NHS England commissioned us to evaluate the diagnostic screening instruments for autism. Using the right screening and triage tools could help reduce waiting times for NHS autism assessment services and make these services more efficient.

Screening tools are for education, primary care, mental health, or any non-autism-specific frontline health or wellbeing staff to determine whether to refer someone for an autism assessment. They may also be used to triage which patients to assess first or to discharge patients from a service.

Many people working within primary care, education or mental health may not have had adequate training or understanding to spot the possible signs of someone being autistic, despite this being in NICE guidelines and government-mandatory training. This means that many autistic people may be undiagnosed and struggling without the support available to them.

At present, services involved in making, reviewing and accepting referrals for autism assessments use a variety of methods to inform clinical decisions. The NHS is experiencing record waitlist lengths for children, young people and adults seeking autism assessment services and mental health services. Long waiting lists mean people are waiting years for answers with unmet support needs. The professionals who use these screening tools must understand the evidence, or lack of evidence, behind them so they can make informed choices about which screening tools to use.

By reviewing and improving diagnostic screening assessments for autism, we can make autism assessment and triage more targeted and efficient, which will help reduce waiting times and improve outcomes for hundreds of thousands of autistic people.

This work has created guidance with evidence-based evaluation of tools and measures commonly used for triage and screening in autism assessment pathways that can be shared nationally.

This resource could be used:

• To help GPs, primary care professionals, and people within education decide which tools to use to screen for possible autism and make referrals. The patient would then be referred to an autism-specific assessment team.
  
  
• In mental health services that are not specific for autistic people, such as community mental health services or NHS talking therapies. Having the correct assessment and resulting support would help reduce the risk of a crisis.
  
  
• In autism assessment services for children and adults, helping staff prioritise assessments to reduce waiting list times.

To develop this resource, we worked alongside expert autism clinicians and researchers, autistic people and other expert stakeholders such as clinical psychologists, psychiatrists, occupational therapists, GPs, nursing professionals, autism service leads and epidemiologists.

• Through workshops and focused discussions, we built upon stakeholders' personal and professional expertise to develop criteria to assess the usefulness of autism screening tools. We discussed and shared ideas and expertise on what appraisal criteria for screening instruments could include. This will help professionals know which existing screening assessments are based on good-quality research.
  
  
• Next, we explored the existing research and information on autism screening tools. We reviewed existing evidence for screening tools and assessed their performance against the criteria established in the workshop.
  
  
• The same expert group gave feedback to review the final appraisal criteria, leading to an evidence-led report on autism screening tools. This report aims to inform national NHS guidance and practice for improving screening and triage in the autism assessment pathway.

This project has the potential to improve the current autism screening and triage guidelines. This will help frontline health professionals use evidence-based screening tools and inform their decisions about which ones to use.

Using the right screening and triage tools could help reduce waiting times for NHS autism assessment services and make these services more efficient.

Getting diagnosed is an important first step. It can help people understand themselves, and help those around them to better support them, and potentially open up formal support. By championing initiatives like this we are continuing to make breakthroughs to reach our 2030 Goal for every autistic person to have support from day one.

[1] NHS autism waiting list statistics, published February 2025.

[2] O'Nions et al. (2023) Autism in England: assessing underdiagnosis in a population-based cohort study of prospectively collected primary care data