Neurodiversity for GPs: Your Essential Guide

Different wiring, same worth — and yes, the consultation may need a software update

☕ Tea-Friendly Learning ⏰ For GP Trainees Short on Time 🚩 Red Flag Focused

Last Updated: 24 March 2026

What This Page Covers

This page is about recognising, understanding, and safely supporting neurodivergent patients in UK general practice. We focus on consultation adaptation, diagnostic thinking, common co-occurring problems, and safety. You'll learn how to run neurodiversity-aware consultations, when to suspect ADHD or autism, how to avoid diagnostic overshadowing, and how to coordinate care across the complex landscape of schools, specialists, and community services.

Why This Matters in GP

Neurodiversity belongs in mainstream general practice, not as a niche add-on. Here's why:

📊 It's Common

~5% have ADHD, > 1 in 100 are autistic, yet only 1 in 9 with ADHD are diagnosed. You're seeing neurodivergent patients every day — whether you recognise them or not.

🎭 It's Often Missed

Especially in women, adults, and people who mask. That "anxious" patient? That "chaotic" teenager? That adult with 15 years of "treatment-resistant depression"? Look again.

💬 It Affects Everything

Presentation, communication, engagement, adherence, health outcomes. If you don't adapt your consultation style, you won't get the history. If you don't recognise the pattern, you'll miss the diagnosis.

⚖️ It's Your Responsibility

Reasonable adjustments are a legal requirement under the Equality Act 2010. Annual health checks for learning disability from age 14+ are an NHS England priority. This isn't optional.

Executive Summary: What You'll Master Today

Because you have 47 other things to do before lunch, and that's just the morning list

Quick Facts at a Glance:

1 in 9

People with ADHD actually diagnosed in UK

>1 in 100

UK population is autistic

15-20 years

Shorter life expectancy for people with learning disabilities

3-4x

Higher depression/anxiety rates in neurodivergent people

📥 Downloads

This shortcode is replaced automatically by WordPress.

🌐 Web Resources

NICE CKS — ADHD
Primary care guidance on recognition, diagnosis, and management
NICE CG142 — Autism in Adults
Recognition, referral, diagnosis, and management
NICE CG170 — Autism in Under 19s
Recognition, referral, and diagnosis in children and young people
ADHD Foundation
Patient information, support groups, training for professionals
National Autistic Society
Information, support, advocacy, and local services directory
Mencap
Learning disability charity — information, advocacy, services
NHS England — Annual Health Checks
Guidance and resources for learning disability health checks
RCGP Health Inequalities Toolkit
Includes neurodiversity and learning disability resources
BNF Online
Prescribing information for ADHD medications and monitoring
BMJ Learning
CPD modules on ADHD, autism, and learning disability

💡

Neurodivergence is common, not rare — ~5% have ADHD, >1% are autistic, ~2% have learning disabilities. You see neurodivergent people every day — you just don't always know it. High masking, late diagnosis, and diagnostic overshadowing mean many are invisible in your records.

🎯

Reasonable adjustments = normal good practice — Longer appointments, clear communication, written summaries, sensory accommodations — these help everyone, not just neurodivergent patients. They're not "special favours", they're legal requirements under the Equality Act 2010.

⚠️

Diagnostic overshadowing is the biggest trap — Don't attribute all symptoms to the known neurodevelopmental condition. Behaviour change in someone with autism/learning disability = physical illness until proven otherwise. UTI, constipation, pain, and dental problems are commonly missed.

💊

You don't need to diagnose everything — Your job is to recognise patterns, adapt consultations, coordinate care safely, and refer appropriately. Specialist services diagnose. You manage the whole person, treat co-occurring conditions, and advocate for reasonable adjustments.

🏥

Annual health checks save lives — Mandatory from age 14+ for learning disabilities. People with learning disabilities die 15-20 years younger, mostly from preventable causes. Your annual health check is the single most important intervention you can offer.

🎓

Transitions unmask problems — School to university, CAMHS to adult services, leaving home — these are high-risk times. Proactive support during transitions prevents crises. Don't wait for the patient to fall apart before offering help.

🔑

Co-occurring conditions are the norm — ADHD + anxiety + dyslexia. Autism + OCD + epilepsy. Learning disability + mental health problems + physical health conditions. Treat all of them. Don't assume one explains the other.

