NICE consults on draft recommendations on recognising autism in adults
NICE is currently developing a clinical guideline on the recognition, referral, diagnosis and management of adults on the autism spectrum. As part of this process, draft recommendations have been published on the NICE website for public consultation.
Commenting on the draft recommendations Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said: "Autism can be difficult to correctly diagnose as there are lots of possible signs and symptoms, as well as coexisting conditions with similar features, such as intellectual disability, attention deficit hyperactivity disorder and obsessive compulsive disorder. Levels of understanding and the availability of services for those with autism vary greatly across the country. The condition is often overlooked by healthcare, education and social care professionals which means that a large proportion of autistic adults find themselves excluded both socially and economically. They often find it difficult to access the support and services they need to live independently.
"The aim of this new NICE guideline is to help reduce variation across the country in the identification and referral of those who have autism, as well as emphasising the importance of joint working for health and social care including learning disabilities service and the criminal justice system.
"We are inviting anyone who has experience with autism, including healthcare professionals, charities and members of the public, to comment on our draft recommendations via one of our registered stakeholders. This is so that we can ensure the final version of our clinical guideline is of greatest benefit to the NHS and importantly to those who live with this condition."
In its draft clinical guideline, NICE advises that:
Structures for the organisation and delivery of treatment and care: A local autism multi-agency strategy group should be set up to include primary healthcare, mental health services, learning disabilities services, the criminal justice system, education, housing, employment, social care and the third sector. Ensure meaningful representation from people with autism and their families or carers.
Identification and initial assessment: Consider further assessment for possible autism when a person has persistent difficulties in reciprocal (two-way) social engagement or social communication and stereotypic (rigid and repetitive) behaviours or resistance to change, and also one or more of the following:
- problems in obtaining or sustaining employment or education
- difficulties in initiating or sustaining social relationships
- previous, or current contact with Child and Adolescent Mental Health Services (CAMHS) or learning disability services
- history of a neurodevelopmental disorder
Psychosocial interventions (employment): For adults with autism of all ranges of intellectual ability, who are having difficulty obtaining or maintaining employment, consider an individual supported employment programme.
Assessment of challenging behaviour should be integrated into a comprehensive assessment for adults with autism. When assessing challenging behaviour undertake a functional analysis and consider identifying and evaluating any factors that may provoke or maintain the behaviour including: any physical health problems; the social environment; the physical environment, including sensory needs; coexisting mental health disorders; communication problems and changes to routine or personal circumstances.
Notes to Editors
About the clinical guideline
1. For further information about the draft recommendations on “Autism: recognition, referral, diagnosis and management of adults on the autism spectrum”, including how stakeholders can submit their comments, visit: http://guidance.nice.org.uk/CG/Wave23/1.
2. Autism is a lifelong neurodevelopmental disorder whose core features are a qualitative impairment in the reciprocity of social interaction and communication, combined with restricted interests or rigid and repetitive behaviour and activities.
3. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health
4. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS
5. NICE produces standards for patient care:
- quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
6. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
 Treatment and care decisions focused on a specific problem behaviour should be informed by a functional analysis of the behaviour, including:
· observation and description, in a range of environments, of the antecedents of the behaviour (the internal and external stimulus or stimuli that appear to trigger the behaviour) and the consequences of the behaviour (that is, the reinforcement received as a result of their behaviour)
· analysis of the observational data aimed at identifying trends in the occurrences of a specific behaviour, stimuli that may be evoking that behaviour, or the needs that the person is attempting to meet by performing the behaviour.
Target interventions at addressing the causes and function(s) of problem behaviour(s).
This page was last updated: 08 December 2011