A Doctoral research project at City St George’s, University of London

Neurodivergent patient Experiences of Emergency Departments

Emergency departments are busy, fast-paced and intense environments designed to treat people who are very unwell, in crisis or critically injured. But, for autistic, ADHD or AuDHD people, visiting an ED may be an overwhelming and traumatic experience.

An ambulance and people outside the main entrance of a hospital emergency department

Background

Research shows that autistic, ADHD and AuDHD people have more physical and mental health conditions and a shorter life expectancy, yet often struggle to access the care they need.1–6

Studies with autistic adults in GP surgeries and other health services point to three common barriers:6–8

  • Sensory: noisy, crowded waiting rooms and bright lights
  • Communication: difficulty explaining symptoms and not feeling understood by staff
  • Uncertainty: not knowing what will happen, or how long the wait will be

Each of these is likely to be even greater in an emergency department. People arrive unwell, in pain or distressed, into a place that is often chaotic, noisy, full of unfamiliar people and hard to predict.9

The evidence

Greater need for healthcare. A worse experience of it.

Autistic people have higher rates of many illnesses and conditions, and they report a much worse experience of healthcare. Evidence for ADHD adults is more limited, but points the same way: a review of 125 reviews linked ADHD with a wide range of mental and physical health risks.4,10

Greater health needs

  • Two to three times

    Autistic adults were two to three times more likely to report long-term conditions of the gut, joints, nervous system, liver or kidneys.

    Survey of 2,305 adults, 1,129 of them autistic. Long-term conditions in every body system tested were more common among autistic adults.

    Source: Ward et al., 2023

  • 1.9 times

    Autistic adults in the UK were diagnosed with anxiety at almost twice the rate of other adults, and with depression at 1.8 times the rate.

    GP records of 15,675 autistic adults without a learning disability, compared with matched adults from the same practices.

    Source: O’Nions et al., 2024b

  • Almost 1 in 3

    Almost 1 in 3 women with diagnosed ADHD in the UK had a recorded diagnosis of depression, twice the rate of other women. Men with ADHD had almost three times the rate of other men.

    GP records of 30,039 adults with diagnosed ADHD, compared with matched adults from the same practices. Depression: women 31% and 15%; men 15% and 5%.

    Source: O’Nions et al., 2025

A worse experience of care

  • Autistic adults rated the quality of their healthcare lower than non-autistic adults on 50 of 51 questions, including access to care and communication.

    Survey of 2,649 adults, 1,285 of them autistic.

    Source: Weir et al., 2022

  • 84% compared with 56%

    84% of autistic adults said they needed support in their daily lives, but only 56% were receiving any.

    UK-wide survey of 2,129 autistic adults, 2015 to 2021. Support covered everyday things such as getting health care, managing money, work, travel, friendships and daily planning.

    Source: Brice et al., 2026

  • 34% of autistic adults surveyed did not access treatment for a potentially serious or life-threatening condition.

    Survey of 507 autistic adults, most living in the UK or Ireland.

    Source: Doherty et al., 2022

Because of this inequality…

…and an expectation of a distressing or frustrating experience, some may avoid going to the hospital at all, even when they are seriously unwell.6,8 In one large survey, 65% of autistic adults said they wait until it is an emergency before seeing a healthcare professional, compared with 52% of non-autistic adults.5

Whilst there is growing recognition of these issues, the voices and experiences of neurodivergent people are rarely included in conversations about how emergency care could improve. Research on sensory-friendly emergency care for autistic patients has focused largely on children, and more than half of it has been written from the perspective of emergency department staff.9

The project

The NEEDs Project (Neurodivergent patient Experiences of Emergency Departments) exists to bridge that gap.

The project is the PhD work of an AuDHD diagnostic radiographer, supervised and advised by a diverse expert team, but most importantly, working in equal partnership with other autistic, AuDHD and ADHD people.

The project uses a Participatory Action Research approach. This means valuing autistic, ADHD and AuDHD people as experts in their own experiences and working together to improve practices. To ensure any proposals for change are realistic and actionable within the current constraints of the NHS, later stages of the project will incorporate the views and experiences of frontline staff and emergency department leads.

Ultimately, the NEEDs Project is about listening, learning and taking action.

Through partnership, research and advocacy, we hope to support lasting change, so that autistic, ADHD and AuDHD adults are no longer expected to fit into systems that weren’t designed for them, but instead are part of reshaping those systems to better meet their needs.

References

  1. Ward JH, Weir E, Allison C, et al. Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults. Mol Autism 2023;14:35. doi:10.1186/s13229-023-00565-2
  2. O’Nions E, Brown J, Buckman JEJ, et al. Diagnosis of common health conditions among autistic adults in the UK: evidence from a matched cohort study. Lancet Reg Health Eur 2024;41:100907. doi:10.1016/j.lanepe.2024.100907
  3. O’Nions E, Lewer D, Petersen I, et al. Estimating life expectancy and years of life lost for autistic people in the UK: a matched cohort study. Lancet Reg Health Eur 2024;36:100776. doi:10.1016/j.lanepe.2023.100776
  4. O’Nions E, El Baou C, John A, et al. Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study. Br J Psychiatry 2025;226:261–8. doi:10.1192/bjp.2024.199
  5. Weir E, Allison C, Baron-Cohen S. Autistic adults have poorer quality healthcare and worse health based on self-report data. Mol Autism 2022;13:23. doi:10.1186/s13229-022-00501-w
  6. Doherty M, Neilson S, O’Sullivan J, et al. Barriers to healthcare and self-reported adverse outcomes for autistic adults: a cross-sectional study. BMJ Open 2022;12:e056904. doi:10.1136/bmjopen-2021-056904
  7. Stein Duker LI, Giffin W, Taylor EE, et al. Barriers and facilitators to primary healthcare encounters as reported by autistic adults: a qualitative study. Front Med (Lausanne) 2025;12:1481953. doi:10.3389/fmed.2025.1481953
  8. Shaw SCK, Carravallah L, Johnson M, et al. Barriers to healthcare and a ‘triple empathy problem’ may lead to adverse outcomes for autistic adults: a qualitative study. Autism 2024;28:1746–57. doi:10.1177/13623613231205629
  9. Sadatsafavi H, Vanable L, DeGuzman P, et al. Sensory-friendly emergency department visit for patients with autism spectrum disorder: a scoping review. Rev J Autism Dev Disord 2023;10:684–98. doi:10.1007/s40489-022-00318-6
  10. French B, Nalbant G, Wright H, et al. The impacts associated with having ADHD: an umbrella review. Front Psychiatry 2024;15:1343314. doi:10.3389/fpsyt.2024.1343314
  11. Brice S, Petrou AM, Hamilton J, et al. Health and social characteristics of autistic adults in the UK-wide Adult Autism Spectrum Cohort (ASC-UK): a cross-sectional study. Res Autism 2026;137:202963. doi:10.1016/j.reia.2026.202963

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