📋

"You might reassure them..." — "ADHD is real, common, and treatable — you're not lazy." "Autism isn't something to fix — it's part of who you are." "This behaviour change isn't 'just their learning disability' — let's find out what's actually wrong." Have these scripts ready.

Consultation Adaptation Strategies

Making your consultation neurodiversity-friendly

Diagnostic Pathways

Structured approach to recognition and referral

Symptom-Based Differential Frameworks

Click each symptom cluster to explore differential diagnoses

Condition	Key Features	How to Distinguish
ADHD	Lifelong pattern, childhood onset, multiple settings, inattention + hyperactivity/impulsivity	Symptoms present before age 12, pervasive across contexts, functional impairment, family history common
Anxiety	Worry-driven distraction, rumination, physical symptoms (palpitations, sweating)	Concentration improves when anxiety treated, situational triggers, no childhood history of ADHD symptoms
Depression	Low mood, anhedonia, fatigue, psychomotor slowing, poor concentration as part of depressive syndrome	Mood symptoms predominate, episodic rather than lifelong, responds to antidepressants
Sleep Disorder	Daytime sleepiness, fatigue, poor concentration due to sleep deprivation	History of poor sleep (insomnia, OSA, shift work), improves with sleep hygiene/CPAP
Thyroid	Hypothyroid: fatigue, weight gain, cold intolerance. Hyperthyroid: anxiety, tremor, weight loss	TFTs abnormal, systemic symptoms, responds to thyroid treatment
Substance Use	Cannabis, alcohol, stimulants — can mimic or worsen ADHD symptoms	Temporal relationship with substance use, improves with abstinence
Autism	Difficulty concentrating on non-preferred tasks, hyperfocus on interests, sensory overload	Social communication difficulties, repetitive behaviours, sensory sensitivities, rigid thinking

⚠️ Co-occurrence is common: ADHD + anxiety, ADHD + depression, ADHD + autism. Treat all conditions. Don't assume one explains the other.

Condition	Key Features	How to Distinguish
Autism	Lifelong social communication difficulties, repetitive behaviours, sensory sensitivities, rigid thinking	Developmental history, pervasive across contexts, doesn't improve with exposure, prefers routine/sameness
Social Anxiety	Fear of negative evaluation, avoidance of social situations, physical anxiety symptoms	Wants social connection but fears judgment, improves with CBT/SSRIs, no repetitive behaviours or sensory issues
Schizoid Personality	Prefers solitude, limited emotional expression, no desire for relationships	Content with isolation (vs autistic people who may want friends but struggle), no sensory/communication difficulties
Hearing Impairment	Difficulty following conversation, asks for repetition, struggles in noisy environments	Audiometry abnormal, improves with hearing aids, no repetitive behaviours or rigid thinking
Language Disorder	Difficulty understanding or using spoken language, not explained by hearing loss	Language-specific difficulties, no social motivation problems, no sensory sensitivities
ADHD	Interrupts, talks excessively, doesn't listen, impulsive social behaviour	Wants social connection, understands social rules but struggles to follow them due to impulsivity
Trauma/Attachment	Difficulty trusting, hypervigilance, avoidance, relationship difficulties due to past trauma	History of abuse/neglect, PTSD symptoms, improves with trauma-focused therapy

Masking: Many autistic people (especially women) mask their difficulties in social situations. They may appear socially competent but find it exhausting. Ask about "social hangover" — needing days to recover after social events.

Condition	Key Features	How to Distinguish
ADHD	Lifelong pattern of disorganisation, impulsivity, poor time management, forgetfulness	Childhood history, pervasive across contexts, doesn't improve with external structure alone
Situational Stress	Recent life events (bereavement, job loss, relationship breakdown) causing temporary chaos	Clear precipitant, previously coped well, improves with time/support
Poverty/Social Deprivation	Chaotic life due to external circumstances (housing instability, financial crisis, domestic abuse)	External factors predominate, improves with practical support, no childhood ADHD history
Substance Misuse	Chaos driven by addiction — financial, relationship, legal problems	Temporal relationship with substance use, improves with abstinence/treatment
Bipolar Disorder	Episodic chaos during manic/hypomanic episodes, interspersed with periods of stability or depression	Episodic rather than lifelong, mood symptoms predominate, family history of bipolar
Personality Disorder	Unstable relationships, impulsivity, emotional dysregulation (especially BPD)	Relationship difficulties predominate, self-harm/suicidality, trauma history common

💊 Co-occurrence: ADHD + substance misuse is very common (self-medication). ADHD + BPD overlaps significantly. Treat both. ADHD medication can reduce impulsivity and improve outcomes.

