Recognising and diagnosing autism in children and young people: summary of NICE guidance.

young person. The tables are intended to alert professionals to the possibility of autism in a child or young person about whom concerns have been raised. They are not intended to be used alone, but to help professionals recognise a pattern of impairments in reciprocal social and communication skills, together with unusual restricted and repetitive behaviours. The table relating to preschool children (or equivalent mental age) is included here as box 1, but see the full version of this article on bmj.com for the other two tables (boxes 2 and 3), which relate to older children. • When considering the possibility of autism, be aware that: -Signs and symptoms should be seen in the context of the child’s or young person’s overall development -When older children or young people present for the first time with possible autism, signs or symptoms may have previously been masked by the child or young person’s coping mechanisms and/or a supportive environment -It is necessary to take account of cultural variation, but do not assume that language delay is accounted for by early hearing difficulties or because English is not the family’s first language; ask about the child or young person’s use and understanding of their first language -Autism may be missed in those with an intellectual disability -Autism may be missed in those who are verbally able -Autism may be underdiagnosed in girls -Signs and symptoms may not be accounted for by disruptive home experiences or a parent’s or carer’s mental or physical illness. • Do not rule out autism because of: -Good eye contact, smiling, and showing affection to family members -Reported pretend play or normal language milestones -Difficulties seeming to resolve after a needs based intervention (such as a supportive structured learning environment) -A previous assessment that concluded that there was no autism, if new information becomes available. GUIDELINES