The Autism Training Gap: Clinicians Feel Unprepared, Patients Feel Misunderstood

In surveys from well over a dozen countries, many doctors, nurses and dentists report little or no training in caring for autistic people, and many feel only moderately confident when they do. Autistic patients describe the same gap from the other side of the consulting room. England now requires this training by law. The early evidence shows training builds confidence; proof that it changes care is still thin.

For an autistic person, the gap can be felt in a single appointment. It is the clinician who talks past them to a companion, or reads a flat expression as calm when it is distress. It is the autistic adult who brings a written list because the last visit went wrong. This is not mainly a failure of goodwill: in study after study, clinicians ask for more training. The failure belongs to the systems that educate, employ and support them, and those are the systems the evidence asks to change.

Four in ten GPs in one UK survey had never been trained in autism

A widely cited UK study surveyed 304 GPs online between September and December 2015. Of these, 39.5% said they had never received any training about autism, and 63.5% had received none during their medical degree or GP specialist training^[1]. They scored well on a knowledge quiz (88% correct on average), but their confidence in identifying and supporting autistic patients was modest: an average of 4.8 on a scale from 1 (“not at all confident”) to 10 (“extremely confident”). They were least confident about deciding which medicines to prescribe. Asked what made the work hard, they named barriers that “overwhelmingly focused on perceived failings of the current healthcare system”, such as unclear referral pathways^[1].

Almost half the respondents had a personal connection to autism, so the authors suggest that GPs who did not respond may have “lesser understanding of the condition”^[1].

Dentistry shows the same pattern. Among 357 UK dental professionals in a study published in 2019, knowledge was again good, but confidence was only moderate: 4.5 on a 7-point scale. Paediatric and special care dentists, the groups most likely to have been trained, were significantly more confident than general dental practitioners^[2]. Psychiatrists report more: most of 172 UK psychiatrists in a survey published in 2019 had received useful autism training, and greater knowledge, experience and training went with higher confidence^[4]. Even so, 140 psychiatrists surveyed in Ireland in 2021 and 2022 had high knowledge but variable confidence, “particularly in relation to care pathways”^[5].

The same gap appears across professions and countries

A systematic review published in 2021 brought together 35 studies from 2001 to 2019. They covered medical students, nurses, GPs, psychiatrists, therapists and others in 14 countries. Its conclusion was plain: healthcare professionals “report only moderate levels of autism knowledge and self-efficacy, and often lack training”^[6]. On the most widely used knowledge questionnaire, average scores ranged from 47% to 71% correct. GPs and adult health providers tended to score lower than paediatric and psychiatric specialists^[6].

Adult care stands out. When Kaiser Permanente Northern California surveyed its adult healthcare providers, 922 replied (a 25.3% response rate). Most said they lacked the skills and tools to care for autistic adults, and a high proportion did not know they had autistic patients at all^[7]. According to the review, 77% of these clinicians rated their autism knowledge as “poor” to “fair”^[6]. A scoping review of 27 studies of clinicians’ experiences found recurring themes of “limited knowledge and resources” and a “need for care coordination and systemic changes”^[8].

Some gaps were about beliefs. The review describes a 2005 US study in which primary care providers were more likely than autism practitioners to attribute autistic children’s behaviour to “cold, rejecting parents”, and a 2009 study in which 41% of healthcare workers in Nigeria attributed autism to “preternatural causes”. None of the reviewed studies after 2013 examined beliefs, so it is not known how common such views still are^[6].

Other surveys point the same way:

Autistic patients describe the gap from the other side of the desk

In an international online survey of 507 autistic and 157 non-autistic adults (most autistic respondents were in the UK), 80% of autistic respondents had difficulty visiting a GP when they needed to, against 37% of non-autistic respondents. “Not feeling understood” was a reason to avoid or delay a visit for 56% of autistic respondents, against 13%. And 67% were “concerned I won’t be taken seriously when I describe my symptoms”. Only 62% said their doctor knew they were autistic^[17].