Condition	Key Features	How to Distinguish
Autism	Need for sameness, routines provide comfort, distress with change, special interests	Lifelong pattern, routines are comforting (not distressing), no intrusive thoughts, pervasive social/communication difficulties
OCD	Intrusive thoughts (obsessions) drive compulsive behaviours, distress if can't perform rituals	Ego-dystonic (person recognises thoughts are irrational), anxiety-driven, responds to SSRIs/CBT
Anxiety Disorder	Repetitive behaviours to reduce anxiety (checking, reassurance-seeking)	Anxiety symptoms predominate, no social communication difficulties, responds to anxiety treatment
Tic Disorder	Repetitive movements or sounds, premonitory urge, suppressible briefly	Motor/vocal tics, wax and wane, no cognitive component, no distress with change

✅ Co-occurrence: Autism + OCD is common. Autistic people have higher rates of OCD. Treat both. SSRIs can help OCD symptoms but won't change autistic traits.

🚨 CRITICAL: Behaviour change in someone with learning disability/autism = physical illness until proven otherwise. Do NOT assume it's "just their condition".

Cause	Clues	Action
Pain	Guarding, facial grimacing, self-injury, aggression, sleep disturbance	Full examination, pain assessment tools (Abbey Pain Scale, DisDAT), trial of analgesia
Infection	UTI, chest infection, dental abscess — may present as behaviour change only	Urine dip, CXR, dental examination, FBC/CRP
Constipation	Very common, often missed. Abdominal pain, distension, overflow diarrhoea	Abdominal examination, PR if indicated, trial of laxatives
Medication Side Effects	New medication, dose change, drug interactions	Medication review, check for akathisia (antipsychotics), sedation, anticholinergic effects
Sensory Overload	Environmental change, noise, crowds, new people	Identify triggers, reduce sensory input, allow recovery time
Mental Health	Depression, anxiety, psychosis — may present atypically	Mental health assessment, collateral history, consider specialist referral
Safeguarding	Abuse, exploitation, bullying — behaviour change may be only sign	Safeguarding assessment, speak to patient alone, involve safeguarding team

Condition	Key Features	How to Distinguish
Tic Disorder	Sudden, rapid, recurrent movements/sounds, premonitory urge, suppressible briefly, wax and wane	Childhood onset, stereotyped, relieved by performing tic, worse with stress/excitement
Tourette's	Multiple motor tics + ≥1 vocal tic, >1 year duration, onset <18 years	Coprolalia (swearing) only in 10%, co-occurring ADHD/OCD common
Stereotypies (Autism)	Repetitive movements (hand-flapping, rocking, spinning), self-soothing, no premonitory urge	Longer duration, rhythmic, comforting (not distressing), part of autism presentation
Myoclonus	Sudden muscle jerks, no premonitory urge, not suppressible	Neurological cause (epilepsy, metabolic, degenerative), EEG abnormal
Chorea	Irregular, flowing, dance-like movements	Sydenham's (post-strep), Huntington's, drug-induced (antipsychotics, levodopa)
Akathisia	Inner restlessness, need to move, pacing, rocking	Antipsychotic side effect, distressing, improves with dose reduction/propranolol
Functional	Variable, distractible, inconsistent, may have psychological stressors	Diagnosis of exclusion, neurology review, MDT approach

Management: Most tics don't need treatment. Reassure patient/family. Treat if severe or causing distress. First-line: habit reversal therapy (CBT). Medications: clonidine, guanfacine, antipsychotics (specialist only).

⚠️ Key Point: Neurodivergent people have 3-4x higher rates of depression/anxiety. Treat both conditions. Don't assume depression explains everything.

