It’s worth remembering:

• What works for one patient may be different for another.
• As many people have more than one neurodivergent condition, effects may overlap. Therefore, a variety of strategies and adjustments may be required.
• Many of the divergent conditions are part of a spectrum. People may not experience all the difficulties or may do so at different levels and at different times.
• In many cases the patient is the best person to know what will work for them.
• Societal causes and not issues related directly to symptoms.

Challenges

• poor attention (or hyper-focus on stimulating tasks) or attention to detail
• hyperactivity or restlessness
• poor time management/prioritisation
• impulsiveness
• overworking, difficulty relaxing
• forgetfulness
• excessive talking.

Strengths

• can hyperfocus on tasks and be extremely productive
• can be very creative and entrepreneurial
• can view things from a different perspective
• problem-solving skills
• empathy
• energetic
• enthusiastic
• hard working
• interested in new things
• sensitive.

Helpful strategies

• providing an action plan with a clear structure may help to implement a change in care or help with hospital routines
• allowing extra time in appointments
• a separate waiting area, or a place to wait outside the main waiting room, for example, a call in from the car
• providing digital reminders for appointments and text messages to link to resources
• having rest or movement breaks in long appointments and being aware fidgeting/doodling may help during appointments
• consider more regular follow-up appointments
• visual prompts in place of written material may help
• being flexible around appointment timings.

Useful resources

• ADHD Foundation
• Katzman, M.A., Bilkey, T.S., Chokka, P.R. et al. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry 17, 302 (2017). 

Challenges

• difficulties with spelling and fluent word reading
• slower verbal processing speed
• slower reading
• reduced verbal memory and working memory.

Strengths

• can view things from a different perspective
• problem-solving skills
• empathy
• creativity
• visual/good pattern recognition

Helpful strategies

• use of a notebook during appointments
• a list of their medications, technology, equipment, and so on, with a discussion on how to pronounce the terms.
• allow time for processing of questions, don’t just repeat or rephrase
• during consultations, coloured paper and overlays/coloured lenses in glasses may be useful for those with stereoscopic sensitivity/Irlen Syndrome—consider in the clinic setting if using visual aids
• may need to be told several times to remember something or need to practice multiple times to complete a skill/become aware, but once embedded will usually achieve successfully
• give clear notes of consultations or previous discussions during care episodes to help with memory and not having to listen and write at the same time.

Useful resources

• British Dyslexia Association

Challenges

• difficulty understanding numbers
• poor sense of estimate of numbers
• slow to perform calculations
• forget mathematical procedures/maths facts
• difficulty counting backwards.

Strengths

• can view things from a different perspective
• problem-solving skills
• strategic thinking
• empathy.

Helpful strategies

• increase in anxiety reduces working memory and can make dyscalculia worse. Work on maths anxiety where possible in the clinical setting
• will need to practice calculations repeatedly to remember the process but also gain confidence—consider using new technology and provide real-life examples to support learning
• patients may double and triple check—be patient and provide reassurance
• consider the reasonableness of an answer.

Useful resources

• British Dyslexia Association. Dyscalculia

Challenges

• poor motor control/coordination
• clumsiness
• poor time management/organisation
• difficulty finding the right words
• difficulties with left/right orientation.

Strengths

• can view things from a different perspective
• problem-solving skills.

Helpful strategies

• stress and tiredness can worsen coordination—consider the timing of appointments/visits
• may need to be told several times to remember something or need to practice multiple times to complete a skill but once embedded will usually achieve successfully
• may find it difficult to find places therefore need clear instructions/map before appointment time
• give clear notes of consultations or any discussions during care episodes to help with memory and not having to listen and write at the same time.

Useful resources

• British Dyslexia Association. Dyspraxia

Challenges

• difficulty interpreting verbal and non-verbal language, for example, the tone of voice and facial expressions
• literal in understanding of language
• difficulty reading other people
• sensory sensitivities
• repetitive/routine behaviours
• anxiety.

Strengths

• attention to detail
• good at following and developing protocols and guidelines
• can view things from a different perspective
• problem-solving skills.

Helpful strategies

• consider any sensory sensitivities, especially around noise/ lighting
• understand that some people may need adjustments around clothing/wearable items if sensitive, for example, technology devices—consider application practicalities and how someone may need time to adjust
• try to reduce noise to a minimum where possible during consultations or care episodes to help with processing.

Useful resources

• National Autistic Society

Challenges

• Physical tics: May include blinking, eye-rolling, grimacing, shoulder sagging, jerking head or limbs, jumping, twirling and touching objects and other people.
• Vocal tics: May include grunting, throat clearing, whistling, coughing, tongue clicking, animal sounds, saying random words and phrases, repeating a sound or word, and swearing.
• Premonitory sensations: Just before a tic, people can have sensations such as a burning feeling in their eyes before blinking, a dry or sore throat before grunting and itching joints or muscles before jerking.
• Stress-induced worsening: Tics often intensify during stressful situations.
• Bullying risk: Children with tics may face bullying or social exclusion.
• Temporary control: Some individuals can suppress tics for short periods, which is exhausting and may lead to a surge in tics afterward.
• Medical device management: Tasks like using an insulin pen/ pump or glucose testing may become challenging due to involuntary movements.

Helpful strategies

• Personalised care and support: Engage with the individual to understand their specific tics and how best to support them.
• Discuss: Document any necessary adjustments for health care settings.
• Stress reduction: Recognise that stress can exacerbate tics. Implement strategies to create a calm environment, particularly in health care settings.
• Managing tic release: After suppressing tics, individuals may experience a sudden increase in tic activity. Providing a quiet, private space for this release can be beneficial.
• Reasonable adjustments in health care settings: Consider the impact of tics on the use of medical devices and allow extra time or help where needed.

Useful resources

• Tourette's Action