Autism and mental health

Autism is a diagnosis given to people who have lifelong differences in:

• how they communicate and interact with others
• their behaviours and interests.

You might hear autism described as a ‘neurodevelopmental disorder’ or condition. This is the term used in the criteria that helps healthcare professionals to make a diagnosis of autism.

Neurodevelopmental conditions are something you are born with, and mean you experience the world differently to other people.

Autism and intellectual disabilities

This information will be most helpful to autistic people who do not have an intellectual disability (also known as a learning disability). Autistic people with intellectual disabilities are a unique and important group who require specific information and support.

The words used to describe autism have changed a lot over time, and will probably continue to change as time goes on. Your clinician should be happy to use the terms you prefer.

Terms used in the past to describe autism included Asperger syndrome and high-functioning autism. If you were diagnosed using either of these terms, that diagnosis is still valid.

In this resource, we will use the word autism, and the phrase ‘autistic people’. These are the terms preferred by the majority of the autistic community in the UK. However, some people prefer alternative terms.

Autism spectrum disorder (ASD) or autism spectrum condition (ASC)

ASD is the diagnosis that you will probably be given by a healthcare professional if you receive a diagnosis today. The word ‘spectrum’ is used to show that the experiences and needs of autistic people are on a broad spectrum. ASC is sometimes preferred because the word ‘disorder’ can have negative connotations.

Neurodiversity

Neurodiversity is a way of understanding autism, other neurodevelopmental conditions and disabilities. The idea of neurodiversity is that all humans experience the world differently.

The word ‘neurodivergent’ is used to describe people whose brains function significantly differently to the general population.

If you want to read more about the words used to describe autism, visit the National Autistic Society website.

If you are autistic, you will have some or all of the following traits.

Social communication and interactions

You might have differences with how you:

• understand social communication with others
• use non-verbal communication such as facial expressions and gestures
• understand and use language in social settings
• start and sustain conversations
• socialise with others
• understand and experience emotions in yourself and others
• share interests with others
• make and sustain friendships.

Behaviour, interests and activities

You might have differences in how you:

• Adapt to new experiences or unexpected events. For example, you might feel very distressed if a plan is changed.
• Develop and stick to your routine. For example, you might need to take the exact same journey to the shops or eat at the exact same time each day.
• Adhere to rules. For example, if you are told how to complete a task at work and are then asked to do it differently, you might find this confusing and frustrating.

You might also:

• Perform rituals, such as doing tasks in a certain order.
• Make repetitive movements (sometimes called stimming) or have particular ways of moving. For example, rocking, walking on your tiptoes, and moving your hands or fingers, sitting or standing in specific ways.
• Have special interests. For example, you might be very interested in a particular TV show, period of history, or type of object.
• Have high sensitivity to sounds, lights, textures, smells or tastes. You might find these things very distressing or uncomfortable. Or you might find them very comforting.

Healthcare professionals use these traits when they are making a diagnosis of autism, to look for evidence of differences between the person they are assessing and the general population.

These traits focus on things that autistic people are unable to do, or struggle to do.

How difficult these traits make your life can depend hugely on:

• your environment
• the understanding and support you receive from the people around you.

How people perceive their autistic traits can also vary hugely. Some people think about autism in terms of strengths or differences, while others think of autism as a disability. Many people think about autism as a combination of these things. All of these perspectives are valid, and how you see autism will probably be unique to you.

Doesn’t everyone have some of these traits?

Many people experience some of the things described above from time to time. However, in autism these traits will be more obvious to you or others. To receive an autism diagnosis, these traits also need to have a significant impact on your daily life, for example on your:

• personal, family and social life
• education or work
• physical and mental health.

Having one or even several of these traits doesn’t necessarily mean that someone is autistic. Many of the traits of autism exist in people who are not autistic, or in people with other conditions.

Why might autism be missed or misdiagnosed?

Autism can be missed in people who:

• are deaf
• are blind
• have intellectual disabilities
• have mental health conditions
• are older
• are girls or women.

