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This pathway covers the recognition, referral, diagnosis and management of autism in children, young people and adults.
The term autism describes qualitative differences and impairments in reciprocal social interaction and social communication, combined with restricted interests and rigid and repetitive behaviours. Here 'autism' refers to 'autism spectrum disorders' encompassing autism, Asperger's syndrome and atypical autism (or pervasive developmental disorder not otherwise specified).
Autism is a lifelong condition that has a great impact on children, young people and adults and their family or carers. Diagnosis and needs assessment can offer an understanding of why a person is different from their peers and can open doors to support and services in education, health services, social care and a route into voluntary organisations and contact with other people and families with similar experiences. All this can improve the lives of people with autism and their families.
The NICE guidance that was used to create the pathway.
Autism: management of autism in children and young people. NICE clinical guideline 170 (2013)
Autism in adults. NICE clinical guideline 142 (2012)
Autism in children and young people. NICE clinical guideline 128 (2011)
Common mental health disorders. NICE clinical guideline 123 (2011)
Effective interventions library
Successful effective interventions library details
These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
Education and learning
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.
Service improvement and audit
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
Information for the public
NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.
Updates to this pathway
27 August 2013 Autism: management in children and young people (NICE clinical guideline 170) added to this pathway.
1 February 2013 Minor maintenance updates.
Attention deficit hyperactivity disorder
Ideas, such as reinforcement and function of behaviour, that underlie behavioural therapies and underpin many interventions teaching adaptive skills for community living for people with autism, including those with challenging behaviour.
Child and adolescent mental health services.
Systems designed to improve the overall quality of healthcare by standardising the care process and promoting organised efficient service user care based on best evidence to optimise service user outcomes.
Cognitive behavioural therapy.
A term used to describe behaviour that is a result of the interaction between individual and environmental factors, and includes stereotypic behaviour (such as rocking or hand flapping), anger, aggression, self-injury, and disruptive or destructive behaviour. Such behaviour is seen as challenging when it affects the person's or other people's quality of life and or jeopardises their safety.
A procedure that involves using one or more substances (chelating agents) to remove materials that are toxic, including heavy metals such as mercury, from the body.
Care programme approach.
Developmental coordination disorder
Diagnostic and Statistical Manual of Mental Disorders, 4th edition
An accessible format for written communication designed for people with a learning disability. It uses simple jargon-free language, short sentences and illustrations.
A therapeutic intervention whereby a facilitator supports the hand or arm of a person with autism while using a keyboard or other devices with the aim of helping the person to develop pointing skills and to communicate.
A method for understanding the causes and consequences of behaviour and its relationship to particular stimuli, and the function of the behaviour. The function of a particular behaviour can be analysed by typically identifying (1) the precursor or trigger of the behaviour, (2) the behaviour itself, and (3) the consequence of the behaviour.
Being over-sensitive (hyper-sensitive) or under-sensitive (hypo-sensitive) to sound, light, colour, smell or taste, which can cause anxiety or even pain in a person with autism.
A family member, partner, carer or other third party known to the person with autism who is able to provide information about the person's symptoms and behaviour so that professionals can have a fuller picture of the person's developmental history. Some assessment tools for autism require information from informants.
International Statistical Classification of Diseases and Related Health Problems, 10th Revision
Lower intellectual ability (usually defined as an IQ of less than 70) that leads to problems in learning, developing new skills, communication and carrying out daily activities. Learning disability severities are defined by the following IQ scores: mild = 50–69, moderate = 35–49 and severe = 20–34. A person with a mild to moderate learning disability may only need support in certain areas. However, a person with a moderate to severe learning disability may have no speech or limited communication, a significantly reduced ability to learn new skills and require support with daily activities such as dressing and eating. Learning disabilities are different from 'learning difficulties', like dyslexia, which do not affect intellect. Learning disability is sometimes also called 'intellectual disability'.
A technique used in behavioural therapy that utilises video and other media. The service user observes target behaviour on the video or computer screen, and repeats it.
Oppositional defiant disorder
Obsessive compulsive disorder
A technique used in behavioural therapy to teach 'rules' of social engagement through providing prompts for behaviour.
Services for people with autism
Services for people with autism
Service organisation and delivery of careView the 'Service organisation and delivery of care for people with autism' path
Children and young people up to 19 years
Children and young people
General principles of care for children and young peopleView the 'General principles of care for children and young people with autism' path
Recognition, referral and diagnosis in children and young peopleView the 'Recognition, referral and diagnosis of autism in children and young people' path
Management and support in children and young peopleView the 'Management and support in children and young people with autism' path
Transition to adult services
Transition to adult services
Transition to adult services
Local autism teams should ensure that young people with autism who are receiving treatment and care from CAMHS or child health services are reassessed at around 14 years to establish the need for continuing treatment into adulthood.
If continuing treatment is necessary, make arrangements for a smooth transition to adult services and give information to the young person about the treatment and services they may need.
The timing of transition may vary locally and individually but should usually be completed by the time the young person is 18 years. Variations should be agreed by both child and adult services.
As part of the preparation for the transition to adult services, health and social care professionals should carry out a comprehensive assessment of the young person with autism.
The assessment should make best use of existing documentation about personal, educational, occupational, social and communication functioning, and should include assessment of any coexisting conditions, especially depression, anxiety, ADHD, OCD and global delay or intellectual disability in line with comprehensive assessment in this pathway.
For young people aged 16 or older whose needs are complex or severe, use the CPA in England, or care and treatment plans in Wales, as an aid to transfer between services.
Involve the young person in the planning and, where appropriate, their parents or carers.
Provide information about adult services to the young person, including their right to a social care assessment at age 18.
During transition to adult services, consider a formal meeting involving health and social care and other relevant professionals from child and adult services.
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General principles of care in adultsView the 'General principles of care for adults with autism' path
Identification and assessment in adultsView the 'Identification and assessment of autism in adults' path
Management and support in adultsView the 'Management and support for adults with autism' path
Paths in this pathway
- Service organisation and delivery of care for people with autism
- General principles of care for children and young people with autism
- Recognition, referral and diagnosis of autism in children and young people
- Recognising possible autism in children and young people
- Referral of children and young people with possible autism
- Deciding on assessment for possible autism in children and young people
- The autism diagnostic assessment for children and young people
- Diagnosing autism in children and young people
- Management and support in children and young people with autism
- Interventions for behaviour that challenges in children and young people with autism
- General principles of care for adults with autism
- Identification and assessment of autism in adults
- Management and support for adults with autism
- Interventions for autism in adults
- Interventions for challenging behaviour in adults with autism
- Interventions for coexisting mental disorders in adults with autism
Pathway created: June 2012 Last updated: August 2013
Copyright © 2013 National Institute for Health and Care Excellence. All Rights Reserved.