What they wanted was simple. Autistic respondents “appreciated GPs who ask direct questions, give clear explanations, are honest about not understanding autism but know that autism is not a mental illness”^[17]. In two UK surveys of 537 and 407 autistic adults, “having access to a clinician who understands autism” came top of all the adjustments. It was rated important by 98.3% for mental health care and 96.5% for physical health care^[18]. The World Health Organization names it directly: “A common barrier is created by health-care providers’ inadequate knowledge and understanding of autism”^[19]. Our article on barriers to healthcare for autistic adults covers the wider picture.

England made training a legal duty, in Oliver McGowan’s name

Oliver McGowan was an autistic teenager with a learning disability. In the government’s words, he “sadly died in 2016 after having a severe reaction to medication which he and his family had asked for him not to receive”^[20]. His mother, Paula McGowan, tells his story in the statutory code of practice that now bears his name. She describes how he was given antipsychotic medication in hospital although he had told staff he did not want it and his family had refused permission. She also records that an independent learning disability mortality review (LeDeR) “unanimously concluded that Oliver’s death was potentially avoidable”. The training carries his name in recognition of his story and his family’s campaign for better training of staff^[20]. See also our articles on the mortality gap and autism and intellectual disability.

Section 181 of the Health and Care Act 2022 requires that, from 1 July 2022, every provider of health and adult social care in England that is registered with the Care Quality Commission must make sure its staff “receive training on learning disability and autism appropriate to their role”^[20]. The Oliver McGowan Code of Practice sets the standards that training must meet. It became final on 6 September 2025^[21]. The government’s recommended package has two tiers. Everyone completes a 90-minute e-learning module. Tier 1 adds a one-hour live online session, and Tier 2 a one-day face-to-face course, each delivered with at least one autistic person and one person with a learning disability. Staff must be trained again at least every three years^[20].

By June 2025, NHS England reported that over 3 million people had completed the first part, with more than 2,700 approved trainers delivering the interactive sessions^[3]. The government’s impact assessment estimated that about 3.1 million health and care workers would need the training: 1.5 million at Tier 1 and 1.6 million at Tier 2^[22]. The two are not directly comparable: the first counts e-learning completions, not full training, and they come from different sources and dates.

Training lifts confidence faster than it changes care

Oliver’s Training was trialled with 8,374 people^[23] and independently evaluated by the National Development Team for Inclusion with My Life My Choice and bemix. At follow-up, depending on the package, 63% to 72% of Tier 1 respondents and 61% to 88% of Tier 2 respondents said they had done something differently when supporting an autistic person or someone with a learning disability, such as booking double appointments or moving someone to a quieter space^[24]. Fewer of those able to change how their workplace ran said they had done so: 27% to 44% after Tier 1 and 27% to 43% after Tier 2^[24]. Some trainees said they “did not feel they were allowed to make changes to the ‘system’”^[23]. These are self-reports, and the evaluators flag “important limitations to the design of the trial and the data collected”^[24]. At Aston University, health students’ confidence in communicating with autistic people rose significantly after Tier 1 training, but 176 students answered the survey beforehand and only 94 afterwards, and there was no longer-term follow-up^[25].

A 2022 systematic review of 17 studies of autism training for doctors and trainees found that trained physicians became more knowledgeable, more confident and more likely to screen for autism. But the authors call for “higher quality data” on whether training improves “physician behavior and patient outcomes”^[26]. The strongest test we found is a US trial of ECHO Autism, which linked 148 primary care clinicians with specialist teams by video for six months; its ten academic centres were randomised to start dates in a partial stepped-wedge design. Knowledge rose by 9% and self-efficacy by 29%. But autism screening and treatment of co-occurring conditions, checked in medical records, did not change significantly. The authors concluded the results give “support for the model in improving clinician knowledge and confidence but little support for achieving practice change”^[27]. Among the UK GPs, too, a personal connection to autism explained more of the difference in confidence than training did^[1].

