What's New?- November 2017

Autism is a lifelong developmental disability that affects how people perceive the world and interact with others. There are around 700,000 people in the UK living with autism and it can affect people from all nationalities, cultures, religions and social backgrounds. This pathway has been published to help GPs know when and how to refer to a specialist autism service for further assessment.

Autism in Adults Glos Care Pathway Overview

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Red Flags
GPs to use own clinical judgement to assess whether or not the patient is in crisis.

2gether- A Guide to Suicide Risk Assessment and Management in Primary Care can be found here.

Practice Point

Please see the "Urgent Care: general" section on G-care for SWAST's guidance on Requesting Ambulance Transport (999 or Urgent)



when a person has had these difficulties since childhood:

  • 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


  • 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 (link to pathway when published)) or mental disorder.



Differential Diagnosis
  • Obsessive compulsive disorders
  • Language Disorders
  • Impaired hearing or sensory impairment
  • Anxiety disorders
  • Schizophrenic Disorders (e.g. schizoid personality disorder)
  • Personality disorders
  • Attachment disorders
Initial Assessment

Consider a brief assessment to ascertain whether the following behaviours are present (if necessary using information from a family member, partner or carer):

  • difficulties in reciprocal social interaction including:
    • limited interaction with others (for example, being aloof, indifferent or unusual)
    • interaction to fulfil needs only
    • interaction is naive or one-sided
  • lack of responsiveness to others
  • little or no change in behaviour in response to different social situations
  • limited social demonstration of empathy
  • rigid routines and resistance to change
  • marked repetitive activities (for example, rocking and hand or finger flapping), especially when under stress or expressing emotion.
  • Notable differences in communication style, e.g. unusual tone of voice, unusual eye contact, unusual use of gesture and facial expression
  • A history of having an intensive interest or unusually specific interest

If two or more of the above categories of behaviour are present, refer for a comprehensive assessment for autism.

Use the Autism-Spectrum Quotient-10 items (AQ-10). The AQ-10 is a screening questionnaire to identify people who need further assessment. The questionnaire should be clinician led and not be given to the patient.

SCORING: Only 1 point can be scored for each question. Score 1 point for Definitely or Slightly Agree on each of items 1,7,8, and 10. Score 1 point for Definitely or Slightly Disagree on each of items 2,3,4,5,6 and 9

If a person scores above six on the AQ-10 , or autism is suspected based on clinical judgement (taking into account any past history provided by an informant), continue with referral to Autism Spectrum Condition (ASC) Diagnostic Assessment Service 2gether.

    Definitely Agree Slightly Agree Slightly Disagree Definitely Disagree
1. I often notice small sounds when others do not 1 point 1 point    
2. I usually concentrate more on the whole picture, rather than the details     1 point 1 point
3. I find it easy to do more than one thing at a time     1 point 1 point
4. If there is an interruption, I can switch back to what I was doing very quickly     1 point 1 point
5. I find it easy to 'read between the lines' when someone is talking to me     1 point 1 point
6. I know how to tell if someone listening to me is getting bored     1 point 1 point
7. When I'm reading a story I find it difficult to work out the characters' intentions 1 point 1 point    
8. I like to collect information about categories of things (e.g. types of car, bird, train, plant etc.) 1 point 1 point    
9. I find it easy to work out what someone is thinking or feeling just by looking at their face     1 point 1 point
10. I find it difficult to work out people's intentions 1 point 1 point    

  • Epilepsy
  • Visual impairment, hearing impairment
  • Mental Health
    • Depression
    • Anxiety
    • Obsessive-Compulsive
    • Neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) are common in adults with autism spectrum condition (ASC).
  • General learning disability
  • Underlying medical conditions, such as untreated phenylketonuria, congential rubella, cytomegalovirus or toxoplasmosis, fragile X syndrome or tuberous sclerosis.
  • Sleep disorders are common
Autism Spectrum Condition (ASC) Diagnostic Assessment Service-2gether


2gether provides a multi-disciplinary assessment service for adults over the age of 18 or students going to attend University in the near future who may be on the Autism Spectrum. The ASC Team comprises speech and language therapists, psychologists and psychiatrists. Occupational therapists may provide additional sensory assessments if required.


  • Assessment to identify the presence of (or lack of) an Autism Spectrum Condition and wider psychosocial needs
  • Regardless of diagnosis the individual will be signposted to services that may be appropriate
  • Six two hour post-diagnostic psycho-educational groups regarding Autism Spectrum Condition and how it impacts on the individual.
  • One two hour post-diagnostic psycho-educational group for carers.
  • Targeted awareness and specialist training for those supporting the individual. For example carers of people receiving a diagnosis, health professionals and social workers.

Consultation appointment open to anyone supporting an individual with an Autism Spectrum Condition and those with an ASC diagnosis. The opportunity to consult with a speech and language therapist, occupational therapist or psychologist either via telephone or face to face will be available by appointment. These consultation appointments will be available on a designated half day per month.

Please follow the resource link below to the ASC referral form. The Autistic Spectrum Quotient 10 (AQ-10) screening tool can be found here. If the score is 6 or above then continue with referral. Please send both the referral form and the completed AQ-10 to:

Pavilion, Lexham Lodge, Copt Elm Road, Charlton Kings, Cheltenham, GL53 8AG

Tel: 01242 634001

Referrals will be discussed and first contact will be made within four weeks.

For more information on the Autism Spectrum condition (ASC) Diagnostic Assessment Service please click here.

To book training or a consultation appointment please contact Jill Tyler:

Ongoing Care

The 2gether Autism Spectrum Condition (ASC) Service is a diagnostic service only. Any ongoing care should be provided through Social Care providers, Gloucestershire County Council in the first instance. Patients should be signposted to appropriate services in the community.

Please also see Gloucestershire's Community Connector Service (Social Prescribing).


Patient Resources

Please see the Community Resources and Patient & Carer Information & Leaflets sections.

Resources for Professionals

National Standards

Please see the National and NICE Guidance section.

There are no significant variations from the national standards in this pathway

Other Online Resources


Please see the Clinician Education section


Pathway Leads

Name Role Organisation
Pete Carter Senior Commissioning Manager Gloucestershire Clinical Commissioning Group
Dr Iain Jarvis GP Gloucestershire Clinical Commissioning Group
Jennie Christer Team Manager 2gether NHS Foundation Trust
Mark Scheepers Consultant Psychiatrist- LD Services 2gether NHS Foundation Trust
Jon Haynes Clinical Director 2gether NHS Foundation Trust
Nathan Gregory Performance and Development Lead 2gether NHS Foundation Trust

Reason for Pathway Selection

Autism is a lifelong developmental disability that affects how people perceive the world and interact with others. There are around 700,000 people in the UK living with autism and it can affect people from all nationalities, cultures, religions and social backgrounds. This pathway has been published to help GPs know when and how to refer to a specialist autism service for further assessment.

Completion Date

November 2017

Review Date

October 2018