Consider arranging an initial appointment to familiarise the autistic child with the consulting room and equipment so that they know what to expect during the eye test. Alternatively, provide accessible information about what will be involved. 

Knowing when something will happen is important to autistic children, as it can help them feel more secure and less anxious. Try and ensure that appointments begin and end when planned, so an appointment at a less busy time of the day might be a good idea.  

Many autistic people find visual supports and prompts useful in helping them to understand what will happen next and importantly when something will end.  

If relevant, speak to parents or carers before the appointment to learn what the patient may like or dislike or respond well to, for instance counting, shapes, lights, TV characters, and so on. You could use these to help them feel more relaxed during their appointment.
 

Communicating 

Some autistic people may struggle with processing and understanding verbal communication, try to avoid using wordy and complex instruction. Ensure that instructions are clear, concise and unambiguous. 

• Use the syntax ‘First X then Y’. 
• Use an egg-timer or countdown clock to indicate how long they will be in the room. 
• Use ‘again’ to indicate that you want to repeat what we just did. 
• Use the parent or carer if they are present as a model: ‘First Mum puts on glasses then Jack puts on glasses'. 
• Use turn-taking: if ‘we’ all do it then at some point it will be ‘my turn’ to look or read or put on the glasses. 
• Give the patient extra time to process and respond to statements and questions. Be patient, repetitive and calm.  

Echolalia is a term to describe the repeating of a phrase or sound. If the patient has echolalia then they may repeat the last part of any phrase heard. Therefore, make sure that you turn questions such as 'better first or second?' around to 'better second or first?' and see if the response remains the same or changes. Or you could simply say ‘this one or this one?’ instead.
 

The examination - what should I do? 

What can be achieved in the eye examination will be dependent on many factors and it may be the case that on the first visit, little clinically can be achieved beyond the patient becoming familiar with the room, and with you. This is as important as a measure of acuity, though, given that you might well be seeing the patient for years to come. 

One measure of vision may be ‘visually curious’. If you give them a toy, do they explore the features with their eyes, or dismiss it because they have difficulty seeing the features of the toy? 

Parents and carers will understand that you may not be able to do a full examination in just one visit. It may be necessary to make a referral to hospital eye services via the person’s GP if you cannot perform a full eye examination, or there is a clinical need which you or your practice cannot meet.
 

Key points 

• Use direct and simple language. 
• See the patient at a quiet time of the day. 
• Allow extra time for the consultation or do parts of the examination over several visits. 
• Explain in advance what will happen during each procedure. 
• Above all else, be patient and understanding. 

This information is drawn from a November 2012 article by Dr Paul Constable, City University, London; Mr Andrew Millington, Cardiff University and Mrs Pamela Anketell and Dr Julie-Anne Little, University of Ulster.