Scenario	Clues	Action
Depression + ADHD	Lifelong concentration difficulties, recent onset low mood, anhedonia, sleep/appetite change	Treat depression (SSRIs/therapy), refer for ADHD assessment, treat both
Depression + Autism	Lifelong social difficulties, recent onset low mood, may present atypically (increased rigidity, meltdowns)	Treat depression (adapted CBT, SSRIs), autism-friendly communication, reasonable adjustments
Undiagnosed ADHD	Years of "treatment-resistant depression", actually unrecognised ADHD causing low self-esteem/failure	Take developmental history, screen for ADHD, refer for assessment
Autistic Burnout	Exhaustion from masking, sensory overload, social demands. Looks like depression but different	Reduce demands, increase support, reasonable adjustments, rest, NOT antidepressants alone
Situational	Clear precipitant (bullying, unemployment, relationship breakdown), improves with support	Practical support, signposting, brief intervention, monitor

✅ Treatment Adaptations: Standard depression treatment works for neurodivergent people BUT may need adaptations: longer appointments, written information, autism-adapted CBT, ADHD medication can improve mood by reducing functional impairment.

Condition-Specific Management

Click each condition for detailed management guidance

Prevalence: ~5% of children, ~2.5% of adults. Male:female ratio 3:1 in children, 1:1 in adults (women underdiagnosed). Only 1 in 9 people with ADHD are diagnosed in UK.

Prevalence: >1 in 100 UK population. Male:female ratio ~3:1 (women underdiagnosed due to masking). Lifelong neurodevelopmental condition affecting social communication and behaviour.

🚨 CRITICAL: People with learning disabilities die 15-20 years younger than general population, mostly from preventable causes. Annual health checks from age 14+ are MANDATORY and save lives.

Definition: Motor coordination difficulties affecting daily activities. Clumsy, poor handwriting, difficulty with sports, dressing, using cutlery. Prevalence ~5-6% of children.

•Diagnosis: Clinical + occupational therapy assessment. Exclude neurological causes.

•Management: Occupational therapy (motor skills training, adaptive strategies). Treat co-occurring ADHD/dyslexia. Workplace/education adjustments.

•Refer: Occupational therapy for assessment and support. Neurology if atypical features or diagnostic uncertainty.

Definition: Difficulty with reading, writing, spelling despite normal intelligence. Prevalence ~10%. Highly heritable.

•Diagnosis: Educational psychology assessment. Exclude vision problems, hearing impairment, learning disability.

•Management: Educational support (phonics, multisensory teaching). Exam adjustments (extra time, reader, scribe). Treat co-occurring anxiety/low self-esteem.

•GP Role: Support applications for exam adjustments, workplace adjustments. Treat mental health co-morbidity. Signpost to charities (British Dyslexia Association).

Definition: Sudden, rapid, recurrent movements (motor tics) or sounds (vocal tics). Tourette's = multiple motor + ≥1 vocal tic, >1 year, onset <18 years.

•Features: Premonitory urge, suppressible briefly, wax and wane, worse with stress/excitement. Coprolalia (swearing) only in ~10%.

•Management: Most don't need treatment. Reassure patient/family. Treat if severe or causing distress. First-line: habit reversal therapy (CBT). Medications: clonidine, guanfacine, antipsychotics (specialist only).

•Co-occurring: ADHD (50%), OCD (30%). Treat both conditions.

•Refer: Severe tics, diagnostic uncertainty, complex co-morbidity. Paediatrics or neurology.

High-Risk Scenarios

Click each red flag for detailed assessment and management

🚨 CRITICAL: Neurodivergent people have 3-9x higher suicide rates. Autistic people without learning disability have 9x higher suicide rate. ADHD + impulsivity = high risk of impulsive self-harm.

Risk Factors

•Undiagnosed/unsupported neurodivergence (years of failure, rejection, misunderstanding)

•Autistic burnout (exhaustion from masking, sensory overload, social demands)

•Transition points (school to university, CAMHS to adult services, leaving home)

•Co-occurring depression/anxiety (very common)

•Social isolation, bullying, unemployment

•ADHD impulsivity (impulsive self-harm, less planning but high lethality)

Assessment

Ask directly: "Are you having thoughts of harming yourself?" "Have you made plans?" "Do you feel safe right now?" Direct questions don't increase risk — they save lives.

