People with neurodiversity may have sensory processing differences and information from the senses. Therefore, hearing, sight, smell, touch, taste, bodily movement and position can be interpreted differently. Each person will have a different experience of their neurodiversity.

For example, they may be highly sensitive to physical stimuli (hypersensitivity) or have a decreased sensitivity (hyposensitivity) to noise, smell, colour or light. The degree of sensitivity can be different for everyone and each sense and needs to be considered in the clinical setting.

Navigational and spatial needs

Navigation and fine motor skills can be impaired in people with neurodiversity, impacting access and inclusivity in the practice building.

People with neurodiversity may have difficulties with body awareness, position sense and balance, are likely to have larger personal boundary requirements, and may also require enhanced space for mobility aids.

This may mean they can unconsciously bump into furniture or people or exhibit unusual body movements. These difficulties can be exacerbated in an unfamiliar and cluttered environment where touching something or somebody may offer reassurance or can be misinterpreted and lead to a negative reaction.

There are some elements of cognitive inclusivity to consider in the clinical environment, including:

• the importance of the general ambience and cleanliness of primary care premises to the wellbeing of patients and the delivery of person-centred, high-quality primary care services
• the role that design should play in enhancing a person’s privacy and dignity, independence, choice and control
• the importance of recognising differences in the sensory experience of those living with cognitive challenges and neurodiversity
• the adaptability of spaces to meet individual needs and circumstances
• the importance of the built environment: approach and access to buildings; spatial sequencing and transition zones; design of reception areas and waiting spaces; provision of alternative spaces; toilet provision for the disabled; decoration, furnishings and signage.

Principles of cognitively inclusive design

The key elements of cognitively inclusive design have been identified as interiors and outdoor spaces which provide an environment that promotes accessibility and support, care and comfort, independence and privacy, safety and security.

These principles apply both to the external and internal environment. Although it is not possible to adapt the health centre environment for each patient, the design should offer as much flexibility as possible to be inclusive and meet the needs of those with neurodiversity.

Useful resources

• Dimensions. Guide for cognitively inclusive design in primary care environments (PDF)

Neurodivergent individuals, such as those with Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), or sensory processing disorders, may find traditional health care settings overwhelming and stressful.

These environments can often be noisy, chaotic and filled with unfamiliar stimuli that can trigger anxiety and sensory overload. To ensure that neurodivergent patients receive the best possible care, it is essential to adapt the health care environment to accommodate someone’s needs (also described as ‘reasonable adjustments’).

Here are some key considerations for adapting secondary health care settings:

Sensory environment

• Reduce noise pollution: Implement measures to minimise noise levels, such as using soundproofing materials, providing quiet zones and limiting unnecessary announcements.
• Control lighting: Ensure adequate lighting without excessive glare or flickering. Consider using natural light and soft, diffused lighting.
• Manage odours: Minimise strong odours, especially those that can trigger sensory sensitivities. Use air fresheners sparingly and avoid harsh chemicals.

Useful resources

• National Autistic Society
• Autism Spectrum News (2024). Creating sensory-friendly health care environments for autistic patients.

Physical environment

• Create calming spaces: Design waiting areas and patient rooms to be calming and uncluttered. Use soothing colours and textures.
• Provide sensory tools: Offer fidget toys, weighted blankets, or other sensory tools to help patients self-regulate.
• Ensure accessibility: Ensure that the physical environment is accessible to individuals with mobility impairments, including ramps, elevators, and accessible toilets.

Useful resources

• Nursing Times. Creating accessible healthcare environments for people with autism, January 2020 / Vol 116 Issue 1, (PDF)
• GOV.UK (2013, last updated 2015). Equality Act 2010.

Social interactions

• Limit social interactions: Minimise unnecessary social interactions, especially during procedures or appointments.
• Provide social support: Offer social support, such as peer support groups or family counselling, to help patients cope with the social challenges of health care.
• Train staff: Educate staff on neurodiversity and how to interact effectively with neurodivergent patients.

Useful resources

• Norfolk Community Health and Care NHS Trust. How can you be more neuro-inclusive?
• National Autistic Society.

Offer flexible scheduling options: Consider offering flexible scheduling options, such as early morning or late evening appointments.

Provide clear instructions: Provide clear and detailed instructions for appointments, including arrival times, procedures and what to expect.

Offer preparation materials: Offer preparation materials, such as information about the health care setting or the procedure, to help patients feel more at ease.

By implementing these adaptations, health care settings can become more inclusive and welcoming for neurodivergent patients, improving their overall experience and outcomes.

Useful resources

• Autism Spectrum News (2024). Creating sensory-friendly health care environments for autistic patients
• Charlie Health. What is masking?
• Kent Community Health, NHS Foundation Trust. Kent Family.