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The principles of neurodiversity in nursing practice

This resource is aimed at nursing staff who want to support patients with neurodiverse conditions across clinical settings confidently. It has been produced by RCN members and nurses working across different sectors.

It has been developed to promote awareness of neurodiversity and embrace the world of neurodiversity across primary, community and secondary care settings. This will also consider different clinical specialisms and the ways nurses can ensure their practice is inclusive and considerate for those with neurodiversity.

Introduction

Infographic of two female nurses and a male nurse smiling

Nurses are at the forefront of emerging clinical specialisms and care for a wide range of patient populations. Providing high-quality, patient-centred care for individuals with neurodiverse conditions is an essential part of modern nursing practice.

Supporting neurodiverse patients requires effective communication, an understanding of their individual needs, and the ability to make reasonable adjustments across various clinical environments.

This resource is designed to help you reflect on and enhance your practice across different settings and specialisms, ensuring more inclusive, compassionate and tailored care for people with neurodiverse conditions.

Neurodiversity refers to natural differences in how people think, learn, process information, and interact with the world. It recognises that no one's brain functions in the same way. These variations may affect mood, behaviour, learning and cognitive functions.

Often, people who are neurodiverse have more than one of these conditions. However, for this guidance, we are including those as neurodiverse as the following (please note, this is not an exhaustive list):

  • Dyslexia
  • Dysgraphia
  • Dyspraxia
  • Dyscalculia
  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Tourette’s syndrome
  • Autistic Spectrum Condition (ASC).

The term ‘Specific Learning Difference’ (SpLD) refers to a difference/difficulty that an individual has with a particular aspect of learning. The most common SpLDs are dyslexia, dyspraxia, ADD, ADHD, dyscalculia and dysgraphia.

Nurses are at the forefront of emerging clinical specialisms and support many different patient populations. Being able to provide high-quality care to patients with neurodiverse conditions is important when it comes to promoting patient-centred care. Understanding neurodiverse conditions requires nursing staff to communicate effectively. This also means considering reasonable adjustments and how the patient may feel across different clinical environments.

Nursing staff are present at many stages of patients' health care journeys. For those with a neurodiverse condition, interacting with staff who know and understand their requirements promotes a sense of trust. Nursing staff are key in supporting patients in often vulnerable or complex conditions.

At the heart of neurodiversity is the idea that individual differences are not weaknesses, but that society imposes expectations based on a majority neurotypical population. When not met, these differences can lead to challenges. By applying a social model approach, we can appreciate that individual differences are not the problem but rather external barriers. By removing these barriers, we build a more inclusive society that values individual strengths and differences.

Neurodivergence is experienced differently by different people. Experiences are influenced by other factors such as race, cultural background and gender (this interplay of factors is referred to as ‘intersectionality’).

This diagram by Kirby and Cleaton shows the percentages for co-occurring conditions ASC, Dyspraxia, Dyscalculia, Dyslexia and ADHD.

Neurodivergence is the term for when someone's brain processes, learns, and/or behaves differently from what is considered ‘typical’. Some neurodivergent conditions include:

  • Dyslexia
  • Dyspraxia (also called Developmental Coordination Disorder, or DCD)
  • Dyscalculia
  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Autism Spectrum Condition (ASC).

These conditions often co-occur, and many symptoms overlap, as shown in the diagram. Neurodivergent groups may be more highly represented in health and social care professions than the general population.

Clinical relation to nursing

Infographic of three nurses of different ethnicities

Understanding neurodivergent conditions is essential for nurses to provide equitable, person-centred care. Being able to recognise signs, adapt communication, and tailor support strategies can significantly improve health outcomes and patient experience.

Dyslexia

  • Genetic factors: Dyslexia often runs in families, indicating a genetic component.
  • Neurological differences: Differences in the brain areas responsible for reading and language processing.

Dyspraxia (DCD)

  • Neurological factors: Impairments in the way the brain processes information, which affect coordination and movement.
  • Genetic links: Some evidence suggests a genetic component.

Dyscalculia

  • Brain functioning: Differences in the brain areas involved in numerical processing.
  • Genetic predisposition: Often runs in families, suggesting a genetic link.