⚠️ Atypical Presentation: Autistic people may not express suicidal ideation in typical ways. Look for behaviour change, withdrawal, giving away possessions, sudden calmness after period of distress.

Management

•Immediate risk: Don't leave alone. Remove means. Crisis team/A&E. Involve family/carers.

•High risk: Urgent mental health referral (same day). Safety plan. Daily contact. Involve crisis team.

•Moderate risk: Mental health referral (within 1 week). Safety plan. Regular follow-up. Treat depression/anxiety.

•Reduce demands: If autistic burnout, reduce sensory/social demands. Time off work/education. Increase support.

•Treat underlying conditions: Depression, anxiety, ADHD. Medication + therapy.

•Signpost: Samaritans, Papyrus (under 35s), National Autistic Society helpline, ADHD Foundation.

🚨 HIGH RISK GROUP: Neurodivergent people (especially learning disability, autism) at higher risk of abuse, exploitation, neglect. Low threshold for safeguarding referral.

Types of Abuse

•Physical abuse: Unexplained injuries, bruises, burns. Behaviour change. Fear of carer.

•Sexual abuse: STIs, pregnancy, sexualised behaviour, fear of examination. May not recognise abuse.

•Emotional abuse: Controlling behaviour, isolation, humiliation, threats. Low self-esteem, anxiety.

•Financial abuse: Unexplained loss of money, inability to pay bills, carer controls finances.

•Neglect: Poor hygiene, malnutrition, untreated medical conditions, inadequate clothing/housing.

•Mate crime: Exploitation by "friends" (theft, coercion, abuse disguised as friendship).

Red Flags

⚠️ Behaviour change: Withdrawal, fear, aggression, self-harm, sleep disturbance. May be only sign of abuse in non-verbal patients.

•Carer answers all questions, won't leave patient alone with you

•Patient fearful, flinches, avoids eye contact with carer

•Unexplained injuries, delay in seeking treatment

•Poor hygiene, malnutrition, untreated medical conditions

•Disclosure of abuse (believe them — false allegations are rare)

Action

Speak to patient alone: Ask carer to leave room. Use simple language. "Are you safe at home?" "Is anyone hurting you?" Document verbatim.

•Immediate risk: Don't send patient home. Police (999) if immediate danger. Emergency safeguarding referral.

•Non-urgent: Safeguarding referral to local authority (adults or children). Document concerns. Follow local policy.

•Capacity: If patient has capacity and refuses safeguarding referral, respect their decision BUT document concerns. If lacks capacity, act in best interests (safeguarding referral).

🚨 DIAGNOSTIC OVERSHADOWING TRAP: Behaviour change in learning disability/autism = physical illness until proven otherwise. Don't assume it's "just their condition".

Common Missed Diagnoses

•Pain: Dental abscess, constipation, UTI, fracture, appendicitis. May present as aggression, self-injury, withdrawal.

•Infection: UTI (very common), chest infection, ear infection, cellulitis. May have no fever or typical symptoms.

•Constipation: Very common, often missed. Abdominal pain, distension, overflow diarrhoea, behaviour change.

•Medication side effects: Akathisia (antipsychotics), sedation, anticholinergic effects, drug interactions.

•Epilepsy: Post-ictal confusion, non-convulsive status, new seizure type.

•Metabolic: Hypoglycaemia (diabetes), hyponatraemia, thyroid, B12 deficiency.

Assessment

Full examination: Don't skip physical examination. Look for signs of pain (guarding, facial grimacing), infection (fever, tachycardia), constipation (abdominal distension).

⚠️ Pain assessment tools: Abbey Pain Scale, DisDAT (Disability Distress Assessment Tool). Use for non-verbal patients.

Investigations

•Urine dip (UTI), FBC/CRP (infection), abdominal X-ray (constipation), blood glucose, TFTs, B12/folate

•Trial of analgesia (if pain suspected), laxatives (if constipation suspected)

•Medication review (side effects, interactions)

⚠️ Definition: Sudden or gradual loss of previously acquired skills. Can't cope with daily activities that were previously manageable. Common at transition points.

Causes

•Autistic burnout: Exhaustion from masking, sensory overload, social demands. Looks like depression but different.

•Transition stress: School to university, CAMHS to adult services, leaving home, job change.

•Mental health crisis: Depression, anxiety, psychosis.

