Table 2.

Recommendations for supporting Autistic SPACE in practice. Adapted from Autistic SPACE.¹³

SPACE framework aspect	Recommendations for implementation
Sensory
Sight	•Reduce anaesthetic room lighting
	•Induce in anaesthetic room rather than theatre
Sound	•Reduce background noise (preparing surgical trays in prep room rather than theatre)
	•Avoid multiple people talking to the patient at once
	•Allow/suggest the use of noise-cancelling headphones and ear plugs
Smell	•Avoid strong smells if possible—cleaning products/air fresheners etc.
Taste	•Respect sensory preferences (e.g. liquid medication)
	•Consider preference for inhalation or i.v. induction
Touch	•Ask about tactile preferences and modify examination technique
	•Avoid casual touch
	•Consider allowing own clothes to theatre with gown over the top
	•Sensory aids such as weighted blankets
Temperature	•Consider environmental temperature and individual thermal preference
	•Offer or avoid additional blankets or forced air warmers as preferred
Interoception and pain	•Ask directly about internal sensations but understand that answering may be difficult
	•Acknowledge and address any complaints of pain, even if they do not appear in pain
	•Adapted pain scales may be required
Predictability	•Give written information in advance—accurate signs/maps etc.
	•Explain carefully what to expect and be as accurate as possible with time frames
	•Allow opportunity for a tour before surgery
	•Allow waiting in a familiar environment (e.g. outside/in own car) if possible
	•Ensure care is provided by staff familiar to the patient where possible
Acceptance	•Neurodiversity-affirmative approach beneficial
	•Understand autistic stimming and monotropic thinking patterns
	•Facilitate need for detailed, factual information
	•Understand distress behaviour
Communication	•Understand autistic verbal and non-verbal communication differences
	•Know that communication ability is reduced by anxiety and sensory stress
	•Use clear unambiguous communication
	•Promote use of augmentative and alternative communication (AAC)
Empathy	•Recognise that autistic people feel empathy but may display it differently
	•Empathy towards autistic patients may be more challenging for non-autistic healthcare providers
Physicalspace	•Allow for increased personal space
	•Avoid proximity to other people where possible
Temporal space	•Allow increased time to respond to questions
	•Allow increased time for decision-making
Emotional space	•Expect differences in emotional expression
	•Allow space to recover, without additional input, if distressed