Overcoming barriers to autistic health care: towards autism-friendly practices

This article struck to my heart, as I believe it will do to many other GPs. A diagnosis of autism in general practice is not usually very difficult and as parents as well as adults become more aware, the diagnosis of autism can and will only increase. This will make it impossible for any secondary care service to meet that demand and nor is this desirable. A diagnosis of autism is a spectrum, not only in its width but also in its length: individual differ in their severity.

The expectations raised what secondary care services can deliver often is not realistic and in my view can be detrimental if it only stigmatise a neuro-developmental disorder. Most advice, perhaps with some educational support should be possible to deliver in a primary care consultation.

Medical treatment requires to date a shared care approach and I would postulate, perhaps somewhat controversial whether some of those decisions could be made in primary care only. The waiting times to get seen by a specialist service are often that long that children during that time have become adults, leaving a long treatment gap at a stage where treatment is more beneficial.

This proposal comes with an important caveat: all trials of any ADHD medication have all been done in the context of support mechanisms and the trialists have confirmed some years ago, that in isolation they may not work that well. Local experience of a learning disabled psychiatrist is that side effects are relative minimal and it either works fairly well, fairly soon or it does not at all.

This is a discussion which should take place.