ADHD

  • Genetic factors: Strong hereditary component.
  • Neurochemical differences: Imbalances in neurotransmitters, particularly dopamine.

Autism Spectrum Condition (ASC)

  • Genetic influences: Strong genetic basis with multiple genes involved.
  • Environmental factors: Possible contributions from prenatal exposure to certain substances and conditions.

Dyslexia

  • Signs: Difficulties with reading, writing, and spelling; slow reading speed, trouble with word recognition.
  • Awareness: Be aware of patients struggling with reading materials, medication labels or written instructions.
  • Assessments: Screening tools such as the Dyslexia Adult Screening Test (DAST) can be used.

Dyspraxia (DCD)

  • Signs: Poor coordination, clumsiness, difficulty with fine motor tasks (for example, buttoning shirts, writing).
  • Awareness: Notice patients having trouble with physical tasks or appearing uncoordinated.
  • Assessments: Use tools like the Developmental Coordination Disorder Questionnaire (DCDQ).

Dyscalculia

  • Signs: Difficulty with mathematical concepts, number sense and performing calculations.
  • Awareness: Pay attention to patients who struggle with tasks involving numbers, such as medication dosages.
  • Assessments: Math-related assessments can identify difficulties.

ADHD

  • Signs: Inattention, hyperactivity, impulsivity, difficulty organising tasks.
  • Awareness: Recognise signs of inattention or hyperactivity that may affect communication and concordance with treatment plans.
  • Assessments: Screening tools like the Adult ADHD Self-Report Scale (ASRS).

Autism Spectrum Condition (ASC)

  • Signs: Social communication difficulties, repetitive behaviours, sensory sensitivities.
  • Awareness: Be mindful of sensory preferences and communication styles, providing a calm and structured environment.
  • Assessments: Use comprehensive tools like the Autism Diagnostic Observation Schedule (ADOS).

Nursing interventions and support

  • Communication: Use clear, concise language and provide information in multiple formats (written, verbal, visual).
  • Environment: Create a sensory-friendly environment, minimising loud noises and bright lights.
  • Support: Offer additional time and help for tasks and ensure understanding of medical instructions.
  • Education: Educate staff about neurodivergent conditions to promote empathy and effective care strategies.

Neurodivergent individuals often exhibit unique strengths, such as:

  • Dyslexia: Strong problem-solving skills, creative thinking and out-of-the-box solutions.
  • Dyspraxia: High levels of determination, strategic thinking and problem-solving abilities.
  • Dyscalculia: Creative and innovative approaches to tasks, strong verbal skills.
  • ADHD: High energy levels, creativity and the ability to improvise.
  • ASC: Exceptional focus on interests, attention to detail and strong memory skills.

By recognising and leveraging these strengths, health care professionals can create a more inclusive and supportive environment for neurodivergent individuals.

Neurodiverse conditions

Infographic of female nurse speaking to patient

This section will focus on the different neurodiverse conditions, considering difficulties, strengths and helpful strategies for each condition; however, 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

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

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

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

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

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

Communication in the clinical environment

Infographic of three nurses of different ethnicities

Effective communication in health care begins with a person-centred approach that adapts to the specific needs of everyone. Developing a communication plan tailored to the patient's preferred methods and sharing this with the entire health care team is vital.

Clear documentation of the communication strategies within medical records ensures that all staff members can respond consistently and appropriately.

For neurodivergent patients, clear language and the avoidance of medical jargon are crucial. Offering written instructions or visual aids can enhance understanding, while a calm environment free of overwhelming sensory triggers provides a more comfortable experience.

For non-speaking patients, it is important to offer alternative communication methods like writing, sign language or technology. Tools such as notepads, tablets and having carers present to interpret where appropriate may be necessary to ensure smooth interactions.

It’s essential to respect individual sensory preferences, allowing neurodivergent patients to use their preferred sensory channels (for example, visual or tactile). Make sure you give people time to process information, as many neurodivergent individuals may need longer to shift between stimuli. Identifying whether they prefer direct or indirect communication and avoiding rapid changes in instructions helps create a more accessible, respectful interaction.

For a practical framework on how to communicate effectively with neurodivergent patients, the Step It Up Approach provides helpful guidance on how to improve your communication with neurodivergent patients.

