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This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
The Bottom Line
- Two core domains: (1) persistent difficulties in social communication and interaction, (2) restricted/repetitive behaviours, interests, or activities
- Onset in early childhood but may not be recognised until adulthood — particularly in women and those with average/above-average IQ ("masking")
- Diagnosis in adults: NICE CG142 — specialist assessment using structured tools (ADOS-2, ADI-R). AQ-10 for screening
- No medication for core autism features — support is environmental, psychoeducational, and psychosocial
- Manage comorbidities: anxiety (~50%), depression (~40%), ADHD (~30%), sensory sensitivities, sleep difficulties
- Reasonable adjustments in healthcare: clear communication, predictability, reduced sensory stimulation, longer appointments
Overview
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition characterised by two core features: persistent difficulties in social communication and social interaction across multiple contexts; and restricted, repetitive patterns of behaviour, interests, or activities. It is a spectrum — individuals vary widely in presentation, strengths, and support needs. Previously separate diagnoses (autism, Asperger syndrome, pervasive developmental disorder) are now unified under ASD in ICD-11 and DSM-5. Many autistic adults were not diagnosed in childhood, particularly women and those with average or above-average cognitive ability, who may have developed sophisticated "masking" or "camouflaging" strategies to navigate social expectations. Late diagnosis can be associated with significant relief but also grief over missed support.
Epidemiology
ASD prevalence is estimated at approximately 1–2% of the UK population (~700,000 adults). The male:female diagnostic ratio is approximately 3:1 in clinical populations, though this is likely an artefact of under-diagnosis in women and girls (the true ratio may be closer to 2:1). Diagnosis rates are increasing due to improved recognition and broadened diagnostic criteria. There is strong genetic heritability (~80%). ASD frequently co-occurs with intellectual disability (~30%), ADHD (~30%), anxiety, depression, epilepsy, and sensory processing differences. Autistic adults have significantly reduced life expectancy due to physical and mental health comorbidities and higher suicide rates.
Clinical Features
Symptoms
Difficulty understanding social cues: body language, facial expressions, sarcasm, implied meaning
Difficulty initiating and maintaining reciprocal social interactions and friendships
Preference for routine, distress at unexpected changes — need for predictability and sameness
Intense, focused interests — often in specific, narrow topics pursued with great depth
Sensory sensitivities: hypersensitivity or hyposensitivity to light, sound, texture, taste, smell
Repetitive behaviours: stimming (hand-flapping, rocking), echolalia, repetitive speech patterns
Masking/camouflaging: consciously mimicking social behaviour — exhausting and associated with burnout, anxiety, depression
Executive function difficulties: planning, organisation, flexible thinking, task switching
Signs
Reduced or atypical eye contact
Flat or atypical prosody in speech (monotone, unusual rhythm)
Literal interpretation of language, difficulty with ambiguity or idioms
Stimming behaviours (may be suppressed in clinical setting)
May present formally or have well-rehearsed social scripts that mask difficulties
Investigations
First-line
AQ-10 screening toolAutism Quotient (10-item version): score ≥6 suggests referral for specialist assessment. Quick, validated screener in primary care
Detailed developmental historyChildhood social, communication, and behavioural development. Informant history (parent/carer) extremely valuable even in adulthood
Second-line
Screen for comorbiditiesAnxiety (GAD-7), depression (PHQ-9), ADHD (ASRS), sleep disorders, eating difficulties — very common
Specialist
Specialist autism assessment (NICE CG142)Carried out by specialist multidisciplinary team. Tools: ADOS-2 (Autism Diagnostic Observation Schedule) and ADI-R (Autism Diagnostic Interview — Revised)
Cognitive assessmentMay include IQ testing to determine co-occurring intellectual disability and guide support needs
1
Post-diagnostic support
- Psychoeducation about autism for the individual and their family/support network
- Signposting to peer support, local autism support organisations, online communities
- Post-diagnostic counselling to process the diagnosis and its implications
2
Environmental and social support
- Reasonable adjustments in healthcare, education, and employment: clear communication, predictable routines, reduced sensory input, written information, longer appointments
- Social skills groups (if desired by the individual — respect autonomy)
- Support with daily living, employment, housing as needed — personalised to individual strengths and needs
- Occupational therapy for sensory and daily living support
3
Managing mental health comorbidities
- Treat anxiety, depression, ADHD as per standard guidelines but with autism-appropriate adaptations
- CBT for anxiety/depression: adapt for autism — concrete, structured, visual aids, fewer metaphors
- Medication (SSRIs, stimulants) as indicated for comorbid conditions — start low, go slow (may be more sensitive to side effects)
- Do NOT offer social skills training for core autism — it is not a deficit to be trained away
4
Medication for core autism
- No medication is effective for the core features of autism (NICE CG142)
- Do NOT offer antipsychotics for core autism features
- Consider melatonin for sleep difficulties (common in autism, often disrupted circadian rhythm)
Complications
- Mental health: Anxiety (~50%), depression (~40%), higher suicide risk (especially in autistic women and late-diagnosed individuals)
- Autistic burnout: Chronic exhaustion from masking and sensory overload — can resemble depression but requires different management
- Social isolation: Difficulty maintaining friendships and relationships
- Employment: High unemployment rates despite strong skills — due to interview barriers, sensory environment, social demands
- Diagnostic overshadowing: Physical and mental health symptoms attributed to autism rather than investigated properly
UKMLA Exam Tips
- 1Two core domains: (1) social communication/interaction difficulties, (2) restricted/repetitive behaviours/interests
- 2Onset must be in early development — but may not be recognised until adulthood (especially in women, masking)
- 3AQ-10 ≥6 = refer for specialist assessment. Diagnosis requires ADOS-2/ADI-R by specialist team
- 4No medication for core autism features. Treat comorbidities (anxiety, depression, ADHD) with adapted standard approaches
- 5Women and girls are under-diagnosed — presentation may differ (masking, internalised rather than externalised difficulties)
- 6Reasonable adjustments in healthcare: essential — clear language, predictability, reduced waiting, sensory considerations
- 7Autism is a neurodevelopmental DIFFERENCE, not a disease to be cured — person-centred, strengths-based approach
practicetest your knowledge on autism spectrum disorderApply what you've learnt with UKMLA-style questions from the iatroX Q-Bank — psychiatry and beyond.
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