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Autism in Adults Glos Care Pathway Overview

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.

Please click the relevant flowchart box to be taken directly to textual information.

                           

Presentation

Consider assessment for possible autism:

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

and

  • 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.
Red Flags
GPs to use own clinical judgement to assess whether or not the patient is in crisis.
  • If patient is in crisis please refer to Crisis Team. Referrer information for Mental Health Services- Gloucestershire including the Contact Centre, Mental Health Acute Response Service (MHARS) (formerly Crisis Resolution and Home Treatment Teams) can be found here.
  • If patient is not in crisis please continue with referral to 2gether Autism Spectrum Condition (ASC) Diagnostic Assessment Service

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

Differential Diagnosis
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
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 Wellbeing Service (Social Prescribing).

Notification of Serious Untoward Incidents (SUIs)

Recent reviews of serious incidents have identified potential system and process changes which could improve the quality and responsiveness of care for people who require secondary care mental health services.

It would be helpful if GPs could please share any information in relation to substance misuse with GHC, particularly when a patient is injecting, as this aids clinical risk assessment and management. It is also really helpful if referrals into mental health services contain an appropriate risk assessment.

In all instances when a patient dies unexpectedly, especially if the cause of death is suspected suicide, GPs should inform GHC as soon as possible. This will allow GHC to quickly put in place support for those bereaved and minimise the risk of appointment letters etc. being sent to the deceased.

Contact: gordonbenson@nhs.net (Assistant Director of Governance & Compliance, GHCNHSFT)

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