A review of a study titled Using an instructional package to support adults with autism in communicating with a medical provider

Wood, J., Dukes, C., & Kearney, K. B. (2024). Using an instructional package to support adults with autism in communicating with a medical provider. Journal of Autism and Developmental Disorders, 56(4), 1283-1295. https://doi.org/10.1007/s10803-024-06635-5

Reviewed by: Tamara A. Bannon, MSW, BCBA, LMSW, LBA (NY & NJ), Endicott College

Why this research topic?

Research Synopses: Adults with Autism Autistic adults often experience barriers to effective preventative care at higher rates than individuals with other disabilities (Wood et al., 2024). These reported challenges include difficulty accessing interventions and supports, as well as fear, anxiety, and distrust resulting from previous negative healthcare experiences. Additional barriers may be related to social communication, sensory processing, bodily awareness, and the need for routine and predictability, which are characteristics associated with autism (Wood et al., 2024). Furthermore, there is a lack of research examining the health status and needs of autistic adults (Best et al., 2025; McLean et al., 2024).

The authors emphasize the importance of supporting autistic adults in communicating effectively with healthcare providers, with the goal of facilitating more comfortable healthcare experiences and greater independence in navigating their healthcare. This collaboration may lead to autistic patients feeling more comfortable during physical exams, developing trusting relationships with their providers, and becoming more independent in navigating their healthcare (Wood et al., 2024).

What did the researchers do?

The researchers examined whether an instructional package could teach autistic adults how to communicate their needs and to request any necessary accommodations from the medical provider during a simulated doctor’s appointment. The participants included three autistic males who were 40 years old or older and experienced challenges finding a primary care physician (PCP) who understood their needs. The study took place virtually via Zoom and included one participant, an interventionist, and a confederate PCP (i.e., a person pretending to be a PCP without the participant knowing) during each session.

The intervention was an instructional package that included a video module (the Module for Autism Self-efficacy in Healthcare [MASH]), guided notes, the Autism Healthcare Accommodations Tool, and behavior skills training (BST). The targeted communication steps included the following: greeting the provider, stating the reason for the visit, describing the need for extra support, explaining two or three accommodations, and asking questions about next steps and follow-up. The acronym “GREEN” was used to help the participants remember the steps. The researchers measured the percentage of GREEN communication steps that participants completed correctly and independently.

During BST, the interventionist taught the participants the GREEN steps and modeled them during a simulated doctor’s appointment with the confederate PCP. The participants then practiced the GREEN steps during a simulated appointment and received feedback. Social validity data were collected from the participants, medical student volunteers, and PCPs and included socially important goals, socially acceptable procedures, and socially significant outcomes (Wood et al., 2024).

What did the researchers find?

The researchers discovered that the participants were able to learn the targeted communication steps in GREEN. During baseline (i.e., before intervention), participants completed only 34% of the steps correctly. All participants greeted the PCP, and two provided additional information; however, none explained helpful accommodations or asked follow-up questions.

After completing MASH and the related activities, BST was implemented. Following BST, participants completed an average of 92% of the GREEN steps correctly. Respondents also viewed the intervention goals as significant, the procedures as socially acceptable, and the outcomes as effective.

The current study highlights the importance of self-advocacy for autistic adults and being able to confidently communicate their health needs to PCPs. Similarly, Best et al. (2025) conducted a qualitative study that interviewed 15 autistic adults to assess their self-advocacy and experiences accessing healthcare services. Their research directly supports the current study, as their findings highlight the importance of self-advocacy in healthcare and its alignment with the neurodiversity movement. Their findings also suggest that self-advocacy can impact access to healthcare services (Best et al., 2025). Additionally, research supports targeting personal-level factors as well as provider-level, organizational, environmental, and technological systems to improve healthcare outcomes for autistic adults (McLean et al., 2024).

What are the strengths of the study?