Developed by Julia Richmond and Vikram Baicher, the acronym can help health care professionals when caring for patients with autism and learning disabilities.

S: Simple and direct questions - ask one question at a time, use simple terms and avoid jargon.
T: Take your time - wait for an answer, allow an extra 10 minutes.
E: Explain to enable compliance - provide a step-by-step explanation of a task and how it benefits the patient.
P: Precise language - avoid metaphors and euphemisms, say exactly what you mean and be descriptive.
I: Include carers - consider the carer’s opinion when making a diagnosis, ask for their help with procedures, ask for a hospital passport.
T: Touch and feel first - allow the patient to hold and touch equipment before you use it on them, warn the patient about sensations.
U: Understand my differences - neurodivergent patients experience and express pain differently.
P: Prepare a low sensory environment - use a quiet, plain room with minimal staff, keep ear defenders nearby, contact the learning disability liaison nurse.

You can read the full explanation and access the original article and image relating to the above model on Don't Forget the Bubbles.

Useful resources

Primary and secondary care and the clinical environment

Infographic of nurse and manager

To ensure patients feel comfortable and safe within the clinical setting, it is important that the design or flow of practice sites consider cognitive inclusivity. The human brain is complex, and its function relies heavily on connections between different brain regions to maximise cognitive awareness. Therefore it is important to consider the environment across different clinical settings focusing on the individual and their individual needs.

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

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

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

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

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

Key principles for clinical specialisms

Infographic of three nurses of different ethnicities

Uncertainty is an inherent part of life, but it can be particularly stressful when managing long-term conditions. For people with neurodiversity, such as autism or ADHD, uncertainty can stem from heterogeneous mental health levels. This includes fluctuating symptoms, varying responses to treatment, or unpredictable day-to-day challenges that can occur whilst also living with one or more long-term conditions. Behaviour change involves altering habits, routines, or mindsets to manage a condition better and improve overall wellbeing. That is why it is important for nurses working across clinical specialisms, they are aware of key principles that can help improve and enhance standards of care for those with neurodiversity.

A cancer diagnosis for any individual is often a life-changing experience. For neurodivergent individuals, this experience can be more challenging. 

This is why nursing staff need to consider the holistic individual experiences of neurodivergent people affected by cancer. Key questions you can answer to help include discussing:

  • who the care team is and their individual roles 
  • who can attend appointments with them
  • what adjustments are available to support the neurodivergent person and their specific needs
  • what will support look like if a neurodivergent person is anxious or concerned about their treatment
  • what resources are available to help patients understand, for example, Macmillan Cancer Support’s neurodiversity resource 
  • how can you share information about the person affected by cancer with the nursing team
  • examples of any previous care provided to those who are neurodivergent and living with cancer
  • how to make the nursing team aware if the neurodivergent person someone is feeling uncomfortable throughout any part of their treatment, including offering key contacts and numbers. Additionally, an alternative to phone calls may need to be offered routinely, depending on individual needs
  • if the neurodivergent person living with cancer is non-speaking or non-speaking at times, to support their use of alternative augmentative communication. For example, communication apps, photos and symbols (if they use them) or encouraging non-speaking forms of communication, for example, photos and symbols.

When thinking about the neurodivergent person’s experience from diagnosis to living with or beyond cancer, the overall experience needs to be considered by nursing staff, including what adjustments can be made to support those affected.

This needs to be discussed with the patient at the beginning and throughout their experience of cancer – needs can change from day-to-day and will likely change throughout treatment.

Autism and cancer

Autistic people often encounter multiple, overlapping barriers when accessing cancer care, and these challenges rarely exist in isolation. Instead, they accumulate across the care pathway, compounding disadvantage and widening health inequalities.

From difficulties in communication and sensory environments, to fragmented pathways and limited professional awareness, each barrier adds weight to the next. A barrier that may seem minor to others can become a significant source of distress for autistic individuals, leading to delays in diagnosis, reduced engagement with treatment and poorer outcomes.

This is why understanding cumulative exposure to these barriers is critical: it highlights not only the need for individual adjustments, but also systemic change to ensure that cancer services are equitable, accessible and responsive to the needs of autistic  individuals.