Who teaches may matter as much as what is taught. In the Oliver McGowan trial, at least 95% of respondents in every package agreed that hearing from someone with lived experience, in person or on video, suited their learning style^[24]. In Dublin, a training session given by an autistic person to 62 dental, dental nursing and hygiene students raised their scores on an “openness to autism” scale by 7.6% and their confidence by 4.9%^[28]. In an Australian hospital, neurodivergent doctors designed and led neurodiversity education for emergency and geriatric medicine staff. Of the 29 attendees who replied, 83% reported more confidence and 90% more acceptance of autistic patients and colleagues^[29]. These are small, uncontrolled studies, and none yet shows whether autistic patients then receive better care.

What the evidence asks of us

The clinicians in these studies are not short of goodwill; they ask for more training and for systems that let them use it. Closing the gap is the job of the institutions that train, employ, regulate and fund them.

• Teach autism in every clinical course, not only specialist ones. NICE guidance for England already says every health and social care professional caring for autistic adults should have “a broad understanding” of autism, including how it interacts with “other coexisting mental and physical disorders and their management”^[30]. The surveys suggest generalists, such as GPs, adult health providers and general dental practitioners, are often the least prepared^[1][2][6].
• Pay autistic people to shape and deliver it. England’s code requires the live part of all such training to be “co-produced and co-delivered by people with a learning disability and autistic people”, and Oliver’s Training uses at least one of each^[20], and NHS England says its co-trainers with lived experience “are paid for their time”^[31].
• Measure care, not just confidence. The ECHO trial shows confidence can rise while practice stands still^[27]. England’s three-year independent evaluation of Oliver’s Training^[20] is a chance to measure what changes for autistic patients themselves.
• Fix what training alone cannot. UK GPs pointed to unclear referral pathways^[1]. US primary care providers cited “inadequate visit time and reimbursement”^[32], and UK dental teams a lack of resources to put support strategies in place^[2]. Training achieves little if services give staff no time, money or permission to act on it.
• Treat it as a global task. Australia’s National Roadmap to Improve the Health and Mental Health of Autistic People 2025–2035 commits to “Improve autism education and training for health and disability professionals”^[33]. The WHO lists “strengthening the ability of the health workforce to provide appropriate and effective care” for autistic people among its priorities^[19].

Language: this piece uses identity-first language (“autistic people”), the preference of most autistic-led organisations, and uses clinical terms such as “autism spectrum disorder” only when naming a study or diagnostic category.

Why we're publishing this

Health Insurance UK is a commercial health-insurance resource, not a charity and not a campaign. We compiled this evidence because autistic people and autistic-led organisations have said for years that too many clinicians do not understand them. They deserve the research behind that case in one place, ready for a medical school, a regulator or a journalist. The case is theirs. Our part is to stand alongside it and say plainly what the figures show: the gap is real, it is international, and closing it is the responsibility of health systems, not of autistic patients who have to explain themselves at every appointment.

How to read this data

Most clinician studies here are cross-sectional surveys of volunteers, measuring self-rated knowledge and confidence. Response rates were often low (25.3% in the Kaiser Permanente survey), and respondents may be more interested in autism than their colleagues. Questionnaires, professions, countries and years differ, so the figures are not directly comparable and are not a trend. The most common knowledge questionnaire tests core features of autism, not how to adapt care. Much of the evidence comes from the US, the UK and Nigeria. Training evaluations are mostly before-and-after self-reports; the ECHO Autism trial is the only randomised study here. Patient figures come from surveys of autistic adults, mostly in the UK. The 77% figure is the 2021 review’s summary of a study whose full text we could not access. More articles are in our Autism & Health research library.

Use this data

Free to cite with attribution to Health Insurance UK. Charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research for general information. It is not medical advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's health, please speak to a qualified health professional.

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