Several myths and misconceptions about neurodivergence can affect care in emergency settings. One common myth is that neurodivergent individuals are intellectually disabled or incapable of understanding complex information. But many individuals with neurodivergence are knowledgeable and capable when given the appropriate support.² As previously stated, given that there is no one “right way” to think or learn, neurodivergence is just a difference—not a deficit.²

Another misconception is that neurodivergent behaviors are always disruptive or intentional. For example, a person with ADHD may appear restless, fidgety, or inattentive, but this is often not due to defiance or disrespect. These behaviors spring from differences in their brain that are part of the condition.¹⁵ Understanding these nuances is critical for emergency physicians, enabling them to approach neurodivergent patients with empathy and tailored strategies that accommodate their unique needs. Emergency physicians can significantly enhance the quality of care they provide by dispelling myths and adopting an informed perspective on neurodivergence.

Effective Communication Strategies to Aid in the ED

When working with neurodivergent patients, emergency physicians can use the following communication strategies to create a positive and respectful experience:

1. Active Listening: Take the time to listen to the patient’s concerns and needs. Show empathy and understanding for their experiences. It’s also important to include caregivers, as they may notice changes and subtle differences in the patient’s behavior.⁵
2. Clear and Concise Language: Use clear and straightforward language when providing information or instructions. Avoid jargon or ambiguous terms that may confuse or overwhelm the patient (e.g., “bandwidth” and “deep dive”). Also avoid using idioms and metaphors, as these are often misunderstood (e.g., “a piece of cake” or “feeling down in the dumps”).^8,11
3. Visual Aids: Use diagrams, charts, or illustrations to improve communication and help those who understand information better through visuals. One simple visual aid, a “now and next board,” is a board with the word “now” on the left and the word “next” on the right. Below those words is space for words, pictures, or even symbols that will let patients know what is going to happen.⁸ Using a board like this in the emergency department can create trust and decrease fear in neurodivergent patients.
4. Create a Calmer Environment: The emergency department can be overwhelming due to noise, crowds, and unfamiliar surroundings.⁸ To help alleviate stress:
   1. Identify specific triggers: Ask the patient what makes them feel uncomfortable or anxious. This could be loud noises, crowds, or certain types of lighting.⁸ Knowing this information can help clinicians and staff tailor the environment to the specific needs of that patient.
   2. Provide a quiet space: If possible, offer a quieter area for patients to wait.
   3. Consider noise-canceling devices: Keeping some ear defenders (noise reduction earmuffs) on hand that can be lent out can significantly reduce noise-related distress.⁸
   4. Adjust lighting: Be mindful of lighting preferences. Some patients may require bright lighting, while others may prefer a darker environment.⁸
5. Allow for Processing Time: Understand that neurodivergent individuals may need extra time to process information and respond. Be patient and give them pauses during the conversation.⁵
6. Pain Assessment: Keep an open mind when assessing pain, especially in children with complex needs. Just because a child can’t express their pain verbally doesn’t mean they aren’t experiencing it. Use a pain assessment tool that considers their developmental stage, parents’ observations of pain, and any information from the child.⁸

Ultimately, emergency physicians can improve care for neurodivergent patients and create a welcoming environment to all seeking medical assistance by implementing effective communication strategies while promoting acceptance and respect. Every patient deserves care that meets their individual needs, and by embracing neurodiversity, emergency physicians can provide truly patient-centered care in the emergency department.