Autism-spectrum disorders (ASD) are a complex group of
developmental disorders frequently associated with comorbid
psychiatric disorder, colouring their presentation and complicating
their management. Presenting over a wide range of age and ability,
they are encountered in all psychiatric specialities.
This report is a consensus view of the psychiatric services
required for many with ASD in adolescence and adulthood. The focus
is often on diagnosis, but this is only one part of a wider process
of multidisciplinary assessment that should then flow on to
management. While the report focuses narrowly on psychiatry, it
recognises that this is only one part of a more extensive range of
services. It is a preliminary exercise, intended to inform the
broader, multidisciplinary and multi-agency approaches that are
under way across the whole of the UK. It is addressed to
psychiatrists, stakeholders in the development of ASD services and
commissioners of adolescent and adult services, across all the
psychiatric specialities.
After a description of the syndrome, its comorbidity and
epidemiology, the report distinguishes diagnosis from the fuller,
multidisciplinary assessment. Reviewing the methodology and
difficulties of this process, it concludes that all psychiatrists
should be able to recognise the syndrome, diagnosing it in
clear-cut cases, and be aware of its implications. This has to be
the subject of postgraduate training at all levels, from basic
psychiatric training through to the consultant’s continuing
professional development.
Besides the lack of services specific to this population,
people with ASD are poorly served by most standard services - in
particular, those who are too old for adolescent services and too
able for learning disability services. For those whose diagnosis is
less straightforward or whose clinical management is more complex,
there needs to be access to local specialist expertise and, where
necessary, to tertiary specialist services. This applies
particularly to the provision for psychiatric admission, whether as
day-patients or in-patients, for a group of people for whom the
usual clinical environ can be distressing and unhelpful.
Psychiatric services need to improve through a combination of
training, better liaison between the specialities and the
development of specialist interest and tertiary services, the last
including the development of autism-specific services both in the
statutory and in the independent sectors.
Psychiatric services are overstretched by existing demands so
that any improvement will only come about if driven by service
commissioners who recognise the shortfall and specifically support
further developments.