Autistic traits can also be expressed differently and be less obvious in people who are:

• in certain careers, such as the military where rules are strict and must be carefully followed
• part of a religious group or establishment, which have specific rituals or routines
• part of a family where other family members are autistic or have autistic traits
• from another culture or country to the one they are living in, or in people who speak another language to the language of the country they are living in.

Misdiagnosis

Unfortunately, it is quite common for autistic people to be misdiagnosed. This might mean being told you have a different condition when you are actually autistic. For example, you might be told you have a mental health condition like anxiety or depression and find out later that you are autistic.

If you are misdiagnosed you might:

• feel confused, misunderstood or not listened to
• be given the wrong medications or treatments
• struggle to get the correct diagnosis.

All of these things can have a negative effect on your mental and physical health.

Many autistic people see their autistic traits as strengths. For example, autistic people might be more direct and honest, which is a communication style that many people prefer. Autistic people can also have a strong sense of justice and loyalty, which can help them to form and maintain long-lasting relationships.

For autistic people who have strong special interests, they can be incredibly knowledgeable and motivated by subjects that are important to them. Autistic people can be very punctual, adhere strongly to rules, be detail-oriented and have a drive for perfection. These attributes can mean they excel at things that require focus and commitment.

Many autistic people also have unique perspectives on the world that help them to approach challenges in original ways. Where autistic people’s strengths are encouraged and supported, they can have strong and fulfilling friendships, relationships and careers.

If you receive an autism diagnosis, your report might refer to levels. For example, level 1, 2 or 3. Your healthcare professional might use these levels to reflect the level of support they think you might need at the time you are assessed.

However, this can be overly simplistic because support needs often change. They can increase or decrease day to day, with age, and in different environments.

It can be more helpful to think of autism like this:

In this example, there are two autistic people. The spikes represent how significant each person’s traits are in each area, or the level of support they need in that area. For example:

• The first person has a larger ‘social differences’ spike, so might need more support socially.
• The second person has a smaller ‘sensory sensitivities’ spike, so might have less differences with how they experience senses like taste and smell.

Some of these spikes might increase or decrease at different times and in different environments.

Some autistic people have other co-occurring conditions or behaviours that can affect the level of support they need. These include:

• Intellectual disabilities.
• Communication differences. For example, being ‘non-verbal’ or ‘non-speaking’.
• Behaviours that challenge, such as aggression and self-injury.

The most important thing is that autistic people should receive:

• the support they need
• in the areas they need it in
• when they need it.

“One of the worst things I’ve had is ‘you don’t seem like you’re autistic’. It belittles the amount of effort I put in because it’s like, I tried, and now I’m being invalidated.” Matthew

Autism is usually first noticed in early childhood, but is sometimes not noticed until later in life.

If you are autistic, your parents or carers might have noticed that you had some autistic traits when you were a child. However, these traits might not have been obvious to others or caused you any challenges until you got older. This is one of the reasons that some autistic people are not diagnosed until they are adults.

More adults are being diagnosed now than in the past. This might be due to:

• an increased understanding of autism in adults and autism in women
• more availability of adult assessment clinics.

People over the age of 40 are far less likely to have received an autism diagnosis. This is probably because until recently autism was seen as a ‘childhood’ condition.

Autism in older people

Older autistic people might have worked hard to manage any challenges. Or they might have received support from friends and family. Because of this their autism might have gone undiagnosed or unnoticed for a long time. However, these people might face challenges related to their autism as they age.

If you are experiencing challenges relating to autism, it is important that you get the support you need, no matter what age you are. It is never too late to seek an autism assessment if you are not receiving sufficient support and understanding.

We do not know exactly what causes autism. As time goes on we will probably learn more about autism and why it happens. It seems that both genetic and environmental factors might work together to make someone more likely to be autistic.

You might be more likely to be autistic if you:

• have a sibling or parent who is autistic
• have certain genetic differences
• experienced differences when you were developing in the womb. For example, reduced blood supply from the placenta.

