Introduction

This leaflet was developed following questions raised in a training course where clinicians were asking for suggestions about adapting their communication style when working with people who are neurodivergent.

In a conversation with service users, the importance of taking into consideration the specific communication needs of this group were highlighted.

Individuals shared their lived experience of attending services and shared suggestions for clinicians to incorporate in their practice.

Preparing for a Session

• Important to check in with individuals regarding what approach ‘fits’ their individual needs.
• Groups sessions can be easier if similar participants are included.
• Helpful to have information before a session including: individual / group agenda, topics to be discussed and how many people are likely to attend.
• Discuss the structure of session at the beginning of the session (eg breaks, start and end times).
• Possibly provide information in a folder or ask if people would mind bringing a folder.
• Check with person whether they prefer email or hard copies of handouts or notes.
• Consider suggesting that people can write things down or bring a list of questions to take in.
• Send out an appointment reminder one week and one day before.
• Prior to the session (on line or in person) ask for permission for students or other clinicians to join sessions.

In Session

• It’s OK to bring in items that help people feel relaxed and comfortable such as fidget toys or doodling.
• Consider activity focused sessions, providing pens and paper.
• Ask if the room is OK, consider the lay out, give people options, choice of where to sit.
• Consider distracting noises inside and outside’ a car alarm / loudly ticking clock’.
• Agree length of sessions- not too long and not too many questions as become overwhelmed. Schedule a break if needed.
• 1-1 eye contact can be a struggle, walking or sharing an activity can be more comfortable or seated side by side.
• Lack of eye contact doesn’t mean not listening.
• Children, young people and adults may struggle to express their feelings verbally, provide an option to write or draw.
• Could write things down – list of questions to take in.
• If things become heated, feeling overwhelmed, feeling hot – take a break.
• Ask if they would like to take a moment to gather their thoughts.
• Body language – notice if people appear uncomfortable, check in that they’re ok.
• ADHD – its ok for people to move round if that is helpful.
• Be given the opportunity to speak even if it takes a while .
• Look out for others guessing / jumping in/ finishing sentences- take a pause.
• Check person is listening – zoning out isn’t being rude.

Other thoughts

• Consider how to explain the purpose of Family Therapy / Therapy / Session.
• Help people feel comfortable enough to speak – ask what helps.
• Check in with listening / understanding of what’s being said.
• Useful phrases which can be used: ‘What I do need to know about your communication style that would help our conversation’?
• ‘I’m going to ask you a question’- give space to answer.
• For some people sessions online may be easier as once the sessions end allows time to reflect alone and process.
• In family therapy some people may worry that the topic might continue to be discussed after the session and lead to arguments. Confirm boundaries of session.
• It may be annoying to have things repeated but used as a skill by the therapist it can be helpful to avoid misinterpretation.
• Being mindful about the impact of medication, some people may feel drowsy especially if getting used to a new or change in medication. Others may find concentration is improved soon after taking medication.
• Timing of sessions, consider arranging sessions outside of mealtimes or when needing to take medication.

Techniques

Externalising the eating disorder (ED)

Is a way of helping individuals to separate themselves from the problem and can be helpful for people they are in relationship with.

‘The person is not the problem the problem is the problem’ (Michael White)

Comments from service users:

For some:

• Hard to relate to this idea.
  Hard to separate self from ED –some people might call their ED a name. This is difficult for some people and in this case, it would be helpful to discuss alternative ways of recognising what is the ED.
• Thoughts and behaviours are more likely to be stuck / embedded.

The Miracle question

Helps people think about how their life would be if the problem didn’t exist.

Thoughts from service users about this technique:

• Struggle as it involves looking at the bigger picture – tend to focus on smaller detail.
• Literal thinking- not possible for the ‘problem’ to just go
• Helpful steps: How does the ED control your day- if it wasn’t controlling your day how would it be different? What would you be thinking / doing, broken down into smaller steps – when you first get up.
• Thoughts / mood / activities you might be doing, not focusing on one thing.
• Small steps at a slower pace: could be seen by professionals as prolonging change – takes time to adjust and incorporate change.

Active Listening

The aim of active listening is to bring about a shared understanding of something, and/or changing the way we speak to each other.

In practice:

Take a conversation between 2 people.

Ask one person a question and ask the other person to listen and feedback what they have heard rather than what they think they have heard.

Helpful to repeat until the feedback fits with what’s been said.

This exercise may take several attempts as often feelings about what has been said are included in the feedback.

It’s reassuring if therapists check they have understood correctly.

Important to:

• Reflect on the process
• Acknowledge the mistake in the moment
• Check in on what’s been said
• Focus on what the person needs, genuine response to support communication
• May support understanding the impact of feeling misunderstood or interrupt cycle of blaming the other person
• Important to consider context and tone of voice

Presenting Information

• Use bullet points – not too wordy, too much information can be overwhelming.
• Bold font, individual preference as to use of colourful pictures.
• PowerPoints – spacing and paragraphs
• Presenting information in a variety of ways. Links to resources
• Bold heading, colour, options

After the Session

• Check with person whether they prefer email or hard copies of handouts/ notes
• Bullet point summary of what was discussed

Communication Passport

The Neurodiversity Passport is designed to help neurodivergent people communicate their needs to professionals in their primary care team and community settings.

It also supports the implementation of reasonable adjustments in these settings.

The passport was developed by the Reasonable Adjustment Service and neurodivergent people, who have used Oxford Health Services, as part of the Autism Pathway Work.

Resources

The UK’s Eating Disorder Charity – Beat

National Autistic Society

ADHD UK – Homepage – ADHD UK