Accessing medical care can be a challenging experience for individuals with developmental disabilities, particularly when it comes to communication.
Medical settings are often overwhelming, filled with unfamiliar faces, complex procedures, and new environments that can heighten stress and anxiety. Educating children about health and medical environments through resources like books and television programs can help them better understand their health and the processes involved in hospitalisation. These challenges are compounded when an individual has difficulty understanding or expressing their needs effectively.
Communication difficulties in medical settings generally fall into three categories:
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Receptive Communication Difficulties – Struggling to understand verbal instructions, medical explanations, or procedural steps.
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Expressive Communication Difficulties – Difficulty conveying symptoms, pain levels, or medical concerns to healthcare providers.
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Social Interaction Challenges – Difficulty engaging in conversation, following social cues, or navigating interactions with medical staff.
For example, an individual with a developmental disability may struggle to describe pain or discomfort, making it difficult for doctors and nurses to provide accurate treatment. Miscommunication can lead to delays in diagnosis, inappropriate interventions, and increased distress for the individual.
Visual communication systems offer a structured, accessible way to support individuals in these settings. By presenting information through objects, images, symbols, or text, these systems provide a predictable and clear means of understanding and conveying essential information.
This article explores how visual communication supports can be used effectively to enhance medical access for individuals with developmental disabilities. We will outline different types of visual supports and discuss how structured visual systems can improve communication during medical appointments.
Whether you are a parent, teacher, practitioner, or caregiver, this guide will provide actionable strategies you can implement at home, in the classroom, or in a care setting to support individuals in accessing medical services more effectively.
Additionally, for further guidance, you can download Dolly Bhargava’s comprehensive resource:
Understanding Developmental Disabilities and Communication Barriers
Developmental Disability is an umbrella term that includes a diverse range of diagnoses which arise from an impairment of the central nervous system.
This includes conditions such as Autism Spectrum Disorder (ASD), Cerebral Palsy, Down Syndrome, Fragile X Syndrome, and Foetal Alcohol Spectrum Disorder. Individuals with these conditions may experience difficulties communicating in any setting and in particular during medical visits.
Each of these conditions presents unique communication challenges:
Autism Spectrum Disorder (ASD)
Individuals with ASD may struggle with both verbal and non-verbal communication. They may have difficulty understanding figurative language, following multi-step instructions, or maintaining eye contact. In a medical setting, patients with ASD may be unable to express pain or discomfort clearly, leading to potential misdiagnoses.
Cerebral Palsy
Some individuals with cerebral palsy experience speech and motor impairments that make verbal communication challenging. A person with cerebral palsy might have difficulty articulating words due to muscle control issues, making it harder for medical staff to understand their needs without alternative communication methods. Having a dedicated team, such as an Autism behavioural Consult team, can provide essential support and resources to both medical staff and parents, enhancing the overall care experience for individuals with developmental disabilities.
Down Syndrome
While many individuals with Down Syndrome develop strong social communication skills, they may struggle with expressive language or understanding complex medical terms. This can lead to difficulties when discussing symptoms, medications, or procedures with healthcare professionals. It is important to prepare individuals with Down Syndrome for hospital visits and stays by providing clear communication about what to expect, maintaining routines, and incorporating play to help them cope with the emotional and psychological aspects of hospitalisation.
Fragile X Syndrome
Often associated with anxiety and sensory sensitivities, individuals with Fragile X Syndrome may become overwhelmed in unfamiliar environments, making communication more difficult. They might rely on repetitive speech patterns or gestures, which may not effectively convey medical needs. For young children, separation from their parents can be their main worry during hospital visits, so it is crucial to reassure them that they will not be alone.
Foetal Alcohol Syndrome
Individuals with FASD often experience difficulties with attention, memory, and processing verbal instructions. In a medical context, this can lead to misunderstandings about treatment plans, difficulty following doctor’s instructions, or miscommunication about symptoms.
By integrating visual supports into medical interactions, healthcare providers and caregivers can ensure that individuals with developmental disabilities receive the care they need while reducing anxiety and frustration.
In the next section, we will explore the different types of visual communication supports available and how they can be effectively implemented in medical settings.
Types of Visual Communication Supports for Children
Visual supports range from simple objects to written words, depending on an individual's cognitive ability. The most effective supports include:
Objects
Physical representations of concepts (e.g., a stethoscope for a doctor’s visit) provide a tangible way to understand an upcoming experience.