•Physical illness: Undiagnosed medical condition causing fatigue, pain.

•Medication side effects: Sedation, cognitive impairment.

Assessment

Exclude physical illness: Full examination, bloods (FBC, TFTs, B12, glucose), urine dip. Don't assume it's "just stress".

💊 Mental health assessment: Depression, anxiety, psychosis. Use adapted tools. Collateral history essential.

Management

•Reduce demands: Time off work/education. Reduce sensory/social demands. Increase support.

•Treat underlying conditions: Depression, anxiety, physical illness.

•Reasonable adjustments: Workplace/education adjustments. Disability benefits if appropriate.

•MDT approach: Mental health, social services, occupational therapy, community learning disability team.

•Safeguarding: If unable to care for self, safeguarding referral. Capacity assessment.

⚠️ High Risk: ADHD + substance misuse is very common (self-medication for symptoms). Autistic people may use substances to cope with social anxiety, sensory overload.

Patterns

•ADHD: Cannabis (calming), alcohol (reduce hyperactivity), stimulants (self-medication). Impulsivity increases risk of addiction.

•Autism: Alcohol (social anxiety), cannabis (sensory overload), prescription drugs (anxiety/sleep).

•Learning disability: Vulnerable to exploitation. May not understand risks. "Mate crime" — given drugs/alcohol by "friends".

Assessment

Screen routinely: AUDIT (alcohol), DAST (drugs). Ask non-judgmentally. "Do you use anything to help you cope/relax/concentrate?"

Management

•Treat underlying neurodivergence: ADHD medication reduces substance misuse. Reasonable adjustments reduce need to self-medicate.

•Addiction services: Refer to substance misuse services. May need neurodiversity-adapted treatment.

•Harm reduction: If not ready to stop, harm reduction advice. Naloxone if opioid use.

•Safeguarding: If exploitation suspected, safeguarding referral.

🚨 Don't Miss: New onset seizures, status epilepticus, acute neurological deficit, raised ICP. Epilepsy prevalence 30% in learning disability, 20-40% in autism.

Red Flags

•First seizure: Urgent neurology referral. Exclude structural cause (tumour, stroke, infection).

•Status epilepticus: Seizure >5 minutes or repeated seizures without recovery. Emergency — call 999. Buccal midazolam/rectal diazepam.

•Behaviour change + seizures: May indicate poor seizure control, post-ictal state, non-convulsive status.

•Acute neurological deficit: Weakness, speech change, visual loss, ataxia. Stroke, tumour, infection. Emergency referral.

•Headache + vomiting + behaviour change: Raised ICP. Tumour, hydrocephalus, infection. Emergency referral.

🚨 Shocking Statistics: People with learning disabilities die 15-20 years younger. 40% of deaths are from preventable causes. Diagnostic overshadowing kills.

Common Missed Diagnoses

•Cancer: Later diagnosis, worse outcomes. Barriers: communication difficulties, diagnostic overshadowing, screening uptake.

•Cardiovascular disease: Higher rates of obesity, diabetes, hypertension. Often untreated.

•Respiratory disease: Aspiration pneumonia (dysphagia), COPD, asthma.

•Gastrointestinal: GORD, constipation, coeliac disease (higher in Down syndrome).

•Epilepsy: Often poorly controlled. SUDEP (sudden unexpected death in epilepsy) risk.

•Sensory impairments: Vision, hearing. Often undiagnosed.

Prevention

✅ Annual health checks: Mandatory from age 14+ for learning disability. Proactive screening, early detection, health action plan.

•Reasonable adjustments for screening (cervical, bowel, breast) — longer appointments, sedation if needed, accessible information

•Low threshold for investigation — don't assume symptoms are "just their condition"

•Treat cardiovascular risk factors aggressively

•Regular medication review (polypharmacy, side effects)

Referral Pathways & MDT Working

Click each service for referral criteria and coordination tips

Service Structure

•Children: CAMHS or community paediatrics (varies by area)

•Adults: Adult ADHD service (psychiatry or specialist clinic)

•Transition: Often gap between CAMHS and adult services. Proactive transition planning essential.

Referral Criteria

Include in referral: Developmental history, school reports, collateral history, screening tool results (ASRS), functional impairment examples, co-occurring conditions, medication history.

