The S3 guidelines on autism: content and validity status

What “S3” means

The therapy guideline describes itself as an S3 guideline: its recommendations rest on a systematic search, selection and assessment of scientific evidence, as far as it was available for the question in hand and considered possible and necessary. The assessment of the evidence and the formulation of the recommendations for the German health and social system followed the criteria of the AWMF, the umbrella organisation of the scientific medical societies. ^[1] For the therapy guideline, the recommendations were agreed at a consensus conference on 22 and 23.11.2018 and in online votes in 2019/2020; the text is dated 2 May 2021. ^[1]

A guideline is not a regulation and not a law. It summarises the state of knowledge at the time it was developed and is meant to help professionals and those affected with decisions.

The two parts at a glance

Item	Part 1: diagnosis	Part 2: therapy
AWMF register number	028-018	028-047
Text version	23.02.2016	02.05.2021
Validity according to DGKJP overview	until 04.04.2021	until 23.03.2026
Lead	DGKJP	DGKJP and DGPPN

^{[2; 1; 3]}

The diagnosis guideline carries a note on the document that it has not been updated for more than five years and is currently being revised. ^[2] How an autism assessment works is described in the article How an autism assessment works.

How the therapy guideline is structured

The long version of the therapy guideline runs to about 590 pages. It is organised by therapy goals, not by individual methods: each chapter answers what was studied for a particular goal and what is recommended. ^[1] The chapters at a glance:

Chapter	Topic
C.1	Introduction: therapy goals and principles of interaction
C.2	Expectations of those affected and relatives of therapy
C.3	Care structure and qualification of therapists
C.4	Therapies to improve autism-specific symptoms
C.5	Specific comorbid developmental disorders (for example language, motor skills)
C.6	Cognitive and daily-living skills
C.7	Treatment of comorbid mental disorders and symptoms
C.8	Crisis intervention
C.9	Partly inpatient and inpatient therapy
C.10	Involving families, relatives, schools and employers
C.11	Methods harmful to health and ethically questionable
C.12	Summary and conclusion

^[1]

The guideline sorts the methods into three groups: psychosocial methods (all training-based and psychoeducational approaches), medication-based methods (medicines and dietary supplements) and other methods. ^[1] The document also includes a guideline report and an evidence report in which the procedure and the individual studies are documented; a short version was planned. ^[1]

How to read “soll”, “sollte” and “kann”

For recommendations based on studies, the guideline distinguishes three grades: ^[1]

• “soll” (should): strong recommendation based on the evidence (grade of recommendation A),
• “sollte” (should, weaker): recommendation based on the evidence (grade of recommendation B),
• “kann” (may): open recommendation based on low evidence (grade of recommendation 0).

Where the body of studies was not sufficient, the guideline group formulated recommendations based on the expertise of the professionals involved. They are marked KKP (“clinical consensus point”, good clinical practice). ^[1] This carries a different weight than a recommendation with a study basis. Many fundamental statements of the guideline, for example on everyday interaction or care structure, are KKP. Each recommendation also states how large the agreement in the vote was, for example “strong consensus (>95 % agreement)”. ^[1]

Individual professional societies submitted dissenting votes. These are pointed out in the long and the short version directly after the recommendation concerned. ^[1]

What “no evidence” means – and what it does not

The guideline makes clear: that there is no evidence for a method does not mean it is ineffective, but that it has so far not been researched sufficiently. Where studies are lacking, further high-quality studies are needed. ^[1] Likewise: if an approach is not mentioned for a particular therapy goal, it is not therefore ineffective in general; it may be described for a different goal or not yet sufficiently studied. ^[1]

At the same time, the guideline stated that the body of studies on autism is significantly better compared with other mental disorders, such as anxiety disorders in childhood and adolescence. ^[1]

Validity: are the S3 guidelines on autism still current?

According to the DGKJP overview, both guidelines have expired. ^[3] The following applies for dealing with this:

• Put contents in time context. Statements from the guideline reflect the state of 2021 (therapy) or 2016 (diagnosis). On this website they are therefore in the past tense (“The 2021 guideline recommended …”).
• Neither overrate nor discard the principles. That a guideline has expired does not mean every statement is outdated. It does mean, however, that it can no longer count as the current position of the guideline group. For decisions in the individual case, professionals are responsible.
• Watch for new versions. We will update the articles as soon as a new guideline is available.
• Status of the overview. When checked on 23.10.2026, the DGKJP overview still gave “valid until 04.04.2021” (diagnosis) and “valid until 23.03.2026” (therapy). ^[3] The Federal Association autismus Deutschland writes (as of August 2026) that the diagnosis guideline is being revised and that the previous version is currently not available. ^[4]

Which statements of the therapy guideline we use in other articles is shown, for example, by the overview What support helps? and the article Evidence on therapies at a glance.

Sources and literature

1. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. Interdisziplinäre S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Langversion, Stand Text 02.05.2021. – Guideline (in German); validity expired on 23 March 2026 according to the DGKJP overview (see no. 3)
2. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 1: Diagnostik. S3-Leitlinie, AWMF-Reg.-Nr. 028-018, Textstand 23.02.2016. – Guideline (in German) (expired; according to the document note under revision)
3. DGKJP. Aktuelle Leitlinien (Einträge 028-018 „Gültig bis 04.04.2021“ und 028-047 „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
4. Bundesverband autismus Deutschland e.V.: Aktuelle Situation zur Autismusdiagnostik in Deutschland, Stand August 2026 (www.autismus.de/autismus/diagnostik.html). Retrieved 23.10.2026 – Professional association (in German)