11 minutes

Cognitive disabilities, anxiety and repairing breakdowns

Break information into steps, give a predictable process and written expectations, and know what to do when a conversation stops working.

What you’ll be able to do

Present information in smaller steps with a written summary for a person with a cognitive disability, offer a predictable process and written expectations to a person with anxiety, and repair a conversation when communication breaks down.
Compare the responses to this question and explain your choice: What is the better response?
Draft What happens at your appointment for your work, including before you come, when you arrive, during the meeting.

Steps, predictability and the way back in

Cognitive disabilities include intellectual disability, brain injury, dementia, learning disabilities and conditions that affect attention, memory or processing. What helps across them is structure: one idea at a time, concrete words instead of abstractions, the steps in order, a pause after each one, and a summary the person can take away in writing or pictures. Explain what will happen before it happens. Check understanding by asking the person to tell you the next step, and if they cannot, break the step smaller rather than repeating it. None of this is talking down. It is the same explanation, delivered so it can be used.

Anxiety, post-traumatic stress, depression and other mental-health conditions create access needs that are often invisible and often about predictability. Not knowing what a meeting is for, being called in without warning, receiving feedback with no written record to check later, or waiting in a crowded room with no idea how long, can make it impossible for a person to think or speak well. The accommodations are usually simple: an agenda in advance, written expectations and follow-up, scheduled rather than ambush conversations, a quieter waiting option, a clear statement of what happens next. Most of them improve the process for everyone.

Communication breaks down sometimes, with anyone. The person goes quiet, or repeats a question you thought you answered, or becomes upset, or you realize you have misunderstood each other for ten minutes. The skill is repair: pause, name it without blame, change something and offer a way back in. “I think I have been going too fast. Let me stop. Would it help if I wrote this down, or if we took a few minutes?” Breakdowns become failures only when staff push through them or blame the person for them.

Repairing a breakdown, in order

Stop talking. Notice what is happening before you do anything else.
Name it neutrally and take the responsibility: “I think I have not explained this well,” not “You are not following.”
Ask what would help: writing it down, slowing down, a break, a different room, a different day, a support person.
Change one thing: channel, pace, place or person, and try again from the last point of shared understanding.
Confirm the way forward with a teach-back and put it in writing.
Afterward, note what broke down and what fixed it, so the next conversation starts from the fix.

Practices by access need

Intellectual disability

Concrete words, short sentences, one step at a time, real examples. Pictures or icons alongside text for key steps. Time to answer. Ask the person to tell you the next step. Never test, quiz or use a tone you would not use with a colleague.

Brain injury or memory disability

Written summary every time. Same order, same words, same person where possible. Reminders the person agrees to. Expect fatigue: shorter meetings, earlier in the day if the person prefers.

Attention or processing disability

A quiet room, one topic at a time, materials in advance, an agenda. Written follow-up with the decisions and actions. Do not read long documents aloud and expect retention; hand them over and walk through the key points.

Anxiety or post-traumatic stress

Predictability: agenda ahead, what you will need from them, how long it will take, what happens after. Scheduled rather than surprise conversations. Written feedback. A choice of seat, a door in view, a break available, no pressure to decide on the spot.

Depression or a fluctuating condition

Flexible timing where the process allows, a written record so a bad day does not erase what was agreed, and no assumption that a quiet response means disinterest.

Make predictability the default

What you can change

You control whether your meetings have an agenda, whether feedback is written down, and whether performance conversations are scheduled or sprung.

What to watch for

Do not treat a request for structure as a complaint about your style. Do not require a formal accommodation before you will send an agenda.

Your next step

For one month, send an agenda before every one-on-one and follow each with two written lines: what was decided and what happens next. Ask your team whether to keep it.

What happens at your appointment

A one-page, plain-language sheet sent with the appointment confirmation, so the person knows the steps before they arrive.

Before you come What to bring, listed one item per line. Who to contact if you cannot find something. A sentence saying you can bring someone with you if you want to.

When you arrive Where to go, who you will meet, how long it usually takes, and that a quieter place to wait is available if you ask.

During the meeting The three or four things you will talk about, in order. A line saying you can ask for a break, ask for anything to be repeated or written down, and take time before deciding anything.

After the meeting What you will receive in writing, when, and who to contact with questions. One name, one phone number that accepts relay, one email.

Draft this sheet for one appointment type your unit runs, test it with two participants, and attach it to the confirmation by default.

Browse and download only. Staff notes are not typed or saved on this page.

Phrases that help

Before a multi-step explanation

“There are three steps. I will go through them one at a time, and I will give you a sheet with all three at the end.”

Checking a step

“Before we go on, what is the first thing you will do when you get home?”

Offering predictability

“Here is what we will cover, how long it will take and what happens after. Is there anything you would like to add or change?”

Starting a repair

“I think I have been going too fast. Let me stop. What would help right now?”

Closing with a record

“I will send you two lines today: what we decided and what happens next. If anything looks wrong, tell me.”

When the person goes quiet

Wait. Then: “Take your time. We can also pick this up in writing or another day if you would prefer.”

A participant with a brain injury nods through a case manager's explanation of a five-step appeal process, then asks, “So what do I do?” Which response is most effective?

Repeat the five steps again, more slowly.

Say, “Let me go one step at a time,” give the first step, check it, and hand over a written sheet with all five steps in order before the meeting ends.

Suggest the participant have a family member handle the appeal.

Try a situation

An employee tells her supervisor she has an anxiety disorder and asks that one-on-one meetings have an agenda sent the day before, that feedback be put in writing after the meeting, and that she not be pulled into unscheduled “got a minute?” conversations about her performance. The supervisor says, “I like to keep things informal. Can you just let me know if something is bothering you?”

What is the better response?

Keep the informal style. Structure would make the team feel micromanaged, and she can speak up when something bothers her.

Agree to the three requests as a working arrangement now, put them in writing, and let her know that if she wants a formal accommodation on record, human resources or the ADA coordinator handles that and the supervisor will support it.

Refer her to the employee assistance program and leave the meeting format as it is.

Carry this forward

Smaller steps, one at a time, in concrete words, with a written or pictured summary to keep: that is the practice for cognitive, intellectual and processing disabilities, and it is not the same as talking down.
For many people with anxiety and other mental-health-related access needs, the accommodation is predictability: an agenda in advance, written expectations, no surprise meetings, and a clear picture of what happens next.
When communication breaks down, pause, name it without blame, change something, the channel, the pace, the room, and offer a way back in.

A scenario decision about a supervisor meeting request, a knowledge check and one conversation you restructured into steps with a written summary.

Before your next meeting with an employee or participant who has asked for predictability, send a short agenda and what you will need from them. After your next multi-step explanation, hand over a one-page summary in plain language.

Your next step

Which of your conversations most often ends with the other person nodding and then not doing the next step, and what would smaller steps and a written summary change?

Send an agenda before your next one-on-one and ask whether it helped

Rewrite one multi-step instruction as numbered steps with one action each

Practice the repair sequence the next time a conversation goes off the rails

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Mark this lesson complete

Participation and course completion in this program do not count toward DHS-required training credits unless management, a director, or DHS leadership expressly approves an exception.