These things have been shown to be associated with an increased likelihood of a person being autistic. This does not mean that these things are definitely the reason that someone is autistic.

What doesn’t cause autism?

There are a number of incorrect and dangerous beliefs about what causes autism. Research has shown no evidence that the following things are associated with autism:

• vaccines
• diet
• parenting style.

It is estimated that at least 1 in every 100 people are autistic. Some studies estimate that this number is higher.

Autism is more commonly diagnosed in men and boys than in women and girls. It is likely that autism is underdiagnosed in women and girls. This means that more women and girls are autistic than we realise. Autistic people are also more likely than the general population to be transgender or nonbinary.

The number of people being diagnosed as autistic is rising, particularly in women. This is likely due to better public awareness and recognition of autism, which has led to more people seeking autism assessments.

Are other conditions more common in autistic people?

Autistic people are more likely to have other conditions like:

• ADHD
• intellectual disabilities
• learning difficulties like dyslexia
• tics
• developmental coordination disorder
• epilepsy
• joint hypermobility and Ehlers-Danlos syndromes.

There is no one test that can diagnose autism. However, there are questions that healthcare professionals can ask to understand if someone is autistic or not.

Speaking to your GP

If you think you are autistic, you should speak to your GP or other healthcare professional. They should ask you questions to understand if you might be autistic and could benefit from an autism assessment.

An autism assessment should be considered if you are experiencing substantial challenges with one or more of the following, and these challenges have been going on for a long time:

• social interactions
• social communication
• rigid and repetitive behaviours, resistance to change or restricted interests.

and if you have had one or more of the following:

• challenges starting and remaining in employment or education
• challenges starting and maintaining relationships
• previous or current contact with mental health services, or learning disability services
• a neurodevelopmental condition or mental illness, currently or in the past.

You might be asked to complete a screening questionnaire, such as the Autism Quotient (AQ). Getting a high score on the AQ does not necessarily mean that you are autistic. You could also get a high AQ score if you have another neurodevelopmental condition or a mental health condition.

Getting an autism assessment

If your GP feels you would benefit from an autism assessment, they should refer you for one. Waiting times for autism assessments vary across the UK, but in some places can be 12 months or longer. In some cases, it can take up to several years.

Some people choose to seek out a private autism assessment. However, private autism assessments are not always accepted by social or healthcare services. For this reason, before you get an assessment from an alternative provider, you should make sure that it will be accepted by your local services.

Who will do my assessment?

An autism assessment might involve a range of professionals trained in different areas. They can work together to understand whether you are autistic. The kinds of professionals involved in your assessment will depend on you and your individual needs.

Your autism assessment might be with an autism assessment team, or another clinical team.

In some cases, your autism assessment might be carried out by a single clinician. Usually this will be a psychiatrist or clinical psychologist.

What should happen in an autism assessment?

Your assessment might involve your family, friends or carers if this could help the person assessing you to understand more about your life.

In an assessment, you and your family, friends or carers might be asked about:

• Whether you have any of the traits of autism described at the beginning of this resource.
• Whether you had them in childhood, adulthood or both.
• Your developmental history. For example, when you learned to speak or walk.
• Any challenges you have now, or had in the past that might put you at risk. For example, self-harm, substance misuse or aggression.
• How well you function in different environments. For example, home, education or employment.
• Any physical or psychological conditions you might have, or have had in the past.
• Other neurodevelopmental conditions you might have, such as ADHD.
• Any sensory sensitivities you have.

An assessment should also use any documentation that might help to get a better understanding of your experiences. For example, old school reports.

Your assessment should be adapted to any communication or accessibility needs you have. For example, if you need a sign language interpreter you can ask for one and it should be provided to you.

What should happen after an autism assessment?

After your assessment is finished you should be given a report that says:

• if you are autistic or not
• what you might need help with
• what your strengths are.

You should then be offered another appointment to talk to someone about your diagnosis.

