This information has been written to assist in the implementation of the NHS and Community Care Act 1990. The contents are, however, applicable to all services provided for people with autism.

Autism is a lifelong developmental disability. The exact causes are still not known but research shows that genetic factors are important. The spectrum of autistic conditions covers a wide range. It varies from profound severity in some through to subtle problems of understanding in others of average or above average intelligence. Autism often occurs with other learning difficulties.

People with autism have a disability characterised by a triad of impairments as follows:

• absence or impairment of two-way social interaction
• absence or impairment of comprehension and use of language and non-verbal communication
• absence or impairment of true flexible imaginative activity, with the substitution of a narrow range of repetitive, stereotyped pursuits

Other conditions sometimes associated with autism may include attention deficit hyperactivity disorder (ADHD), or learning difficulties such as dyslexia and dyspraxia. People with autism may also experience high or low sensory sensitivity, resulting in unusual reactions to their surroundings.

Autism leads to related problems which may include:

• resistance to change
• obsessive or ritualistic behaviour
• high levels of anxiety
• lack of motivation
• inability to transfer skills from one setting to another
• vulnerability, and susceptibility to exploitation
• depression
• challenging behaviour
• self-injury.

People with autism need and the service should provide:

• a person-centred approach, taking the individual's needs, wishes and aspirations into account
• individual and detailed person centred support plans
• detailed and specific strategies to achieve social interaction, communication and independence skills
• highly planned structured activity
• appropriate staff levels to implement the strategies and provide staff support in all areas
• an appropriate physical environment.

The service and the staff should provide:

• consistency and stability in the environment and in all interaction
• continuous external motivation and positive intervention
• alternative and augmented communication systems which enable individuals to communicate effectively with those around them.

The service also needs to provide:

• a support system to handle and relieve staff stress
• specialised staff training providing both an induction programme and an ongoing programme to reinforce and update the needed staff skills.

The staff role is crucial in enabling people with autism to participate more fully in everyday life. Staff need a thorough understanding of the underlying impairment and to be attuned to the way the person with autism sees the world.

The staff training programmes should aim to provide:

• an ability to understand and interpret the verbal or non-verbal communications of the person with autism
• an ability to translate situations, events and concepts into language that can be understood and grasped by the person with autism
• a sensitivity in the recognition of anxiety levels
• non-aversive skills in the management and reduction of challenging behaviour
• recognition of the value of repetitive reinforcement and the ability to make careful use of structure in order to counteract the lack of motivation inherent in this disability
• an understanding of the effect of the sensory environment on the individual.