George is forty years old and has Asperger syndrome. He is very articulate. His expressive and receptive communication is excellent on a literal and factual level, although he finds it difficult to comprehend subtle social cues or underlying meaning. He lives alone with support from his parents. George does not seem able to link discomfort or pain to a specific health problem, and sometimes does not appear to identify pain at all. George attends surgery alone and explains that his mother made the appointment for him because she was worried about his eyes but he does not think there is a problem. You can immediately tell that George’s eyes are both severely infected.

Strategies

• In clear and simple terms, explain to George how you intend to conduct the examination and what you are looking for.
• Explain to him the visible symptoms of infection and if possible use a mirror to show him.
• Ask direct questions to elicit whether he has had any symptoms he has not noticed, such as rubbing his eyes or finding them difficult to open after sleep due to the discharge.
• Provide factual information on eye infection and discuss with him why treatment and good eye hygiene are important. George will respond well to factual information and will probably be able to digest a large amount, especially if it is provided both through discussion and in written form.
• Provide explicit instruction on treatment, follow-up and prevention of further infection.
• Prompt George to ask questions about anything he does not understand.