There are multiple possible outcomes from an autism assessment, including:

• A diagnosis of autism.
• Being told you have autistic traits but have not reached the ‘threshold’ of an autism diagnosis.
• Receiving a different diagnosis, or being referred for separate assessments or support.

Do I need an autism diagnosis?

Getting an autism diagnosis is one way to get the right care and support for you. If you are autistic and have challenges in your life, a diagnosis can identify these challenges and the kinds of support that might help you.

However, an autism diagnosis is not essential. You might decide that you don’t need a diagnosis if:

• you are not facing any substantial challenges in your life
• you have worked out ways to support yourself
• you are getting the kind of support you need already.

It is also important to note that a diagnosis isn’t necessary to apply for benefits, though it can be helpful.

If you are autistic and are experiencing challenges, you might benefit from support in certain areas of your life.

Following a diagnosis

If you have been given an autism diagnosis, you might be offered some of the following things. These things will be particularly helpful if you have any coping mechanisms that might put you at risk, such as self-harm. Unfortunately, while many people would benefit from support following a diagnosis, this often doesn’t happen.

A care plan. This should be developed with you, and consider your needs and any changes to your environment that might help you. If appropriate, your care plan might also look at the needs of your family, partner or carer.

A health passport. This can help you to communicate your needs to healthcare professionals. There are lots of different kinds of health passports, but you can see an example of one from the National Autistic Society.

A safety plan, if you are at risk of significantly harming yourself or other people, or if you are at risk of exploitation or abuse. This would cover:

• Things you can do to reduce this risk.
• How different services might need to be involved in your care.
• Advice for your friends, family and carers on how they can support you.
• Changes to your environment that can help.

Other forms of support

Depending on the help you need, where you live and the services available in your area, you might be able to access support around:

• life skills
• social interaction and isolation
• employment
• risk of victimisation
• anger and aggression.

Unfortunately, in many parts of the UK these services are not available, or can only be accessed privately. If you have very high support needs, you might be able to access support through social care services.

Reasonable adjustments

Employers, colleges, universities, and health and social care services are legally required to make ‘reasonable adjustments’. These are changes that help to ensure people with disabilities are not put at a substantial disadvantage. This includes autistic people.

This is defined by the Equality Act 2010 and the Disability Discrimination Act 1995 in Northern Ireland. You can find out more about disability and the law on the Government website.

Reasonable adjustments can be made in your workplace, in educational settings and at hospital or healthcare appointments. Some might be small, for example:

• Asking your healthcare professional to lower the lighting at an appointment.
• Telling your work that you will eat lunch at the same time every day, and asking your colleagues not to put meetings in during that time.
• Listening to music during a hospital procedure.

Or they could be bigger, for example:

• Asking your work to adapt your hours to fit around your routine.
• Being given more time during exams, or being allowed to do your exams in a private room.
• Working from home, if this is possible with your job.

To work out what reasonable adjustments you need, start by thinking about:

• what things you find difficult
• which environments you find them difficult in.

What if my request for reasonable adjustments is denied?

Reasonable adjustments are a legal requirement. However, we know that people can still face problems when requesting them.

The disability charity Scope has a detailed page on reasonable adjustments at work. This looks at how to ask for reasonable adjustments, and what to do if your request is denied.

Access to Work

Access to Work is a service provided by the Department for Work and Pensions (DWP). It can provide disabled people with practical and financial support, and is available to people who are:

• employed
• self-employed
• or looking for employment.

It is available to people who need support that goes beyond the reasonable adjustments described above. For example, Access to Work might help your employer to pay for a job coach or additional training for you.

If your employer is struggling to make the kinds of adjustments you need, speak to them about Access to Work. Read about eligibility and the application process on the UK Government website.

Remember, you do not need to have received an autism diagnosis to access reasonable adjustments or Access to Work.

Almost all mental health problems and mental illnesses are more common in autistic people than in the general population. In fact, between 3 and 5 in every 100 people who use mental health services are autistic. And about 1 in 10 people who are admitted to psychiatric inpatient wards are autistic.

