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


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


  1. Autism: recognition, referral, diagnosis and management of adults on the autism spectrum (PDF). NICE guideline CG142, 27 Jun 2012.
  2. Autism in adults (CG142): implementation tools and other resources. NICE, June 2012.
  3. Autism pathway. NICE
  4. Autism Spectrum Quotient (AQ-10) test: A quick referral guide for adults with suspected autism who do not have a learning disability (PDF).
  5. Fulfilling and rewarding lives: the strategy for adults with autism in England (PDF). Department of Health, 3 Mar 2010.
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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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