Adult Autism Diagnostic Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • The referral pathway for autism diagnosis of people age 18+ who do not meet the Learning Disability Services criteria.
  • People with high end autistic needs who do not have a learning disability IQ (>70) and tend to manage but not thrive in a community that does not fully understand their behaviours.

This guidance does not cover:

  • People with an autism diagnosis who need treatment for a comorbidity should be referred to the appropriate service for that comorbidity, that service should make reasonable adjustments
  • People age 18+ who meet the criteria for Learning disability services

Assessment

Autistic Spectrum Disorder (ASD)

  • National prevalence data suggests that there are around 700,000 people with Autism in the UK; or 1 in a 100. Between 48-56% of these will not have a learning disability, i.e. have an IQ greater than 70; many do not have a confirmed diagnosis.
  • ASD is a lifelong condition that affects how a person communicates with and relates to other people. It also affects how a person makes sense of the world around them. Autism is known as a spectrum condition both because of the range of difficulties that affect adults with autism and the way that these present in different people. This means that while some people can lead relatively independent lives, others will require significant support.
  • In recent years there have been a number of national developments relating to people with autism. The introduction of the Autism Act (HMSO 2009) and the publication of the national autism strategy Fulfilling and Rewarding lives: the strategy for adults with autism in England (Department of Health 2010) place a statutory duty on the NHS and Local Authorities to ensure that services are in place to meet the needs of people with autism.
  • These developments culminated in the national strategy for adults with autism: Think Autism - Fulfilling and Rewarding Lives, the strategy for adults with autism in England. Any service development should encompass and build upon the principles detailed in this document.

Signs and Symptoms

Consider assessment for possible autism when a person has one or more of the following:

  • Persistent difficulties in social interaction
  • Persistent difficulties in social communication
  • Stereotypic (rigid and repetitive) behaviours, resistance to change or restricted interests
  • Problems in obtaining or sustaining employment or education
  • Difficulties in initiating or sustaining social relationships
  • Altered sensory sensitivity, sensory processing difficulties
  • Emotional dysregulation

History and Examination

  • Evidence of abnormalities in early development (including social interactions, social communication, lack of imaginative play, restricted, repetitive interest pattern)
  • A history of a neurodevelopmental condition (including learning disabilities and attention deficit hyperactivity disorder) or mental disorder
  • Family history of Autism or other neurodevelopmental disorders

Differential Diagnoses

  • Learning Disabilities
  • Attention deficit hyperactivity disorder (ADHD)

Red Flags

Seek immediate or urgent specialist advice/treatment if:

  • presenting with acute comorbid mental health issue follow normal referral pathway into mental health or learning disability services
  • presenting with urgent social care needs contact Adult Social Care

Investigations

Undertake the following to aid diagnosis, inform management or prior to referral:

  • For adults with possible autism who do not have a moderate or severe learning disability use the Autism-Spectrum Quotient– 10 items (AQ-10)[1]. (If a person has reading difficulties, read out the AQ-10.)

Referral

Referral Criteria

  • Autism is suspected based on clinical judgement (taking into account any past history provided by an informant) and/or score of 6 or above on AQ-10
  • Referral for the diagnosis of autism is to South West Yorkshire Partnership NHS Foundation Trust (SWYPFT) Autism Assessment Service
  • Adults with learning disabilities should be referred to the Community Learning Disabilities Team for a comprehensive assessment (all adults with a learning disability should be Read coded – if there is uncertainty about the presence of learning disabilities the Community Learning Disabilities Team should be contacted)

Referral Requirements

  • All referrals should be supported by a completed referral form which incorporates the AQ-10 assessment

Referral Instructions

  • e-Consultation is not available for this specialty
  • Wakefield - all routine referrals should be made directly to SWYPFT ASD service (available 9-6) via:
    • Tel: 01924 316490
    • Fax: 01924 328112
    • ADHD and Autism Service, Manygates Clinic, Portobello Road, Wakefield, WF1 5PN.
    • kathryngibbs@nhs.net
    • Please Note: The SWYPFT ASD service does not provide out of hours services, In an emergency situation please contact the relevant emergency services
  • North Kirklees - referrals can also be made via the Trusts Single Point of Access Team
    • 01924 284555 (Kirklees) 24/7

Supporting Information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation

Patient information/Public Health/Self Care

Evidence/Additional information

  • NICE guidance (CG142)
  • Individuals who have a diagnosis of Autism and their carer's are entitled to a social care assessment; however they will only be eligible for services if they have eligible needs.

Assurance & Governance

  • This guidance was developed on: 03.2017
  • This guidance was ratified by: OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 03.2019
  • Ref No: MH2 – 03.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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