Executive summary (primary care lens)
- Recognise: lifelong social communication differences, restricted/repetitive patterns, sensory sensitivities, and functional impact (work, relationships, daily living).
- Primary care role: validate concerns, assess risk (self-harm, exploitation, safeguarding), screen for coexisting conditions, and refer for diagnostic assessment where appropriate.
- Reasonable adjustments improve access: predictable appointments, clear written summaries, sensory-friendly environments, and explicit communication.
Recognition: common consultation cues
- Repeated difficulty with social reciprocity, workplace conflict, burnout, or “masking” fatigue.
- Marked sensory sensitivity (noise, light, textures) affecting function.
- Rigid routines, intense interests, distress with change.
- High rates of coexisting anxiety/depression, ADHD, sleep problems, and GI symptoms.
Risk and safeguarding
Assess for self-harm, exploitation, domestic abuse, substance use, and crisis presentations. Autistic adults can be at increased vulnerability due to social naivety, isolation, and communication barriers—document and act on safeguarding concerns.
Management principles (what CG142 emphasises)
- Do not use medication to treat the core features of autism.
- Address coexisting mental disorders using standard evidence-based pathways, adapted with reasonable adjustments.
- For behaviour that challenges, prioritise environmental/psychosocial approaches; specialist input is usually required before antipsychotics are considered.
- Offer carers/support networks information and signposting (employment, benefits, advocacy, local autism services).
Frequently asked questions
Should I prescribe an SSRI for “autism-related anxiety”?
Treat anxiety disorders as you normally would, but adapt delivery (communication, pacing, sensory factors). Medication can be appropriate for diagnosable anxiety/depression; it is not for “autism itself”.
What’s the simplest “reasonable adjustment” that helps?
Clear written plans after consultations, explicit instructions, predictable follow-up, and allowing more time or alternative communication where needed.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.