This research represents an initial step toward improving preventive care for autistic adults with complex healthcare needs who face barriers when accessing appropriate services. The study demonstrated several strengths. First, following the instructional package, all three participants learned to discuss their healthcare needs with the PCP and identify three accommodations that could support them during a medical appointment. Furthermore, the participants demonstrated these communication skills with a different PCP, including one of a different gender, and continued to use the skills after the intervention ended. Importantly, all participants continued to demonstrate the targeted skills at follow-up for up to 8 weeks after the intervention was removed, suggesting that these skills were learned and retained over time.

A second strength of the study was that the instructional package was found to be socially valid by all respondents. The intervention also supported improved communication between the participants and healthcare providers, which has the potential to support greater access to preventative healthcare and strengthen self-efficacy among autistic adults. In addition, because the intervention was self-paced, participants could process the information at their own pace while experiencing fewer potential social communication challenges and having greater control over communicating and advocating for their healthcare needs (Wood et al., 2024). Another strength of the study was the high interobserver agreement, which reached 100%. This means that two separate individuals independently collected data and agreed on what was recorded. Treatment fidelity, or the extent to which the intervention was carried out as intended, was also high at 95%. These measures help support that the participants’ responses were recorded consistently and accurately and that the intervention was implemented as planned.

What are the limitations of the study?

One limitation of this study was that all participants were males 40 years old or older and were able to communicate their needs vocally. The authors emphasized that it is yet to be determined how other autistic adults who do not communicate using speech, have limited verbal abilities, or use augmentative and alternative communication devices would respond to the intervention. Moreover, Wood and colleagues (2024) highlighted that generalizing the intervention to in-person appointments should be a focus of future research. Additionally, it remains unknown whether improvements in communication will result in better healthcare outcomes for autistic adults.

What do the results mean?

The results of this study demonstrate the potential effectiveness of an instructional package in improving communication and helping autistic adults self-advocate for their healthcare needs. While autistic adults face barriers to healthcare and may have sensory and communication needs that are not always understood by PCPs, teaching these communication and self-advocacy skills may be a promising and empowering approach. Furthermore, when PCPs have a better understanding of autism and learn how to communicate effectively with autistic patients, they may be better prepared to provide appropriate accommodations and individualized care (Ball et al., 2026; Stein Duker et al., 2025). Therefore, efforts should focus on enhancing self-advocacy among autistic individuals while also improving healthcare systems to better support their needs and healthcare outcomes (McLean et al., 2024). Although these findings are promising, more research is required to assess the intervention with a more diverse population, including younger adults, females, and individuals from different geographic locations. In addition, in-person implementation in actual healthcare settings would be needed to further assess the effectiveness of this intervention (Wood et al., 2024).

References

Ball, R. C., Richdale, A. L., Lawson, L. P., & Morris, E. M. J. (2026). Barriers to mental healthcare for autistic and non-autistic adults: An investigation of number, severity, and type of barriers encountered. Autism, 30(7), 1687-1703. https://doi.org/10.1177/13623613261433100

Best, M., Lindsay, R., Demissie, S., Burakov, I., Ramos-Torres, S., & Burke, M. (2025). From awareness to action: Facilitators and advocacy in healthcare by autistic adults. Autism, 29(10), 2513-2523. https://doi.org/10.1177/13623613251343350

McLean, K. J., Meghan, H., Koenig, J., Horvath, M., Vigil, M., Werner, N. E., & Bishop, L. (2024). “I’m dealing with a health care system that doesn’t get it”: Barriers and facilitators to inclusive healthcare for autistic adults. Autism, 28(6), 1382-1393. https://doi.org/10.1177/13623613241236380

Stein Duker, L. I., Giffin, W., Taylor, E. E., Shkhyan, L., Pomponio Davidson, A., & Mosqueda, L. (2025). Barriers and facilitators to primary healthcare encounters as reported by autistic adults: A qualitative study. Frontiers in Medicine, 12. https://doi.org/10.3389/fmed.2025.1481953

Reference for this article:

Bannon, T. A. (2026). Research synopsis: Using an instructional package to support adults with autism in communicating with a medical provider. Science in Autism Treatment, 23(11).

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Using an Instructional Package to Support Adults with Autism in Communicating with a Medical Provider