Below are some suggestions from Dr. Char Goodwin, lead researcher for the Autistic Experiences of Breast Cancer research project. The three-year project, funded by Breast Cancer Now, explores the cumulative effects of autism-specific barriers to health care in relation to cancer care, directly from autistic people themselves.

Neurodiversity and cancer infographic

Infographic was created by Dr Char Goodwin for the Autistic Experiences of Breast Cancer research project and featured in the Autistic and living with cancer: What you need to know – Autistic and Living the Dream blog co-written with Katie Munday.

  • Awareness of autism at pre diagnosis (orange): Recognition of autistic needs must begin before diagnosis: accessing cancer screening and when a patient has been recalled after screening or is experiencing symptoms that require investigation. Many GP surgeries rely on telephone booking systems, yet using the phone can be very difficult or even impossible for some autistic individuals.
  • Impact of multiple appointments (light blue): Cancer care often involves numerous tests, procedures and treatments. Planning and preparation for these appointments can be challenging, and delays or cancellations may cause significant distress. One poor experience can influence how an autistic patient engages with future treatment and care plans.
  • Communication formats and paperwork (dark blue): Appointments generate paperwork and often require navigating electronic systems. It is essential to identify the most accessible format for each patient, whether that is paper, digital or alternative resources, depending on someone’s preference.
  • Sensory sensitivities (green): GP surgeries and hospitals can be noisy, brightly lit and filled with unfamiliar smells. Cancer diagnosis and treatment often involve multiple examinations, and some autistic people may find being touched particularly difficult. This can complicate autonomy and consent, making it important to consider alternative examination approaches. It may also involve families or carers to support diagnostic requirements.
  • Continuity of care across professionals (yellow): Cancer treatment involves multiple health care professionals. It is important to make sure that those providing care are aware of the  autistic patient’s needs and offer consistent support and continuity throughout their treatment experience.
  • Supporting patients through treatment and side effects (pink): Cancer treatments such as surgery, chemotherapy, radiotherapy, targeted therapy and hormone/endocrine therapy can cause significant side effects. Understanding what these experiences are like for autistic patients, and how side effects affect daily life, is crucial when it comes to providing effective support.
  • Hospitalisation during side effects (purple arrow): When side effects require hospitalisation, autistic patients may face additional challenges in navigating care while feeling acutely unwell. This cumulative burden must be recognised and addressed in service planning.

Support for those living with and beyond cancer who are neurodivergent

Macmillan provides a range of generic resources that can be accessed by patients to support their diagnosis, when having treatment and living beyond cancer. Although not specifically designed to support neurodivergent people, the advice in these resources are transferable. They include access to:

  • An online community for people to connect and share their experiences.
  • Audiobooks – these are available on prevention, understanding certain cancers, understanding treatments and life beyond cancer.
  • Easy-read booklets – these are also available to support understanding in a format relevant to the patient and their needs.

Although these resources were not created by individuals with lived experience of neurodivergence, they provide information that may be useful.. Their purpose is to provide practical guidance, promote understanding and help reduce barriers to care. By offering adaptable approaches, these resources can be applied to meet the diverse needs of neurodivergent individuals, ensuring services are more accessible, equitable and responsive.

Transparency statement

Here at the RCN, we recognise there are currently limited cancer-specific resources and patient leaflets tailored for people who are neurodivergent. As such, the information presented here is grounded in best practice and informed by emerging research in the field.

To ensure accuracy, relevance, and sensitivity, this work has been developed in collaboration with Dr Char Goodwin, whose expertise has guided the adaptation of these materials to improve the support offered to neurodivergent individuals navigating cancer care and reviewed by Katie Munday, whose research explored the experiences of cancer services of Disabled and Neurodivergent people. This will be updated as new research and evidence-based materials emerge in the future.

Below are some suggestions from Katie Munday, community researcher with Help & Care cancer service projects. The ‘What I Would Like to Say…’ project explored disabled and/ or neurodivergent people’s experiences of cancer services, to support the development of recommendations aimed towards improving the accessibility of these services. These recommendations were then solidified in the second phase which entitled, ‘What I Would Like to Change’.

It uses findings from the previous projects to make recommendations for improving the accessibility of cancer services.

