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. It is present from early childhood – even when only recognised in adulthood – and now includes what used to be called Asperger syndrome.
The single most important fact for primary care is that 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) | Plus a real-world impact (one or more) |
|---|---|
|
• Persistent difficulty with social interaction – reading others' thoughts or feelings, two-way (reciprocal) conversation. |
• Problems getting or keeping employment or education. |
|
• Persistent difficulty with social communication – literal interpretation, missing sarcasm or cues, seeming blunt without intending it. |
• Difficulty initiating or sustaining friendships or relationships; social isolation. |
|
• Rigid or repetitive behaviour – insistence on routine, distress at change, repetitive movements (“stimming”), or intense focused interests. |
• Previous or current contact with mental health or learning disability services. |
|
• Sensory sensitivities – unusual reactions to sound, light, touch, smell or taste. |
• 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), and remain especially alert to under-recognition in women and older adults who have learned to mask.
Source: NICE CG142 · NHS
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