Ep 61 – Autism

In this episode Dr Hannah Rosa and Dr Nicky Mulgrew discuss autism and the role we play within general practice. They focus on when we should refer children and adults to specialists to get a possible diagnosis of autism and also explore how we can adapt our workplaces and our communication styles to make our surgeries more comfortable places for autistic people to visit.

Key references discussed in the episode:

1. ICD-11. 6A02 Autism spectrum disorder.
2. Belcher H. 2022. Autistic people and masking.
3. Unigwe S, et al. Br J Gen Pract. 2017 Jun;67(659):e445-e452. doi: 10.3399/bjgp17X690449.
4. Buckley C. 2016. Autistic spectrum disorders.
5. Crane L., et al. Autism. 2016 Feb;20(2):153-62. doi: 10.1177/1362361315573636.
6. NICE. Autism spectrum disorder in under 19s: recognition, referral and diagnosis (CG128). 20 December 2017.
7. NICE. Autism spectrum disorder in adults: diagnosis and management (CG142). 14 June 2021.
8. Mandell DS, et al. Am J Public Health. 2009 Mar;99(3):493-8. doi: 10.2105/AJPH.2007.131243.
9. Hirvikoski T, et al. Br J Psychiatry. 2016 Mar;208(3):232-8. doi: 10.1192/bjp.bp.114.160192.

Useful resources:

• Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R).
• Autism Spectrum Quotient (AQ-10) test.
• National Autistic Society. Good Practice Guide for Mental Health Professionals.
• National Autistic Society website.
• The online Solihull parenting course.

Key take-home points:

• Autism is a lifelong neurodevelopmental disorder that affects at least 1% of the population.
• The ICD-11 definition states that autism spectrum disorder is characterised by persistent deficits in social interaction, social communication and behavioural differences. It occurs typically in early childhood, but symptoms may not become fully manifest until later. Deficits are sufficiently severe to cause impairment in important areas of functioning. Individuals along the spectrum exhibit a full range of intellectual functioning and language abilities.
• Two useful screening tools are the M-CHAT-R for toddlers and AQ-10 for adults.
• Masking, or camouflaging, is a strategy that autistic people often use to hide parts of themselves to blend in with others around them. Worryingly, studies are now showing that these techniques can be detrimental to mental health.
• There are higher rates of both mental and physical health conditions for autistic people when compared with neurotypical people, and there are many barriers which prevent autistic people from arranging and attending healthcare appointments. But there are a number of small changes that we can all make to ensure that out surgeries are more accessible to autistic people.