Neurodivergence in Pre-Hospital Care: ADHD and Autism with David Birch

Neurodiversity is something paramedics encounter every day, whether we consciously identify it or not. It is present in the child who will not tolerate the blood pressure cuff, the adult who cannot answer questions in sequence, or the patient who appears agitated under blue lights but settles in a quiet room. Autism and ADHD are not rare edge cases; they are common neurodevelopmental differences that shape how people process information, regulate emotion, experience sensory input, and respond to stress.Both are frequently hidden. Many adults remain undiagnosed. Others mask extensively, particularly in public or professional settings, meaning the first time their coping strategies fail may be during illness, injury, or crisis. In the pre-hospital environment, defined by urgency, noise, bright lighting, unfamiliar touch, and compressed decision-making, those coping mechanisms can collapse quickly. What follows may look like resistance, inconsistency, hostility, or disengagement. In reality, it is often cognitive overload or dysregulation.Autism and ADHD also overlap significantly. Executive dysfunction, sensory sensitivity, communication differences, emotional lability, and difficulties with working memory can coexist. For paramedics operating under time pressure, rapid behavioural interpretation becomes almost automatic: cooperative or not, intoxicated or sober, compliant or difficult. When neurodivergence is not considered, behaviour is framed as intentional rather than neurological.Today on the Pre-hospital Care Podcast, I’m joined by David Birch to unpack this in practical terms. We explore how ADHD and autism actually present on scene, beyond stereotypes, and why behaviours such as poor eye contact, restlessness, blunt communication, or inconsistent histories are so often mislabelled as non-compliance or intoxication. We examine the clinical risk of those assumptions, from premature diagnostic closure to inappropriate use of sedation or restraint.Most importantly, we discuss what paramedics can do differently. Not complex protocols or lengthy interventions, but small, deliberate, patient-centred adjustments: simplifying language, reducing sensory load where possible, allowing processing time, offering clear structure and predictability, and reframing behaviour through a neurodiversity-informed lens. You can see more from David's lectures on YouTube here: https://www.youtube.com/watch?v=CkzXbjG7uiY&t=594s