasing in prevalence worldwide. There has been an exponential increase in autism-related research since 2010, when the first Singapore Clinical Practice Guidelines (CPG) on autism was published. Understanding of autism has since evolved to adopt a lifespan approach beyond that of a childhood condition. The aim of this CPG was to provide an updated set of recommendations for children and adolescents to aid clinical practice for professionals. Method: A multidisciplinary workgroup that comprised representatives from various sectors worked on this CPG. Clinical questions were organised into 10 different sections, each with its own subgroup of members. Seventeen existing international guidelines were evaluated using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE-II) framework, of which 4 met criteria to act as references. Literature review across multiple databases was conducted between January 2011 to 2023; Grading of Recommendations, Assessment, Development and Evaluation (GRADE-like) methodology was used to synthesise evidence. Recommendation statements were derived, following Delphi-style consensus surveys among the workgroup. The draft guidelines underwent external review and public consultation before being formalised. Results: Recommendation and good practice statements pertaining to care of children and adolescents on the autism spectrum across 10 different sections were developed. Evidence matrices complement these recommendations and detail relevant evidence behind each recommendation statement. Conclusion: It is intended for these guidelines to promote effective management and healthcare services for children and adolescents on the autism spectrum, by reinforcing good and evidence-based clinical practice within our national context.

2023 clinical practice guidelines on autism spectrum disorder in children and adolescents in Singapore

Autism is a neurodevelopmental condition that is increasing in prevalence worldwide. There has been an exponential increase in autism-related research since 2010, when the first Singapore Clinical Practice Guidelines (CPG) on autism was published. Understanding of autism has since evolved to adopt a lifespan approach beyond that of a childhood condition. The aim of this CPG was to provide an updated set of recommendations for children and adolescents to aid clinical practice for professionals. A multidisciplinary workgroup that comprised representatives from various sectors worked on this CPG. Clinical questions were organised into 10 different sections, each with its own subgroup of members. Seventeen existing international guidelines were evaluated using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE-II) framework, of which 4 met criteria to act as references. Literature review across multiple databases was conducted between January 2011 to 2023; Grading of Recommendations, Assessment, Development and Evaluation (GRADE-like) methodology was used to synthesise evidence. Recommendation statements were derived, following Delphi-style consensus surveys among the workgroup. The draft guidelines underwent external review and public consultation before being formalised. Recommendation and good practice statements pertaining to care of children and adolescents on the autism spectrum across 10 different sections were developed. Evidence matrices complement these recommendations and detail relevant evidence behind each recommendation statement. It is intended for these guidelines to promote effective management and healthcare services for children and adolescents on the autism spectrum, by reinforcing good and evidence-based clinical practice within our national context.

Shake it baby, but only when needed: Preschoolers adapt their exploratory strategies to the information structure of the task.

Previous research has suggested that active engagement with the world drives children's remarkable learning capabilities. We investigated whether preschoolers are "ecological learners," that is, whether they are able to select those active learning strategies that are most informative in a given task. Children had to choose which of two exploratory actions (open vs. shake) to perform to find an egg shaker hidden in one of four small boxes, contained in two larger boxes. Prior to this game, children either learnt that the egg was equally likely to be found in any of the four small boxes (Uniform condition), or that it was most likely to be found in one particular small box (Skewed condition). Results of Study 1 show that 3- and 4-year-olds successfully tailored their exploratory actions to the different likelihood-distributions: They were more likely to shake first in the Uniform compared to the Skewed condition. Five-year-olds were equally likely to shake first, irrespective of condition, even when incentivized to shake only when needed (Study 2a). However, when the relevance of the frequency training for the hiding game was highlighted (Study 2b and Study 2c), the 5-year-olds showed the same behavioural pattern as the younger preschoolers in Study 1. We suggest that ecological learning may be a key mechanism underlying children's effectiveness in active learning.

"Why is Toma late to school again?" Preschoolers identify the most informative questions.

The current study investigates whether preschoolers are able to successfully identify the most effective among given questions, adapting their reliance on different types of questions (constraint-seeking vs. hypothesis-scanning) based on the quantitative measure of expected information gain. Children were presented with storybooks describing the reasons why a fictional character, Toma, was late to school over several days. In 3 experiments with 5-year-old children, we manipulated the frequency and likelihoods of the reasons presented. Children were asked to identify which of 2 given questions would be more effective in finding out why Toma was late to school again. In a fourth experiment, we investigated whether preschoolers are adaptive learners, that is, whether they can identify the most effective question iteratively, and we extended our investigation to younger preschoolers (3- and 4-year-olds). We find that children assessed the effectiveness of different types of questions based on the hypothesis space currently under consideration, and this adaptation may be guided by expected information gain. Overall, our results suggest that over the preschool years, children begin to develop the computational foundations that support successful question-asking strategies. (PsycINFO Database Record