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Yeah, structure is definitely helpful with essay writing. I know that helped tremendously when I actually had a pattern to follow. When I didn't, I tended to struggle more with writing.

How does he go pacing himself? I have no concept of time so in perusal time I work out how many questions I have to answer by half-time and then glance up at the clock a fair bit as I go. I could easily get stuck on one question and spend most of the exam time working on it. It's not natural for me to do things out of order so I've had to learn to skip questions that will slow me down and come back to them at the end. Even with these techniques I seem to initially freeze when we are allowed to turn our papers over and always get a pretty slow start - not sure how to sort that one out.

It might help to look at the mark schemes for past exam papers if he hasn't done this already, this shows exactly what the examiners are looking for and what details will get marks in an essay. You can download them from the websites of the exam boards, google the name and you should find it.

Does he have the same issues with coursework? It's possible it could be partially due to the environment, either due to distractions (e.g. hearing everyone writing at once if he has any auditory issues) or perhaps just how unusual the situation is (personally I often get more nervous about the exam room layout than the exam itself). If it is due to this and you get a diagnosis you could request suitable accommodations, or alternatively perhaps provide some experience with exam settings.

[Moved from General Autism Discussion to Parents' Discussion]

Has he been taught test-taking skills? Like:
Scan the questions, do the easiest first.
Leave the question for last if you don't know the answer.
It's been so long since I've been in school, so I can't remember more.

Okay, I did a search on this and found some cool stuff:
Essays: http://www.testtakingtips.com/test/essay.htm
General test taking help: http://www.testtakingtips.com/test/gentest.htm
For parents: http://www.testtakingtips.com/parents/index.htm
Wow, this is neat, I'd better keep this website for when I homeschool.

This is always a difficult problem for my son. He spends a lot of time getting used to each instructors expectations and testing styles. By the end of the semester he finally gets it, but the damage has been done.

Some things that have helped us along the way:
1. Asking the instructor to see an old test. So you know what kind of testing structure is going on.
2. Looking at your sons tests to see what areas he is struggling with.
3. Asking the instructor to give more detailed feedback, not enough detail does not explain what parts where missing. Its broad and just useless.
4. Asking for a study guide. This way your son is not wasting time on memorizing useless facts.
5. Asking for the point breakdown of the test. Some tests are all essay, others are mixed. Knowing what sections make up the biggest points of the test can help you decide which things to study for, and what to prepare your son for so the points he does earn count the most (sometimes its just about the math). Ex. My sons math teacher lets them put together a toolbox to use on the tests. I found out, too late of course, that this tool box is worth 10 points on the test and she puts what is supposed to be on it ONLINE. Gesh.. That is a FREE 10 points!! ! Other teachers have given them HINTS during class as to what is on the test. Your son may be missing these, so asking the instructor for some extra support may be beneficial.
6. Practice Tests. A LOT of instructors do not let people know there are websites that accompany their text books. These often have practice tests (and depending on the instructor, sometimes they actually USE questions from these practice tests).
7. If the instructor gives a clue to the largest essay that will be on the test (some do, some don't) have him write a practice version at home. I know a LOT of kids who find this to be highly beneficial to them, because in a testing situation they forget things while trying to construct a huge essay.
8. Breaking down study material into smaller chunks of information, and studying them for short periods of time. For instance, if my son has vocab to test, he will study five words for five minutes. Then engage in something he really enjoys. This is repeated over and over again.
9. Find a special place for your son to study. My son, for whatever reason, loves studying in the bathroom with the fan on. So he goes in, turns the fan on , shuts the door and sits there studying. I think its because.... the fan acts as white noise. The room is small. He knows no one can disrupt him, after all a bathroom is a private place no one can invade, right? Find some place like this for your son.