There are a few different reasons for this, including:

• A lack of appropriate support – Not getting timely or appropriate support and care can lead to poor mental health. Over time this can lead to someone developing a mental illness. Sometimes when autistic people are given support, this isn’t adapted to their needs and doesn’t recognise how mental health and autism work together. This can also mean these treatments aren’t as effective as they should be, and can be counter-productive.
• An unsuitable environment – Our society and culture is not always designed for autistic people. For some autistic people, navigating this environment can be incredibly difficult, and can also lead to poor mental health.
• Poor treatment – Autistic people are also more likely to experience bullying or victimisation. This can of course have a negative effect on their self-esteem and sense of identity.

If you are autistic and experiencing a mental health problem, you should be offered the same treatments as other people. However, you might find it helpful for the treatments and support you get to be adapted to your needs.

The treatments you are offered shouldn’t cause you distress, or negatively affect your wellbeing. If this happens, let the person treating you know. They should work with you to adapt the treatment to your needs.

You should never be denied access to mental health services because you are autistic. You should also never be told that you must have an autism diagnosis before you can have support or treatment for a mental health problem.

We have included a list of suggestions for healthcare professionals on how to adapt treatments for autistic people. You can find this in the ‘information for health and social care professionals’ section of this resource.

There can be some differences in how mental health problems or mental illnesses come across in autistic people. It can be helpful for autistic people and their friends and family to know this so that, if they are showing signs of a mental illness, these are not missed. It can also help to avoid autistic traits being mistaken for signs of mental illness.

Anxiety disorders

Anxiety disorders include generalised anxiety disorder, panic disorder and OCD.

Some of the signs of anxiety disorders might be more common in autistic people than in people who are not autistic. For example, if you are autistic you might be more likely to:

• have a strong, fixed routine
• act in ways that might seem obsessive or compulsive to others
• feel more anxious when faced with change.

These things might just be a normal part of your personality. However, if you experience these things more than usual, or are feeling increasingly distressed, speak to your GP.

Depression

Autistic people might be more likely to act in ways that seem like signs of depression to others. For example, if you prefer to spend lots of your time alone this could appear to the people around you as though you are isolated or depressed.

If you are autistic and you or someone else notices:

• you are increasingly withdrawn and isolated
• you are less interested in interacting with others
• changes to your eating and sleeping patterns
• you are becoming increasingly sensitive to your environment (noises, people or places)
• you are speaking less or not speaking at all when you usually do
• you are repeating rituals more than usual, or not doing rituals that you usually do regularly

these might be signs of depression. You should speak to someone you know or your GP if you think you are experiencing depression.

Suicide

The risk of suicide is much higher in people with an autism diagnosis than in the general population. It is particularly a risk for people who have unmet support needs, are isolated or unemployed, or who have depression.

You should speak to your GP or another healthcare professional urgently if you are:

• harming yourself
• thinking about harming yourself more than usual
• making plans to kill yourself
• struggling to push these thoughts away.

If you have seriously hurt yourself or feel like you are about to kill yourself, call 999 immediately or go to your local A&E department.

Eating disorders

Many autistic people will have different patterns of eating, such as:

• very fixed mealtimes
• only eating certain recipes or brands of food
• being very particular about the sensory qualities of foods, such as appearance, colour or texture.

However, if your eating patterns cause you to:

• lose or gain a lot of weight
• become malnourished
• feel distressed

this might mean that you have an eating disorder.

Eating disorders include anorexia and bulimia, binge eating disorder and a condition called avoidant/restrictive food intake disorder (ARFID).

If you are worried about your eating, or think you might have an eating disorder, speak to your GP. 

Personality disorder

Personality disorder is a diagnosis that can be given to people who find it difficult to manage their emotions and feelings, and their relationships with other people.

