NICE launch new guideline and pathway on the referral, diagnosis and management of autism in adults

Half a million people in England and Wales have autism and most of them were diagnosed in childhood or adolescence. Healthcare professionals sometimes overlook the condition in adults and this can lead to serious problems for the individual, including isolation, confusion and social exclusion.

The National Autistic Society have estimated that only 15% of adults with autism are in full-time employment, even though the majority are both willing and able to work.

NICE have published their first guideline for autism in adults and it’s accompanied by a care pathway that includes children and young people.

Staff knowledge

The guideline says that all staff working with adults with autism should have an understanding of:

The nature, development, and course of autism
The impact on personal, social, educational, and occupational functioning
The impact of the social and physical environment

Diagnosis

The guideline says that GPs should consider a diagnostic assessment for possible autism under certain specific conditions:

When a person has one or more features including:

persistent difficulties in social interaction or social communication
stereotypic (rigid and repetitive) behaviours
resistance to change or restricted interests

The person should also have one or more of the following features, if a diagnostic assessment for possible autism is to be considered:

problems in obtaining or sustaining employment or education
difficulties in initiating or sustaining social relationships
previous or current contact with mental health or learning disability services
a history of a neurodevelopmental condition (including learning disabilities and attention deficit hyperactivity disorder) or mental disorder

The guideline says that GPs and other healthcare professionals should consider using the Autism Spectrum Quotient (ASQ) for adults with possible autism who do not have a moderate or severe learning disability.

A comprehensive assessment for autism should be taken if the person has an ASQ score of over six, or autism is suspected based on clinical judgement.

Individual supported employment programmes should be considered for adults with autism without a learning disability or with a mild learning disability, who are having difficulty obtaining or maintaining employment.

The programme should include help with writing CVs and job applications and preparing for interviews, training for the identified work role and work-related behaviours, and should carefully match the person with autism with the job.

Professor Stephen Pilling, Director of the National Collaborating Centre for Mental Health, which developed the guideline on NICE’s behalf said:

The new NICE guideline clearly identifies the most common, recognisable characteristics that could suggest an individual is autistic. We hope that this advice will inspire greater confidence and awareness among healthcare professionals, and so allow more adults with autism to have their individual needs recognised and receive the support they need.

Future research

The guideline also highlights a number of areas for future research:

The clinical and cost effectiveness of the following interventions for coexisting mental health problems:

Facilitated self help for mild anxiety and depressive disorders
Cognitive behavioural therapy for moderate and severe anxiety disorders
Selective serotonin reuptake inhibitors for moderate and severe depression

The clinical and cost effectiveness of augmentative communication devices
The optimal structure and organisation of specialist autism teams for improvements in care

The Mental Elf