Katie also works on the Trans Aware Cancer Care project. Its second phase has linked closely with the earlier projects to support the Southampton and Salisbury Breast Screening Service at University Hospital Southampton. These projects were funded and supported by Wessex Cancer Alliance, Macmillan Cancer Support and the National Institute for Health and Social Care.

From the findings of these projects, several key recommendations emerged to improve accessibility and patient experience:

  • Compassion and sensitivity and the importance of using a person-centred and empathetic approach. This can contribute towards mitigating some of the anxiety and isolation felt by disabled communities when navigating cancer services.
  • Effective communication to provide disabled patients with clear and accessible information to support informed decision-making regarding matters of their own cancer care.
  • Making accessibility a priority through actively supporting and meeting disabled patients’ individual access needs to remove barriers to health care and build more inclusive services.
  • Supporting patients’ understanding through improved accessibility to resources, including plain language communication. Communicate clearly and effectively while checking understanding.
  • Taking a holistic approach through individualised care, supporting patients’ emotional wellbeing and extending that emotional care to family members.
  • Ensure the accessibility of practice. Improve access to health care settings, screening, and appointments. Accessibility adjustments to make services accessible to everyone.
  • Expand knowledge of disabled experiences through working through assumptions and stereotypes, appreciate and act on national disability initiatives and take a more empathetic approach.  

ADHD and diabetes

Overall, patients with comorbid ADHD (ADHD that occurs alongside another mental health, neurodevelopmental, or medical condition) tended to have worse glycaemic control. On the other hand, those with ASD did not show this difference when compared to patients with type 1 diabetes alone.

Strategies that can be applied include:

  • Consistent routines, such as regular mealtimes and glucose monitoring, can help stabilise blood sugar levels. Developing a structured daily schedule can also make managing insulin injections or medication easier. Structured environments and clear expectations can enhance focus and reduce stress.
  • Self-monitoring techniques, such as keeping a journal or using apps, can help track symptoms, triggers, and responses to different strategies. Feedback from these tools can guide behaviour adjustments.
  • Setting realistic goals for personal development or daily tasks can help individuals with neurodiversity build skills and achieve a sense of accomplishment. Using visual aids or checklists can support planning and execution.
  • Developing coping strategies, such as mindfulness or sensory management techniques, can help manage stress and sensory overload. Building resilience involves recognising and leveraging personal strengths and finding supportive communities.
  • Increasing awareness about neurodiversity can foster a better understanding of someone’s condition and how it impacts daily life. Education can also promote self-advocacy and help navigate social or occupational environments.
  • Engaging with support groups or online communities. Connecting with others who share similar experiences can offer validation and practical support. Advocating for inclusive environments and building supportive relationships can improve social integration.

Changing behaviour in diabetes care can be difficult because of several factors, such as:

  • the long-term nature of the disease
  • the requirement for continuous self-management
  • the intricate interactions among psychological, social and physiological aspects.

By approaching behaviour change in a systematic and supportive way, individuals with neurodiversity and diabetes can more effectively manage their conditions, decrease uncertainty and improve their overall quality of life.

Dyscalculia and diabetes

Managing dyscalculia alongside diabetes can be particularly challenging, especially when tasks involve mathematical calculations, such as determining insulin doses, counting carbohydrates, and using insulin pumps. However, several strategies can help simplify these processes:

  • For insulin injections, using fixed doses can reduce the need for mental arithmetic. This works well for people who eat similar meals every day. For example, if someone always has breakfast with 40g of carbohydrates, and their insulin-to-carb ratio is 1 unit per 10g, they could consistently take 4 units of insulin every morning.
  • Diabetes-specific apps can further help with these calculations by allowing carbohydrate ratios and correction factors to be programmed in advance. The app will calculate the correct insulin dose based on what someone eats, so they don’t have to do the maths themselves. Many apps also track how much insulin is still active in someone’s body, helping to avoid taking too much by accident.
  • For those using insulin pumps, setting up personalised insulin-to-carbohydrate ratios and correction factors in advance, like diabetes apps, can minimise the need for on-the-spot calculations. People using hybrid closed-loop systems (also known as “artificial pancreas” systems) who eat similar meals can sometimes use fixed doses, too. The system’s algorithm can then fine-tune any small over- or underdoses.
  • Visual aids can make managing diabetes even easier. Things like colour-coded charts or cheat sheets with photos of common meals and their carb content can save time and reduce errors. These quick-reference tools help people find the right dose without needing to work it out every time.

