Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

General principles of care

  • All staff working with autistic adults should:

    • work in partnership with autistic adults and, where appropriate, with their families, partners or carers

    • offer support and care respectfully

    • take time to build a trusting, supportive, empathic and non-judgemental relationship as an essential part of care.

  • In order to effectively provide care and support for autistic adults, the local autism multi-agency strategy group should include representation from managers, commissioners and clinicians from adult services, including mental health, learning disability, primary healthcare, social care, housing, educational and employment services, the criminal justice system and the third sector. There should be meaningful representation from autistic people and their families, partners and carers.

Identification and assessment

  • 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, and

    • 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 mental health or learning disability services

      • a history of a neurodevelopmental condition (including learning disabilities and attention deficit hyperactivity disorder) or mental disorder.

  • For adults with possible autism who do not have a moderate or severe learning disability, consider using the Autism-Spectrum Quotient – 10 items (AQ-10). (If a person has reading difficulties, read out the AQ-10.) If a person scores 6 or above on the AQ-10, or autism is suspected based on clinical judgement (taking into account any past history provided by an informant), offer a comprehensive assessment for autism.

  • When assessing behaviour that challenges carry out a functional analysis (see recommendation 1.5.3) including identifying and evaluating any factors that may trigger or maintain the behaviour, such as:

    • physical disorders

    • the social environment (including relationships with the family, partner, carer(s) and friends)

    • the physical environment, including sensory factors

    • coexisting mental disorders (including depression, anxiety disorders and psychosis)

    • communication problems

    • changes to routine or personal circumstances.

Interventions for autism

  • For autistic adults without a learning disability or with a mild learning disability, who are having difficulty obtaining or maintaining employment, consider an individual supported employment programme.

Organisation and delivery of care

  • Autism strategy groups should be responsible for developing, managing and evaluating local care pathways. The group should appoint a lead professional responsible for the local autism care pathway. The aims of the strategy group should include:

    • developing clear policy and protocols for the operation of the pathway

    • ensuring the provision of multi-agency training about signs and features suggesting possible autism, and training and support on the operation of the pathway

    • making sure the relevant professionals (health, social care, housing, educational and employment services and the third sector) are aware of the local autism pathway and how to access services

    • supporting the integrated delivery of services across all care settings

    • supporting the smooth transition to adult services for young people going through the pathway

    • auditing and reviewing the performance of the pathway.