Autism

Overview

Autism is a lifelong condition that affects how a person communicates, behaves and reacts compared with people who are not autistic. Each autistic person has their own experiences, and signs may be noticed at a very young age or not until later in life. The NHS describes common signs in children and adults, such as differences in communication, repetitive movements, sensory differences and distress at changes in routine. Autism is a difference rather than an illness, and there is no cure. A diagnosis comes from an assessment by a team of health professionals, usually after a referral from a GP.

Symptoms

What a clinician may find

• Differences in communication, such as not responding to their name or less eye contact.
• Repetitive movements such as hand flapping or rocking.
• Being worried or upset by changes in routine or surroundings.
• Sensory differences, such as distress at certain sounds or textures.
• In adults, getting very anxious about social situations or finding it hard to make friends or preferring to be on their own.

Complications

• Masking, which means adapting so that signs are not always noticeable, can make everyday activities and social interactions feel exhausting and stressful.
• Other conditions such as anxiety, depression, an eating disorder or ADHD can occur alongside autism and can make the signs harder to see.

Diagnosis

The NHS says there is no definitive sign or list of signs that can show whether someone is autistic; autism is assessed by clinicians who gather information on multiple signs. Assessment is carried out by a team of health professionals. A GP is the usual route to referral, and for children a school's special educational needs coordinator (SENCO) can also refer. For children under 5 a health visitor can be contacted. NICE guidance for under 19s covers recognition, referral and diagnosis from birth up to 19 years.

Treatment

The NHS describes support options for the time before and after an assessment. While waiting for an assessment, the NHS suggests speaking to teachers or the SENCO at school, to a manager or HR at work, or asking the local council for a needs assessment. A GP or education professional can say what support is available in the meantime. Telling people close to the person about autism can help them understand how to support them.

Prevention

Autism is a lifelong condition. The National Autistic Society says valproate exposure in pregnancy is now a rare cause of autism because prescribing of valproate is restricted.

Key facts

What is autism?

Autism is a lifelong condition that affects how a person communicates, behaves and reacts. The NHS describes the main signs as differences in how someone communicates, behaves and reacts compared with people who are not autistic.

The NHS says signs might be noticed at a very young age, or not until later in life.

The NHS also says there is no definitive sign, or list of signs, that can show whether someone is autistic. Instead, autism is assessed by clinicians who gather information on multiple signs. This is why a formal assessment by a team of health professionals matters. The sections below describe the signs the NHS lists for children and for adults, how assessment works, what is known about causes, and where to turn for help, including in a crisis.

What are the signs of autism in children?

The NHS lists signs in how a child communicates, behaves and responds to the world. Examples of communication differences include not responding to their name and using eye contact less often. Another NHS page mentions not smiling or responding to other people's facial expressions, and a preference for playing alone.

Repetitive movements, sometimes called stimming, are also described. They include rocking, spinning, flapping the hands and flicking the fingers. The NHS notes that these movements can also be a way to calm down or to handle excitement.

Autistic children may be worried or upset by changes in routine, by their environment, or by new situations, and some have strong emotional reactions to a change in routine.

Sensory differences are common in the NHS descriptions. A child may react strongly, or not at all, to lights, sounds, smells, tastes or textures, and some children eat only a limited range of foods because of texture or how food is served.

Autism can look different in girls. The NHS says autistic girls may hide some signs by copying how other children behave and play, and may show fewer repetitive behaviours than autistic boys. This can make diagnosis harder, so a girl's needs may be missed.

What are the signs of autism in adults?

The NHS lists signs in adults that include getting very anxious about social situations and finding it hard to make friends or preferring to be on their own. Other NHS pages mention that autistic people may be unsure how much eye contact to use, that making small talk is often hard, and that socialising can leave adults exhausted.

The NHS explains that some people learn to adapt so that signs are not always noticeable. This is called masking, and it can make everyday activities and social interactions feel exhausting and stressful. NHS inform adds that masking is not a conscious choice, and that an autistic person may not be able to start or stop masking at will.

The NHS says women may copy how other people behave, appear to cope well in social situations, be very quiet in difficult situations and hide their feelings, and show fewer repetitive behaviours than autistic men. It may also be harder to see signs of autism if an adult has other conditions such as anxiety, depression, an eating disorder or ADHD.

An NHS trust describes a short questionnaire called the AQ10, which gives only a general indication of whether someone might be autistic.

What causes autism?

The sources used here describe only some of what has been studied about the causes of autism.

Valproate is an anti-seizure medicine. A Danish registry study found that maternal use of valproate during pregnancy was linked to a significantly increased risk of autism spectrum disorders, even after allowing for maternal epilepsy. The National Autistic Society describes valproate exposure in pregnancy as a rare cause now, because prescribing of valproate is restricted.

A review of antenatal factors found little evidence that environmental exposures play a significant role in causing autism. The same review noted that most infants who were exposed before birth to such drugs or chemicals do not develop autism.

Because there is a lot of public discussion about causes, it is worth saying that the sources checked for this page do not describe a single cause that applies to all autistic people.

How is autism assessed and diagnosed?

Autism is usually diagnosed by an assessment from a team of health professionals. Referral usually comes through a GP, or, for children, through a school's special educational needs coordinator (SENCO). NHS inform advises contacting the GP practice if a child might be autistic and a formal assessment is needed, and a health visitor or GP can be contacted for children under 5. The NHS says it is possible to wait a few months for an appointment.

The NHS describes a second opinion as an option if a GP is reluctant to refer. Private assessments are also possible, and a referral from a GP or other NHS professional is not needed to request a private or independent assessment.

NICE guidance for under 19s covers recognition and diagnosis from birth up to 19 years. It asks providers to set up a single point of referral to the autism team. Practitioners are told to consider referral when they have concerns about possible autism based on reported or observed features. NICE says that a positive score on a screening tool may support a decision to refer but can also reflect reasons other than autism, and that a negative score does not rule out autism.

Support while waiting and when to get help

The NHS suggests that while waiting for an assessment, a person can speak to teachers or the SENCO at school, to a manager or human resources at work, and can ask the local council for a needs assessment. A GP or education professional can say what support is available in the meantime. The NHS says telling people close to the person about their or their child's autism can help them understand how to support them.

The NHS advises consulting a GP, or a health professional already seen, if someone thinks they or their child may be autistic. A GP appointment is the usual first step.

For urgent mental health help that is not an emergency, NHS 111 has a mental health option that connects to a local NHS crisis line, free and open 24 hours a day. If someone is in immediate danger, has seriously harmed themselves or may be about to, call 999 or go to A&E. Samaritans can be called free at any time on 116 123 by anyone who wants to talk, including people who feel suicidal.

Frequently asked questions