Clinical Scenarios
Real situations practitioners encounter. Monotropism-informed responses.
Medication Adherence
"They keep missing doses"
Monotropic explanation:
- Object permanence: Medications "disappear" when not in view
- Deep focus: Miss dose time when absorbed in activity
- Not resistance or non-compliance
Strategies that work:
- Medication where they'll see it (bathroom sink, coffee maker)
- Pill organizers visible in daily path
- Alarms with persistent notifications
- Habit stacking ("When you make coffee, take medication")
Emergency Department
Patient seems disconnected from urgency
Monotropic explanation:
- Attention tunnel on one thing (pain, object, thought)
- Medical urgency not in current attention channel
- Not denial — different attention allocation
Response:
- Gently redirect attention: "I need to talk to you about something important"
- Pause and wait for attention shift
- Clear, direct communication once they're with you
Mental Health
Difficulty describing emotional states
Monotropic explanation:
- Interoception and emotion labeling require attention
- May need processing time to "scan" emotional state
- Not alexithymia necessarily — may be attention allocation
Response:
- Allow silence for internal scanning
- Systematic prompts: "Check your chest... your stomach... your shoulders..."
- Body-first approach: "Where do you feel that in your body?"
Pediatrics
Child "won't cooperate" with exam
Monotropic explanation:
- Attention on something else (toy, thought, sensory input)
- Forced switching is distressing
- Not defiance — attention architecture
Response:
- Join their attention first: "I see you have a dinosaur"
- Signal transition: "In a moment, I need to look at your ears"
- Allow completion: Let them finish what they're doing if possible
Surgery/Procedures
Post-procedure patient seems confused
Monotropic explanation:
- Anesthesia recovery affects attention even more
- Orienting to multiple new inputs overwhelming
- One thing at a time is essential
Response:
- Minimal stimuli in recovery
- One caregiver, one voice
- Simple, repeated information
- Written instructions for later
Long-term Care
Inconsistent engagement with treatment plan
Monotropic explanation:
- Object permanence: Plan "disappears" between appointments
- Not lack of motivation — attention moved elsewhere
- Context-dependent recall
Response:
- Visual reminders (charts, calendars, photos)
- Shorter intervals between check-ins
- Consistent provider when possible
- Connect plan to current interests/focus
Key Principles Across All Settings
- Signal transitions — Don't surprise with changes
- One thing at a time — Sequential, not parallel
- Check explicitly — Don't assume awareness
- Allow processing time — Silence isn't resistance
- Visual supports — Reduce memory load
- Consistency — Same providers, same sequences
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