Regular consultations with a diabetes nurse or dietitian can ensure that these strategies are tailored to the individual's needs, making diabetes management more accessible and less stressful for those with dyscalculia.

Sick day rules and complications

Managing complications and sick day rules for individuals with neurodiversity requires a thoughtful, flexible approach that respects their unique needs and capabilities.

They may struggle with executive functioning, making it harder to follow complex medical guidelines or recognise early signs of complications. Due to someone’s unique challenges in self-care, it can be key to create a 'sick day rule' with the individual (if possible) and their caregivers. It should outline what to do when unwell, who to contact, and how to adjust the insulin regimen.

This involves creating a personalised plan that accommodates the patient's cognitive and sensory preferences, ensuring clear and simple communication of instructions. This personalised approach helps prevent complications and ensures effective management of both diabetes and neurodiversity conditions during illness, reducing stress, and promoting overall wellbeing.

Information processing and resource formatting

There are certain tasks that those who are neurodivergent may find more challenging about information processing, formatting and communication. In addition to difficulty focusing, these include:

  • Changes to routine - reparation and preplanning of appointments, clear aims and objectives, visual planner.
  • Taking things literally - sharing precise, clear information and avoiding ambiguity.
  • Challenges with social interaction - eye contact and body language. Consider virtual communication where appropriate.
  • Issues around sensory-touch and spatial awareness - for example, when demonstrating sensor application, consider social stories

How to offer additional support:

  • Visual aids: Use graphs, charts, and illustrations to present information clearly. These can help break down complex topics into manageable chunks, especially for people with ADHD. Visual tools often improve understanding, memory, and engagement. Avoid overly complex or cluttered visuals, as these can be confusing and reduce retention.
  • Active listening: Be aware that some individuals are sensitive to body language and facial expressions, so listening attentively and responding thoughtfully is important.
  • Speech delivery: Pay attention to how you speak — your pace, tone, and pauses between sentences can all affect how well someone processes what you're saying.
  • Repetition: It can help to repeat key points and review what has been discussed to check understanding.
  • Step-by-step demonstration: Visually showing a task in small steps can aid learning. In some cases, social stories (using real photos of the individual and those involved in care) can help put the task into context.
  • Processing time: Allow individuals time to think about and process information and encourage them to talk to someone they trust if they have questions.
  • Written prompts: Encourage individuals to write down questions or use self-advocacy cards to help them express their needs or concerns.
  • Preferred communication: Many neurodivergent people prefer online or written communication, as it avoids eye contact and non-verbal cues they may find difficult. Keep written information clear, factual, and free from ambiguity or overload.
  • Talking mats: These are useful visual tools that can support individuals who struggle with verbal communication.
  • Clear goals: Setting simple objectives and clear aims can help with focus and engagement, especially as planning and organisation can be more challenging.

Reasonable adjustments for patients with neurodiversity

Infographic of three nurses of different ethnicities

Reasonable adjustments in the health care setting can significantly enhance the quality of life and care experience for both health care professionals and patients with neurodiversity. These adjustments should be tailored to the individual's specific needs and the demands of their role or condition.

Although the NHS Accessible Information Standard is not autism-specific, it lays out the expected basic standards for accessibility in the English NHS. Important considerations include:

  • Accessible health care environments: Ensuring that health care facilities are accessible and inclusive, with clear signage, quiet areas and sensory-friendly waiting rooms.
  • Culturally sensitive care: Providing culturally sensitive care that acknowledges and respects the unique needs and experiences of individuals with neurodiversity.
  • Clear communication and explanations: Using clear and simple language, avoiding jargon and providing visual aids to help patients understand their condition and treatment plan.
  • Assistive technologies: Using assistive technologies, such as communication aids or sensory tools, to support patients' needs.
  • Support for caregivers: Offering support and resources for caregivers of patients with neurodiversity.
  • Documentation: Once reasonable adjustments are agreed with the patient, these should be documented on their record with an alert for future clinicians to enable them to prepare for consultants.
  • Health passport: These can be used to list communication preferences and highlight areas that could potentially cause distress.

