Patients with Autism Spectrum Disorder (ASD) face a number of challenges in the doctor’s office.

Communication barriers, lack of physician knowledge of ASD, and the stigma attached to the disorder cause patients on the spectrum to receive less than optimal care in medical settings intended to facilitate healing, as noted in an article published by Pediatric Research.

Malik-Soni N, Shaker A, Luck H, et al. Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood. Pediatr Res. 2022;91(5):1028–1035.

 

Some patients who exhibit severe behavior—self-injury, aggression, and destruction of property—are physically restrained by medical staff, which can hurt the patient and damage their trust in HCPs.

Doctors can provide more effective, safer care to these patients by familiarizing themselves with their communication preferences and sensory issues, as well as by using alternative methods to address severe behavior.

 

Learn your patient’s communication style

According to the Academic Autistic Spectrum Partnership in Research and Education (AASPIRE), individuals with ASD tend to communicate atypically.

Caring for patients on the autism spectrum. AASPIRE Healthcare Toolkit. 2022.

While some may be able to express that they successfully received your verbal information, others may not.

 

The same is true of different modes of communication. Some patients may struggle to verbally communicate, while others have more difficulty processing what you say without a visual aid.

Steer clear of making assumptions about what your patient understands. Instead, consult them or their caretakers for information about how they communicate, and what they need from you.

Find out whether your patient can understand spoken language and respond to you verbally. Learning if they read, write, or use alternative and augmentative communication methods such as sign language, picture-based systems, or computer programs can help you determine the most effective mode of communication.

Once you have this information, you can then use patient-specific strategies to obtain as much information about their health issue as possible.

 

Limit sensory input

Patients on the spectrum often demonstrate increased or decreased sensitivities to their environment. Certain sounds, lights, touch, tastes, and smells could hinder physician-patient interactions, leading to ineffective healthcare.

You can foster an environment that works best for your patient. Talk to them or their caretaker about what’s needed from you to create a sense of calm.

For example, AASPIRE recommends using natural light instead of fluorescents, and meeting with the patient in a quiet room. Speak only when the room is otherwise noise-free so your patient can focus on your voice.

Allow them to use noise-canceling headphones, sunglasses, and sensory toys to increase their comfort. Avoid any unnecessary physical touch. If you must touch your patient, clearly explain what you’ll do prior to initiating contact.

 

Use alternative strategies to address severe behavior

Let’s say you’ve done everything right. You took the time to get to know your patient and how they communicate, and you went above and beyond to provide a comfortable space for them.

But upon examination, your patient exhibits severe behavior. Maybe they start thrashing, becoming aggressive toward you or themselves, or beat on the table. Do you physically restrain them?

According to the Journal of Autism and Developmental Disorders, physically restraining patients with ASD paves the way for greater harm to them and their ability to trust you.

Salvatore GL, Simmons CA, Tremoulet PD. Physician perspectives on severe behavior and restraint use in a hospital setting for patients with autism spectrum disorder.J Autism Dev Disord. Published online October 16, 2021:1–14.

 

Physical restraints can cause skin breakdown, muscle mass loss, and infection, among other injuries.

Instead of a method that damages the long-term doctor-patient relationship, try these alternative strategies to address severe behavior:

• Adapt the room to suit the patient’s needs. Reduce the number of HCPs in the room, and mitigate any underlying background noise.

• Change your medical approach. Can you use a quieter tone of voice? Is there a medical assessment you can navigate differently, or save for a future visit? Can you provide a simpler explanation of a medical issue?

• Make items in the room accessible to patients. If your patient needs a sensory toy, perhaps your stethoscope could do the trick. Pillows may be helpful. In the wake of severe behavior, allowing your patient time to play with these items—even if it distracts from the task at hand—could help reduce severe behaviors without physical restraints.