Waiting Lists

⚠️ Often 1-3 years. While waiting: treat co-occurring conditions, reasonable adjustments, signpost to charities, workplace/education liaison. Right to Choose (England) — patient can choose alternative provider.

Shared Care

•Specialist initiates and stabilises medication

•GP continues prescribing under shared care agreement

•GP monitors: BP, HR, weight, side effects, efficacy

•Annual review with specialist

Service Structure

•Children: CAMHS or community paediatrics (varies by area)

•Adults: Autism diagnostic service (often separate from ADHD service)

•Post-diagnosis support: Often limited. Signpost to charities, social services, occupational therapy.

Referral Criteria

Include in referral: Developmental history, AQ-10 score, collateral history (essential), functional impairment examples, co-occurring conditions, school reports if available.

Waiting Lists

⚠️ Often 1-3 years. While waiting: start reasonable adjustments NOW (don't wait for diagnosis), treat co-occurring conditions, signpost to National Autistic Society.

Team Composition

•Learning disability psychiatrist, nurses, psychologists, occupational therapists, speech and language therapists, social workers

Referral Criteria

•Diagnostic uncertainty (suspected learning disability)

•Complex mental health (depression, psychosis, challenging behaviour)

•Capacity assessment (complex decisions)

•Safeguarding concerns

•Need for specialist support (behaviour management, communication, sensory)

SENCO = Special Educational Needs Coordinator. Every school has one. They coordinate support for children with SEN.

GP Role

•Provide medical information for EHCP (Education, Health and Care Plan) applications

•Support requests for reasonable adjustments (extra time, quiet room, movement breaks)

•Liaise with school nurse re: medication (e.g., ADHD medication at school)

•Advocate for child if school not providing adequate support

Red Flags

🚨 School exclusions: High rate in neurodivergent children. Often due to unmet needs. Advocate for support, not punishment. Exclusion worsens outcomes.

Key Partners

•Social services: Care packages, safeguarding, benefits advice, housing support

•Occupational therapy: Sensory strategies, motor skills, daily living skills, workplace assessments

•Speech and language therapy: Communication support, AAC, social skills

•Educational psychology: Cognitive assessment, dyslexia diagnosis, EHCP support

•Mental health services: Depression, anxiety, psychosis, crisis support

•Charities: National Autistic Society, ADHD Foundation, Mencap — information, support groups, advocacy

Coordination Tips

✅ Be the coordinator: Neurodivergent patients often fall through gaps between services. GP is often best placed to coordinate care, advocate, and ensure continuity.

Simple Changes, Big Impact

•Flag on record: "Neurodivergent — book longer appointments, reduce sensory overload"

•Appointment system: Offer first/last appointments (quieter waiting room), allow online booking (reduces phone anxiety)

•Waiting room: Quiet area, dim lights option, fidget toys, clear signage

•Communication: Written summaries, clear language, check understanding, allow processing time

•Staff training: Basic neurodiversity awareness for all staff (receptionists, nurses, GPs)

•Information: Accessible patient information (easy read, pictures), signposting to charities

These adjustments help everyone, not just neurodivergent patients. Clear communication, longer appointments, reduced sensory overload — these are just good practice.

📝 AKT Pearls

ADHD diagnosis requires: Symptoms before age 12, ≥2 settings, functional impairment, not better explained by another condition.

✅ Autism core features: Social communication deficits + restricted/repetitive behaviours. Sensory sensitivities common but not required for diagnosis.

⚠️ Learning disability: IQ <70 + adaptive functioning deficits + onset before adulthood. Annual health checks mandatory from age 14+.

💊 ADHD medication: Methylphenidate first-line (children/adults). Lisdexamfetamine alternative. Atomoxetine if stimulants contraindicated.

🚨 Diagnostic overshadowing: Behaviour change in learning disability/autism = physical illness until proven otherwise. Don't assume it's "just their condition".

🎭 SCA Scenarios

Scenario 1: Adult ADHD

35-year-old with lifelong concentration difficulties, job-hopping, relationship problems. Suspects ADHD. Take developmental history, use ASRS, collateral history, refer for assessment.

Scenario 2: Autistic Burnout

Diagnosed autistic adult, sudden functional decline. Exclude physical illness, reduce demands, reasonable adjustments, treat co-occurring depression.

