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1. Introduction
In June 2012 the National Institute for Health and Clinical Excellence (NICE) published clinical guidance on the recognition, referral, diagnosis and management of adults on the autism spectrum (National Institute for Health and Clinical Excellence, 2012).
Autism Spectrum Disorder (ASD) is a life-long neurodevelopmental condition that is diagnosed when difficulties in social interaction and communication co-occur with restricted and repetitive behaviours and interests. Prevalence has been estimated at 1 per cent of the population (Baron-Cohen et al., 2009). Symptom type and severity varies widely between individuals on the autistic spectrum; level of disability and development of secondary problems also vary enormously. Therefore, guidance for diagnosis and management of ASD need to accommodate this range and variety of difficulties, allowing service users and professionals to extract the information of relevance to any individual.
Historically, ASD is a diagnosis made by child psychiatrists. However, more and more people now seek diagnosis for the first time in adulthood. The prevalence of ASD in adults is around 1.1 per cent (Brugha et al., 2012). Despite this high prevalence, it has been reported that four out of five adults with ASD find obtaining a diagnosis difficult, if not impossible (Taylor and Marrable, 2011). An accessible and practical guide on recognition, referral, diagnosis and management of autism in adults is therefore of the utmost importance.
NICE is a Special Health Authority developed in England and Wales in 1999. It provides a single source of guidance for service users, professionals and the public, and aims to improve standards of care, minimise variation in provision and quality of care across the National Health Service (NHS), and ensure that the health service is person centred. The Guideline Development Group (GDG) for the National Autism in Adults Guidelines was a multidisciplinary team, including people with autism and carers, and professionals from psychiatry, clinical psychology, general practice, nursing, paediatrics, social care, education and the private and voluntary sectors. The guidance was developed within a context of under-commissioning of health and social care provision for adults with ASD (Mills and Francis, 2010; Powell, 2002), which ran counter to equality legislation (Her Majesty's Government, 2010) and the NHS constitution (Department of Health, 2013).
The first mention of NICE guidance for adults with ASD was...