Photographs
Images of people, places, or medical equipment help clarify what to expect, reducing anxiety and uncertainty.
Computer Line Drawing
Symbols or illustrations, such as those used in Picture Exchange Communication Systems (PECS), aid comprehension and provide non-verbal ways to convey needs.
Written Words
Simple text explanations reinforce understanding for individuals who can read and process written language.
The appropriate choice of visual support depends on the individual’s level of comprehension, and it is best to start with concrete representations (objects, photographs) before progressing to abstract symbols or written words.
When and How to Use Visual Communication Supports in Medical Visits
Visual communication supports can be used at different stages of a medical visit to enhance understanding and interaction:
Before the Visit: Guidance for Parents
Caregivers can introduce visual schedules to outline the steps of the visit, helping the individual anticipate what will happen.
Photographs of the clinic, waiting room, and medical staff can be used to familiarise the individual with the setting in advance.
Choice boards can be prepared to help the individual indicate preferences (e.g., sitting on a chair or lying down for an examination).
During the Visit
Caregivers and healthcare providers can use pain scales with visual indicators to help individuals communicate their discomfort.
First-then boards can encourage cooperation by showing a preferred activity after completing a medical task.
Doctors can use communication aids brought by caregivers, such as picture cards or digital apps, to facilitate interaction.
After the Visit
Written words or illustrated social stories can help reinforce what happened during the visit.
Caregivers can use visual supports to remind individuals of follow-up appointments or medication schedules.
A reward or motivation board can help encourage positive associations with medical visits for future interactions. Additionally, when young children return home after a hospital stay, they may experience emotional and developmental changes, such as increased clinginess, regression, and disturbances in sleep and appetite, making this transition period significant for both the children and their families.
Visual Systems for Patients' Medical Appointments
Beyond individual visual supports, embedding them into structured visual systems enhances communication and provides predictability for individuals with developmental disabilities.
Calendar systems help individuals anticipate upcoming medical appointments by marking important dates. A calendar can be used at home or in a classroom setting to visually prepare the individual for the upcoming visit, reducing anxiety by making the event feel more predictable.
Schedule systems visually outline the sequence of activities throughout the day. A “Now” schedule shows the immediate next step, while a “First-Then” schedule displays the current task and the one that follows. A daily schedule can break down the entire day, incorporating the medical visit into a familiar routine, helping the individual understand when the appointment will take place and what will happen before and after.
Mini-schedule systems break down each stage of the appointment into smaller, more manageable steps. For example, arriving at the clinic, waiting, meeting the doctor, undergoing an examination, and leaving. By following a structured process, individuals with developmental disabilities can feel more comfortable and prepared, knowing exactly what to expect at each stage.
Choice systems provide individuals with control over their experience. For instance, they may be allowed to choose between two different doctors, decide whether they want to sit or stand during an examination, or select a preferred reward after the visit, such as a small toy or activity. This sense of control can significantly reduce stress and improve cooperation.
Cause-effect links explain the consequences of certain actions. A visual aid might illustrate that failing to take medicine could lead to feeling unwell, while brushing teeth helps prevent cavities. These tools help reinforce the importance of medical treatments and encourage adherence to healthcare advice.
Social stories describe what will happen during a medical appointment in simple, reassuring terms. For example, “The dentist will ask me to sit in a chair. They will use a small mirror to look at my teeth. If I feel nervous, I can hold my mom’s hand.” This technique provides comfort and predictability.
Category books group relevant visuals under specific themes, such as medical professionals, medical equipment, or medical procedures. Familiarising individuals with these categories helps them feel more at ease with the medical environment.
Behavioural expectations charts help the child understand the rules, procedures and behaviours expected in a medical setting, such as using an inside voice, keeping hands to themselves, and following the doctor’s instructions.
Feeling-problem-solution charts allow individuals to express emotions and identify solutions. If they feel scared, they can look at the chart to find ways to cope, such as taking deep breaths or holding a caregiver’s hand.
Chat books provide a record of past visits, reinforcing positive experiences and reducing anxiety for future appointments.
By integrating these structured visual systems, medical professionals and caregivers can create a more inclusive and accessible healthcare experience for individuals with developmental disabilities.