Scenario 3: Behaviour Change

Learning disability patient, sudden aggression. Don't assume it's "just their condition". Full examination, pain assessment, urine dip, medication review.

Scenario 4: Reasonable Adjustments

Autistic patient struggling with appointments. Offer longer appointments, written information, reduce sensory overload, don't force eye contact.

📋 WPBA Ideas

COT: ADHD Assessment

Consultation with suspected ADHD. Developmental history, ASRS, collateral history, functional impairment, referral letter.

CbD: Annual Health Check

Learning disability annual health check. Physical examination, bloods, screening, mental health, epilepsy review, health action plan.

DOPS: Autism Communication

Consultation with autistic patient. Clear communication, written information, reasonable adjustments, sensory considerations.

SEA: Diagnostic Overshadowing

Reflect on case where physical illness was initially missed due to diagnostic overshadowing. Learning points, system changes.

QI Project: Reasonable Adjustments

Audit reasonable adjustments in practice. Implement changes (flagging system, longer appointments, staff training). Re-audit.

💪 You're Already Doing More Than You Think

Every time you book a longer appointment, use clear language, or adapt your consultation style, you're making a difference. Reasonable adjustments aren't "special favours" — they're good medicine.

🧠 You Don't Need to Be an Expert

Your job isn't to diagnose everything or know all the answers. It's to recognise patterns, adapt consultations, coordinate care safely, and refer appropriately. You're doing great.

🤝 Small Changes, Big Impact

Flagging records, offering first appointments, providing written summaries — these tiny changes transform patient experience. You don't need a specialist clinic to be neurodiversity-friendly.

🎯 Remember the Basics

Behaviour change = physical illness until proven otherwise. Annual health checks save lives. Treat co-occurring conditions. Don't assume one diagnosis explains everything. You've got this.

🌟 Now go forth and be brilliantly neurodiversity-aware. Your patients will thank you. 🌟

Neurodiversity for GPs: Your Essential Guide

What This Page Covers

Why This Matters in GP

📊 It's Common

🎭 It's Often Missed

💬 It Affects Everything

⚖️ It's Your Responsibility

Executive Summary: What You'll Master Today

What This Page Covers:

Quick Facts at a Glance:

📥 Downloads & Resources

📥 Downloads

🌐 Web Resources

📚 Quick Navigation

🧠 Brainy Bites: Essential Neurodiversity Wisdom

1️⃣ Data-Gathering & Examination Tips

Consultation Adaptation Strategies

2️⃣ Diagnostic Approach & Investigations

Diagnostic Pathways

🔀 ADHD Diagnostic Pathway

🔀 Autism Diagnostic Pathway

3️⃣ Differential Diagnosis Frameworks

Symptom-Based Differential Frameworks

4️⃣ Common Conditions GPs Should Manage Confidently

Condition-Specific Management

Core Symptoms (DSM-5 Criteria)

Inattention (≥6 symptoms):

Hyperactivity/Impulsivity (≥6):

Non-Pharmacological

Pharmacological (Specialist Initiation)

Core Features (DSM-5)

No "Cure" — Management is Support & Adaptation

Severity Levels

What to Check

5️⃣ Red Flags & Conditions Not to Miss

High-Risk Scenarios

Risk Factors

Assessment

Management

Types of Abuse

Red Flags

Action

Common Missed Diagnoses

Assessment

Investigations

Causes

Assessment

Management

Patterns

Assessment

Management

Red Flags

Common Missed Diagnoses

Prevention

6️⃣ Service Navigation, Systems & Team Working

Referral Pathways & MDT Working

Service Structure

Referral Criteria

Waiting Lists

Shared Care

Service Structure

Referral Criteria

Waiting Lists

Team Composition

Referral Criteria

GP Role

Red Flags

Key Partners

Coordination Tips

Simple Changes, Big Impact

7️⃣ Exam & Portfolio Corner

📝 AKT Pearls

🎭 SCA Scenarios

Scenario 1: Adult ADHD

Scenario 2: Autistic Burnout

Scenario 3: Behaviour Change

Scenario 4: Reasonable Adjustments

📋 WPBA Ideas

COT: ADHD Assessment

CbD: Annual Health Check