Supporting Autistic Adults in Personal Injury and Clinical Negligence Claims: Practical Guidance for Legal Professionals by Dr Justin Savage & Dr Ashley Francis
Adults with autism—or those who present with autistic traits but have no formal diagnosis—often face unique challenges when navigating personal injury or medical negligence litigation. These comprise differences in communication, processing, and coping that can significantly affect how a claimant engages with the legal process. For solicitors, experts and legal professionals, recognising these patterns early and adapting practice accordingly can improve evidence quality, reduce distress, and support fair access to justice.
- Recognising Autism and Autistic Traits—Even Without a Diagnosis
Many adults with autism remain undiagnosed, particularly women and those with high verbal ability (Lai & Baron‑Cohen, 2015). Others may have traits that affect functioning but fall short of diagnostic thresholds. Indicators include literal interpretation, sensory sensitivities, social‑communication differences, and difficulty with open‑ended questioning. In the author’s experience, difficulties in emotional expressiveness require extra investigation to avoid erroneously concluding that the incident did not affect them. The author’s have found their additional specialist training in the assessment and diagnosis of autism helpful in identifying and adapting to such nuances. Various literature and autism awareness trainings can of course also help those involved in these cases (see the reference list for some useful organisations).
The absence of a diagnosis should never be taken as evidence that no adaptations are needed. The Equality Act 2010 protects individuals with substantial and long‑term impairments, regardless of formal diagnosis.
- Communication: Clarity, Structure and Predictability
Autistic adults often benefit from structured, concrete communication. Research shows that autistic individuals process language more literally and may struggle with ambiguity or rapid conversational shifts (American Psychiatric Association, 2022; Happé & Frith, 2020).
Solicitors and others involved can support this by:
- Using clear, unambiguous language
- Providing written summaries
- Breaking tasks into steps
- Allowing extra processing time
Predictability reduces anxiety and improves engagement (National Autistic Society, 2023).
- Interviewing and Evidence Gathering
Open‑ended questions can be difficult for autistic adults, who may provide literal or brief responses. Studies show that structured interviewing improves accuracy and reduces cognitive load (Maras, 2020).
Helpful strategies include:
- Asking specific, concrete questions; e.g. going through symptom lists and then asking for examples of avoidance/nightmares/etc, rather than asking what symptoms they had more generally.
- Allowing pauses
- Avoiding assumptions based on eye contact or tone.
- Offering written formats for evidence
These adjustments improve both the claimant’s experience and the quality of evidence.
- Managing Anxiety and Overwhelm
Litigation is inherently stressful. Autistic adults often experience heightened anxiety, especially in unpredictable or sensory‑intense environments (Kerns et al., 2014). Reasonable adjustments may include:
- Remote meetings
- Quiet waiting areas
- Support persons
- Advance notice of agendas
These are simple, low‑cost changes that significantly reduce distress.
- Medico‑Legal Assessments: Preparing the Expert and the Claimant
Experts should be informed if autism or autistic traits are suspected. Research shows that autistic adults may under‑report symptoms, struggle with abstract questions, or mask difficulties in formal settings (Hull et al., 2017).
Preparing the claimant with a clear explanation of the assessment process improves cooperation and accuracy.
- Capacity, Consent and Decision‑Making
Most autistic adults have full decision‑making capacity. Difficulties arise when information is presented too quickly or abstractly. The Mental Capacity Act 2005 requires professionals to support decision‑making by adapting communication.
Best practice includes:
- Plain language
- Concrete examples
- Written explanations
- Time to process decisions
Where capacity is borderline, a specialist assessment may be appropriate.
- Understanding the Impact of Injury on Autistic Claimants
Autistic adults may experience disproportionate functional impact from injury, pain, or cognitive symptoms. Research highlights increased vulnerability to sensory overload, anxiety, and executive‑function difficulties following stress or trauma (South et al., 2017).
These factors may influence:
- Prognosis
- Rehabilitation engagement
- Loss of earnings
- Care needs
Psychological or psychiatric input can help clarify causation and functional impact, though a formal diagnosis would be required to make comment upon any exacerbations of specific autism related problems.
- Reasonable Adjustments in Litigation
Under the Equality Act 2010, autistic adults—diagnosed or not—may be entitled to reasonable adjustments. The courts have increasingly emphasised the duty to accommodate neurodivergent litigants (e.g., Rackham v NHS Professionals Ltd [2019]).
Examples include:
- Extra time for hearings
- Written questions in advance
- Breaks during cross‑examination
- Remote attendance
- Clear, concrete language
Solicitors should identify and request adjustments early where possible.
- When to Consider Referral for Assessment
Referral for autism assessment may be helpful when communication difficulties affect the claim or when functional impact is unclear. However, a diagnosis is not required for reasonable adjustments or for understanding the claimant’s needs.
Conclusion
Working effectively with autistic adults in personal injury and clinical negligence claims requires awareness, flexibility, and a willingness to adapt communication and process. These adjustments are simple, practical steps that improve fairness, reduce distress, and enhance the quality of evidence. By recognising autistic traits—diagnosed or not—and tailoring support accordingly, legal professionals can ensure that autistic claimants are fully heard, fully understood, and fully supported throughout the litigation journey.
References
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). APA Publishing.
British Psychological Society BPS)
Equality Act 2010 (UK).
Happé, F., & Frith, U. (2020). Annual Research Review: Looking back to look forward—changes in the concept of autism and implications for future research. Journal of Child Psychology and Psychiatry, 61(3), 218–232.
Hull, L., et al. (2017). “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. Journal of Autism and Developmental Disorders, 47, 2519–2534.
Kerns, C. M., et al. (2014). Anxiety in Autism Spectrum Disorder: Clinical and Research Considerations. Psychiatry Research, 220(1–2), 1–10.
Lai, M.-C., & Baron‑Cohen, S. (2015). Identifying the lost generation of adults with autism spectrum conditions. The Lancet Psychiatry, 2(11), 1013–1027.
Maras, K. (2020). Autism and the Criminal Justice System: Challenges and Opportunities. Journal of Autism and Developmental Disorders, 50, 1–12.
Mental Capacity Act 2005 (UK).
National Autistic Society. (2023). Working with autistic adults: Professional guidance. NAS Publications.
Rackham v NHS Professionals Ltd [2019] UKET 2200909/2018.
South, M., et al. (2017). Increased Anxiety and Sensory Over-Responsivity in Autism. Autism Research, 10(3), 385–395.
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