The relationship between personality disorder and neurodevelopmental conditions is complicated. Autistic people are sometimes misdiagnosed with personality disorder. This is because these two diagnoses share some similarities. Healthcare professionals should consider this when making a diagnosis of autism or personality disorder. Some people will be diagnosed with both personality disorder and autism.

Psychosis

Psychosis is when someone’s thoughts and feelings change so dramatically that they lose contact with reality.

Unfortunately, psychosis can be missed in autistic people, and sometimes autism is mistaken for psychosis. This is because some of the traits of autism can be confused for psychosis symptoms, and the other way around. For example, if an autistic person has very strong beliefs about something, this could be mistaken with the delusions that exist in psychosis. Delusions are beliefs that people with psychosis have that are very real to them, but are not shared by anyone else.

It is important that healthcare professionals understand that these conditions can be confused, and that they can both happen at the same time. Understanding this can help to ensure autistic people, and people experiencing psychosis, are correctly diagnosed and supported.

Autistic burnout

‘Burnout’ is when autistic people are physically and mentally exhausted, and are struggling to function.

Burnout is not a diagnosis, but is used by autistic people to describe their experiences. If autistic people experience frequent burnouts this can have a negative effect on their mental health.

What causes autistic burnout?

Autistic burnout is thought to happen when autistic people have to spend a lot of time in environments:

• that are not suited to them
• where they are expected to cover up, or ‘mask’ their autistic traits.

These experiences can put autistic people under a huge amount of stress. This can result in them experiencing burnout.

How can autistic burnout be avoided?

The National Autistic Society have a helpful list of things that can help to relieve or prevent autistic burnout. This list was created with the support of autistic people:

• Acceptance and support from others
• Not being encouraged or forced to hide autistic traits.
• Formal support, such as those we looked at earlier in this resource.
• Reducing unwanted expectations or stresses.
• Setting healthy boundaries with others and leading a healthy lifestyle. This can mean making sure you get enough sleep, eat well and exercise regularly.
• Learning how to recognise when burnout might happen before it does.

It is important that burnout is not treated as a mental health crisis. This is because burnout and other mental health problems like anxiety or depression need to be treated differently.

Admission to a psychiatric hospital

If you are experiencing very severe mental health problems, you might be admitted to a psychiatric hospital. Admissions to psychiatric hospital can be more stressful for autistic people because of things like:

• Being away from your normal home environment.
• Sensory stimulation in the hospital ward. For example, noise from other patients and bright lighting.
• Not being able to follow your normal routine.
• Having to interact with unfamiliar healthcare professionals.

If you are admitted to a psychiatric hospital, you might find it helpful to have a trusted family member or advocate to support you. Filling in a ‘health passport’ can help healthcare professionals to better understand your needs. 

Here are some things that friends, family and carers can do to help support the autistic people in their lives.

Finding out that someone is autistic

Sometimes friends and family notice that someone might be autistic before they do. For autistic people, their experiences are normal for them and it can sometimes take an outsider to notice.

On the other hand, you might only find out that someone you know is autistic after they do. You can make a huge difference by reacting respectfully and thoughtfully when someone tells you that they are autistic. Here are some things you could say:

• Thank you for telling me – Show the person that you appreciate them sharing this important part of themselves with you.
• Would you like to tell me more? – The person you know might want to talk to you about any challenges they have been having, and what they want to do next. Asking them if they want to tell you more can make sure that the information they share is on their terms.
• How can I support you? – It can feel tempting to ask lots of questions, or to make lots of suggestions. Instead of presuming what they need, ask the person you know how you can help them. If they aren’t sure, asking them what things they are finding difficult could help you both identify where your help would be most beneficial.
• I’m here if you need to talk – Encourage the person you know to come back to you if they want to talk more. This can help them to know that the opportunity is always available.

Learning

Autism is often misunderstood. If you haven’t met an autistic person before you might have ideas about autism that are untrue or out of date.

Or, if you have met an autistic person before, you might expect other autistic people you meet in the future to act in similar ways. A saying that is sometimes used is ‘if you have met one autistic person, you have only met one autistic person’.

