Choice, consent and support from companions

Autistic patients may attend alone or with a parent, carer, advocate, support worker, friend or partner. A companion can be helpful, but staff should keep the patient central wherever possible.

Support staff can protect the patient's autonomy by asking the patient first, offering one choice at a time, checking comfort before touching and involving a registrant or manager when consent or capacity is unclear.

Everyday choice and consent

• Ask before touch: frame fitting, measurements and positioning can feel intrusive.
• Explain equipment: describe what a device does in practical terms and what the patient will be asked to do.
• Offer real choices: make optional scans, coatings, frames or appointments explicit rather than implied.
• Reduce sales pressure: provide time, clear prices and space to decide.
• Use one decision at a time: too many options can become overwhelming.
• Respect refusal or pause: a patient may say no or need more time.

Working with companions

Ask the patient, "Would you like this person to help with the conversation?" If they agree, a companion can support memory, communication, regulation and practical choices. Staff should still speak to and look at the patient rather than only addressing the companion.

If a companion answers for the patient, pressures them, blocks private moments or disagrees with the patient's apparent wishes, pause and escalate. This could indicate concerns about consent, privacy, safeguarding or capacity depending on the circumstances.

Consent, capacity and four-nations detail

Companions can support communication, but they should not automatically replace the patient's voice.