Autism and ADHD in the harmonization consultation: how to adapt

Harmonization is a procedure done on the face, with touch, bright light, the smell of antiseptic, a needle and a lot of conversation. For some autistic patients or those with ADHD, that combination can be hard to tolerate, and not for lack of willingness. This text helps you adapt the care without treating the patient as incapable and without losing clinical safety.

A caution before anything else: autism and ADHD are spectrums and very different conditions from each other. No single rule fits everyone. The principle that works is to ask, agree and respect.

What changes in the consultation for someone who is autistic or has ADHD?

The most common friction points tend to be sensory, communication-related and attention-related.

How to make consent truly count?

Informed consent only makes sense if the patient understood what will be done, the risks and the alternatives. With patients who process information differently, the care goes into the format, not the content.

• Break the explanation into small parts and confirm understanding after each one.
• Use literal language. Avoid "just a little pinch" and metaphors.
• Offer the form in writing beforehand, to read calmly at home.
• Make it clear that they can pause, ask to stop or back out at any time.
• Record in the patient record how the explanation was given and that the patient confirmed they understood.

Patient autonomy still applies. A companion can help with communication but does not decide in place of someone who has the capacity to decide. When there is doubt about that capacity, or if the patient is a minor, follow the rules of your professional council in Brazil and the rules on legal guardians.

What to ask in the medical history?

In the medical history, the most important point is the medication list. Some patients with ADHD use stimulants, and some use other drugs for anxiety, sleep or irritability. That is not a reason to refuse care, but it must be known and assessed by the professional, who decides case by case whether anything needs to be considered before the procedure.

Also ask about:

• sensitivity to touch on the face and to strongly scented products;
• previous experiences with procedures and what went well or badly;
• anxiety about needles or about lying down;
• the need for breaks, a companion or quiet music.

And the post-procedure period?

Care instructions need to be clear and, preferably, written. Patients with ADHD may forget what was said in the consultation, and autistic patients may follow an instruction to the letter, which is good when the instruction is precise and risky when it is vague.

Warning signs (severe and disproportionate pain, change in skin color, vision changes) apply to all patients and must be written clearly, with the contact phone number.

Is there any specific care with photos?

Photos are part of the procedure and can be a source of discomfort: the flash, the positioning, being asked not to smile. Explain why they will be taken, how they will be used, and ask for specific authorization, in line with the LGPD (Brazil's data protection law). You can photograph with adequate ambient light and no harsh flash, without losing the standard of standardized clinical photography.

When to adapt further or postpone?

If the patient becomes very dysregulated, with crying, intense agitation or shutting down, the safest approach is usually to pause, offer some time and, if needed, reschedule. Insisting on finishing the same day increases the risk of movement, mistakes and a bad memory of the visit. An aesthetic procedure is rarely urgent, and a shorter second appointment may be the best solution.