Sensory Accommodations in Healthcare

As the first virtual primary care platform for neurodivergent adults, supporting our members’ sensory needs is core to Hopper’s mission, but many neurodivergent folks aren’t aware of all of the ways we can be accommodated in a healthcare setting. It can also be intimidating to ask a doctor or nurse to do something differently when we’re sick, in pain, or just looking for help, so many folks end up working hard to mask their neurodivergent needs to try and avoid stigma, bias, or lack of understanding.

We believe that everyone should get care how they need it, and are committed to reducing stigma in asking for and receiving accommodations. Here’s a break down of some common challenges and suggested accommodations by sense - feel free to share this with your doctor, dentist, or other healthcare professional!

OVERVIEW OF THE SENSES & SENSITIVITIES

Since elementary school, we’ve been taught that the 5 basic human senses are touch, sight, hearing, smell, and taste. We will be exploring these 5 plus an additional 3 that aren’t considered “basic”, but are very relevant to sensory processing in neurodivergent people. The additional 3 senses we’ll consider are proprioception (the ability to know where your body is positioned without using sight), vestibular (the ability to know whether you are upright/hanging upside down in space), and interoception (how you feel - hungry/thirsty/anxious/temperature).

For neurodivergent people, extremes in response to sensory input are very common. In each of the 8 senses we discussed, a person can be hyper- or hypo- sensitive, and each individual can have very different levels of sensitivity to each sense, requiring a range of accommodations. Hypersensitive means being more responsive to sensory stimuli than others, while hyposensitive means being less responsive to sensory input. These two definitions will be very helpful as we dive into accommodation specifics, so keep them in mind! 

TACTILE

For folks with tactile sensitivity, telehealth has immediate and obvious benefits for Hopper members. In a digital environment, Hopper members can comfortably use fidget toys, weighted blankets, or stress balls without fear of judgment and in the comfort of their own home. Similarly, Hopper members can wear whatever clothing is comfortable for their tactile sensitivities and preferences (PJs, bathrobes, and Snuggies are common), without worrying about putting on “outside clothes” to get to an appointment, or cloth or paper gowns with bothersome ties, tags, or textures.

Tactile sensitivities can be accommodated in care planning too: Dylan suffers from high blood pressure, and his doctor has asked that he take and record his blood pressure morning and night. Dylan is also autistic and struggles with tactile hypersensitivity, and the texture of the cuff combined with the hard squeezing sensation on his arm is very distressing. Dylan’s team at Hopper may recommend wrist or finger measurement that minimizes these uncomfortable sensations, because while these techniques may be slightly less accurate, the most important part is helping Dylan create a habit he can maintain without fear or distress. For specialist or urgent visits outside of Hopper, Dylan’s care team gives him documentation to share with other clinicians and works with Dylan to plan ahead for instances where using a blood pressure cuff on his arm may be unavoidable.

For people with hyposensitivity to touch who may have high pain tolerance, it’s also important to share needs and plan accommodations with providers - some folks may need a different plan for anesthesia in the case of surgical or dental procedures, and differences in reporting level of pain need to be taken into account.

VISUAL

For folks with visual sensitivity, telehealth is also a great channel for care, with lots of opportunities for accommodations. Hopper members can turn on closed captioning during virtual appointments to support their information processing, video can be turned off when not specifically needed for diagnosis, and lighting and brightness of the environment is controlled entirely by the member. 

In addition to digital tools like closed captioning, we can also offer our members with visual sensitivities different modes of communication. For example, if reading text-based messages is difficult for a Hopper member, their care team can record and send voice memos with information and instructions.

When Hopper members are referred out to specialists for in-person visits, we provide instructions to the staff and provider specific to visual accommodations as well: dimming exam room lights, giving notice before the brightness level changes, or being seen in a room with the fewest decorations, colors, clutter, and other visual stimuli are all examples of what our members may need. For vision testing at an optometrist, it may be possible to offer a different format for the test, or have certain exams that require bright light be done less frequently, depending on the member’s health history. Many of these accommodations seem simple, but this type of self-advocacy isn’t yet the norm in healthcare settings and many providers aren’t aware of the helpful or harmful impact of sensory experiences.

AUDITORY

The ability to access care and support from home allows neurodivergent people to have much more control over their environment and to minimize unwanted auditory stimuli (hyper-), or to include soothing background sounds of their choice (hypo-). For members who are hypersensitive to sound and are easily distracted by background noises, noise canceling headphones may help them more comfortably focus. This is a unique perk of telehealth that allows folks to avoid loud, startling, distracting, or unpleasant noises that may be unavoidable in in-person clinical settings.

In addition to members being able to control their own environment, we also offer our members with auditory sensitivities different modes of communication. For example, if sound on a video call are uncomfortable for a Hopper member, members can use captions and chat in the appointment instead. We also offer more direct messaging, email, text, and visual resources. 

When Hopper members are referred out to specialists for in-person visits, we provide written steps and language to use when informing providers that they may need instructions repeated or delivered in a different sensory format. This could be as simple as asking a provider to write down any instructions and give the patient the paper to look at while the provider reads through them (or doesn’t, and just lets them read silently).

