GPAtlas🧭 When to suspect
Autism (autism spectrum disorder) is a lifelong neurodevelopmental condition defined by two core domains: persistent difficulties in social communication and social interaction, together with restricted, repetitive patterns of behaviour, interests or activities – the latter now explicitly including sensory differences in both ICD-11 and DSM-5. Features are present from early childhood, although they may be masked until social demands exceed the child's capacity, and they cause impairment across more than one setting (typically home and school).
The role of primary care is recognition and referral, not diagnosis. Diagnosis is a clinical, multidisciplinary judgement made by the local autism team using ICD-11 or DSM-5 criteria – there is no blood test or scan. Two skills matter most: recognising the pattern (and taking concerns seriously even when others do not share them), and recognising the one presentation that needs a faster, different route – regression.
Refer on the basis of features suggesting possible autism, weighing their severity and duration, their consistency across settings, their functional impact, the level of parental concern, and the factors that increase the likelihood of autism (see History). Loss of previously acquired skills is the exception that changes the route:
| Presentation | First referral route |
|---|---|
| Regression in language or social skills, child < 3 years | Refer directly to the local autism team (proceed to diagnostic assessment) |
| Regression in language, child > 3 years | Refer first to a paediatrician or paediatric neurologist |
| Regression in motor skills, any age | Refer first to a paediatrician or paediatric neurologist |
| Features suggesting possible autism (no regression) | Routine referral to the local autism team |
Take parents' or carers' (and, where appropriate, the child's) concerns seriously even if a school, another professional or a previous assessment did not – autism is under-recognised in girls and in verbally-able children, and good eye contact, affection or apparently normal early language do not exclude it.
Source: NICE CG128
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