Assessing ASD in Adults
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by significant difficulties in the following areas:
A. Persistent deficits in social communication and social interaction over time and across a range of contexts
- Unusual or abnormal social approach and response
- Limited reciprocal social interaction, reduced sharing of interests and emotions
- Difficulty in using or integrating verbal and non-verbal communication including eye contact, gesture, facial expression and body language
- Difficulty in developing and maintaining relationships, adjusting behaviour to suit social contexts
B. Restricted, repetitive patterns of behaviour, interests, or activities as manifested by at least two of the following:
- Unusually formal, repetitive or inflexible use of speech, language motor movements or objects
- Insistence on routines or ritualized behaviour patterns, or excessive resistance or distress in response to change
- Unusually specific or intense interests or preoccupations
- Under or over reaction to sensory factors (e.g. adverse response to specific sounds or textures, excessive smelling or touching of objects).
C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
D. Symptoms together limit and impair everyday functioning.
NB Autism Spectrum Disorder encompasses diagnostic criteria for Asperger’s Syndrome and Atypical Autism as defined in ICD-10 and DSM-IVR. Severity of presentation is best described in terms of the level of functional impairment which can be highly variable in different individuals.
Referral Guidelines
Adults who present with significant difficulties in social interaction, communication and rigid or repetitive behaviours and thinking are at increased risk of developing additional mental health difficulties.
Referral for further assessment and investigation should also take account of presenting symptoms that may indicate additional, comorbid conditions including anxiety, depression, sleep disorder, eating disorder, substance abuse or addiction.
Referrals should go to the patient’s local sector mental health team who will undertake further screening and diagnostic assessment as appropriate.
Screening for ASD should:
- Check for symptoms
- Assess the level of functional impairment experienced
- Take account of contextual and / or third party information (current and /or historical)
1 Check for symptoms
Ask the patient to complete the AQ10 screening tool by ticking one option for each question.
Scoring:
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 the individual scores more than 6 out of 10, refer for assessment by the local sector mental health team (CMHT)
If the patient scores less than 6 a referral may still be made if clinically indicated.
2 Assess the level of functional impairment experienced
Consider completing the WEISS Functional Impairment Rating Scale – Self Report (WFIRS-S) with the patient (or informant) to determine general level of functioning if there are no presenting health concerns.
Review the symptom screener with your patient and evaluate the level of impairment associated with their symptoms.
Referral to the local mental health team for a more detailed assessment of ASD is only indicated if there is some evidence of functional impairment. This may be self reported or described with the patient’s consent by an informant (e.g. parent or other family member, professional, e.g. Occupational Therapist or Clinical Psychologist, or someone who knows the patient in an educational or employment context).
3 Record third party information
Where possible it is helpful to include any additional information on symptoms and functioning from a third party (family or professional) that indicates:
a) Difficulties relating to social interaction and communication, rigid or inflexible thinking and behaviour and impact on everyday functioning
b) An indication of difficulties apparent from an early stage in the patient’s life (by primary school age).
If the patient describes significant impact on functioning in two or more areas persisting over time, consider a referral to the locality mental health team for further assessment.
Insert ASD ICP (see below)
Please consult any previous letters from mental health services for results and recommendations from previous assessments.
How to refer:
(Edinburgh/other areas?)
All referrals should be made through SCI Gateway using the adult mental health SCI referral protocol which should be completed in full.
Please include the AQ10 score with the referral.
Who to refer:
- The patient scores six or more on the ASD symptom screener (AQ10) and / or
- The patient is experiencing significant functional impairment in two or more areas (e.g. family life, work, education, looking after self, social life, risk taking)
- Consider referral for patients with an existing diagnosis of ASD seeking support for their mental health.
Who not to refer:
Patients with a diagnosis of learning disability or suspected learning disability (with or without a diagnosis of ASD) should be referred to the Community Learning Disabilities Team.
Patients who score below 5 on the AQ10 and who report no significant impact on everyday functioning should not be referred for further assessment of ASD.
Patients with an existing diagnosis of ASD with no additional mental health concerns can be signposted to Number 6, the one stop shop for ASD (insert link to Edinburgh website for all patients in the Lothians).
Patients with an existing diagnosis of ASD seeking support for their mental health – consider referral to the local community mental health team.
GP screening and referral
SIGN 145: Clinical Guideline for Assessment, Diagnosis and Interventions of ASD
NICE – ASD in Adults Diagnosis and Management
Patient Information
The ASD Post Diagnostic Pack contains information and signposting to resources for people who have had a diagnosis of ASD or who are seeking further information and support. It is divided into six sections and is available on the NHS Lothian Intranet:
ASD Post Diagnostic Pack Section 1 Introduction
Number 6, the One Stop Shop, Edinburgh
Funded through Autism Initiatives, Number 6 is a service for autistic adults who fit the following criteria: 16 and over, do not have a learning disability and live in the Lothians or the Scottish Borders. Number 6 provides free social opportunities, 1-1 advice and support on a range of issues.
Autism Awareness Charity & Services for Children & Adults in Scotland, providing information, services and support to families and professionals. Scottish Autism have developed an online programme, Right Click for individuals, parents and families of autistic people to access.
SWAN – Scottish Women’s Autism Network
Scottish Women’s Autism Network (SWAN) was established in partnership with Autism Network Scotland and functions as a hub for peer support and networking.
