Creating an Inclusive Healthcare Environment for Neurodiverse Patients: 5 Practical Strategies
BY Nicoletta Boik, BSN, RN | 11 MIN READ
For a neurodivergent patient, a routine healthcare visit can involve an overwhelming combination of bright lights, unfamiliar sounds, strong odors, physical contact, crowded spaces, unpredictable changes, complex instructions and rapid communication. These factors can create barriers that are easily overlooked by healthcare professionals who do not experience the environment in the same way. This makes autism-informed nursing care, neurodiversity-affirming care and inclusive healthcare increasingly important competencies for nurses across every specialty.
The need is substantial. Current CDC surveillance data estimate that approximately 1 in 31 children aged 8 years in the United States was identified with autism spectrum disorder in 2022 (Maenner et al., 2025). These patients are already in our clinics, hospitals, emergency departments and communities. The question is not whether nurses will care for autistic and neurodivergent patients. The question is whether nurses will be prepared to care for them well.
“Difficult” Patient or Inaccessible Healthcare Environment?
What if the patient who will not make eye contact is not being disrespectful?
What if the child who refuses a blood draw is not being “noncompliant?”
What if the adult who takes five minutes to answer a question is not ignoring the nurse?
It may be that the healthcare environment is asking the patient to function in a way that does not account for how they process the world.
Neurodivergent individuals are not a homogeneous population. Neurodivergence refers broadly to differences in neurological functioning and can encompass conditions such as autism and ADHD.
One patient may find eye contact uncomfortable, while another may have no difficulty with it. One patient may need reduced lighting, while another may prefer a familiar level of stimulation. One patient may communicate verbally, while another may use an AAC device, writing, typing, gestures or a support person. One patient may want extensive explanations before a procedure, while another may prefer concise information. Therefore, the goal of autism-informed nursing care is not to memorize one “correct” way to interact with autistic patients. It is to learn how to individualize care.
Barriers to Care
Healthcare is only effective when patients can actually access, understand and participate in it, yet research demonstrates that autistic adults experience significant barriers to healthcare access. In an international cross-sectional study, 80% of autistic adults reported difficulty visiting a general practitioner, compared with 37% of non-autistic respondents (Doherty et al., 2022).
The problem is not necessarily that autistic individuals do not want healthcare but that the system may contain barriers that make receiving care difficult. Respondents to the study reported difficulties with:
- Communicating symptoms and health concerns.
- Navigating appointment systems.
- Managing sensory stimulation.
- Understanding what will happen during an appointment.
- Communicating with healthcare professionals.
- Coping with unfamiliar environments.
- Returning to healthcare after negative previous experiences.
These barriers can have consequences that extend well beyond a single appointment. When a patient begins avoiding healthcare because the experience feels inaccessible, the consequences can become a patient safety issue. Preventative screenings may be missed. Symptoms may remain unreported. Chronic conditions may go unmanaged. Procedures may be delayed. Trust in healthcare may deteriorate. For nurses and nursing students, this creates an important responsibility. The future of nursing requires more than clinical knowledge. Nurses must also understand communication, accessibility, health equity, cultural humility and individualized care.
Language Matters: Respecting How Neurodivergent Patients Identify
Before discussing how nurses can create more inclusive healthcare environments, we need to discuss how we refer to or talk about these individuals. The words healthcare professionals choose can communicate respect, reinforce assumptions, influence how a patient is perceived, and shape the relationship between the patient and the healthcare team.
Research examining autism terminology has found meaningful differences in preferences between individuals and groups, demonstrating that there is no universally preferred way to describe them (Shuck et al., 2025; Taboas et al., 2023).
Two commonly used approaches are identity-first language, such as “autistic individual,” and person-first language, such as “individual with autism.” Identity-first language is preferred by many autistic individuals, particularly within English-speaking autism communities, because autism may be understood as an integral part of who they are rather than something separate from their identity. In a 2023 study of U.S. autism stakeholders, autistic adults overwhelmingly preferred identity-first terminology, although preferences differed among other stakeholder groups (Taboas et al., 2023).
However, this preference should never be assumed for every patient. A recent systematic review of 19 studies involving 6,350 participants found substantial variation in language preferences. Although more participants preferred identity-first language in many of the studies, person-first language also had meaningful support, and some participants reported no preference at all (Shuck et al., 2025).
Nurses should make sure the patient’s preferred language takes precedence. When appropriate, a nurse can ask, “How would you prefer that I refer to you?” That question communicates that the patient’s voice matters. The same principle applies to patient communication methods, sensory accommodations, physical boundaries and participation in care.
What Is Your Patient’s Behavior Communicating?
An autism diagnosis does not tell a nurse everything they need to know about a patient. Two neurodivergent patients may have entirely different communication styles, sensory experiences, support needs and preferences.
Some individuals engage in masking, meaning they may consciously or unconsciously suppress behaviors associated with autism or ADHD to navigate social expectations. This can make distress less visible to healthcare professionals and may result in an inaccurate assumption that a patient is comfortable simply because they appear calm.