Effective Communication with Medical Staff
Effective communication with medical staff is crucial for ensuring that children with developmental disabilities receive the best possible care. Medical staff should be aware of the child’s learning style and comfort level with touch to provide personalised care. Parents can play a significant role in facilitating communication by providing information about their child’s needs and preferences. Visual supports, such as pictures or symbols, can also be used to help children understand medical procedures and communicate their needs.
Medical staff can enhance communication by using visual supports tailored to the child’s comprehension level. For instance, a picture of a stethoscope can help a child understand that the doctor will listen to their heartbeat. Parents can assist by sharing insights about their child’s preferred communication methods and any specific triggers or calming techniques. This collaborative approach ensures that the child feels understood and supported throughout the medical visit.
Creating a Supportive Medical Environment
Creating a supportive medical environment is essential for reducing anxiety and stress in children with developmental disabilities. Medical staff can create a welcoming atmosphere by using simple language, being patient, and providing emotional support. The use of visual supports, such as pictures or videos, can also help children understand what to expect during medical visits. Additionally, medical staff can involve parents in the care process to provide reassurance and support.
A supportive environment begins with clear and compassionate communication. Medical staff should explain procedures in simple terms and use visual aids to illustrate each step. For example, showing a video of a routine check-up can demystify the process for the child. Involving parents in the care process is equally important; they can offer comfort and familiarity, helping to ease the child’s anxiety. By fostering a calm and understanding atmosphere, medical staff can make medical visits a more positive experience for children with developmental disabilities.
Overcoming Barriers to Medical Care
Children with developmental disabilities may face barriers to medical care, such as difficulty communicating their needs or understanding medical procedures. Medical staff can overcome these barriers by using visual supports, such as pictures or symbols, to communicate with children. Additionally, medical staff can involve parents in the care process to provide emotional support and facilitate communication. By providing personalised care and using visual supports, medical staff can help children with developmental disabilities feel more comfortable and secure during medical visits.
To address communication barriers, medical staff can use tools like pain scales with visual indicators, which allow children to express their discomfort levels more accurately. Visual schedules can outline the steps of the visit, helping the child understand what will happen next. Involving parents is crucial; they can interpret their child’s non-verbal cues and provide emotional support. This collaborative effort ensures that the child’s needs are met, and their medical visits are as stress-free as possible.
Family and Caregiver Involvement
Family and caregiver involvement is essential for ensuring that children with developmental disabilities receive the best possible care. Parents can provide valuable information about their child’s needs and preferences, which can help medical staff provide personalised care. Additionally, parents can provide emotional support and reassurance during medical visits, which can help reduce anxiety and stress in children. Medical staff can involve parents in the care process by explaining medical procedures, providing updates on treatment, and seeking their input on care decisions.
Parents are invaluable partners in the medical care of children with developmental disabilities. They can share insights about their child’s communication style, sensory sensitivities, and coping mechanisms. During medical visits, parents can offer comfort and familiarity, helping to alleviate the child’s anxiety. Medical staff should actively involve parents by explaining procedures in detail, providing regular updates, and considering their input in care decisions. This collaborative approach ensures that the child receives comprehensive and compassionate care tailored to their unique needs.
Conclusion
Effective communication is fundamental to ensuring individuals with developmental disabilities can access medical care with confidence and ease. By integrating visual communication supports and structured systems, healthcare providers, caregivers, and educators can significantly improve medical experiences for these individuals.
Visual aids, from simple objects and photographs to complex visual schedules and social stories, serve as powerful tools in reducing anxiety, enhancing understanding, and facilitating clearer interactions between individuals and medical professionals. When used proactively—before, during, and after medical visits—these supports create a more predictable and empowering healthcare experience.
For families and caregivers, preparing individuals in advance using visual schedules, category books, and behavioural expectations charts can set a foundation for success. Medical professionals can further enhance interactions by incorporating these tools into their practice, using clear language, and allowing extra time for processing.
By adopting visual communication strategies, we can foster a more inclusive healthcare system that meets the unique needs of individuals with developmental disabilities, ensuring they receive the best possible care and support. For further guidance, refer to A Guide to Using Visual Communication Systems to Support People with Developmental Disability and Complex Needs Access to Medical Services by Dolly Bhargava.