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Introduction Autism causes challenges with communication, coupled with sensory sensitivities that can make emergency department (ED) presentations difficult. PERUKI has care for children with special educational needs and disabilities in their top 10 priorities and the National Autism Innovation Strategy aims to address the bespoke challenges and barriers facing autistic people (prevalence rate of 3.38% in Ireland, 2022). We aimed to identify unique challenges and barriers faced by neurodivergent children in emergency services and to create inclusive healthcare environments across Children’s Health Ireland (CHI).Methods The voice of neurodiverse patients and families were sought to guide and inform a transformative process. Opportunistic interviews with children and parents presenting to three EDs/units in CHI from 9 th August to 25thSeptember 2024 and feedback via electronic surveys were conducted. Ethical approval was obtained. Data was analysed using excel.Results Thirty patient/parent interviews were conducted with age range of 2–15 years. Thirteen patients had mild (43%), 11 with substantial (37%) and 6 with very substantial support needs (20%). Presentations were 33% for injuries and 66% were medical. Interventions to aid examination ranged from 2 to 9. Difficulties encountered are detailed in figure 1. Free text suggestions to improve experience included sensory toys/room by 39%, friendly staff 32%, single/quiet room by 29%, minimise waiting by 18%, and the play specialist 11%. Preferences on sensory toys were elicited. Surveys data further emphasised the different communication styles. Four patients were admitted, 23 were discharged and 3 had follow up with plastics/orthopaedics.Abstract #244 Figure 1Difficulties experiencedConclusion The patient interviews/surveys aimed to hear the voices of neurodiverse patient to design the implementation of new tools to improve care. This feedback will be used to design social stories, a communication passport, visual communication aids and to develop an education curriculum for our health care staff. *presenting author