Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings
Autistic people experience significant health disparities and reduced life expectancy. Barriers to accessing healthcare are associated with adverse health outcomes. Autism training and healthcare professionals' knowledge about autism is variable, and heterogeneity among autistic people leads to additional educational and clinical complexities. Autism remains nebulous for many practitioners, who are unclear about communication differences, access needs or life experiences common to autistic people. Healthcare environments can be challenging for all patients but autistic people may require specific accommodations to allow equitable access. The authors have developed a simple framework which may facilitate equitable clinical services at all points of access and care, using the acronym ‘SPACE’. This encompasses five core autistic needs: Sensory needs, Predictability, Acceptance, Communication and Empathy. Three additional domains are represented by physical space, processing space and emotional space. This simple yet memorable framework encompasses commonalities shared by autistic people.
The acronym ‘SPACE’ offers a simple framework for autism-specific accommodations: Sensory needs, Predictability, Acceptance, Communication and Empathy plus physical, processing and emotional space.
Processing spaceThis is the additional time required to process new information or unexpected changes. Compared to non-autistic people, making decisions, responding to questions or accepting suggestions may require longer (Royal College of Psychiatrists, 2020; Vicario et al, 2020). Understanding this aspect of autistic experience and having the patience to wait is invaluable. It may appear that an autistic person is not answering or did not understand, and so the temptation is to repeat or rephrase the question, both of which can re-start the processing time thus further delaying resolution (Haydon et al, 2021). This is complicated by the fact that some autistic people, particularly those with co-occurring attention deficit hyperactivity disorder, may have become distracted (Young et al, 2020), so a simple prompt such as ‘are you still thinking?’ can sometimes be helpful.
