Autism in adults: signs, assessment and support

The NHS says autism is something you are born with and affects how you communicate with and understand others, how you think, learn and pay attention, and how you respond to light, sound, smell, taste and touch. Some autistic people have a learning disability, and some have average or above average intelligence. It is not known what causes autism, but it can run in families, and the NHS says it is not caused by vaccines or medicines.

Autistic people are more likely to have conditions such as epilepsy, anxiety, eating disorders or depression, and ADHD is also more common.

The NHS says signs in adults may be similar to those in children, but you may have learned to adapt so they are not always noticeable. This is called masking, and it can make everyday activities and social interactions feel exhausting and stressful.

• Finding it hard to talk to other people, or spending more time alone.

• Difficulty understanding facial expressions, gestures or tone of voice.

• Taking things literally, for example not understanding phrases such as "it's a piece of cake".

• Fixed ways of doing things and distress when routines change.

• Repetitive movements (stimming) such as rocking, hand flapping or finger flicking.

• Very focused specialist interests.

• Strong sensory reactions, or none at all, to light, sound, smells, tastes or textures.

• Problems staying in education or keeping a job, difficulty making friends and relationships, and mental health problems.

The NHS says it can be harder to see signs of autism in women because of masking. Autistic women may be more likely to copy how others behave, appear to cope well in social situations, be very quiet in difficult situations and hide their feelings, show fewer repetitive behaviours than autistic men, and have a mental health condition such as anxiety, depression or an eating disorder. Autistic men can mask too. It may also be harder to spot autism in adults who have other conditions such as a learning disability, anxiety, depression, an eating disorder or ADHD.

The NHS suggests speaking to a GP, who can often refer adults to a local autism team. You may also be referred while getting help for another condition. NICE guidance for adults says clinicians can consider a short screening questionnaire, the AQ-10, in people without a moderate or severe learning disability, and that a score of 6 or above, or clinical suspicion, should lead to a comprehensive assessment.

The NHS says the team may ask you to fill in questionnaires, ask about behaviour with others, early life, and life at home, work or college, speak to someone who knew you as a child and someone who knows you now, read GP reports and ask for documents such as school reports or workplace assessments. You then receive a report saying whether you are autistic, what you are good at, what you might need help with, and whether other conditions were found.

If your referral is accepted the NHS says it can take a few months or longer to get an assessment, and a GP can tell you what support is available meanwhile. If you find it hard to get a referral you can ask to speak to someone else, such as another GP, for a second opinion. In England you can choose which NHS service does the assessment and may find a clinic with shorter waits through Right to Choose.

If you disagree with the result you can ask the assessment team why they decided as they did, ask the GP or team to refer you for a second opinion, or pay for another assessment by a professional you choose who works outside the NHS.

Autism is not treated as an illness, but the NHS says there are ways of managing it and getting support, including care plans and information for the person and their family. NICE guidance for adults recommends supported employment programmes, including help with CVs and interviews, training for the role, matching the person to a suitable job and advice to employers about reasonable adjustments. Mental health conditions that co-occur, such as anxiety or depression, can be treated in their own right.

NHS assessment is free but waits can be long. Private assessment can be quicker. Check that the team is multidisciplinary or that the assessing clinician is suitably qualified and experienced in adult autism, that the report follows recognised criteria, and whether the NHS or your employer or university will accept it for support; the NHS notes you can pay for another assessment outside the NHS if you disagree with a result.