For some folks with auditory hypersensitivity, sounds such as toilets flushing, equipment alarms dinging, or hand dryers whirring can be extremely distressing. The clinic may be able to offer a quieter office location or even a quieter appointment time, and we’ll guide Hopper members through this process to ensure their auditory needs are met so they can feel as comfortable as possible during their visit. If it’s not possible to eliminate all background noise, the provider can also wait to give important instructions while there are other noises happening. In addition, rather than loudly calling the person’s name in the waiting room, staff can reduce startling or unpleasant sensory responses by approaching from the front and waving before saying hello.

GUSTATION

Our conversations with members around diet, eating habits, and nutrition, are approached in the context of individual sensory needs, preferences, and safe foods. For someone with gustation sensitivity, it doesn’t make sense to simply ask, “Are you eating enough vegetables?” when a member with hypersensitivity to taste could find vegetable textures distressing enough to need to avoid them altogether. For pre-diabetic or type 2 diabetic members, it’s especially important to give folks the space to talk about nutrition in relation to these sensory needs, since many neurodivergent people with taste sensitivities may rely on ultra-processed foods for their predictable flavors and textures, and recommendations for dietary changes need to be realistic in order to be effective.

OLFACTORY

For folks with olfactory sensitivity, telehealth allows people to have better control over their environment and to minimize unwanted olfactory stimuli (hyper-), or to include soothing fragrances of their choice (hypo-). Certain smells in clinical settings can be very strong and distressing even to people with little or no sensitivity to smell, so for someone with hypersensitivity, it can be untenable. Of course, telehealth provides the basic perk of folks being able to avoid clinic smells such as bleach, rubbing alcohol and other strong cleaning agents.

When Hopper members are referred out to specialists for in-person visits, Hopper can provide written directions and requests to the clinic staff for patients to be seen in a room or office location that minimizes intense smells. We can also help Hopper members with olfactory sensitivities by working together to come up with new coping strategies that minimize effort for the patient when it comes to in-person visits and common smells in clinical settings.

PROPRIOCEPTION & VESTIBULAR

It’s common for folks with proprioceptive and/or vestibular hypersensitivity to avoid movement, not enjoy participating in physical activities and sports, and tire easily from having to stand for periods of time or engage in physical activity. When communicating about activity in relation to physical health and mental wellbeing, our conversations with Hopper members will always be conscious of and in context of sensitivity to proprioception. For example, a standardized questionnaire about physical activity might not be fitting for someone with sensitivity to proprioception, and it could be upsetting for someone to receive questions that don’t make sense for their sensory needs and lifestyle. 

Telehealth allows Hopper members with proprioceptive sensitivity to avoid movement that may be uncomfortable. For someone with vestibular sensitivity, they may be fearful of escalators, elevators, stairs, or nonlevel walking zones. Importantly, being upside down or having to balance can be extremely uncomfortable for some people - recommending yoga as gentle exercise, for example, might be a bad choice. Hopper supports members who may need procedures that typically involve this type of movement (like tilt-table tests for POTS), by guiding them through which accommodations or alternative procedures/tests would be most helpful. For many procedures, it is possible to give the patient plenty of time and breaks and allow a support person to be present. There are plenty of ways to navigate accommodating these types of sensory needs, and Hopper members know they have their primary care team to advocate for them with other healthcare providers.

INTEROCEPTION

Folks with interoception hyposensitivities may struggle to recognize bodily sensations like hunger, thirst, pain, or the need to use the bathroom - this is especially common in autistic and ADHD adults. For these individuals, being in in-person clinical settings can be anxiety-provoking, especially if there isn’t an open understanding with the provider about this sensitivity when talking about bowel habits, eating patterns, or pain levels. Hopper can provide guidance for in-person providers that explains these differences and how the patient may need extra time and explicit preparation instructions for urine samples or blood draws - it is not uncommon for folks who are hyposensitive to interception to be dehydrated from forgetting to drink enough fluids. Too many neurodivergent folks have shared stories of being shamed or uncomfortable during procedures because of low hydration, when simple communication from providers about preparation could have prevented any discomfort.

With interoception hypersensitivity, a person may interpret slight pressure from their bladder as an extreme need to urinate, for example, and they may need to use the restroom frequently. Some folks with this hypersensitivity may like to use signals for thirst or needing to use the restroom, instead of announcing their needs, and Hopper clinicians ask for and respect these signals. In addition, if a patient has an extremely high pain tolerance or even the inability to feel pain, it’s important for us to inform providers outside of Hopper, especially if they will be undergoing any sort of procedure that typically requires feedback on pain level.

CONCLUSION

It’s important to note that while these are all examples of sensory accommodations in healthcare for neurodivergent adults, everyone is different and has unique needs. Sensory needs can change over time and even over the course of a day as energy levels vary - the examples given here are just a few of the many possibilities. At Hopper, support of our neurodivergent members’ sensory needs is a key component of how we treat health differently, and we hope you will join us!