Nurses must be careful not to equate visible behavior with internal experience. A patient may appear quiet but be overwhelmed. A patient may appear resistant but be frightened. A patient may appear disengaged but be processing information. A patient may appear calm while masking significant distress. The behavior is information. The nurse’s responsibility is to understand what that information may be communicating and identify reasonable ways the healthcare system can become more accessible to the patient.
Practical Tips to Creating Inclusive Healthcare Encounters
1. Make the sensory environment more accessible.
Healthcare environments can contain numerous sensory stimuli, including bright lighting, alarms, conversations, equipment sounds, odors and physical contact.
When clinically appropriate, nurses can:
- Reduce unnecessary background noise.
- Lower lighting when possible.
- Offer a quieter waiting or examination space.
- Minimize unnecessary interruptions.
- Permit appropriate sensory supports such as headphones.
- Ask the patient which environmental factors are most difficult.
The objective is not to eliminate every sensory stimulus. It is to remove unnecessary barriers.
2. Communicate early and allow processing time.
Nurses should use concrete language, provide one instruction at a time when appropriate, and avoid immediately repeating a question when a patient does not respond. For example, instead of, “Are we ready to get started?” Try: “I am going to check your blood pressure first. Then I will ask you about your symptoms.” Avoid assuming that eye contact indicates attention, understanding, honesty or respect. Eye contact is not a clinical measurement of engagement.
3. Provide information before the appointment or procedure.
Predictability can reduce uncertainty. Whenever possible, patients and families can receive:
- Written appointment information
- A step-by-step description of the visit
- Photographs of the clinic or examination room
- Information about procedures
- Information about who will be involved in the appointment
- Instructions regarding what the patient should bring
This can be particularly valuable for unfamiliar experiences such as MRIs, blood draws, vaccinations, surgery consultations, or new specialist appointments. Preparation should be viewed as an accommodation, not an inconvenience.
4. Narrate before physical contact.
Before touching a patient, explain what will happen whenever clinically appropriate.
- “I am going to place the blood pressure cuff on your arm now.”
- “I am going to listen to your lungs. My stethoscope may feel cool.”
- “I am going to clean your arm first. Then you will feel a quick pinch.”
This provides predictability and allows the patient an opportunity to prepare. Respecting physical boundaries is part of building trust.
5. Document what works.
If a patient communicates that reduced lighting, written instructions, additional processing time, headphones or advance warning before touch improves their healthcare experience, the information should be documented appropriately according to organizational policy. Documentation allows effective accommodations to become part of the patient’s continuing care rather than remaining knowledge held by only one nurse. Compare “patient became difficult during previous blood draw” with “patient benefits from step-by-step explanations, advance warning before physical contact, reduced environmental stimulation, and additional processing time.” The first statement labels the patient. The second gives the next nurse a plan. That is the difference between documenting a problem and documenting a solution.
The Goal Is to Make the System Fit the Patient
Autistic and neurodivergent patients do not need nurses to become autism specialists overnight. They need nurses who are willing to listen, observe, ask, adapt and respect individual preferences. The evidence is clear that autistic individuals encounter substantial barriers within healthcare, and those barriers can influence whether patients seek care, communicate symptoms, complete procedures and return for future appointments (Doherty et al., 2022).
The solution does not always require a major institutional overhaul. Sometimes, it begins with a nurse lowering the lights. Sometimes, it means allowing five additional seconds for a patient to process a question. Sometimes, it means explaining before touching. Sometimes, it means providing written instructions. Sometimes, it means asking, “What would make this visit easier for you?” The most important intervention might be simply listening to the answer.
Autism-informed nursing care is not about treating every autistic patient the same. It is about recognizing that every patient may require something different to participate fully and safely in their care. For nursing students and practicing professionals who want to contribute to a more inclusive healthcare system, learning how to provide neurodiversity-affirming care is an opportunity to transform not only individual patient encounters, but healthcare culture itself. The future of nursing should not ask, “How can we make this patient fit our system?” It should ask, “How can we make our system accessible to the patient?”
Next Steps
If you are interested in becoming a nurse or taking your nursing career to the next level, Elmhurst University offers multiple programs, including Bachelor of Science in Nursing, Master of Science in Nursing (MSN) and Doctor of Nursing Practice (DNP) as well as on-campus and online Master’s Entry in Nursing Practice (MENP) programs that provide a pathway to nursing for those with a bachelor’s degree in another field. To learn more about these programs, fill out the form below.
Nicoletta Boik is a Registered Nurse and a May 2026 graduate of Elmhurst University, where she earned her B.S. in nursing, with minors in psychology, intercultural studies, and communication sciences and disorders. Her academic and research interests center on autism, neurodiversity, healthcare accessibility and patient-centered care. As an undergraduate research student, Boik conducted an honors independent study examining the healthcare experiences of autistic adolescents and adults and exploring social, communication and behavioral factors that influence their integration into healthcare. Her research was presented at multiple conferences, including the National Collegiate Honors Council (NCHC), International Educators of Illinois (IEI). She also was selected for Elmhurst University’s competitive Summer Research Fellowship in Summer 2025.
