Autistic Adults in General Practice – Recognising, Supporting & Understanding
https://www1.racgp.org.au/ajgp/2021/march/recognising-supporting-and-understanding-autistic
🌟 Why it matters
- Autistic adults experience earlier mortality (mean life-expectancy ≈ 54 yrs) and markedly poorer physical & mental health than non-Autistic peers.
- Undiagnosed or mis-diagnosed autism leads to inappropriate labels (e.g. personality disorder) and missed preventive care, amplifying risk.
- Primary care is the logical “gate-keeper” for recognition, accurate diagnosis and long-term support.
🌟Barriers to Recognition
- Media stereotypes (e.g. lack of eye contact, inability to work or have relationships) skew GP expectations.
- Autism may be camouflaged (e.g. polite, overly cautious, maintaining eye contact).
- Women and gender-diverse individuals often remain undiagnosed due to social masking.
- Many Autistic adults report lifelong difficulties with employment, social connection, and mental health.
🌟 Clues to an undiagnosed Autistic adult
| Domain | Practical red flags in a consultation |
|---|---|
| Camouflaging / masking | Excessive eye-contact over-politeness scripted responses “model patient” appearance despite marked internal anxiety |
| Psychiatric history | Chronic anxiety depression suicidality (9-fold ↑ risk) repeated medication “failures”. |
| ADHD overlap | ADHD diagnosis (≈ 5 × more common in Autistic adults). |
| Sensory profile | Light “too bright” noises “too loud” fabrics “itchy” strong aversions / cravings for textures or flavours |
| Somatic presentations | Atypical pain descriptions mismatched symptom clusters medically-unexplained fatigue. |
| Family pattern | First-degree relatives (or children) with autism/ADHD. |
| Gender | Women often highly skilled at masking – look for exhaustion after social demands, eating disorders, or late-onset “burn-outs”. |
| Identity | Higher rates of LGBTIQA+ identification |
| Social tolerance | “Wiped out” after shopping centres / noisy cafés preference for small, predictable settings. |
| Executive function | Frequently late / early missed tests Forgetting appointments difficulty with planning and task completion hyper-organisation may be a coping strategy |
🌟Frequently co-occurring medical conditions
(non-exhaustive – consider autism in recurring combinations)
- Anxiety & Depression
- ADHD
- Migraine with aura
- Eating disorders / ARFID
- PTSD
- Sleep apnoea & insomnia
- Functional GI disorders & IBS
- Epilepsy
- Hypermobility spectrum disorders / Ehlers–Danlos
- Fibromyalgia
- OCD
- Autonomic dysfunction (POTS, vasovagal episodes)
🌟 Consultation style that works
- Strengths-based, identity-affirming language – avoid deficit framing (“disorder”, “impairment”).
- Direct, concrete communication – short sentences, no sarcasm or metaphors unless explained.
- Give processing time – wait >5–10 s after a question; don’t interpret silence as non-engagement.
- One question at a time – linear structure, visible agenda; summarise frequently.
- Offer alternative communication – typed answers, visual aids, email follow-up.
- Validate sensory needs – dim lights, silence computer tones, allow noise-cancelling headphones.
🌟 Practice-level adjustments (“Autism-friendly” GP clinic)
| Barrier | Practical fix |
|---|---|
| Over-stimulating waiting room | Option to wait in car SMS when doctor ready Offer quiet waiting areas |
| Phone booking anxiety | Enable online or app-based appointment systems choice of long appointments. |
| Unpredictable delays | Display queue position or realistic wait-time estimates apologise when running late. |
| Executive-function hurdles | SMS/email reminders written step-by-step plans offer to book referrals while patient present. |
| Front-desk interactions | Train reception staff in autism-positive language and clear instructions. Be mindful of lateness or missed appointments due to executive dysfunction |
| Continuity & preventive care | Schedule standing reviews (e.g. 6-monthly) to catch HTN, lipids, cancer screening. |
| Communication | Use clear, direct language (no sarcasm/irony/analogies). Allow extra time to process and respond. Avoid “reading between the lines”. |
🌟 Building long-term therapeutic alliance
- Trust first – non-judgemental curiosity, listen to lived experience.
- Normalise testing – “Many adults discover they’re Autistic later in life; would you like information about assessment?”
- Shared management plan – address co-morbidities, sensory regulation strategies, mental-health supports, occupational-therapy referral.
- Advocacy – assist with NDIS documentation and workplace adjustments where appropriate.
- Follow-up – proactive recalls for vaccines, metabolic checks, and mental-health screening.
🌟 What to Do Next: If Autism is Suspected
- Sensitive conversation:
- Gently explore the possibility with the patient.
- Use strengths-based, non-pathologising language that promotes autism acceptance.
- Respect the patient’s autonomy; not all may want to pursue assessment.
- Autism Spectrum Quotient (AQ) screening:
- 50-item self-administered online questionnaire.
- Measures presence of Autistic traits.
- Not diagnostic — screening tool only.
- Can help patient decide if formal assessment is appropriate.
- Formal assessment:
- Typically conducted by a psychologist or psychiatrist experienced in adult autism.
- For females or gender-diverse patients: Choose clinicians familiar with non-male presentations of autism.
- Barriers: cost, location, waitlists, lack of adult-focused or Autistic-led services in Australia.
- Post-diagnostic support:
- Autism-informed counselling is beneficial post-diagnosis.
- Peer connection with other Autistic adults is supportive and validating.
🌟 | Take-home messages for busy GPs
- Think “Could this be autism?” whenever you see: lifelong social fatigue, sensory hypersensitivity, multiple anxiety disorders, ADHD, or enigmatic chronic pain/fatigue.
- Masking means “textbook” social deficits may be absent during short GP visits.
- Small environmental & communication tweaks dramatically reduce healthcare barriers.
- Regular, structured reviews plus an empathetic stance save lives – literally – by mitigating the nine-fold suicide risk and closing the 20-year life-expectancy gap.
| Resources for general practitioners to support provision of care to Autistic adults | ||
| Resource | Description | URL |
| Autism HealthPathways | Online tool used to help make assessment, management and referral decisions. Pathways for autism have been developed by the HealthPathways Mackay team and are ready to be localised. | www.healthpathwayscommunity.org/News/Latest-Community-News/ArticleID/3072/HealthPathways-Mackay-puts-the-spotlight-on-Autism-Spectrum-Disorder |
| AASPIRE Healthcare Toolkit | Online toolkit that includes information, checklists and worksheets for primary healthcare providers, Autistic patients and supporters | https://autismandhealth.org |
| My Health Passport for Autistic people | PDF tool developed by the UK National Autistic Society to help Autistic people to communicate their needs to healthcare professionals | www.autism.org.uk/advice-and-guidance/topics/physical-health/my-health-passport |
| NICE clinical guideline – Autism spectrum disorder in adults: Diagnosis and management | Online guideline providing information on diagnosis and managing suspected or confirmed autism in adults | www.nice.org.uk/guidance/cg142 |
| UK Royal College of General Practitioners Autistic Spectrum Disorders Toolkit | Online toolkit that includes information, checklists and worksheets for general practitioners | www.rcgp.org.uk/clinical-and-research/resources/toolkits/asd-toolkit.aspx |