GPAtlas🧭 When to suspect
Autism is a lifelong neurodevelopmental condition, defined by persistent differences in social interaction and communication alongside restricted or repetitive behaviours, insistence on routine, or intensely focused interests.
• Present from early childhood – even when only recognised in adulthood.
• Now includes what used to be called Asperger syndrome.
Most autistic adults in the UK are undiagnosed. Many have spent a lifetime learning to camouflage (“mask”) their difficulties, which is effortful and exhausting and delays recognition – particularly in women and in older adults.
The primary-care task is recognition and appropriate referral, not diagnosis – diagnosis is a specialist, multidisciplinary process. Consider autism when there are persistent core difficulties and a genuine real-world impact.
| Core difference (one or more) |
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• Persistent difficulty with social interaction – reading others' thoughts or feelings, two-way (reciprocal) conversation. |
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• Persistent difficulty with social communication – literal interpretation, missing sarcasm or cues, seeming blunt without intending it. |
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• Rigid or repetitive behaviour – insistence on routine, distress at change, repetitive movements (“stimming”), or intense focused interests. |
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• Sensory sensitivities – unusual reactions to sound, light, touch, smell or taste. |
| Plus a real-world impact (one or more) |
|---|
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• Problems getting or keeping employment or education. |
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• Difficulty initiating or sustaining friendships or relationships; social isolation. |
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• Previous or current contact with mental health or learning disability services. |
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• History of another neurodevelopmental condition (especially ADHD) or a mental disorder. |
Heighten suspicion with:
• Longstanding or treatment-resistant anxiety or depression
• A lifelong sense of being “different”
• An autistic relative (including a recently-diagnosed child prompting self-recognition)
Remain especially alert to under-recognition in women and older adults who have learned to mask.
Source: NICE CG142 · NHS
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