Sarah is sixteen years old. She has ASD and a moderate learning disability and has come to see you for ongoing treatment. A keyworker from her care establishment has accompanied her on previous visits but the keyworker often varies. Sarah has come with someone who knows her very well this time but Sarah is responding as if it is her first visit. She asks your name and your date of birth. She appears anxious and is unwilling to sit down or answer your questions. Each time you begin to ask her how she is feeling, she talks over you and does not let you finish. She appears to have a fascination for dates and birthdays and lists of dates are what she keeps repeating.

Strategies

• Ask Sarah if she will take turns in speaking with you; let her start by having a minute to ask you questions as this may help her become calmer.
• Have a concrete object that symbolises whose turn it is to talk (e.g. a pen or paperweight) and let her hold it first during her turn. Try to ensure you use the same object for each appointment.
• Enlist the help of her keyworker.
• Ask to hold the object to signify that it’s your turn to talk.
• Involve the keyworker in having a turn so that they can add any relevant information.
• Continue in this way until you have asked the necessary questions.