When you are trying to learn more about autism, focus on information that is:

• reliable
• evidence-based
• recent
• produced by or with autistic people

Sometimes the most useful thing you can do is ask the person you know questions about their own experiences of autism.

Here are some things that health and social care professionals can do to better support autistic people. These things were suggested by the psychiatrists and autistic people who helped to write this resource.

Terminology

Respect the language that autistic people use to describe their experiences. For example, if someone describes themselves as ‘being autistic’, or as ‘having ASD’, you can mirror this language.

Communication

Autistic people and people who aren’t autistic often communicate and process information in different ways. This can make it challenging for doctors to communicate effectively with their patients and understand their needs. By bearing in mind that communication challenges might come up, and approaching each interaction with your patients thoughtfully, you can help to avoid misunderstandings and improve care.

Access to services

Autistic people have a right to access services. Being autistic should never be used as a reason not to give someone the support they need.

Reports

Be conscious of how you are writing reports, and remember that the person might read them. Use clear and respectful language.

Processing time

Give time for the person you are working with to access and process information. Allow opportunities for them to ask follow-up questions.

Reasonable adjustments

It can be difficult to find time to make larger reasonable adjustments. However, many adjustments are small, free and quick. For example, asking if any changes can be made to the space you are in to make the person more comfortable. This could be as simple as:

• moving seats
• closing the curtains
• closing the door to reduce noise
• turning off brighter lights.

Prescribing medication

Autistic people are often more likely to develop side-effects from psychiatric medication. It is best to ‘start low and go slow’ with medication doses.

Trauma-informed care

Remember that autistic people are more likely to have experienced bullying or victimisation. They might also have had very difficult experiences in health and social care, been misdiagnosed, or not given the support they needed. Find out if your Trust has a trauma-informed care policy.

Adapting treatments

The National Institute for Health and Care Excellence (NICE) has suggested some ways that healthcare professionals can adapt treatments for autistic people:

• Creating a more structured approach to therapy. For example, having a planned agenda for each session and clearly explaining the goals of treatment.
• Offering written and visual information, as well as verbal.
• Focusing on changing behaviour rather than thinking. For example, encouraging practical daily activities that can improve mood, like a daily walk.
• Avoiding use of metaphors, ambiguous language or hypothetical situations. These are often used in therapy to help explain concepts, but might not be helpful for autistic people.
• Involving family, friends or carers in therapy, if it would help your patient to get the most out of their treatment.
• Offering regular breaks.
• Incorporating special interests into therapy. For example, if your patient is very interested in a TV programme, storylines from that programme could be used to explore ideas in therapy.

• Autism spectrum disorder in adults: diagnosis and management – This information from NICE explains what care and treatment autistic adults should expect from healthcare professionals.
• National Autistic Society (autism.org.uk) – The National Autistic Society supports autistic people and their families and offers advice and guidance about autism on their website.
• I am autistic card - The National Autistic Society has a card that people can use to let others know that they are autistic and might need some extra time or help in certain situations. This can be particularly helpful for autistic people with communication differences when they need to interact with frontline workers like the police or healthcare professionals.

Resources for professionals

• The psychiatric management of autism in adults (CR228), July 2020 – The Royal College of Psychiatrists’ report on the management of autism.
• How to do a great assessment for someone with autism (PDF), Skills for Care – Information for health and social care professionals on how to do great assessments with autistic people.
• Good practice guide: For professionals delivering talking therapies for autistic adults and children (PDF) – This detailed guide from the National Autistic Society and Mind offers information on giving talking therapies to autistic people.

This information was produced by the Royal College of Psychiatrists’ Public Engagement Editorial Board (PEEB). It reflects the best available evidence at the time of writing.

Clinical experts: Dr Conor Davidson, Dr Alison Lennox, Dr Miriam Isaac and Dr Sana Fatima

Experts by experience: Verity Westgate and Matthew Riley

Full references available on request.