Psychiatric Services for Adolescents and Adults with Asperger Syndrome and Other Autistic-Spectrum Disorders

Council Report CR136, April 2006, Royal College of Psychiatrists, £ 7.50, 40 pp

Autistic-spectrum disorders (ASD) are a complex group of developmental disorders frequently associated with comorbid psychiatric disorder, colouring their presentation and complicating their management. Presenting over a wide range of age and ability, they are encountered in all psychiatric specialties.

This report is a consensus view of the psychiatric services required for many with ASD in adolescence and adulthood. The focus is often on diagnosis, but this is only one part of a wider process of multidisciplinary assessment that should then flow on to management. Although the report focuses narrowly on psychiatry, it recognises that this is only one part of a more extensive range of services. It is a preliminary exercise, intended to inform the broader, multidisciplinary and multiagency approaches that are under way across the whole of the UK. It is addressed to psychiatrists, stakeholders in the development of ASD services and commissioners of adolescent and adult services, across all the psychiatric specialties.

After a description of the syndrome, its comorbidity and epidemiology, the report distinguishes diagnosis from the fuller, multidisciplinary assessment. Reviewing the methodology and difficulties of this process, it concludes that all psychiatrists should be able to recognise the syndrome, diagnosing it in clear-cut cases, and be aware of its implications. This has to be the subject of postgraduate training at all levels, from basic psychiatric training through to the consultant's continuing professional development.

Besides the lack of services specific to this population, people with ASD are poorly served by most standard services - in particular, those who are too old for adolescent services and too able for learning disability services. For those whose diagnosis is less straightforward or whose clinical management is more complex, there needs to be access to local specialist expertise and, where necessary, to tertiary specialist services. This applies particularly to the provision for psychiatric admission, whether as day-patients or in-patients, for a group of people for whom the usual clinical environment can be distressing and unhelpful. Psychiatric services need to improve through a combination of training, better liaison between the specialties and the development of specialist interest and tertiary services, the last including the development of autism-specific services both in the statutory and in the independent sectors.

Psychiatric services are overstretched by existing demands, so that any improvement will only come about if driven by service commissioners who recognise the shortfall and specifically support further developments.