When developing and improving services it is important to consider how accessible they are. For example:

  • Health information: Is there clear, accessible information about health education, specific conditions, and when/how to seek help — including links from the hospital website?
  • Booking options: Can people make or change appointments in different ways (e.g. telephone, video, mail, email, text)? Relying only on phone calls can be a major barrier for autistic people.
  • Clinic details: Is there information about how to find the clinic, what to expect during the visit, and whether someone can or should come with them? Are there options if no one is available to attend or support?
  • Waiting areas: Are there alternative, quieter spaces available for people to wait away from busy waiting rooms?
  • Appointment flexibility: Is there room in the schedule to allow longer or more flexible appointment times for autistic patients?
  • Booking instructions: Are there clear, step-by-step instructions on how to book or check in for appointments?

This is a term used to describe living with more than three incurable health conditions. Multimorbidity is also used to describe this situation. It is not clearly understood why one person may develop these conditions sooner than another, Research has found that people living in deprivation have a higher risk of developing these conditions than people living in affluent areas.

Deprivation is the result of lacking income and other essential resources and is often understood as living in poverty. This lack of basic necessities can have serious consequences for a person's health and their ability to thrive. In clinical settings, multi-disciplinary teams (MDTs) often need to work together to support each individual and address the wide-ranging impact of deprivation.

Multidisciplinary and multi-agency working means bringing together knowledge, skills, and best practice from different professions and services. It involves working across organisational boundaries to better understand the person’s needs, rethink how care is delivered, and find shared solutions that offer the best support.

In 2022, WHO recommended that teamwork and collaboration in multi-professional teams is a major skill-mix change and is key for organising and coordinating health and care services. It must be focused on the person, examining their priorities in order to identify realistic achievable outcomes.

Team-based planning in neurodiverse care

For a person living with a neurodiverse condition such as autism, sensory overload can be a huge barrier in the clinical setting. For example, crowded waiting rooms or too many people/services in one room may cause distress. This is why the importance of MDTs must be analysed in these circumstances and adaptations tailored depending on the clinic. This will ensure that the right people are in the right place at the right time.

The aim should be to prevent the person from feeling overwhelmed by too many people or excessive sensory input. Pre-clinic planning with the patient, their family, or caregivers can help ensure that any concerns are identified and addressed by the appropriate services. For example, some patients may prefer later appointments to avoid crowded waiting rooms.

Promoting change and equality

Infographic of two women and a man smiling

Having reviewed the key principles for supporting patients living with neurodiversity in the clinical setting, recognition of neurodiversity needs to be clearer when developing and reviewing health care services.

Nursing staff are key to safe and effective care. As a result, nurses must consider the following as a ‘Call to Action’ to promote change and equality in the clinical environment:

  • Policy—does your area have a particular policy on neurodiversity? If not, how can you develop one or add to an existing policy? By developing or amending an existing policy it will support structured change and consider a patient-centred approach to service planning and implementation.
  • Neurodiversity champions—by nominating an individual to become a ‘neurodiversity champion’ we can ensure that the patient voice is being recognised in the clinical environment, with a contact point for nursing staff to discuss any concerns or ideas for improvement. Consider how this could be applied to your health care organisation and what benefit it will add to supporting your services.
  • Mandatory training—do you have specific neurodiversity training? Are you aware of where to access this? Using the section on Key principles for clinical specialisms, work with your team to ensure you are aware of what training is required and how this can be accessed to support high-quality care.

Case studies

Case study 1

What does neurodiversity mean to you?

References and authors

Infographic of two women smiling

A special thanks and acknowledgement to the RCN Education Forum for their support in providing material for this resource.

References

Anemone, R. (2024). Autism Spectrum News: Creating sensory-friendly health care environments for autistic patients.

Burt Alistair, Tomlinson Justin, Timpson Edward, Selous Andrew, Department of Health, and Williams Lea (eds.) (2016). Progress report on Think Autism : the updated strategy for adults with autism in England.

Charlie Health (2023). What is masking?

Commission for Equality in Mental Health (2020). Mental health for all?

Cross-Party Group on Autism (2020). The accountability gap: a review of the Scottish Strategy for Autism. 

Diabetes UK. Your legal rights when you have diabetes.

Dimensions (2022). Guide for cognitively inclusive design in primary care environments.

Equality and Human Rights Commission (2011). Employment Statutory Code of Practice.

Equality and Human Rights Commission (2022). The Public Sector Equality Duty (PSED).

Gillan C (2019). The Autism Act, 10 years on: a report from the All Party Parliamentary Group on Autism on understanding, services and support for autistic people and their families in England. Edited by All Party Parliamentary Group on Autism.

Gloucestershire Health and Care Foundation Trust (2024.) A-Z of easy read health resources – locally and nationally (PDF).

Government Equalities Office (2013). Disability: Equality Act 2010 - Guidance on matters to be taken into account in determining questions relating to the definition of disability. 

Haydon, C., Doherty, M. and Davidson, I.A., (2021). Autism: making reasonable adjustments in healthcare. British Journal of Hospital Medicine, 82(12), pp.1-11.

Hunt J and Great Britain, Parliament, House of Commons, Health and Social Care Committee (eds.) (2021). The treatment of autistic people and people with learning disabilities. 

Julia Richmond, Vikram Baicher (2022). Communicating with neurodivergent patients, Don't Forget the Bubbles.

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

Kent Family Community Health NHS Foundation Trust (2024). Neurodivergence. 

Legislation.gov.uk. Equality Act 2010.

Legislation.gov.uk. Autism Act 2009.  

Legislation.gov.uk. Employment Rights Act 1996. 

Legislation.gov.uk. Disability Discrimination Act 1995. 

Legislation.co.uk. Northern Ireland Act 1998.

Local Government Association (2022). Get in on the Act: Health and Care Act 2022. 

Mackley A, Powell A, Foster D, Parkin E, Kirk-Wade E, Masala F, Lewis J, Abreu L, Roberts N, Brione P and Long R (2024). Autism: Overview of policy and services. 

National Autistic Society (2024). What is Autism?

National Autistic Society (2014). Top 5 autism tips: managing sensory difference.

NHS England (2019). Make it easy! Making information easier to understand for people with a learning disability (PDF).

NHS Providers (ed.) (2022). Building the right support for people with a learning disability and autistic people action plan.

Norfolk Community Health and Care (2024). How can you be more neuroinclusive?  

Nottingham Insight (2024). Deprivation and poverty. 

Pathfinders for Autism (2024). Visual supports for hospital and doctor visits. 

Social Care Institute for Excellence (2024). Multidisciplinary teams working for integrated care.

Turner L and Andrew N (2018). The law and neurodiversity at work. GMB Union (PDF).

United Nations General Assembly (2006). United Nations Convention on the Rights of Persons with Disabilities.

United Nations (2017). Committee on the Rights of Persons with Disabilities reviews report of the United Kingdom.

University and College Union (2022). Neurodiversity in the workplace: supporting neurodivergent members at work and campaigning for neurodiversity-friendly workplaces (PDF).

Urban Health (2018). From one to many Exploring people’s progression to multiple long-term conditions in an urban environment (PDF).

This resource has been created by the RCN Diabetes Forum with support from the Professional Lead for Long Term Conditions - this has been produced in line with the peer support service resource created by the RCN Education Forum.

Authors include:

Amanda Williams—Vice Chair for RCN Diabetes Forum and Lead Diabetes Nurse, East Kent Hospitals University NHS Foundation Trust

Michelle Turner—Forum Chair for RCN Diabetes Forum

Tamsin Fletcher Salt—RCN Diabetes Forum Committee Member and Clinical Diabetes Nurse Specialist Diabetes and Endocrine Nurse Team Leader

Marie Presgrave—RCN Diabetes Forum Committee Member and Lead Diabetes Nurse – South Tees Hospitals NHS Foundation Trust

Dr Rachael Major—RCN Education Forum Chair and Postgraduate and Academic CPD Lead The Guernsey Institute 

Callum Metcalfe-O'Shea—UK Professional Lead Long Term Conditions 

Special thanks to reviewers:

Dr Tom Nicholson [He/Him]—Assistant Professor in Mental Health Nursing, Northumbria University

Jonathan Beebee—UK Professional Lead for Learning Disability Nursing and Neuroscience Nursing

 
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